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. 2025 May 14;15(5):784.
doi: 10.3390/life15050784.

Clinical and Paraclinical Peculiarities of SARS-CoV-2 and Influenza Infections in Children: A Comparative Study

Maria Oana Săsăran  1 , Carmen Viorica Muntean  2 , Andreea Bianca Stoica  2 , Carmen Schwesig  3   4 , Anca Meda Văsieșiu  5 , Anca Doina Pleșca  6 , Cristina Oana Mărginean  2
Affiliations

Clinical and Paraclinical Peculiarities of SARS-CoV-2 and Influenza Infections in Children: A Comparative Study

Maria Oana Săsăran et al. Life (Basel). .

Abstract

Background: SARS-CoV-2 and influenza can present with similar clinical pictures in children, with symptoms and paraclinical particularities which might aid in the differentiation of the two entities and which can be suggestive of various complications. The present study aims to identify clinical and paraclinical differences between pediatric SARS-CoV-2 and influenza infection and to assess the utility of hematological parameters for prediction of their related complications.

Methods: In this study, 266 children were retrospectively enrolled, divided into two groups: 129 children diagnosed with SARS-CoV-2 infection and 137 children infected with influenza. In each case, particular symptoms were recorded, as well as hospitalization duration, pediatric intensive care unit (PICU) admission or O2 supplementation requirement. Parameters of the hemoleucogram and biochemistry parameters were also collected for comparative assessment.

Results: SARS-CoV-2 infections were more commonly associated with digestive symptoms, whereas influenza infections implied longer hospital stays and higher likelihood of PICU admission necessity. Monocytes and lymphocyte/monocyte ratios (LMRs) were significantly higher in the SARS-CoV-2 group (p < 0.01, p = 0.02). Several hematological parameters, such as neutrophil/lymphocyte ratios, correlated with hospitalization duration in SARS-CoV-2 and influenza B infections (p < 0.01, p = 0.01), whereas LMR was predictive of respiratory distress (p = 0.02) in the same study groups.

Conclusions: According to the study, monocyte levels and LMR can aid in the distinction of pediatric SARS-CoV-2 and influenza infections and LMR and NLR can be used particularly as predictors of complicated course of these infections.

Keywords: SARS-CoV-2 infection; children; hematological parameters; influenza infection.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Spider graph for symptom distribution pattern between the two groups.
Figure 2
Figure 2
(A) Linear, ascending trend picturing a non-parametric Spearman correlation for the association between neutrophil levels and hospitalization duration in the influenza B study group. (B) Non-parametric Spearman correlation showcasing a linear, descending trend of monocyte levels in relation to hospitalization duration in the influenza A study group.
Figure 3
Figure 3
(A) Non-parametric Spearman correlation exhibiting a linear, ascending relationship between NLR and hospitalization duration in the SARS-CoV-2 group. (B) Non-parametric Spearman correlation shows a linear, descending trend between NLR and hospitalization duration in the influenza B group. (C) Non-parametric Spearman correlation for the linear, ascending association between CRP and hospitalization duration in the SARS-CoV-2 group. (D) Non-parametric Spearman correlation for the inverse, linear association between LDH and hospitalization duration in the influenza A group.
See this image and copyright information in PMC

References

    1. Siddiqui M., Gültekingil A., Bakırcı O., Uslu N., Baskın E. Comparison of Clinical Features and Laboratory Findings of Coronavirus Disease 2019 and Influenza A and B Infections in Children: A Single-Center Study. Clin. Exp. Pediatr. 2021;64:364–369. doi: 10.3345/cep.2021.00066. - DOI - PMC - PubMed
    1. Laris-González A., Avilés-Robles M., Domínguez-Barrera C., Parra-Ortega I., Sánchez-Huerta J.L., Ojeda-Diezbarroso K., Bonilla-Pellegrini S., Olivar-López V., Chávez-López A., Jiménez-Juárez R. Influenza vs. COVID-19: Comparison of Clinical Characteristics and Outcomes in Pediatric Patients in Mexico City. Front. Pediatr. 2021;9:676611. doi: 10.3389/fped.2021.676611. - DOI - PMC - PubMed
    1. Delahoy M.J., Ujamaa D., Taylor C.A., Cummings C., Anglin O., Holstein R., Milucky J., O’Halloran A., Patel K., Pham H., et al. Comparison of Influenza and COVID-19–Associated Hospitalizations among Children < 18 Years Old in the United States—FluSurv-NET (October–April 2017–2021) and COVID-NET (October 2020–September 2021) Clin. Infect. Dis. 2022:ciac388. doi: 10.1093/cid/ciac388. - DOI - PMC - PubMed
    1. Asseri A.A., Shati A.A., Al-Qahtani S.M., Alzaydani I.A., Al-Jarie A.A., Alaliani M.J., Ali A.S. Distinctive Clinical and Laboratory Features of COVID-19 and H1N1 Influenza Infections among Hospitalized Pediatric Patients. World J. Pediatr. 2021;17:272–279. doi: 10.1007/s12519-021-00432-1. - DOI - PMC - PubMed
    1. Bullock A., Dalton A.F., Stockwell M.S., McLaren S.H., Sano E., Nguyen H.Q., Rao S., Asturias E., Lutrick K., Ellingson K.D., et al. Ongoing Symptoms After Acute SARS-CoV-2 or Influenza Infection in a Case-Ascertained Household Transmission Study: 7 US Sites, 2021–2023. Clin. Infect. Dis. 2025:ciaf026. doi: 10.1093/cid/ciaf026. Online ahead of print . - DOI - PubMed

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