Fikile C Mabena, Vicky L Baillie, Martin J Hale, Bukiwe N Thwala, Nonhlanhla Mthembu, Toyah Els, Natali Serafin, Jeanine du Plessis, Peter Swart, Sithembiso C Velaphi, Karen L Petersen, Jeannette Wadula, Nelesh P Govender, Charl Verwey, David P Moore, Fatima Y Moosa, Firdose L Nakwa, Basetsana V Maroane, Grace Okudo, Theodore M Mabaso, Ziyaad Dangor, Marta C Nunes, Shabir A Madhi
{"title":"2019年非洲儿童冠状病毒病相关死亡的临床特征和组织病理学","authors":"Fikile C Mabena, Vicky L Baillie, Martin J Hale, Bukiwe N Thwala, Nonhlanhla Mthembu, Toyah Els, Natali Serafin, Jeanine du Plessis, Peter Swart, Sithembiso C Velaphi, Karen L Petersen, Jeannette Wadula, Nelesh P Govender, Charl Verwey, David P Moore, Fatima Y Moosa, Firdose L Nakwa, Basetsana V Maroane, Grace Okudo, Theodore M Mabaso, Ziyaad Dangor, Marta C Nunes, Shabir A Madhi","doi":"10.1097/INF.0000000000003227","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.</p><p><strong>Methods: </strong>Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.</p><p><strong>Results: </strong>SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.</p><p><strong>Conclusions: </strong>COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.</p>","PeriodicalId":118937,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":" ","pages":"e323-e332"},"PeriodicalIF":0.0000,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"9","resultStr":"{\"title\":\"Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children.\",\"authors\":\"Fikile C Mabena, Vicky L Baillie, Martin J Hale, Bukiwe N Thwala, Nonhlanhla Mthembu, Toyah Els, Natali Serafin, Jeanine du Plessis, Peter Swart, Sithembiso C Velaphi, Karen L Petersen, Jeannette Wadula, Nelesh P Govender, Charl Verwey, David P Moore, Fatima Y Moosa, Firdose L Nakwa, Basetsana V Maroane, Grace Okudo, Theodore M Mabaso, Ziyaad Dangor, Marta C Nunes, Shabir A Madhi\",\"doi\":\"10.1097/INF.0000000000003227\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.</p><p><strong>Methods: </strong>Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.</p><p><strong>Results: </strong>SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.</p><p><strong>Conclusions: </strong>COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.</p>\",\"PeriodicalId\":118937,\"journal\":{\"name\":\"The Pediatric Infectious Disease Journal\",\"volume\":\" \",\"pages\":\"e323-e332\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"9\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Pediatric Infectious Disease Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/INF.0000000000003227\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Pediatric Infectious Disease Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/INF.0000000000003227","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children.
Background: Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.
Methods: Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.
Results: SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.
Conclusions: COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.
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