CARACTERÍSTICAS CLÍNICAS E LABORATORIAIS DA INFECÇÃO POR SARS-COV-2 EM CRIANÇAS E ADOLESCENTES

Martins, Marlos Melo; Prata-Barbosa, Arnaldo; Magalhães-Barbosa, Maria Clara de; Cunha, Antonio José Ledo Alves da

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Revista Paulista de Pediatria

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Brasil

Español English

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Sumário

ARTIGO DE REVISÃO • Rev. paul. pediatr. 39 • 2021 • https://doi.org/10.1590/1984-0462/2021/39/2020231 copiar

CARACTERÍSTICAS CLÍNICAS E LABORATORIAIS DA INFECÇÃO POR SARS-COV-2 EM CRIANÇAS E ADOLESCENTES

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Apresentar as atuais evidências sobre as características clínicas e laboratoriais da infecção pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) durante a infância e a adolescência.

Fonte de dados:

Revisão narrativa realizada nas bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde na Biblioteca Virtual em Saúde (LILACS/BVS), Scopus, Web of Science, Cochrane Library, portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect e Cumulative Index to Nursing and Allied Health Literature (CINAHL), com o uso dos termos SARS-CoV-2, COVID-19 e novo coronavírus e criança, recém-nascido e adolescente.

Síntese dos dados:

Diferentemente dos adultos, as crianças infectadas pelo SARS-CoV-2 apresentam formas clínicas leves ou assintomáticas na maior parte dos casos. As crianças sintomáticas apresentam predominantemente febre baixa e tosse, com alguns sintomas gastrointestinais associados. Casos graves são a minoria e ocorrem especialmente abaixo de um ano de idade. A detecção de partículas virais em fezes parece ser mais persistente em crianças, podendo servir como ferramenta diagnóstica e de controle do tempo de quarentena. Diferentemente dos adultos, as crianças podem apresentar respostas inflamatórias distintas, como tem ocorrido nos novos casos de síndrome de Kawasaki-like associada à infecção pelo SARS-CoV-2.

Conclusões:

Crianças, na sua maioria, apresentam quadros assintomáticos ou leves, com predomínio de febre, tosse e sintomas gastrointestinais. Novos relatos de diferentes reações sistêmicas inflamatórias em crianças têm sido notados, com manifestações clínicas distintas daquelas tipicamente observadas em adultos.

Palavras-chave:
SARS-CoV-2; COVID-19; Criança; Recém-nascido; Adolescente

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Número de crianças	7	20	10	36	25	171
Faixa etária (anos)	0-13	0-14	1-18	1-16	0-14	0- 15
Masculino/feminino	4/3	13/7	5/5	23/13	14/11	104/67
Local	China	China	China	China	China	China
Período	Janeiro Fevereiro	Janeiro Fevereiro	Janeiro Fevereiro	Janeiro Março	Fevereiro	Janeiro Fevereiro
Febre	5 (71,4%)	12 (60%)	4 (40%)	13 (36,1%)	13 (52%)	71 (41,5%)
Tosse	5 (71,4%)	13 (65%)	3 (30%)	7 (19,4%)	11 (44%)	83 (48,5%)
Mialgia/fadiga	0	1 (5%)	---	---	---	13 (7,6%)
Diarreia, náuseas e/ou vômitos	4 (57,1%)	3 (15%)	0	---	3 (12%)	15 (8,8%)
Odinofagia	1 (14,3%)	1 (5%)	0	---	---	---
Dispneia/taquipneia	3 (42,9%)	2 (10%)	0	1 (2,8%)	2 (8%)	49 (28,7%)
Anormalidade de TC tórax	5 (71,4%)	16 (80%)	5 (50%)	19 (52,8%)	17 (68%)	111 (64,9%)
Leucocitose	2 (28,6%)	2 (10%)	---	---	---	---
Neutropenia	1 (14,3%)	---	---	---	---	---
Linfocitose	---	3 (15%)	---	---	---	---
Linfopenia	---	7 (35%)	0	11 (30,6%)	10 (40%)	6 (3,5%)
Leucopenia	---	4 (20%)	0	7 (19,4%)	---	---
TGO e TGP aumentadas	2 (28,6%)	5 (25%)	3 (30%)	2 (5,6%)	---	---
CK/CKmB aumentada	4 (57,1%)	15 (75%)	---	11 (30,6%)	---	---
PCR aumentada	2 (28,6%)	16 (80%)	0	1 (2,8%)	---	---
Procalcitonina aumentada	3 (42,9%)	16 (80%)	0	6 (16,7%)	---	---
VHS aumentado	3 (42,9%)	---	---	---	---	---
Necessidade de oxigênio	2 (28,6%)	---	1 (10%)	6 (16,7%)	2 (8%)	4 (2,3%)

