A mild type of childhood C0VID-19 - A case report

This case is about a 9-year-old child diagnosed with COVID-19, with a history of epidemiology; SARS-CoV-2 nucleic acids testing was positive, while chest CT examination was negative. The clinical classification was light.

Case Report
A 9-year-old male patient was hospitalized due to having had a fever for three days. The child had no obvious inducement of fever three days before this. His temperature was as high as 38.9 degree C, and he presented no chill or shivering, cough, sputum or sore throat, chest tightness or chest pain, acid reflux, nausea, abdominal pain or diarrhea, dizziness or headaches, or breathing cyanosis, and no weakness or muscle ache. The patient had lived in Wuhan for a long time. There was also no clear history of exposure to patients infected with SARS-CoV-2. He was in good health and denied a history of food and drug allergies.
Routine blood examination in the external hospital showed:
leukocyte 13.07 *10^9/L,
erythrocyte 4.25*10^12/L,
neutrophil ratio 72.71%,
lymphocyte ratio 16.12%,
absolute value of lymphocyte 2.1 * 10^9/L,
influenza A and B pathogen detection were negative.
 A chest X-ray did not find any obvious abnormality in either lung. The patient was given "oral administration of cattilan and intravenous drip of lysine acetylsalicylate injection" for one day (the specific dosage is unknown), and no fever occurred. The child was sent to hospital by his parents for further diagnosis and treatment.
Because the child had lived in Wuhan two weeks before the onset of the disease and had a fever, SARS-CoV-2 infection was not excluded. During patient admission examination: T 36.6 degree C, P 100 times/min, R 20 times/min, BP 100/65 mmHg, no congestion in the pharynx, no swelling of the tonsils, clear breath sounds in either lung, and no obvious dry and wet rales were recorded. Routine blood examination after admission was conducted with the following results: white blood cell 4.22 * 10^9/L, red blood cell 3.80 *10^12/L, hemoglobin 118.00 g/L, platelet 363.00 *10^9/L, neutrophil percentage 37.40%, lymphocyte percentage 53.80%.
 Novel coronavirus nucleic acids testing was positive. Results for biochemical
examination are:
lactate dehydrogenase 69U/L[, aahydroxybutyrate dehydrogenase 258U/L[, creatine kinase 139U/L, creatine kinase isoenzyme 41U/L, C- reactive protein 15.2 mg/L, serum amyloid >300 mg/L, procalcitonin 0.28 ng/mL.

Discussion.
The diagnosis of COVID-19  is based on viral nucleic acid detection and gene sequencing, but nucleic acid detection has strong specificity and poor sensitivity. Chest imaging findings are characteristic. Some patients have imaging findings earlier than clinical manifestations. The stages of imaging manifestations include early, advanced, and severe[2]. There are few existing reports of children, and only one case report of adults.
Children and teenagers infected with SARS-CoV-2 have mild clinical symptoms and radiological manifestations[4], and are rarely severe or critical. Mild-stage patients have mild clinical symptoms and no pneumonia on imaging[1]. Thin-slide chest CT can be non-invasive and more sensitive to nucleic acids and clinical manifestations. In order to avoid missed diagnosis of the progress in this child, a chest CT examination was performed on the third and fifth days of admission. No positive signs were found, which can provide high indication for clinical judgment of good prognosis. The child's nucleic acid turned negative eight days after admission and he was then discharged.

Based on the clinical and imaging data of this case, the following guidelines are recommended. If children and adolescents have a history of living or traveling in epidemic areas within one to two weeks, or they have had contact with confirmed or suspected cases, or stay in an aggregated disease
environment, the possibility of their infection with SARS CoV- 2 cannot be ruled out, even when their clinical symptoms are mild and there is no typical chest imaging manifestation. SARS-CoV-2 nucleic acid or gene testing is required for these patients. If these tests are positive, the patient should be placed under immediate quarantine. Patients with negative results from viral nucleic acid testing need to be closely observed or to undergo CT examination of lung changes to reduce and avoid missed diagnosis and misdiagnosis of patients with atypical clinical manifestations and occult symptoms, in order to take timely isolation and prevention measures.


Xiaoping Yin a,1, Li Dong b,1, Yu Zhang a, Weilin Bian b, Hongjun Li c,*
a Department of Radiology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
b Department of Radiology, Baoding People's Hospital, Baoding, Hebei 071000, China
c Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China.