COVID-19 and children

Autori:

Mario Blekić, Blaženka Miškić, Blaženka Kljaić Bukvić

Sažetak
Novi koronavirus, nazvan virus teškog respiratornog sindroma (engl. Severe Acute Respiratory Syndrome Coronavirus-2, SARS-CoV-2), identificiran je u prosincu 2019. godine. U sljedećim mjesecima, zahvaljujući obilježjima brzog i lakog prijenosa infekcije među ljudima, SARS-CoV-2 doveo je do pandemije s više od 2.000.000 oboljelih i više od 100.000 smrti. Bolest uzrokovana virusom SARS-CoV-2 nazvana je koronavirusna bolest 2019 (engl. Coronavirus disease 2019, COVID-19), a obilježena je općim simptomima infekcije koji su praćeni upalnim promjenama donjih dišnih putova. U manjeg broja inficiranih, ponajprije osoba starije životne dobi s komorbiditetima, bolest napreduje ka akutnom respiratornom distresu, višestrukom zatajenju organa i letalnom ishodu. Epidemiološka izvješća prikazuju mali postotak djece među oboljelim osobama (≤5%). Djeca imaju laboratorijske dokaze infekcije virusom ili blaže do umjereno teške kliničke slike, s nešto blažim radiološki potvrđenim upalnim promjenama u plućima nego odrasli i rijetkim letalnim ishodima. Uočeno je kako su jednako osjetljiva na infekciju kao i odrasle osobe, ali nije do kraja razjašnjeno zašto ostaju asimptomatski odnosno imaju blage do umjereno teške oblike COVID-19. Uzroci se traže u međudjelovanju između domaćinovih imunoloških snaga i patogenetskih mehanizama virusa. Dječja dob je obilježena virusnim infekcijama i cijepljenjem koji pružaju križnu imunost odnosno reaktivnost prema drugim patogenima, povećanim brojem limfocita te povećanom ekspresijom angiotenzin konvertirajućeg enzima 2 (engl. angiotensin converting enzyme 2, ACE2). Smatra se kako bi navedena obilježja dječje dobi mogla pružiti zaštitu od težih i letalnih oblika COVID-19. I u novorođenačkoj dobi postoji mogućnost infekcije i razvoja različitih oblika bolesti. Detaljnim analizama amnionske tekućine, krvi iz pupkovine i majčinog mlijeka za sada nije dokazan vertikalni prijenos infekcije s majke na dijete. Novorođenčad i dojenčad, posebice s komorbiditetima, zbog imunološke nezrelosti i nedostatka križne imunosti ugroženija su razvojem koronavirusne bolesti. U tijeku trajanja pandemije neophodno je strogo provoditi protektivne mjere protiv širenja infekcije, tražiti prve znakove bolesti kako bi se što ranije započelo primjereno liječenje.
Summary

The new coronavirus, called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in December 2019. In the following months SARS-CoV-2 has led to a pandemic with over 2,000,000 confirmed cases and 100,000 deaths. The disease caused by SARS-CoV-2, called the coronavirus disease 2019 (COVID-19), is characterized by general symptoms of infection, which are accompanied with inflammatory changes in the lower respiratory tract. In a small number of infected people, most notably the elderly with comorbidities, the disease progresses to acute respiratory distress and multiple organ failure with lethal outcome. Epidemiological reports, however, show a small percentage of children among the sick: up to 5%. Children tend to have laboratory evidence of virus infection or mild to moderately severe clinical presentations, with slightly milder radiological changes in the lungs than adults, and with rare lethal outcomes.. It has been observed that children are as susceptible to infection as adults, but it is not fully understood why they remain asymptomatic, or have mild forms of COVID-19. The causes for that are sought in the interaction between the host immune forces and the pathogenic mechanisms of the virus. Childhood is characterized by viral infections and vaccinations that provide cross-immunity and reactivity to other pathogens, increased lymphocyte counts and increased expression of angiotensin converting enzyme 2 (ACE2). It is considered that the characteristics mentioned above could provide protection against the more severe forms of COVID-19. When it comes to the newborns, analyses of amniotic fluid, cord blood and breast milk have not yet demonstrated the vertical transmission of infection from mother to child. While the pandemic lasts, it is necessary to implement strict protective measures against the spreading of the disease, and to look for the first signs of the disease in order to start the appropriate treatment as soon as possible.

Volumen: 3-4, 2020

Liječ Vjesn 2020;142:64–74

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