	Xu et al.²⁵25. Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;26:502-5. https://doi.org/10.1038/s41591-020-0817-4 https://doi.org/https://doi.org/10.1038/...	Cai et al.²⁶26. Cai J, Xu J, Lin D, Yang Z, Xu L, Qu Z, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis. 2020;ciaa198. https://doi.org/10.1093/cid/ciaa198 https://doi.org/https://doi.org/10.1093/...	Su et al.²⁷27. Su L, Ma X, Yu H, Zhang Z, Bian P, Han Y, et al. The different clinical characteristics of corona virus disease cases between children and their families in China-the character of children with COVID-19. Emerg Microbes Infect. 2020;9:707-13. https://doi.org/10.1080/22221751.2020.1744483 https://doi.org/https://doi.org/10.1080/...	Du et al.²⁸28. Du W, Yu J, Wang H, Zhang X, Zhang S, Li Q, et al. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China. Infection. 2020;48:445-52. https://doi.org/10.1007/s15010-020-01427-2 https://doi.org/https://doi.org/10.1007/...	Tan et al.¹⁴14. Tan YP, Tan BY, Pan J, Wu J, Zeng SZ, Wei HY. Epidemiologic and clinical characteristics of 10 children with coronavirus disease 2019 in Changsha, China. J Clin Virol. 2020;127:104353. https://doi.org/10.1016/j.jcv.2020.104353 https://doi.org/https://doi.org/10.1016/...	Garazzino et al.¹⁵15. Garazzino S, Montagnani C, Donà D, Meini A, Felici E, Vergine G, et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Euro Surveill. 2020;25:2000600. https://doi.org/10.2807/1560-7917.ES.2020.25.18.2000600 https://doi.org/https://doi.org/10.2807/...
Número de crianças	10	10	9	14	10	168
Faixa etária (anos)	0-15	0-10	0-9	0-16	1-12	0-17
Masculino/feminino	5/5	4/6	3/6	6/8	3/7	94/74
Local	China	China	China	China	China	Itália
Período	Janeiro Fevereiro	Janeiro Fevereiro	Janeiro Fevereiro	Janeiro Fevereiro	Janeiro Março	Janeiro Março
Febre	7 (70%)	8 (80%)	2 (22,2%)	5 (35,7%)	4 (40%)	138 (82,1%)
Tosse	5 (50%)	6 (60%)	1 (11,1%)	3 (21,4%)	3 (30%)	82 (48,8%)
Mialgia/fadiga	---	---	---	---		3 (1,8%)
Diarreia, náuseas e/ou vômitos	3 (30%)	0	---	---	1 (10%)	22 (13,1%)
Odinofagia	4 (40%)	4 (40%)	---	---	---	9 (5,4%)
Dispneia/taquipneia	---	0	---	---	---	16 (9,5%)
Anormalidade de TC tórax	5 (50%)	4 (40%)	---	6 (42,8%)	5 (50%)	---
Leucocitose	---	3 (30%)	---	---	1 (10%)	---
Neutropenia	2 (20%)	3 (30%)	---	---	0	---
Linfocitose	3 (30%)	1 (10%)	---	---	0	---
Linfopenia	3 (30%)	0	---	---	0	---
Leucopenia	1 (30%)	1 (10%)	---	---	0	---
TGO e TGP aumentadas	1 (10%)	2 (20%)	0	---	---	---
CK/CKmB aumentada	0	5 (50%)	6 (66,6%)	---	---	---
PCR aumentada	3 (30%)	3 (30%)	0	---	---	47/121 (38,8%)
Procalcitonina aumentada	5 (50%)	0	---	---	---	---
VHS aumentado	3 (30%)	---	0	---	---	---
Necessidade de oxigênio	0	0	0	0	0	---

