Infections Of Upper Airways Research Articles

Adenotonsillectomy Does not Alter the Risk of Upper Airway Infections in Children.

Given the conflicting evidence regarding adenotonsillectomy and the risk of upper airway infections (UAIs), including acute pharyngitis (APT), rhinosinusitis (ARS), and otitis media (AOM), we evaluated the risk of developing UAIs following adenotonsillectomy in a childhood population. In this population-based follow-up study, we used data from the National Health Insurance Service-National Sample Cohort. The adenotonsillectomy group (n=2,377) included patients aged <10 years who underwent an adenotonsillectomy. For every patient with APT (n=2,309), ARS (n=2,308), and AOM (n=2,207) who had an adenotonsillectomy, four participants were randomly selected for the control groups (n=9,204, n=9,196, and n=8,788, respectively) using propensity score matching. The number of postoperative hospital visits for UAIs was recorded for 1 to 9 years, and the equivalence test was used to compare the number of visits between the adenotonsillectomy and control groups. There were no significant differences in the incidence of APT, ARS, or AOM at the margin of equivalence of difference (-0.5 < 95% confidence interval of difference < 0.5) between the two groups from postoperative year 1 to year 9. The hospital visits for these diseases gradually decreased over time in both groups. There was a significant decrease in the number of visits for APT, ARS, and AOM in the 5-9 years age group when compared with those in the <4 years age group (P < .01). Our results suggest that adenotonsillectomy does not alter the frequency of UAIs in children. NA Laryngoscope, 131:2376-2383, 2021.

The Emerging Role of Small Extracellular Vesicles in Inflammatory Airway Diseases.

Extracellular vesicles (EVs) are produced and released by all cells and are present in all body fluids. They exist in a variety of sizes, however, small extracellular vesicles (sEVs), the EV subset with a size range from 30 to 150 nm, are of current interest. By transporting a complex cargo that includes genetic material, proteins, lipids, and signaling molecules, sEVs can alter the state of recipient cells. The role of sEVs in mediating inflammatory processes and responses of the immune system is well-documented, and adds another layer of complexity to our understanding of frequent diseases, including chronic rhinosinusitis (CRS), asthma, chronic obstructive pulmonary disease (COPD), and upper airway infections. In these diseases, two aspects of sEV biology are of particular interest: (1) sEVs might be involved in the etiopathogenesis of inflammatory airway diseases, and might emerge as attractive therapeutic targets, and (2) sEVs might be of diagnostic or prognostic relevance. The purpose of this review is to outline the biological functions of sEVs and their capacity to both augment and attenuate inflammation and immune response in the context of pathogen invasion, CRS, asthma, and COPD.

A COMPARATIVE STUDY OF DEEP NECK SPACE INFECTIONS (DNSI) IN DIABETIC VERSUS NON-DIABETIC PATIENTS: OUR EXPERIENCE IN A TERTIARY CARE CENTRE

Background:The term deep neck space infections (DNSIs) encompasses infections of several different areas of the neck formed by the potential spaces formed by different fascial layers of the neck. The etiology of DNSI include pharyngo-tonsillar infections (most commonly in children), odontogenic infections, sialolithiasis and sialadenitis, congenital anomalies like cysts and sinuses of the neck. Predisposing factors may include Extremes of age, Immunodeciency, Diabetes mellitus and Intravenous drug abuse. The microbiology of deep neck infections usually reveals mixed aerobic and anaerobic organisms, often with a predominance of oral ora. Both gram-positive and gram-negative organisms may be cultured. DNSI usually mandate early intervention on an urgent basis because of the risk of potentially fatal complications such as airway obstruction, mediastinitis and vascular complications. Airway assessment and intervention plays a pivotal role in the management of DNSI. Aims and Objectives: The present study aims to compare the clinical presentation, complications, treatment outcomes and microbiology of DNSIs in diabetic vs non-diabetic patient populations.The objective is to have a proper understanding of the disease so that a much organized treatment protocol can be established. 70 patients were enrolled for this comparative st Materials and Method: udy in Indoor wards of a Tertiary care centre. The study was conducted from January 2019 to December 2019 for 1year. Patients diagnosed with DNSI (by imaging studies) and admitted in ward of ENT and Head Neck Surgery were selected. Parapharyngeal Space was mos Results: t common involved space in both Diabetics (52.38%) and Non Diabetics (41.46%), followed by Submandibular Space. Most common organism in both groups was Klebsiella pnemoniae. Odontogenic infection and Upper airway infections were 2 leading causes of DNSI in both Diabetics and Non Diabetics in this study. The Diabetic groups affected had much older age with longer hospital stay and had more frequent complications than Non Diabetic group. Diabetics also needed more frequent tracheostomy (28.57%) than Non Diabetics (2.44%). Diabetic patients as a subgroup Conclusion: of DNSIs pose many unique problems including older age at presentation, involvement of multiple neck spaces, prolonged hospital stay and operative interventions. As these patients have higher rate of complications and poorer prognosis, early institution of therapy, strict glycemic control and operative interventions are more often required.

