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COVID-19 in children: Pathogenesis and current status
Insights
Children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) typically experience milder COVID-19 symptoms than adults. However, some children can develop multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition similar to Kawasaki disease (KD).
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Virology
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global pandemic.
- Children with COVID-19 generally exhibit milder symptoms compared to adults, with fewer cases of severe respiratory illness.
- A subset of children can develop severe respiratory disease or a hyperinflammatory response, termed multisystem inflammatory syndrome in children (MIS-C), which shares similarities with Kawasaki disease (KD).
Purpose of the Study:
- To review current evidence on the pathogenesis of COVID-19 in children.
- To investigate the relationship between COVID-19, Kawasaki disease (KD), and multisystem inflammatory syndrome in children (MIS-C).
- To enhance understanding of the clinical course, diagnosis, and management of these conditions in pediatric populations.
Main Methods:
- Review of existing scientific literature and evidence.
- Analysis of the distinct phases of COVID-19 pathogenesis.
- Comparative examination of clinical features in children with KD versus MIS-C.
Main Results:
- COVID-19 pathogenesis involves two overlapping phases: viral infection and host immune response.
- Children with KD show fewer COVID-19-associated KD features, less severe acute respiratory distress syndrome, and shock compared to children with MIS-C.
- Children's immature immune systems contribute to milder COVID-19 disease presentation.
Conclusions:
- While most children experience mild COVID-19, some develop SARS-CoV-2-associated MIS-C, presenting a hyperinflammatory state.
- MIS-C in children shares clinical similarities with Kawasaki disease.
- Understanding the distinct pathogenesis and clinical presentations is crucial for managing pediatric COVID-19 and related inflammatory syndromes.
Background:
Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C).
Objective:
The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions.
Results:
The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19-associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C.
Conclusion:
COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2-associated MIS-C similar to KD.
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