COVID-19 en pediatría: aspectos clínicos, epidemiológicos, inmunopatogenia, diágnóstico y tratamiento

José Ramón Acosta Torres, Maité Pérez Cutiño, Magela Rodríguez Prieto, Alejandro Morales González

Texto completo:

PDF

Resumen

Introducción: La Organización Mundial de la Salud declaró desde el 11 de marzo de 2020 la infección por el coronavirus denominado SARS-CoV-2, como una pandemia, existente desde finales de 2019 en la provincia china de Wuhan. La enfermedad producida por este coronavirus se denomina COVID-19, entidad que ha mostrado una baja morbilidad y mortalidad en pediatría.

Objetivo: Examinar factores epidemiológicos, sintomatología, diagnóstico y tratamiento de la enfermedad en la edad pediátrica.

Métodos: Se revisó la literatura utilizando la base de datos PubMed para identificar artículos publicados hasta el 30 de abril 2020, informes, series de casos y datos de laboratorio.

Resultados: La edad de presentación con mayor frecuencia ocurrió en los pacientes mayores de 5 años con 2,5 % de casos graves, acompañados de fiebre, tos, congestión nasal, disnea, vómitos y diarreas como síntomas más frecuentes. Los datos de laboratorio indican una media de conteo leucocitario entre 6,1 y 6,8 × 105, linfopenia con rango entre 2,5 y 40 %, y aumento de las enzimas alaniltranferasa y creatininfosfoquinasa, además del marcador antiinflamatorio proteína C reactiva, este último con concentraciones entre el 17 y 62,5 %. La transmisión vertical no ha sido verificada. El tratamiento utilizado con mayor frecuencia es Lopinavir/ ritonavir e interferón. La radiografía de tórax fue normal entre el 20 y el 66 %. No se registran fallecidos en las seis series revisadas.

Consideraciones finales: La infección por SARS-CoV-2 en pediatría evoluciona con un pronóstico favorable, pero se necesitan más investigaciones para un mejor conocimiento de la entidad.

Palabras clave: coronavirus; COVID-19; SARS-CoV-2; citocinas; retrovirales.


Referencias

Hageman JR. The coronavirus disease 2019 (COVID-19). Pediatric annals. 2020;49 (3):e99-e100.

Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. Journal of medical virology [Internet]. 2020 [cited abril 2020; 92(4):[424-32 pp.]. Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.25685.

.

Singhal T. A review of coronavirus disease-2019 (COVID-19). The Indian Journal of Pediatrics [Internet]. 2020 [cited abril 2020:[1-6 pp.]. Available from: https://link.springer.com/content/pdf/10.1007/s12098-020-03263-6.pdf.

OMS. Declaración sobre la segunda reunión del Comité de Emergencias del Reglamento Sanitario ‎Internacional (2005) acerca del brote del nuevo coronavirus (2019-nCoV) 2020 [cited abril 2020. Available from: https://www.who.int/es/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-.

Aragón-Nogales R, Vargas-Almanza I, Miranda-Novales MG. COVID-19 por SARS-CoV-2: la nueva emergencia de salud. Rev Mex Pediatr. 2019;86(6):213-8.

Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19). Statpearls [internet] [Internet]. 2020 [cited abril 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554776/.

Martínez Soria J, Torres Ramírez C, Orozco Rivera ED. Características, medidas de política pública y riesgos de la pandemia del Covid-19. In: Dirección, General , de , Investigaciones, Estratégicas, editors. 2020.

Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. The Lancet Infectious Diseases. 2020. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2820%29301985/fulltext?fbclid=IwAR2D2B9587LGFjnLdtdrAUwbzsMPgy8Lxi-wcxr-031xdKyTTll7KgXFupE.

Hasan A, Mehmood N, Fergie J. Coronavirus disease (COVID-19) and pediatric patients: a review of epidemiology, symptomatology, laboratory and imaging results to guide the development of a management algorithm. Cureus. 2020;12(3). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123290/.

Martinez MA. Compounds with therapeutic potential against novel respiratory 2019 coronavirus. Antimicrobial Agents and Chemotherapy. 2020;64(5). Aviable from: https://aac.asm.org/content/aac/64/5/e00399-20.full.pdf

Hong H, Wang Y, Chung H-T, Chen C-J. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol. 2020;61(131):e2.

Schoeman D, Fielding BC. Coronavirus envelope protein: current know ledge. Virol J [Internet]. 2019 abril 2020 [cited aril 2020; 16(69):[1-22 pp.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537279/pdf/12985_2019_Article_1182.pdf.

Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. NEngl J Med [Internet]. 2020 [cited abril 2020. Available from: https://doi.org/10.1056/NEJMc2001468.