Infected laryngeal foreign body: A case report

Foreign body aspiration is a major cause of accidental death in children. Laryngeal foreign bodies in some cases, especially when it is narrow cause little airway obstruction and may even present like upper airway infection. This can delay the diagnosis and even may be mis-treated as laryngitis. A child presented to the department of ENT with throat pain and hoarseness of voice but gave a history of foreign body ingestion 1 week before. Though the child presented with laryngitis like symptoms, considering the foreign body ingestion history, diagnostic work-up was done to rule out foreign body in larynx. On X-ray, a radio-opaque foreign body was seen in the larynx above the glottis. He was taken to the operation theatre and under general anaesthesia, foreign body was seen and was piercing the posterior pharyngeal wall. It was carefully removed and pus was seen leaking from the removal site. After a course of antibiotics, the child was apparently normal then.A Laryngeal foreign body shows a wide variety of presentations depending on its size and shape. Hence, the children with laryngitis like symptoms should be investigated for foreign body aspiration irrespective of the symptoms if a history of foreign body ingestion was given.

The impact and prevalence of SARS-CoV-2 in patients with head and neck cancer and acute upper airway infection in a tertiary otorhinolaryngology referral center in Denmark.

PurposeTo determine the prevalence of SARS-CoV-2 at a Danish tertiary referral otorhinolaryngology clinic during the first wave of the COVID-19 pandemic among patients with suspected acute upper airway infection (UAI) and patients operated for head and neck cancer (HNC), respectively. To monitor changes in the number of patient encounters for acute UAI and the number of referrals for the workup of HNC. Trial registration: NCT-04356560 (Clinicaltrials.gov).MethodsProspective enrolled case series of all patients with suspected acute UAI (n = 88) and of patients undergoing surgery for HNC (n = 96), respectively, from March 23rd to May 5th, 2020, at a public tertiary referral otorhinolaryngology clinic in Denmark. SARS-CoV-2 was diagnosed with nasopharyngeal and oropharyngeal swabbing. Patients with suspected acute UAI had symptoms and definitive diagnoses registered in a database. Trends in the number of referrals and patient encounters were retrieved from an electronic patient journal system and analyzed retrospectively.ResultsEighty-eight patients with acute UAI were enrolled including 55 men and 34 women, median age of 31 years (range: 10 months to 82 years). One patient (1.1%) tested positive. Among 96 patients operated for HNC, zero tested positive. The number of referrals for HNC workup, and patient encounters for peritonsillar abscesses, decreased markedly in the first 3 weeks.ConclusionThe prevalence of SARS-CoV-2 during the first 6 weeks of the first wave was minimal among patients with acute UAI and zero among patients operated for HNC. The decrease in referrals for the workup of HNC may increase time to treatment initiation and patient morbidity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-020-06514-6.