	Ma et al.¹⁶16. Ma YL, Xia SY, Wang M, Zhang SM, Du WH, Chen Q. Clinical features of children with SARS-CoV-2 infection: an analysis of 115 cases. Zhongguo Dang Dai Er Ke Za Zhi. 2020;22:290-3. https://doi.org/10.7499/j.issn.1008-8830.2003016 https://doi.org/https://doi.org/10.7499/...	Sun et al.¹⁷17. Sun D, Li H, Lu XX, Xiao H, Ren J, Zhang FR, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World J Pediatr. 2020;16:251-9. https://doi.org/10.1007/s12519-020-00354-4 https://doi.org/https://doi.org/10.1007/... *	Liu et al.¹⁸18. Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: focus on pregnant women and children. J Infect. 2020;80:e7-13. https://doi.org/10.1016/j.jinf.2020.03.007 https://doi.org/https://doi.org/10.1016/...	Zhong et al.¹⁹19. Zhong Z, Xie X, Huang W, Zhao W, Yu Q, Liu J. Chest CT findings and clinical features of coronavirus disease 2019 in children. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020;45:236-42. https://doi.org/10.11817/j.issn.1672-7347.2020.200206 https://doi.org/https://doi.org/10.11817...	Dodi et al.²⁰20. Dodi I, Castellone E, Pappalardo M, Rubini M, Veronese P, Ruberto C, et al. SARS-CoV-2 infection in children in Parma. Acta Biomed. 2020;91:214-5. https://doi.org/10.23750/abm.v91i2.9563 https://doi.org/https://doi.org/10.23750...
Número de crianças	115	8	4	9	14
Faixa etária (anos)	---	0-15	0-9	0-12	---
Masculino/feminino	73/42	6/2	2/2	4/5	9/5
Local	China	China	China	China	Itália
Período	---	Janeiro Fevereiro	---	---	Janeiro Abril
Febre	29 (25,2%)	6 (75%)	3 (75%)	2 (22,2%)	14 (100%)
Tosse	47 (40,9%)	6 (75%)	3 (75%)	5 (55,5%)	5 (35,7%)
Mialgia/fadiga	---	1 (12.5%)	1 (25%)		3 (21,4%)
Diarreia, náuseas e/ou vômitos	---	4 (50%)	---	0	2 (14,3%)
Odinofagia	---	---	---	---	7 (50%)
Dispneia/taquipneia	---	8 (100%)	---	---	---
Anormalidade de TC tórax	49 (42,6%)	8 (100%)	3 (75%)	---	---
Leucocitose	---	---	0	1 (11,1%)	---
Neutropenia	---	---	2 (50%)	5 (55,5%)	---
Linfocitose	---	---	2 (50%)	2 (22,2%)	---
Linfopenia	---	---		1 (11,1%)	1 (7,1%)
Leucopenia	---	---	1 (25%)	1 (11,1%)	---
TGO e TGP aumentadas	11 (9,6%)	4 (50%)		---	---
CK/ CKmB aumentada	34 (29,6%)	---		---	---
PCR aumentada	---	5 (62,5%)	1 (25%)	9 (100%)	---
Procalcitonina aumentada	---	5 (62,5%)		0	---
VHS aumentado	---	---		---	---
Necessidade de oxigênio	3 (2,6%)	8 (100%)*	0	0	0

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[1] *Autor correspondente. E-mail: marlosmartins@globo.com (M.M. Martins).