AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Joseph M Bodi, Department of pediatrics, Kinshasa University Hospital, School of medicine, Kinshasa University.
Citation: Bodi JM, Makulo JRR, Monkoti MM, Aketi LP, Matula IK. (2021) A Congolese infant of 4 months and 8 days presenting a severe form of Covid-19. Biomedical Research and Clinical Reviews. 3(4); DOI: 10.31579/2692-9406/038
Copyright: © 2021 Joseph M Bodi, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 22 December 2020 | Accepted: 29 January 2021 | Published: 23 March 2021
Keywords: Covid 19; severe form; infant; sub-Saharan Africa; DR Congo
To date, only a few rare cases of severe forms of Covid-19 in children, especially infant, have been described in other parts of the world. So far no case reported in sub-Saharan Africa (SSA). We report the case in the Democratic Republic of Congo of an infant of 4 months and 8 days old, who presented after malaria disease, a picture of bronchopneumonia with severe respiratory failure (Pa O2 :49 mmHg). The RT-PCR made it possible to diagnose a Covid-19 of severe form. The infant had probably been infected by his mother and had no other co-morbidities that could induce a decrease in immunity. The CT scan injuries were comparable to those described in adults. Under oxygen, anticoagulation, hydroxychloroquine and Azythromycin, the outcome was good. Pediatricians in SSA countries should be careful and not miss cases of COVID19 in infant population with severe respiratory syndrome usually observed in most of lung infectious disease.
Several data around the world show that the effects of the new pandemic of COVID-19 are less of a concern in children, who seem to be asymptomatic or to develop mild illness [1-3]. The reasons justifying this relative protection of children are not fully understood. However, most studies suggest that in rare severe forms of Covid-19 in children, the same risk factors in adults are evoked to children, including comorbidities such as cardiac pathology, diabetes, chronic pulmonary disease, HIV and drug-induced immunosuppression [4]. In sub-Saharan Africa (SAA), children constitute a greater proportion of the population and may be more vulnerable for several other reasons as the prevailing malnutrition, HIV, tuberculosis which contribute to the occurrence of severe respiratory tract infection [5, 6]. In addition, the other risks are linked to the meager resources allocated to the health sector, the priority that families sometimes give to adult with health problems and low vaccines coverage which exposes SSA children to several diseases that can reduce their immunity [7-9].
To our knowledge, no severe form of Covid-19 in children has been described in Central Africa. Until now, rare cases of severe covid-19 in children living in SSA have been described, especially in South Africa [10, 11]. In general, these children had progressed well despite a sometimes serious clinical picture. This clinical case concerns an infant of 4 months and 8 days, who presented a severe form of Covid-19. Apart from malaria and anemia, no other co-morbidity was associated. The importance is to attract the attention of pediatricians so as not to overlook such cases despite their rarity. The CT images as well as the management strategy are also discussed. The requirement for informed consent was obtained from the patient's parents.
A 4-month and 8 days -old male infant admitted on 4th August 2020 with a severe distress respiratory. He was transferred from a private hospital. The story of the disease started by fever, dyspnea and cries 9 days before. He received tea and orange juice because parents suspected abdominal pain also because of cries. His condition was not improved after receiving these drugs from family members at home. He was admitted at a private hospital where he was treated with gentamicin, amoxicillin, vitamin C, Argyrol nose drops and received also blood transfusion because hematocrit was low (21%). The private hospital transferred the infant at University hospital because no improvement was observed. At admission, respiratory rate was high (60 cycles/minute) with tachycardia at 166/minute. The weight was 5Kg which was normal for the age and the birth weight was 2800grammes. The lung auscultation reported under crakes in the two lungs. Oto-Rhino-Laryngology exam was normal. After all the physical exam, the pediatric team suspected a severe Bronchopneumonia. Because of local COVID 19 score (table 1) with the value of 4/26 (fever: 2 and distress syndrome: 2), COVID 19 was suspected also. The diagnosis was confirmed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). So, the children has been admitted at the Covid treatment center. COVID 19 IgM and IgG antibodies were nor performed.
If the triage score is low, clinical suspicion of covid19 infection is retained
Conclusion:
Laboratory tests showed an elevated white blood cell (WBC: 22.800/mm3) count and neutrophil count (68%), low C-reactive protein (CRP: 4mg/L), and elevated total and direct bilirubin (respectively 3.09 and 2.44umpl/L). Alanine aminotransferase (ALAT), and aspartate amino transaminase (ASAT) were elevated (95.3 and 64.46 U/L In addition, Blood gaz showed low Pao2 (Table 2). The chest CT showed pure Ground Glass Opacities (GGOs), located under pleural at posterior segment VI of upper right lobe (Fig1 and fig3) and hilar bilateral patches along with Broncho vascular bundles (Fig2).The test for the mother was positive for COVID 19 without any manifestations
Diagnosis: We concluded to: SARS –Cov-2 in infant 4 months and 8 days, sepsis with pneumopathy origin and malaria with hemolytic anemia.