Preliminary Study for Non-drug Oriental Medical Treatment of Acute Upper Airway Infection in Athletes

Objectives The purpose of this review is to proactively assist the study of non-drug treatment of acute upper respiratory tract infections in athletes by investigating the trend of drug-free korean medicine treatment for common colds. Methods We searched 6 web databases and compiled papers with acupoint to investigate research on korean medicine treatment for common colds. Results Since November 8, 2009, 15 papers have been published that meet the conditions I set, and many journals published in Chinese journals by researchers at universities and hospitals in China, who are mostly used self-created criteria rather than international jackson standards, and various drug-free treatments were used for each situation, and all valid results were obtained. Conclusions In this study, the trend of non-drug korean medical common cold treatment was analyzed, and further research is required to verify the objective treatment effect.

Pharyngeal Carriage of Beta-Haemolytic Streptococcus Species and Seroprevalence of Anti-Streptococcal Antibodies in Children in Bouaké, Côte d'Ivoire.

The pharynx of the child may serve as a reservoir of pathogenic bacteria, including beta-haemolytic group A streptococci (GAS), which can give rise to upper airway infections and post-streptococcal diseases. The objective of this study was to determine the prevalence of beta-haemolytic Streptococcus spp. in pharyngeal samples stemming from children aged 3–14 years in Bouaké, central Côte d’Ivoire. Oropharyngeal throat swabs for microbiological culture and venous blood samples to determine the seroprevalence of antistreptolysin O antibodies (ASO) were obtained from 400 children in March 2017. Identification was carried out using conventional bacteriological methods. Serogrouping was performed with a latex agglutination test, while an immunological agglutination assay was employed for ASO titres. The mean age of participating children was 9 years (standard deviation 2.5 years). In total, we detected 190 bacteria in culture, with 109 beta-haemolytic Streptococcus isolates, resulting in an oropharyngeal carriage rate of 27.2%. Group C streptococci accounted for 82.6% of all isolates, whereas GAS were rarely found (4.6%). The ASO seroprevalence was 17.3%. There was no correlation between serology and prevalence of streptococci (p = 0.722). In conclusion, there is a high pharyngeal carriage rate of non-GAS strains in children from Bouaké, warranting further investigation.

Chronic adenoiditis.

In addition to acute adenoiditis and adenoid hypertrophy/vegetation, chronic adenoiditis is another disease of the adenoids. However, most physicians overlook chronic adenoiditis or confuse it with adenoid hypertrophy/vegetation. The incidence of chronic adenoiditis has increased in recent years as a result of higher rates of chronic nasopharyngeal or upper airway infections. The clinical characteristics of chronic adenoiditis can include but are not restricted to the following: long-term infection (especially bacterial infection); obstruction of the upper airway; infections of adjacent regions, such as the nose, nasal sinus, pharyngeal space, middle ear, and atlantoaxial joint; induced upper airway cough syndrome; and the presence of several “infectious-immune” diseases, including rheumatic fever, autoimmune nephropathy, and anaphylactoid purpura. To date, no consensus on the treatment of chronic adenoiditis is available. However, adenoidectomy can address the local obstruction, and some patients benefit from systemic or local anti-bacterial therapy. Physicians in the Departments of Otolaryngology, Respiration, and Pediatrics should be familiar with the clinical manifestations of chronic adenoiditis and try to develop effective treatment methods for this disease.

Comparative analysis of the tonsillar microbiota in IgA nephropathy and other glomerular diseases

Immunoglobulin A nephropathy (IgAN) involves repeated events of gross haematuria with concurrent upper airway infections. The mucosal immune system, especially the tonsil, is considered the initial site of inflammation, although the role of the tonsillar microbiota has not been established in IgAN. In this study, we compared the tonsillar microbiota of patients with IgAN (n = 21) and other glomerular diseases (n = 36) as well as, healthy controls (n = 23) from three medical centres in Korea. The microbiota was analysed from tonsil swabs using the Illumina MiSeq system based on 16S rRNA gene. Tonsillar bacterial diversity was higher in IgAN than in other glomerular diseases, although it did not differ from that of healthy controls. Principal coordinates analysis revealed differences between the tonsillar microbiota of IgAN and both healthy and disease controls. The proportions of Rahnella, Ruminococcus_g2, and Clostridium_g21 were significantly higher in patients with IgAN than in healthy controls (corrected p < 0.05). The relative abundances of several taxa were correlated with the estimated glomerular filtration rate, blood urea nitrogen, haemoglobin, and serum albumin levels. Based on our findings, tonsillar microbiota may be associated with clinical features and possible immunologic pathogenesis of IgAN.