Rasmussen SA, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation. Obstetrics and Gynecology. 2020.Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141586/

Ma X, Su L, Zhang Y, Zhang X, Gai Z, Zhang Z. Do children need a longer time to shed SARS-CoV-2 in stool than adults? Journal of Microbiology, Immunology and Infection [Internet]. 2020 [cited abril 2020. Available from: https://www.sciencedirect.com/science/article/pii/S1684118220300700/pdfft?md5=096b41eff8f43283f63b6a77aa2d0108&pid=1-s2.0-S1684118220300700-main.pdf.

Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants born to mothers with a new coronavirus (COVID-19). Frontiers in Pediatrics [Internet]. 2020 [cited abril 2020; 8:[104 p.]. Available from: https://www.frontiersin.org/articles/10.3389/fped.2020.00104/full?utm_campaign=ba-cov-sci-fped-pregnancy&utm_medium=cvlp&utm_source=fweb&fbclid=IwAR1MF_mC5gM5lTNr038Odyb-0NsEHSLCg6X35bBAk6ehKsvPfwq6PGCr7qU.

Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical transmission of coronavirus Disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal and pediatric pathology [Internet]. 2020 [cited abril 2020:[1-5 pp.]. Available from: https://www.tandfonline.com/doi/pdf/10.1080/15513815.2020.1747120.

Mullins E, Evans D, Viner R, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound in Obstetrics & Gynecology [Internet]. 2020 [cited abril 202-0. Available from: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/uog.22014%4010.1002/%28ISSN%291469-0705.covid-19_in_obgyn.

Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? The Lancet [Internet]. 2020 [cited abril 2020; 395(10228):[931-4 pp.]. Available from: https://doi.org/10.1016/S0140-6736(20)30567-5.

Buckley R. Linfocitos T, linfocitos B y linfocitos asesinos naturales. In: WB Saunders Company, editor. Nelson Texbook of pediatric. ed. Pensylvania:2001. p. 683-5.

Lacagnina M, Watkins L, Grace P. Toll-like receptors and their role in persistent pain. Pharmacol Ther [Internet]. 2018 [cited abril 2020; 184:[145-84 pp.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858962/.

Arenas-Padilla M, Mata-Haro V. Regulation of TLR signaling pathways by microRNAs: implications in inflammatory diseases. Central-European journal of immunology [Internet]. 2018 [cited mayo 2020; 43(4):[482 p.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858962/.

Kindler E, Thiel V, Weber F. Chapter Seven - Interaction of SARS and MERS Coronaviruses with the Antiviral Interferon Response. Adv Virus Res [Internet]. 2016 [cited abril 2020; 96:[219-43 pp.]. Available from: https://www.sciencedirect.com/science/article/pii/S0065352716300458?via%3Dihub.

Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID‐19 infection: Different points from adults. Pediatric pulmonology [Internet]. 2020 [cited abril 2020; 55(5):[1169-74 pp.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168071/.

Cai J, Xu J, Lin D, Xu L, Qu Z, Zhang Y, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clinical Infectious Diseases [Internet]. 2020 [cited abril 2020. Available from: https://ipna-online.org/wp-content/uploads/2020/04/A-case-series-of-10-Chinese-children-with-COCID-19-infection-outside-of-Wuhan-China_EN.pdf.

Sun D, Li H, Lu X-X, Xiao H, Ren J, Zhang F-R, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World Journal of Pediatrics [Internet]. 2020 [cited abril 2020:[1-9 pp.]. Available from: https://link.springer.com/content/pdf/10.1007/s12519-020-00354-4.pdf

Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clinical Chemistry and Laboratory Medicine (CCLM) [Internet]. 2020 [cited abril 2020; 1(ahead-of-print). Available from: https://www.degruyter.com/view/journals/cclm/ahead-of-print/article-10.1515-cclm-2020-0272/article-10.1515-cclm-2020-0272.xml.

Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. Jama [Internet]. 2020 [cited mayo 2020; 323(16):[1582-9 pp.]. Available from: file:///C:/Users/Jose/Downloads/jama_shen_2020_pc_200002.pdf.

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. Emerging Microbes & Infections [Internet]. 2020 [cited abril 2020; 9(1):[707-13 pp.]. Available from: https://www.tandfonline.com/doi/pdf/10.1080/22221751.2020.1744483.

Benveniste O. Making the Diagnosis of Myositis: Laboratory Testing in Myositis2020 [cited mayo 2020; 17(1):[161-5 pp.]. Available from: https://link.springer.com/chapter/10.1007/978-3-030-15820-0_17.

