Sandbox: HAR

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Presentations


  • Presentation of COVID-19 is less severe in children as compared to adults.
  • According to CDC, as of April 2, 2020, 1.7% confirmed cases of COVID-19 were reported in children aged <18 years age among the total number of confirmed cases of COVID-19.
  • COVID-19 in children could range from asymptomatic presentation to mild to severe disease.
Symptoms
  • Fever and Cough are one of the most common symptoms reported in children. One study showed fever is prevalent in 47.5% of children and cough in 41.5% among the 1124 children with COVID-19. According to the CDC, fever, and cough was reported in 56% and 54% of children with COVID 19
  • Dyspnea, nasal congestion, pharyngeal erythema, and sore throat are also common presentations in children.
  • Gastrointestinal symptoms-The gastrointestinal manifestation in COVID-19 positive children are diarrhea, vomiting, abdominal pain, nausea, and anorexia.
    • Children can present with gastrointestinal symptoms in the absence of respiratory symptoms.
  • Cutaneous Findings
Severity of Disease in Children with COVID-19
  • Asymptomatic presentation-
    • A large number of children with COVID-19 are asymptomatic.
    • According to one study 14.2% of children were asymptomatic. Another study showed 18% of asymptomatic children with COVID-19.
  • Mild Disease
    • Few numbers of children also present with mild manifestations of COVID-19.
    • A study showed 36.3% of children present with a mild form of the disease.
  • Severe
    • 2.1% of children present with a severe form of COVID-19 disease.
    • Children with underlying comorbidities are more susceptible to getting severe COVID-19 disease.

Complication 1

Multisystem Inflammatory Syndrome in Children(MIS-C)
  • It is a condition that causes inflammation of some parts of the body like heart, blood vessels, kidneys, digestive system, brain, skin, or eyes.
  • According to recent evidence it is suggested that children with MISC had antibodies against COVID-19 suggesting children had COVID-19 infection in the past.
  • It causes following symptoms
    • Fever lasting 24 hours or longer.
    • Vomiting
    • Diarrhea
    • Pain in the stomach

Skin rash Red eyes Redness or swelling of the lips and tongue Feeling unusually tired Redness or swelling of the hands or feet

Complication 2

COVID-19 and HIV

Overview

  • An observational prospective study found out that the incidence of HIV-infected individuals to be affected by SARS-CoV-2 was similar to the general population.
  • Specific antiretroviral therapy did not affect COVID-19 severity.
  • Immunosuppression(low CD4 cell counts) was associated with COVID-19 severity.
  • Patients with HIV infection often have other comorbidities(lung disease, cardiovascular disease) therefore, increasing the risk for severe-COVID-19 disease.

Risk

  • At present people with HIV who are at greatest risk of Severe COVID-19 infection are people -
    • who have lowCD4 cell count.
    • not on antiretroviral therapy.

Presentation

  • There hasn't been any observable difference in clinical presentation among people with HIV infection as compared to the general population.
  • Common symptoms for COVID-19 are
    • Fever or chills
    • Cough
    • Shortness of Breath or difficulty breathing
    • Fatigue
    • Muscle or Body aches
    • Headache
    • New loss of taste or smell
    • Sore Throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea

Recommendations for Patients with HIV

  • Maintain the supply for antiretroviral therapy for a minimum of 30 days.
  • Virtual visit and telemedicine should be considered for non-urgent care and non-adherence counseling
  • People with suppressed HIV viral load and in stable health, should postpone their routine medical care and laboratory visits to the extent possible.
  • If they develop symptoms of COVID-19 like fever, cough, shortness of breath, etc they should seek medical advice.
  • They should make sure their vaccination status is uptodate.

Specific Populations with HIV

Pregnant Patients