Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),has spread around the world.However,approaches to distinguish COVID-19 from pneumonia caused by other pathogens have not yet been reported.We retrospectively analyzed the clinical data of 97 children with probable COVID-19.A total of 13(13.4%)patients were confirmed positive for SARS-CoV-2 infection by nucleic acid RT-PCR testing,and 41(42.3%)patients were found to be infected with other pathogens.Notably,no pathogen was detected in 43(44.3%)patients.Among all patients,25(25.8%)had familial cluster exposure history,and 52(53.6%)had one or more coexisting conditions.Fifteen(15.5%)patients were admitted or transferred to the PICU.In the 11 confirmed COVID-19 cases,5(45.5%)and 7(63.6%)were positive for IgM and IgG against SARS-CoV-2,respectively.In 22 patients with suspected COVID-19,1(4.5%)was positive for IgG but negative for IgM.The most frequently detected pathogen was Mycoplasma pneumonia(29,29.9%).One patient with confirmed COVID-19 died.Our results strongly indicated that the detection of asymptomatic COVID-19 or coexisting conditions must be strengthened in pediatric patients.These cases may be difficult to diagnose as COVID-19 unless etiologic analysis is conducted.A serologic test can be a useful adjunctive diagnostic tool in cases where SARS-CoV-2 infection is highly suspected but the nucleic acid test is negative.