Sinha I. Guidance for the clinical management of children admitted to hospital with suspected COVID-19[cited abril 2020. Available from: http://patchsa.org/wp-content/uploads/2020/03/Guidance-for-the-clinical-management-of-children-admitted-to-hospital-with-suspected-COVID-19.pdf.

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics [Internet]. 2020 [cited abril 2020. Available from: http://www.svnp.es/sites/default/files/peds.2020-0702.full_.pdf.

Lee P-I, Hu Y-L, Chen P-Y, Huang Y-C, Hsueh P-R. Are children less susceptible to COVID-19? Journal of Microbiology, Immunology, and Infection [Internet]. 2020 [cited abril 2020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102573/.

Kelvin AA, Halperin S. COVID-19 in children: the link in the transmission chain. The Lancet Infectious Diseases [Internet]. 2020 abril 2020]. Available from: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30236-X/fulltext.

Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. New England Journal of Medicine [Internet]. 2020 [cited abril 2020. Available from:

https://www.nejm.org/doi/full/10.1056/NEJMoa2001191.

Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical

Features of 69 cases with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis [Internet]. 2020 [cited abril 2020. Available from: doi:10.1093/cid/ciaa27.

National Health Commission and State Administration of Traditional Chinese Medicine. Diagnosis and treatment protocol for novel coronavirus pneumonia. 2020 [cited mayo 2020. Available from: https://www.chinalawtranslate.com/wp-content/uploads/2020/03/Who-translation.pdf.

MINSAP. Guía terapéutica para el tratamiento de pacientes con COVID-19. Particularidades en el manejo del paciente pediátrico (anexos VI III al VI V). La Habana, Cuba2020.

SEIP. Documento de manejo clínico del paciente pediátrico con infección por SARS-CoV-2. Sociedad Española de Infectologia Pediátrica [Internet]. 2020 [cited abril 2020. Available from: https://www.seipweb.es/wp-content/uploads/2020/03/213-aep-sip-secip-seup.-documento-de-manejo-clínico-del-paciente-ped%CC%81trico-Extracto-del-documento-del-Ministerio.pdf.

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience trends [Internet]. 2020 [cited abril 2020; Biosci Trends (14):[1 p.]. Available from: https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01047/_pdf.

Soto A. Cuando la vehemencia supera la evidencia: el caso del uso de hidroxicloroquina para el tratamiento del COVID-19. Acta Médica Peruana [Internet]. 2020 [cited abril 2020; 37(1). Available from: file:///C:/Users/Jose/AppData/Local/Temp/914-Texto%20del%20art%C3%ADculo-3053-2-10-20200515.pdf.

Fu B, Xu X, Wei H. Why tocilizumab could be an effective treatment for severe COVID-19? Journal of translational medicine [Internet]. 2020 [cited mayo 2020; 18(1):[1-5 pp.]. Available from: https://translational-medicine.biomedcentral.com/track/pdf/10.1186/s12967-020-02339-3.

Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine [Internet]. 2020 [cited mayo 2020. Available from: doi:10.1001/jamainternmed.2020.0994.

Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral research [Internet]. 2020 [cited abril 2020:[104787 p.]. Available from: https://doi.org/10.1016/j.antiviral.2020.104787.

Zhu R-f, Gao R-l, Robert S-H, Gao J-p, Yang S-g, Zhu C. Systematic Review of the Registered Clinical Trials of Coronavirus Diseases 2019 (COVID-19). medRxiv [Internet]. 2020 [cited abril 2020. Available from: https://www.medrxiv.org/content/medrxiv/early/2020/03/03/2020.03.01.20029611.full.pdf.

CEDMED. Nota informativa del CEDMED sobre la modalidad terapéutica: Homeopatía y la aprobación PrevengHo®Vir2020 [cited abril 2020. Available from: https://www.cecmed.cu/noticias/nota-informativa-cecmed-prevengho-vir.

Pang J, Wang MX, Ang IYH, Tan SHX, Lewis RF, Chen JI-P, et al. Potential rapid diagnostics, vaccine and therapeutics for 2019 novel coronavirus (2019-nCoV): a systematic review. Journal of clinical medicine [Internet]. 2020 [cited abril 2020; 9(3):[623 p.]. Available from: doi:10.3390 /jcm9030623.

Watson J, Whiting PF, Brush JE. Interpreting a covid-19 test result. BMJ [Internet]. 2020 [cited Mayo 2020; 369. Available from: doi: 10.1136/bmj.m1808 (Published 12 May 2020.

Enlaces refback

  • No hay ningún enlace refback.




Copyright (c) 2020 José Ramón Acosta Torres, Maité Pérez Cutiño, Magela Rodríguez Prieto, Alejandro Morales González

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.