Clinical management of COVID-19 paediatric cases.

Coronaviruses are a family of viruses present in different species of animals, which can infect humans, causing epidemics and pandemics. On January 9th, 2020, a new virus was announced as the cause of an outbreak of severe pneumonia in Wuhan, China. On March 11th, WHO declared the SARS-CoV-2 pandemic, the disease was called COVID-19. The virus is transmitted by droplets, contact and airborne during aerosol-generating procedures. In almost all pediatric cases a household contact was the source of infection. Unlike adults, the disease in children has a mild course, even in those under one year of age. The main symptoms are fever, dry or productive cough, headache, general discomfort, and shortness of breath, which is a sign of severity. The incubation period is 1-12.5 days (media 5-6 days). The most affected age group are school children. The disease may present as a mild acute upper airway infection, or as pneumonia. Very few cases progress to severe pneumonia and other complications such as acute respiratory distress syndrome, shock and multiorgan failure. There is not yet a specific antiviral treatment approved for use in children. This document aims to guide the management of suspected or confirmed pediatric patients of COVID-19.

PACHYONYCHIA CONGENITA: A CASE REPORT

Pachyonychia congenita (PC) is an ultra-rare genodermatosis of keratinization characterized by thickness of nails and palmar and plantaris hyperkeratosis. The oral alterations comprise oral leukokeratosis and cheilosis, so the dentist must identify them early and intervene. Our goal is to report a case of a 12-year-old girl with painful oral leukokeratosis in the tongue, absence of the 18th tooth, and mastication impairment, as well as hoarse voice, disseminated papules, total nails hyperkeratosis, andrecurrent upper airway infections (mouth breather). The genetic test showed KRT17 mutation, causing the substitution of leucine for proline and the production of defective keratin. Therapeutic options are: retinoids, dental and medical procedures, orthosis, keratolytics, analgesics, and gene therapy. Multidisciplinary follow-up is fundamental to the rehabilitation of the patients and challenges them and healthcare professionals. Pachyonychia congenita (PC) is an ultra-rare genodermatosis of keratinization characterized by thickness of nails and palmar and plantaris hyperkeratosis. The oral alterations comprise oral leukokeratosis and cheilosis, so the dentist must identify them early and intervene. Our goal is to report a case of a 12-year-old girl with painful oral leukokeratosis in the tongue, absence of the 18th tooth, and mastication impairment, as well as hoarse voice, disseminated papules, total nails hyperkeratosis, andrecurrent upper airway infections (mouth breather). The genetic test showed KRT17 mutation, causing the substitution of leucine for proline and the production of defective keratin. Therapeutic options are: retinoids, dental and medical procedures, orthosis, keratolytics, analgesics, and gene therapy. Multidisciplinary follow-up is fundamental to the rehabilitation of the patients and challenges them and healthcare professionals.

Pediatric Emergency Medicine Simulation Curriculum: Bacterial Tracheitis.

