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Objective: As known, COVID-19, stemming from the SARS-CoV-2 virus, exhibits distinct clinical patterns across various variants. This research endeavors to comprehensively analyze the variations in clinical presentations between these variants and the original strain, particularly in pediatric COVID-19 pneumonia cases.
Materials and Methods: Patients diagnosed with COVID-19 pneumonia who were admitted to Mersin City Research and Training Hospital between June 2020-2022, were included in the study. Clinical and laboratory data of the patients were evaluated according to their variant status.
Results: 56% (n=62) of 110 pediatric patients were female, and their average age was 11±5.9 (median 13). 31%(n=34) of the patients were infected with the original strain, 20% (n=22) were alpha, 40% (n=44) were delta, and 9% (n=10) were omicron variant. 6% (n=7) of the patients were asymptomatic, 11% (n=12) were mildly symptomatic, 76% (n=83) were moderate (respiratory distress), and 7% (n=8) were severe clinical patients requiring mechanical ventilation. Fever and shortness of breath were most frequently seen in delta, and cough in alpha variant (p=0.0001;p=0.014;p=0.039,respectively). The most severe disease detected in omicron was alpha, delta and original virüs (p=0.001). No relationship detected between the laboratory values of the patients and the variant status (p>0.05). When patients were compared based on radiological severity, no significant differences were found between the variants (p=0.214). However, when cases were classified according to pneumonia severity, regardless of the variant status, higher levels of ferritin (p=0.0001) and CRP (p=0.037) were observed, while lymphocyte count (p=0.009) decreased with increasing pneumonia severity. It's noteworthy that no patient fatalities occurred.
Conclusion: In our study, the most severe clinical picture was shown in the omicron variant, followed by the alpha variant. But, omicron cases were limited, and it is important to examine variants in a larger population.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
World Health Organization. Tracking SARS-CoV-2 variants. 2023 [cited 2023 Sep 21]. Available from: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants
Türk Toraks Derneği solunum sistemi enfeksı̇yonları çalışma grubu. Covıd-19 pandemı̇ sürecı̇nde öne çıkan SARS-CoV-2 varyantları [Internet]. [cited 2023 Sep 20]. Available from: https://toraks.org.tr/files/mf/site/1-3d23507c.pdf
Gupta P, Gupta V, Singh CM, Singhal L. Emergence of COVID-19 Variants: An Update. Cureus 2023;3:15(7):e41295. DOI: https://doi.org/10.7759/cureus.41295
Domnich A, Orsi A, Ricucci V, et al. Real-world performance of SARS-CoV-2 rapid antigen testing through the Alpha-, Delta- and Omicron-dominant waves of the COVID-19 pandemic. Int J Infect Dis 2023;135:18–20. DOI: https://doi.org/10.1016/j.ijid.2023.07.029
Akçeşme FB, Köprülü TK, Erkal B, et al. Tracking the circulating SARS-CoV-2 variants in Turkey: Complete genome sequencing and molecular characterization of 1000 SARS-CoV-2 samples. bioRxiv 2022. DOI: https://doi.org/10.1101/2022.04.19.488722
Forrest CB, Burrows EK, Mejias A, et al. Severity of Acute COVID-19 in Children <18 Years Old March 2020 to December 2021. Pediatrics 2022;149(4):e2021055765. DOI: https://doi.org/10.1542/peds.2021-055765
Menni C, Valdes AM, Polidori L, et al. Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID Study. Lancet 2022;399(10335):1618-24. DOI: https://doi.org/10.1016/S0140-6736(22)00327-0
Esper FP, Adhikari TM, Tu ZJ, et al. Alpha to Omicron: Disease Severity and Clinical Outcomes of Major SARS-CoV-2 Variants. J Infect Dis 2023;227(3):344-52. DOI: https://doi.org/10.1093/infdis/jiac411
Deville JG, Song E, Ouellette CP. COVID-19: Clinical manifestations and diagnosis in children. In: Edwards MS, editor. UpToDate [updated Aug 2023; cited 20 Sep 2023]. Available from: https://www.uptodate.com/contents/covid-19-clinical-manifestations-and-diagnosis-in-children
Maldonado-Cabrera A, Colin-Vilchis JA, Haque U, et al. SARS-CoV-2 Variants of Concern and Clinical Severity in the Mexican Pediatric Population. Infect Dis Rep 2023 11;15(5):535–48. DOI: https://doi.org/10.3390/idr15050053
Goldenberg NA, Sochet A, Albisetti M, et al. Consensus-based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID-19–related illness. J Thromb Haemost 2020;18(11):3099-105 DOI: https://doi.org/10.1111/jth.15073
Deville JG, Song E, Ouellette CP. COVID-19: Management in children. In: Edwards MS, editor. UpToDate [updated Aug 2023; cited 20 Sep 2023]. Available from: https://www.uptodate.com/contents/covid-19-management-in-children.
Center for Disease Control and Prevention. SARS-CoV-2 Variant Classifications and Definitions [Internet]. 2023 [cited 2023 Sep 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-classifications.html
Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-NCoV). Radiology 2020;295(1):202-7. DOI: https://doi.org/10.1148/radiol.2020200230
Palabiyik F, Kokurcan SO, Hatipoglu N, Cebeci SO, Inci E. Imaging of COVID-19 pneumonia in children. Br J Radiol 2020;93(1113):20200647. DOI: https://doi.org/10.1259/bjr.20200647
TC Sağlık Bakanlığı. COVID-19 Çocuk Hasta Yönetimi ve Tedavi Rehberi. [updated 2020; cited 20 Sep 2023]. Available from: https://covid19.saglik.gov.tr/covid-19rehbericocukhastayonetimivetedavi.pdf
Yeşil E. Covid-19 tanılı çocuk olguların değerlendirilmesi: Tek merkez deneyimi. Mersin Univ Saglık Bilim Derg 2023;16(2):270–9.
Choi JH, Choi SH, Yun KW. Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis. J Korean Med Sci 2022;37(5):1–14. DOI: https://doi.org/10.3346/jkms.2022.37.e35
Aydogan O, Saylan EG, Guven O, Ayaz A, Yigitbasi T. Prevalence of SARS-CoV-2 Variants in COVID-19 Positive Patients. Klimik Dergisi 2022;17:35(4):220–3. DOI: https://doi.org/10.36519/kd.2022.4264
Keleş YE, Pekçevik Y, Yılmaz D, et al. Thorax Computed Tomography Imaging and Chest X-Rays Results in Children with Different Clinical-Stages of COVID-19. Cocuk Enfeksiyon Derg 2023;17(2):1175-84. DOI: https://doi.org/10.5578/ced.20239820
Nava-Muñoz, Gómez-Peña S, Fuentes-Ferrer ME, Cabeza B, Victoria A, Bustos A. COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings. Radiologia 2021;63(6):484-494. DOI: https://doi.org/10.1016/j.rxeng.2021.06.003