COVID-19 and severe ENT infections in pediatric patients. IS there a relationship?

Abstract

Background: Preliminary evidence suggests that children are just as likely to become infected with SARS-CoV-2 as adults but are less prone to developing severe clinical conditions. However, there are pediatric inflammatory conditions that have also been encountered. The aim of this report is to determine whether there is a relationship between COVID-19 and severe infections in the ear, nose, throat, and deep cervical area (ENT) in pediatric populations.

Materials and methods: A compilation was made of all the cases of ENT area infections in the pediatric population per month attended to at the Niño Jesús University Children's Hospital from January 2010 to June 2020. Endemic channels and dispersion analysis were designed to analyze the incidence presented in the year 2020, compared to what was expected based on historical data from 2010 to 2019. Then, an epidemiological interview was conducted of the close contacts of COVID-19 of the children who presented a severe ENT infection in 2020. Finally, a serological test of IgG antibodies was performed on all of them to find out if they had overcome the COVID- 19.

Results: 620 patients from 1022 were eligible for the study. We observed a significant outbreak in the incidence of complicated mastoiditis and deep cervical infections with complications in the year 2020 (13 patients) linked to the COVID-19 pandemic. From these patients, 54% had been confirmed or had high suspicion of close contact with COVID-19.15.4% of children were positive in serological tests for IgG antibodies.

Conclusion: There has been a significant increase in mastoiditis and deep cervical infections with complications in the first four months of 2020, which constitutes an outbreak. A considerable number (54%) of these complicated infections were related to close contact with COVID-19. Still, only 15.4% were positive in serological tests for IgG antibodies, so we cannot establish a direct categorical relationship. The limitations in primary care due to a shortage of human resources in dealing with the pandemic's initial onslaught and changes in help-seeking behavior could explain increased complicated infections.

Keywords: COVID-19; Children; Endemic channels; Pandemic; Public health; Severe ENT infections.

Fig. 1

Pediatric ENT Infections. Stratified by Presence of Complications. The image contrasts the cumulative incidence of pediatric ENT infections with/without complications of the 2020 year (black line) in the endemic channels where four areas were determined by the quartiles of the cases observed in the previous years from 2010 to 2019: success (green area), security (yellow area), alarm (red area), and outbreak. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Types of severe infections. Location of pediatric ENT severe infections stratified by the referred cases. The image contrasts the cumulative incidence of mastoiditis, deep cervical abscess, and sinusitis with complications from the 2020 year (black line) in the endemic channels where four areas were determined by the quartiles of the cases observed in the previous years from 2010 to 2019: success (green area), security (yellow area), alarm (red area), and outbreak. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)