IntroductionPediatric bacterial tracheitis is a rare but life-threatening upper airway infection with mortality rates estimated as high as 20%, typically affecting children between 6 months and 12 years old. Given such high mortality rates, we felt it was important to train medical personnel to evaluate and manage this condition.MethodsThis simulation-based curriculum was developed for health care professionals involving the evaluation and management of an 8-year-old male with symptoms of fever, stridor, worsening barking cough, and increased work of breathing. Critical actions included identifying stridor and airway respiratory distress; monitoring and supporting airway, breathing, and circulation; administering racemic epinephrine and dexamethasone; and identifying and treating bacterial tracheitis as the underlying cause. Scenario-specific debriefing tools were put together to elicit scenario feedback and aid in formative learning.ResultsThe scenario was conducted with six fellows and 12 residents and medical students. Per the survey data, the case was rated as highly relevant (median = 5) and highly realistic (median = 5) by participants on a 5-point Likert scale.DiscussionPediatric bacterial tracheitis is a low frequency, but high-risk scenario that was amenable to simulation as an educational modality and was well-received by participants. The debriefing tools were implemented as a means of helping instructors customize the scenario for learners based on respective educational backgrounds and learning styles.

The relationship between human coronaviruses, asthma and allergy-An unresolved dilemma.

Human coronaviruses (HCoVs) such as HCoV‐229E or OC43 are responsible for mild upper airway infections, whereas highly pathogenic HCoVs, including SARS‐CoV, MERS‐CoV and SARS‐CoV‐2, often evoke acute, heavy pneumonias. They tend to induce immune responses based on interferon and host inflammatory cytokine production and promotion of T1 immune profile. Less is known about their effect on T2‐type immunity. Unlike human rhinoviruses (HRV) and Respiratory Syncytial Virus (RSV), HCoVs are not considered as a dominant risk factor of severe exacerbations of asthma, mostly T2‐type chronic inflammatory disease. The relationship between coronaviruses and T2‐type immunity, especially in asthma and allergy, is not well understood. This review aims to summarize currently available knowledge about the relationship of HCoVs, including novel SARS‐CoV‐2, with asthma and allergic inflammation.

Prophylaxis of Upper Airway Infections in a Patient with Partial IgA Deficiency: Concurrent Use of Sublingual Immunotherapy with Inactivated Whole-Cell Bacterial Extract and Der p1

Selective IgA deficiency is the most common type of primary immunodeficiency, but there is not yet a specific effective treatment. The most prevalent clinical manifestations are infectious diseases of the respiratory system. We report herein the case of an 11-year-old female with selective IgA deficiency and recurring episodes of respiratory infections associated with rhinitis and asthma. We evaluated the efficacy of sublingual immunotherapy combined with inactivated whole-cell bacterial extract and Der p1-specific immunotherapy. After 18 months of clinical follow-up, we observed a significant reduction in the number of episodes of respiratory infections associated with control of atopic diseases. We also observed a 3-fold increase in serum IgA levels compared to treatment initiation. This case demonstrates the potential utility of the concurrent use of sublingual immunotherapy with inactivated whole-cell bacterial extract and Der p1 for successful control of allergy and infection in partial selective IgA deficiency.

Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life.

IntroductionAcute adult supraglottitis (AAS) is one of the upper airway infections that can potentially cause upper airway obstruction and, if not treated promptly, can be life-threatening. The widespread use of vaccines against Hemophilus influenzae has decreased the incidence of epiglottitis in children, whereas the incidence of AAS is on the rise. We aim to highlight the presentation, diagnosis, and management in AAS with our study. Patients and MethodsA retrospective analysis was performed on all patients admitted to a tertiary health care facility surgical intensive care unit (SICU) where AAS was identified and the demographic data, duration of symptoms, imaging studies, management, and complications were recorded. In these patients, the diagnosis of AAS was confirmed by nasopharyngeal endoscopy. Data was entered in the IBM Statistical Package for Social Sciences (SPSS), version 23 (IBM SPSS Statistics, Armonk, NY), and groups were compared using student t-test and chi-square test. P values of ≤ 0.05 were considered statistically significant.ResultsA total of 118 patients were admitted to the SICU. The male: female ratio was 3.9: 1. Major risk factors were smoking and drinking cold liquids. The common presenting symptom was sore throat (89.8%). The thumb sign was positive in 65% of the patients. Common bacteria were the Streptococcus species (11.9%). Ceftriaxone was the most commonly prescribed inpatient antibiotic. All patients received steroids as adjuvant therapy. Adrenaline nebulization was used in 66% of the cases. Forty-six percent of patients required endotracheal intubation. In 10.2% of patients, intubation was not possible and in 12.7% of patients, a tracheostomy was done. Ludwig’s angina was the most frequent complication. Patients presenting with dysphagia and fever had a significantly higher incidence of Ludwig’s angina (P ≤ 0.02 and 0.005, respectively). AAS patients complicating into Ludwig’s angina (severe cellulitis of submandibular, submental, and sublingual spaces) had a significantly longer duration of symptoms, a higher incidence of streptococcal infection, airway interventions, and prolonged stay in an intensive care unit (p ≤ 0.05).ConclusionMale gender, smoking, and drinking cold liquids were the risk factors associated with AAS, and thumb sign on lateral neck soft tissue x-ray was suggestive of it. AAS caused by Streptococcus species was a relatively serious condition, leading to complications like Ludwig’s angina.

