Severe Acute Respiratory Syndrome in Children

Lauren J. Stockman, MPH*†; Mehran S. Massoudi, PhD, MPH*; Rita Helfand, MD*; Dean Erdman, DrPH*; Alison M. Siwek, MPH*†; Larry J. Anderson, MD*; Umesh D. Parashar, MD, MPH*

Disclosures

Pediatr Infect Dis J. 2007;26(1):68-74. 

In This Article

Clinical Features

Patients meeting the case definitions for laboratory-confirmed and probable SARS had similar clinical features, but patients with suspect SARS had a lower prevalence of constitutional symptoms, such as chills or myalgia, and lower rates of laboratory abnormalities ( Table 2 ). The difference in clinical presentation of suspect SARS cases may reflect the nonspecificity of the clinical case definition and the inclusion of both SARS-CoV-infected and uninfected people in this group.

Among laboratory-confirmed and probable pediatric SARS cases, the most common symptoms included fever (98%), cough (60%), nausea or vomiting (41%) and constitutional symptoms such as myalgia (29%), chills (28%) and headache (28%). In cohorts that included children identified from the Amoy Gardens residential estate outbreak in Hong Kong, diarrhea was not more common when compared with cohorts of children with other epidemiologic exposures (17% versus 29%). This observation is of interest given that diarrhea was found to be a prominent symptom among adults with SARS from the Amoy Gardens cohort, of whom 73% developed diarrhea.[17]

Radiographic abnormalities were noted in 97% of laboratory-confirmed and 96% of probable cases, although as in adults these abnormalities were often not detectable in the first few days of illness. Probable cases were more likely to have radiographic abnormalities at admission than were laboratory-confirmed cases (82% versus 48%; P < 0.05). Because almost all pediatric cases in both groups subsequently had radiographic evidence of pneumonia during illness, it is possible that this difference is a result of earlier hospital care sought for patients in the laboratory confirmed group although data on time from illness onset to hospitalization are not available. The most prominent radiographic findings included patchy infiltrates, opacities and areas of consolidation with multifocal lesions, predominantly in the lower lobes; the location of these lesions is consistent with the pattern seen in adults.[16] The most common hematologic and biochemical abnormalities included lymphopenia, leukopenia, thrombocytopenia and elevated levels of lactate dehydrogenase and alanine aminotransferase.[13,14,16]

Adolescents older than 12 years of age with laboratory-confirmed or probable SARS had a clinical presentation similar to that of adult patients with SARS, whereas children in this group 12 years of age or younger had a milder illness with a favorable outcome ( Table 3 ). The difference in clinical presentation among children 12 years or younger and children older than 12 years of age was observed for both cases meeting the laboratory-confirmed and probable SARS case definitions. Compared with pediatric patients older than 12 years of age, constitutional symptoms such as myalgias, headache and chills were reported less frequently in children 12 years of age or younger. Younger children also were less likely to be admitted to an intensive care unit, receive supplemental oxygen or be treated with methylprednisolone.

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