Background: COVID-19, a disease caused by the new coronavirus SARS-CoV-2, spread worldwide, and Bergamo was one of the most affected areas in Europe. Following the first outbreak, more than half of the population of the Bergamo province had been infected. We aimed to describe the patients admitted to our unit shortly after the first outbreak. Methods: we retrospectively reviewed the notes of all pediatric patients diagnosed with COVID-19. We enrolled patients with positive swabs or serology and classified them based on the pattern and the timing of presentation after the first outbreak. This setting was considered a reliable reflection of the consequences of unmitigated SARS-CoV-2 circulation. Results: We diagnosed 35 patients over a 3-month period and we identified six patterns presenting in two temporal phases: Early phase, Group 1 (median of 20 days from epidemic start, IQR: 15–27): neonatal sepsis ( n .7), pneumonia ( n .5), flu-like symptoms ( n .2). Late phase, Group 2 (59:51–66 days, p < 0.001): MIS-C ( n .18), neurological manifestations ( n .3). Group 1 differed from Group 2 for younger age (1 vs. 8 years, p = 0.02), lower C-reactive protein (0.9 vs. 16.6 mg/dl, p = 0.008), procalcitonin (0.16 vs. 7.9 ng/ml, p = 0.008) and neutrophil count (3,765 vs. 6,780/μl, p = 0.006), higher rate of positive swabs (14/14 vs. 9/21, p < 0.001), higher lymphocyte count (3,000 vs. 930/μl, p = 0.006) and platelet count (323,000 vs. 210,000/μl, p = 0.009). Conclusions: Following an outbreak of unmitigated SARS-CoV-2 diffusion, infected children may present with clinical patterns suggesting two temporal clusters, the first characterized by markers of direct viral injury, the second suggesting an immune-mediated disease.
【저자키워드】 COVID-19, Immunity, children, SARS–CoV−2, clinical manifestation, 【초록키워드】 SARS-CoV-2, Europe, Pneumonia, serology, C-reactive protein, procalcitonin, Sepsis, MIS-C, Spread, Lymphocyte count, Epidemic, outbreak, Patient, Clusters, Platelet, age, circulation, group, disease, marker, Injury, Neonatal, Pediatric patient, neutrophil count, new coronavirus SARS-CoV-2, positive swab, diffusion, infected children, neurological manifestation, immune-mediated disease, consequence, Bergamo, enrolled, affected, caused, the patient, diagnosed, median, characterized, presenting, diagnosed with COVID-19, flu-like symptom, the timing, 【제목키워드】 SARS-CoV-2, pattern, experience, Epicentre, presentation, Italian,