The infant was treated according to the national policy of COVID 19 treatment in Democratic Republic of Congo with Azithromycin (10mg/Kg once per day for 5 days), chloroquine (10mg/Kg once per day for 5 days) Lovenox (0.025cc, twice per day for 7 days), Vitamin C ( 5ml, twice per day for 7 days) and Zinc (2.5ml twice per days for 7 days. Malaria was treated with quinine (5 drops, three time per day for 7 days: 3X10mg /kg of Quinine per day for 7 days). He received intermittent oxygen using extractor 5 liter/minute for 3 days. The child was treated during 8 days at Kinshasa University Hospital CTC and was discharged on 17 August 2020
This rare case in the context of Covid-19 is very illustrative. The initial table evokes malaria, but thanks to the attention of pediatricians (based on the warning signs), the in-depth examinations have made it possible to diagnose Covid-19.
Basically, children have often milder disease than adults. In COVID-19 children, severity is classified as mild (asymptomatic or subclinical), normal, severe, and critical [12]. Mostly in children, cases are mild or normal severity and case fatality rate is very low. In children, the milder course of the disease results to their immature immune system, which does not overreact to the virus, but the reasons why disease tends to be less severe in children requires more researches for best evidence.
It is observed and reported that children usually have, atypical, mild and asymptomatic disease with only fever (50%) and cough (38%) which are the main presenting complaints [9]. Two other children admitted in our CTC had no symptoms. They were just tested positive after family screening because parents were COVID 19 positive. Our patient presented fever and severe distress syndrome using oxygen treatment for the management of the case. According to the severity of the diseases in children, studies [13] found that children may develop also severe disease and lead to worse outcome, especially when diagnosis is delayed because of atypical presentations at the beginning of the disease. Our patient, finally developed severe clinical features with severe distress. So far, many questions remain without response, especially the reason which can explain the severity of the disease in our infant. Association with malaria could explain the severity of the disease? The first pediatrics severe case was reported in Wuhan. He was 13-month-old boy without previous comorbidity and he developed shock, acute respiratory distress, and renal failure [14]. Fortunately, our child did not develop shock and renal failure. Risk factors for severe disease in children are not well understood because no more cases are reported. Laboratories figures can be different compared to adults [15].In our case, whole White Blood Cells and neutrophil were increased but CRP was decreased. ALAT and ASAT were elevated
It is necessary to thing to other infectious diseases of the lungs in case of atypical features at chest CT for differential diagnosis, including bronchopneumonia, mycoplasma pneumonia, and seasonal influenza. CT scan, basically in adults found that injuries could involve all lobes. Injuries in the upper lobes are more severe and there are 4 categories of CT findings described in adults:(a) Pure Ground-Glass Opacities (GGOs), (b) pure consolidation, (c) both GGOs and consolidation; and(d) small nodules and patches along with Broncho vascular bundles, similar to bronchopneumonia [10]. The chest CT scan of the infant found Pure Ground-Glass Opacities (GGOs) under pleural at posterior segment of upper lobe of right lung and patches along with Broncho vascular bundles at the 2 hiles. These images observed in our children can explain the severity of the disease.
Mostly in children, the CT features are different compared to adults [11].The GGOs are regularly present in adult. The distribution of injuries is located frequently in the peripheral and posterior areas of both lungs [12].
The infant was treated according to the national policy of COVID 19 treatment .This protocol was approved by the concertation between University and the technic secretariat of COVID19 riposte. Corticoids were not given to our patient because not included in our protocol in that moment. The evolution were very good with this protocol and the infant was discharged after 8 days of treatment.
In conclusion, severe cases of SARS-COV-2 exist in pediatrics population. Pediatricians should be aware to check children with severe distress. By this way, we can diagnose early and treat correctly children infected by Coronavirus.
Competing interest
The authors declare that they have no competing interests.
Authors’ contributions
BJM, MJRR, MIK, MMM, ALP, MFM and LVV conceived, designed, deployed and wrote directed the case report study MJK, NBM, OGO, MNM received the patient sat the Centre of Covid Treatment and treated the infant.
LMT and TFT performed the CT scan exam.
Acknowledgments
The authors thank NGO ALIMA for the support received about the treatment of patients with VOVID19. They thanks INRB for the logistics support.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
