DISCUSSION
Children of all ages, regardless of gender, can be infected with
COVID-19 infection, although more cases have been reported in younger
children and infants (9). Furthermore, the mean age of infection in
children up to age of 15 was determined as 6.7 (9). In their study, Lara
S et al found the rate of boys as 52% and the median age as 13
(4.2-16.6) years (10). Again, in a recent study, boys 13 (65%), Girl 7
(35%), Age <1 month 3 (15%), 1 month-1 year 6 (30%), 1-3y 5
(25%) (11). In this study, the rate of boys in PCR (-) covid-19 cases
was found as 44.9%, while the rate of boys in PCR (+) cases was
determined as 50.8%. addition, the age distribution was 13% 0-1 years,
15.2% 2-3 years, 134-6 years, 20%, 3-10 years and 38.4% 11-18 years.
In the light of the data discussed above, it is possible to say that
there is no difference in terms of age or gender in COVID-19 cases (9).
Currently, it is difficult to define the clinical characteristics of
children with COVID-19 infection since there are small number of
scientific clinical studies conducted on children (12). In a study
conducted in China, the rate of asymptomatic COVID-19 infection in
children was reported as 13% (13). In a previous study conducted in
different countries, while the most common clinical symptoms in children
with covid-19 were determined as Cough (%21-85.1), Fever (%26-59.2),
Shortness of breath (%2.67-59.2), Diarrhea 1 (%3.7-7.6), jess
frequently sore throat, sneezing, fatigue and vomiting have been
reported (3,4,11,14,16). Also it has been reported that children may
have more upper respiratory symptoms than lower respiratory symptoms and
recover within 1-2 weeks (9,17). In this study, the most common clinical
symptoms in children were determined as fever (64.7%), cough (53.2%),
respiratory distress (12.2%), myalgia (24.5%) and diarrhea (12.9%).
In addition, diarrhea and cough symptoms were more common in younger age
group children, while myalgia was significantly more common in older age
group children. It can be concluded that the use of these clinical
findings in the diagnosis of COVID-19 is limited since clinical symptoms
are nonspecific in children, they are observed at low rates and may be
confused with many upper respiratory tract infections. COVID-19
infection can affect many laboratory parameters in children (3). In a
study conducted in Italy, 36.8% and 15.7% leukopenia and lymphopenia
were detected among the patients, respectively, while AST and ALT
increases were reported as 18.3% and 11.8%, respectively (3). Henry et
al., In their study conducted on 66 children, determined normal
leukocyte counts (69.2%), neutropenia (6.0%), neutrophilia (4.6%),
lymphopenia (3.0%), high C-reactive protein (13.6%) and high
procalcitonin (10.6%). 20 children were evaluated in a study published
in China, it was determined that leukopenia (20%), lococytosis (10%),
lymphopenia (35%), lymphocytosis (15%), high ALT (25%), high creatine
kinase-MB as (75%) (11). In this study, it was determined that high CRP
(35.3%), ALT (5.8%), high AST (11.5%), high WBC as (23.7%) and low
WBC as (14.4%), while high level of ALT, AST, WBC, Lymphocyte were
determined as statistically significantly higher in younger age group
children and high neutrophilia in older age group. In the light of given
data, it is possible to say that laboratory parameters are important
parameters in the diagnosis and follow-up of COVID-19. Some recent
studies have reported that CT imaging, especially in adults, may have a
high sensitivity and prognostic value (5). However, since the severity
and frequency of COVID-19 pneumonia is observed lower in pediatric
patients in comparison with adults, the imaging findings, mode of
involvement and the role of CT imaging may differ from adult patients
(6,7). In a study conducted in Italy, it was reported that 41.5% of
children with chest X-ray had ground glass opacity and 9.8% had focal
consolidation (3). In another study, it was reported that there was
29.33% no abnormality in CT imaging, 29.3% local patch shading, 34.6%
bilateral patched shading, and 6.67% ground glass opacity (3). In
another study, it was reported that there was 20% normal, 30%
unilateral and 50% bilateral involvement on chest CT (11), in another,
CT findings that reminded the infection were found in 25.9% of
pediatric patients (19), in this last study, the presence of lung Rx
findings (48.2%) and CT findings (24.5%) were detected in the
patients. It is understood that lung CT imaging is a very limited test
in diagnosis and follow-up, since COVID-19 infection in pediatric cases
is generally less common and milder in comparison with adults. The
standard test for the diagnosis of COVID-19 is considered as the RT-PCR
test, especially in patients without obvious clinical findings (5).
While PCR test positivity makes the diagnosis of COVID-19 with full
accuracy, PCR test negativity may be seriously insufficient to determine
the diagnosis of COVID-19. The major reason for this is the high false
negativity of the PCR test due to many factors, especially in children
and adult COVID-19 patients without obvious clinical findings (5).
Specifically, in the largest study from China, most cases were diagnosed
as an outpatient and only 34.1% of cases were confirmed by the
laboratory (20). At the time of diagnosis, 13-15% of virologically
positive children may be asymptomatic (13,15). While in this study, the
PCR positivity rate was determined as 43.9%, the frequency of fever,
high CRP, leukocytosis, high neutrophil and CT findings were detected
statistically significantly higher in PCR (-) cases compared to PCR (+)
cases, frequency of respiratory distress, high lymphocyte and CT
findings were significantly lower. Within the scope of given data, it is
understood that when the PCR test is used for diagnostic purposes in
children, it is a test with low sensitivity and it may cause
false-negative, especially in cases with fever, high CRP, leukocytosis,
high neutrophil and respiratory distress in CT findings.
As a result, COVID-19 infection may indicate different nonspecific
clinical, laboratory and radiological findings in children not only
compared to adults but also among pediatric age groups. In addition, PCR
test results are being affected by conditions like fever, respiratory
distress, high CRP, leukocytosis, high neutrophil and CT finding. We
believe that further comprehensive studies are needed on this subject.