Increased Respiratory Viral Detection and Symptom Burden Among Patients with Primary Antibody Deficiency: Results from the BIPAD Study

BackgroundPatients with primary antibody deficiency (PAD) are at increased risk of respiratory tract infections, but our understanding of their nature and consequences remains limited.ObjectiveTo define the symptomatic and microbial burden of upper airway infection in adults with PAD relative to age-matched controls.MethodsProspective 12-month observational study consisting of a daily upper and lower airway symptom score alongside fortnightly nasal swab with molecular detection of 19 pathogen targets.ResultsA total of 44 patients and 42 controls (including 34 household pairs) were recruited, providing more than 22,500 days of symptom scores and 1,496 nasal swabs. Swab and questionnaire compliance exceeded 70%. At enrollment, 64% of patients received prophylactic antibiotics, with a 34% prevalence of bronchiectasis. On average, patients with PAD experienced symptomatic respiratory exacerbations every 6 days compared with 6 weeks for controls, associated with significant impairment of respiratory-specific quality-of-life scores. Viral detections were associated with worsening of symptom scores from a participant's baseline. Patients with PAD had increased odds ratio (OR) for pathogen detection, particularly viral (OR, 2.73; 95% CI, 2.09-3.57), specifically human rhinovirus (OR, 3.60; 95% CI, 2.53-5.13) and parainfluenza (OR, 3.06; 95% CI, 1.25-7.50). Haemophilus influenzae and Streptococcus pneumoniae were also more frequent in PAD. Young child exposure, IgM deficiency, and presence of bronchiectasis were independent risk factors for viral detection. Prophylactic antibiotic use was associated with a lower risk of bacterial detection by PCR.ConclusionsPatients with PAD have a significant respiratory symptom burden associated with increased viral infection frequency despite immunoglobulin replacement and prophylactic antibiotic use. This highlights a clear need for future therapeutic trials in the population with PAD, and informs future study design.

Clinical Pediatric Anesthesia: A Case-Based Handbook

Clinical Pediatric Anesthesia: A Case-Based Handbook

Children From the Age of Three Show a Developmental Switch in T-Cell Differentiation.

Every sixth child suffers from hypertrophy of the adenoid, a secondary lymphoid organ, at least once in childhood. Little is known about the impact of pathogen-provocation vs. developmental impact on T-cell responses after 1 year of age. Therefore, developmental and infection-driven influences on the formation of T-cell-compartments and -multifunctionality in adenoids were analyzed taking into account patient's history of age and inflammatory processes. Here, we show that in adenoids of 102 infants and children similar frequencies of naïve, effector, and memory T-cells were accumulated, whereby history of suffering from subsequent infection symptoms resulted in lower frequencies of CD4+ and CD8+ T-cells co-expressing several cytokines. While patients suffering from sole nasal obstruction had balanced Th1- and Th17-compartments, Th1 dominated in patients with concomitant upper airway infections. In addition, analysis of cytokine co-expressing CD4+ and CD8+ T-cells showed that children at the age of three or older differed significantly from those being 1- or 2-years old, implicating a developmental switch in T-cell differentiation at that age. Yet, dissecting age and infectious history of the patients revealed that while CD8+ T-cell differentiation seems to be triggered by development, CD4+ T-cell functionality is partly impaired by infections. However, this functionality recovers by the age of 3 years. Thus, 3 years of age seems to be a critical period in an infant's life to develop robust T-cell compartments of higher quality. These findings identify important areas for future research and distinguish an age period in early childhood when to consider adjusting the choice of treatment of infections.

