Typical and Atypical Clinical Presentation of COVID-19 Infection in Children in The Top of Pandemic in EL-Minia Governorate (Two Center Experience)

BACKGROUND: A novel coronavirus that is identified as the cause of pandemic situation inFebruary2020 and affects adults and children with variable presentation and outcome. OBJECTIVE: We studied the typical and atypical clinical and laboratory presentation of COVID-19 during the peak of the first wave in two main referral hospitals, upper Egypt EL-Minia governorate. METHODS: Among 88 children with suspected cases tested for COVID-19, only 22 proved to be positive. Studied patients were classified into three groups based on age. The first group was 2–5years, the second was 5–10years, and the third included those aged more than 10 years. All patients met diagnostic guidelines established by the Egyptian Ministry of Health. RESULTS: out of the positive 22 (25%) patients, 13(59.1%) of them were male, while 9 (40.9%) were females. All enrolled patients have a history of near contact exposure (100%). Thrombocytopenia was the highest presenting symptom in all enrolled patients18 (81.8%), while other hematological findings were anemia in 11 (50%), thrombotic symptoms in 2 (9.1%), pancytopenia in 2(9.1%) while bleeding was found in 1 patient (4.5%). Fever, present in 16 (72.7%), the most common constitutional symptom in COVID-19, was not reported in all enrolled patients, while sore throat was reported in only 2 patients (9.1%). The respiratory presentation was only dominant in positive chest C.T. finding, 17(72.3%), rather than clinical symptoms; GUT symptoms were the dominant presenting features as vomiting was found in 15 (68.2%), diarrhea in 10 (45.5%), abdominal pain in 11 (50%), jaundice in 9 (40.9%) and dehydration in 6 (27.3%). Neurological symptoms were convulsions in 4 (18.2%), while encephalopathy was 2 (9.1%). Nephritis was the only renal presentation in the enrolled patients, 3 (13.6%). Cardiac presentations were only cyanosis 8 (36.4%) and arrhythmias 6 (27.3%). CONCLUSION: COVID-19 has many clinical classic presentations in children; however other non-typical presentations like hematological, CNS, and renal presentations have been reported.