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. 2021 Sep 1;40(9):e323-e332.
doi: 10.1097/INF.0000000000003227.

Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children

Fikile C Mabena  1   2 , Vicky L Baillie  1   3 , Martin J Hale  1   4 , Bukiwe N Thwala  1   3 , Nonhlanhla Mthembu  1   3 , Toyah Els  1   3 , Natali Serafin  1   3 , Jeanine du Plessis  1   3 , Peter Swart  4 , Sithembiso C Velaphi  2 , Karen L Petersen  2 , Jeannette Wadula  5 , Nelesh P Govender  6 , Charl Verwey  1   2 , David P Moore  1   2 , Fatima Y Moosa  2 , Firdose L Nakwa  2 , Basetsana V Maroane  2 , Grace Okudo  2 , Theodore M Mabaso  2 , Ziyaad Dangor  1   2 , Marta C Nunes  1   3 , Shabir A Madhi  1   7
Affiliations

Clinical Characteristics and Histopathology of Coronavirus Disease 2019-Related Deaths in African Children

Fikile C Mabena et al. Pediatr Infect Dis J. .

Abstract

Background: Globally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem.

Methods: Surveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution.

Results: SARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS.

Conclusions: COVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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