Clinical manifestations of children with COVID‐19: A systematic review

BackgroundThe coronavirus disease 2019 (COVID‐19) outbreak is an unprecedented global public health challenge, leading to thousands of deaths every day worldwide. Despite the epidemiological importance, clinical patterns of children with COVID‐19 remain unclear. The aim of this study was to describe the clinical, laboratorial, and radiological characteristics of children with COVID‐19.MethodsThe Medline database was searched between December 1st 2019 and April 6th 2020. No language restrictions were applied. Inclusion criteria were (a) studied patients younger than 18 years old; (b) presented original data from cases of COVID‐19 confirmed by reverse‐transcription polymerase chain reaction; and (c) contained descriptions of clinical manifestations, laboratory tests, or radiological examinations.ResultsA total of 38 studies (1124 cases) were included. From all the cases, 1117 had their severity classified: 14.2% were asymptomatic, 36.3% were mild, 46.0% were moderate, 2.1% were severe, and 1.2% were critical. The most prevalent symptom was fever (47.5%), followed by cough (41.5%), nasal symptoms (11.2%), diarrhea (8.1%), and nausea/vomiting (7.1%). One hundred forty‐five (36.9%) children were diagnosed with pneumonia and 43 (10.9%) upper airway infections were reported. Reduced lymphocyte count was reported in 12.9% of cases. Abnormalities in computed tomography were reported in 63.0% of cases. The most prevalent abnormalities reported were ground‐glass opacities, patchy shadows, and consolidations. Only one death was reported.ConclusionsClinical manifestations of children with COVID‐19 differ widely from adult cases. Fever and respiratory symptoms should not be considered a hallmark of COVID‐19 in children.

Mean platelet volume levels in children with sleep-disordered breathing: a meta-analysis

BackgroundPediatric sleep-disordered breathing (SDB) correlated with respiratory conditions of snoring and hypopnea. Mean platelet volume (MPV) was an inflammatory marker, related to increased inflammatory condition of pediatric patients. Increase of MPV level may cause failure to thrive or increased upper airway infection rate. The aim of this study was to perform systematic review and meta-analysis to investigate the difference on MPV values for pediatric SDB, and compare the change on MPV after surgery in patients with pediatric SDB.MethodsA systemic review of the studies from PubMed, EMBASE, and Cochrane Library databases was conducted in March 2020, supported by reviewing of published articles for studies comparing MPV in pediatric SDB. Meta-analysis was used to compare the change of MPV in pediatric SDB, and sub-group analysis was also used to compare the MPV decrease after surgeries of adenoidectomy or adenotonsillectomy.ResultsThere were seven studies included in the review. Six of them including 963 subjects showed that a significant increase of MPV was noted in pediatric SDB compared to those in pediatric non-SDB (P < 0.05). Total standardized mean difference (SMD) in MPV between pediatric SDB and non-SDB was 0.51 (95% CI =0.30–0.72, P < 0.05). A significant decrease of MPV was found in pediatric SDB patients who underwent surgery (total SMD = − 0.36; 95% CI = − 0.70– -0.02, P < 0.05). Decreases of MPV after adenoidectomy and adenotonsillectomy were observed, but only the effect of adenotonsillectomy had a statistical significance (total SMD = − 0.72; 95% CI = − 1.18 – -0.26, P < 0.05).ConclusionThe MPV was significantly higher in patients with pediatric SDB, indicating the presence of increased platelet activity in pediatric SDB patients. The level of MPV could be reduced by the two surgeries, especially adenotonsillectomy.