A total of 92 children were evaluated. Fifty children (54%) were diagnosed with COVID-19 infection by a positive SARS-CoV-2 RT-PCR test. Since chronic patients may have different clinical manifestations, they were described separately from previously healthy patients. (Tables 1 and 2).
Twenty-six patients with confirmed COVID-19 infection had a previous chronic medical condition. The most common underlying condition was cancer (16% of the patients), followed by chronic lung disease (12%), obesity (8%), chronic kidney disease (6%) and neurological disorders (4%). Three patients had more than one chronic condition.
From the evaluated symptoms, 35 children presented fever (70%), 36% excessive crying and dry cough, and we found hyposmia in 4% of the patients. We found that digestive symptoms were common, 24% of the patients presented only gastrointestinal symptoms. All patients without any respiratory or gastrointestinal symptoms were immunocompromised.
From the evaluated signs, 30 children presented pharyngeal erythema (60%), 24 with irritability (24%) and 10 rhinorrhea and conjunctival hyperemia (20%).
The first symptom to appear was fever in 36% of the cases and cough in 12%, followed by fatigue, rhinitis, and excessive crying in 8% of the patients. Manifestations intentionally sought but not found in any patient were expectoration, mucopurulent rhinorrhea, posterior nasal discharge, mucopurulent conjunctival discharge, and epistaxis. Manifestations intentionally sought that were found in only one patient were nasal mucosa oedema, rhonchi, cyanosis, lymphadenopathy, grunting, and wheezing.
Analyzing the diagrams of the symptom appearance chronology, we defined three different patterns:
Pattern “A” or almost asymptomatic: with only one or two symptoms.
Pattern “S” or sudden: onset of four or more symptoms in the first 24 to 36 hours.
Pattern “D” or disperse: sequential onset of symptoms over several days.
The patterns were distributed in an irregular form in both groups; nonetheless, considering only the patients with pneumonia, the “S” pattern was found in seven of nine of the chronically ill patients, in two of eight immunocompromised patients, in four of the five patients with chronic lung disease and in three of four obese patients.
The rate of admission was significantly higher in chronically ill (61.5%) versus healthy individuals (31.7%); however, seven of the twenty-six chronically ill individuals were admitted for previous disease decompensation. Of the eight immunocompromised patients, two developed pneumonia. Four of the five patients with obesity also developed pneumonia
All patients with pneumonia except one were admitted. Only one patient developed Kawasaki-like syndrome. Two patients required mechanical ventilation: one of them was a patient with cystic fibrosis and the other was a kidney transplant patient who died.