Serveur d'exploration sur la COVID en France

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Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review.

Identifieur interne : 001344 ( Main/Exploration ); précédent : 001343; suivant : 001345

Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review.

Auteurs : Sojung Yoon [Corée du Sud] ; Han Li [États-Unis] ; Keum Hwa Lee [Corée du Sud] ; Sung Hwi Hong [Corée du Sud, États-Unis] ; Dohoon Kim [Corée du Sud] ; Hyunjoon Im [Corée du Sud] ; Woongchan Rah [Corée du Sud] ; Eunseol Kim [Corée du Sud] ; Seungyeon Cha [Corée du Sud] ; Jinho Yang [Corée du Sud] ; Andreas Kronbichler [Autriche] ; Daniela Kresse [Autriche] ; Ai Koyanagi [Espagne] ; Louis Jacob [Espagne, France] ; Ramy Abou Ghayda [États-Unis] ; Jae Il Shin [Corée du Sud] ; Lee Smith [Royaume-Uni]

Source :

RBID : pubmed:32942705

Abstract

Background and objectives: Characterization of pediatric coronavirus disease 2019 (COVID-19) is necessary to control the pandemic, as asymptomatic or mildly infected children may act as carriers. To date, there are limited reports describing differences in clinical, laboratory, and radiological characteristics between asymptomatic and symptomatic infection, and between younger and older pediatric patients. The objective of this study is to compare characteristics among: (1) asymptomatic versus symptomatic and (2) less than 10 versus greater or equal to 10 years old pediatric COVID-19 patients. Materials and Methods: We searched for all terms related to pediatric COVID-19 in electronic databases (Embase, Medline, PubMed, and Web of Science) for articles from January 2020. This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: Eligible study designs included case reports and series, while we excluded comments/letters, reviews, and literature not written in English. Initially, 817 articles were identified. Forty-three articles encompassing 158 confirmed pediatric COVID-19 cases were included in the final analyses. Lymphocytosis and high CRP were associated with symptomatic infection. Abnormal chest CT more accurately detected asymptomatic COVID-19 in older patients than in younger ones, but clinical characteristics were similar between older and younger patients. Conclusions: Chest CT scan findings are untrustworthy in younger children with COVID-19 as compared with clinical findings, or significant differences in findings between asymptomatic to symptomatic children. Further studies evaluating pediatric COVID-19 could contribute to potential therapeutic interventions and preventive strategies to limit spreading.

DOI: 10.3390/medicina56090474
PubMed: 32942705


Affiliations:


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Le document en format XML

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<title xml:lang="en">Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review.</title>
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<name sortKey="Yoon, Sojung" sort="Yoon, Sojung" uniqKey="Yoon S" first="Sojung" last="Yoon">Sojung Yoon</name>
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<nlm:affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</nlm:affiliation>
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<name sortKey="Li, Han" sort="Li, Han" uniqKey="Li H" first="Han" last="Li">Han Li</name>
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<nlm:affiliation>College of Medicine, University of Florida, Gainesville, FL 32610, USA.</nlm:affiliation>
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<name sortKey="Yang, Jinho" sort="Yang, Jinho" uniqKey="Yang J" first="Jinho" last="Yang">Jinho Yang</name>
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<name sortKey="Kresse, Daniela" sort="Kresse, Daniela" uniqKey="Kresse D" first="Daniela" last="Kresse">Daniela Kresse</name>
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<name sortKey="Jacob, Louis" sort="Jacob, Louis" uniqKey="Jacob L" first="Louis" last="Jacob">Louis Jacob</name>
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<nlm:affiliation>Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles</wicri:regionArea>
<placeName>
<region type="region" nuts="2">Île-de-France</region>
<settlement type="city">Versailles</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Ghayda, Ramy Abou" sort="Ghayda, Ramy Abou" uniqKey="Ghayda R" first="Ramy Abou" last="Ghayda">Ramy Abou Ghayda</name>
<affiliation wicri:level="2">
<nlm:affiliation>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115</wicri:regionArea>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
<affiliation wicri:level="2">
<nlm:affiliation>Division of Urology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Urology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115</wicri:regionArea>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Shin, Jae Il" sort="Shin, Jae Il" uniqKey="Shin J" first="Jae Il" last="Shin">Jae Il Shin</name>
<affiliation wicri:level="1">
<nlm:affiliation>Department of Pediatrics, College of Medicine, Yonsei University, Seoul 03722, Korea.</nlm:affiliation>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>Department of Pediatrics, College of Medicine, Yonsei University, Seoul 03722</wicri:regionArea>
<placeName>
<settlement type="city">Séoul</settlement>
<region type="capital">Région capitale de Séoul</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Smith, Lee" sort="Smith, Lee" uniqKey="Smith L" first="Lee" last="Smith">Lee Smith</name>
<affiliation wicri:level="1">
<nlm:affiliation>The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge CB1 1PT, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge CB1 1PT</wicri:regionArea>
<wicri:noRegion>Cambridge CB1 1PT</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Medicina (Kaunas, Lithuania)</title>
<idno type="eISSN">1648-9144</idno>
<imprint>
<date when="2020" type="published">2020</date>
</imprint>
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<front>
<div type="abstract" xml:lang="en">
<i>Background and objectives:</i>
Characterization of pediatric coronavirus disease 2019 (COVID-19) is necessary to control the pandemic, as asymptomatic or mildly infected children may act as carriers. To date, there are limited reports describing differences in clinical, laboratory, and radiological characteristics between asymptomatic and symptomatic infection, and between younger and older pediatric patients. The objective of this study is to compare characteristics among: (1) asymptomatic versus symptomatic and (2) less than 10 versus greater or equal to 10 years old pediatric COVID-19 patients.
<i>Materials and Methods:</i>
We searched for all terms related to pediatric COVID-19 in electronic databases (Embase, Medline, PubMed, and Web of Science) for articles from January 2020. This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
<i>Results:</i>
Eligible study designs included case reports and series, while we excluded comments/letters, reviews, and literature not written in English. Initially, 817 articles were identified. Forty-three articles encompassing 158 confirmed pediatric COVID-19 cases were included in the final analyses. Lymphocytosis and high CRP were associated with symptomatic infection. Abnormal chest CT more accurately detected asymptomatic COVID-19 in older patients than in younger ones, but clinical characteristics were similar between older and younger patients.
<i>Conclusions:</i>
Chest CT scan findings are untrustworthy in younger children with COVID-19 as compared with clinical findings, or significant differences in findings between asymptomatic to symptomatic children. Further studies evaluating pediatric COVID-19 could contribute to potential therapeutic interventions and preventive strategies to limit spreading.</div>
</front>
</TEI>
<pubmed>
<MedlineCitation Status="In-Process" Owner="NLM">
<PMID Version="1">32942705</PMID>
<DateRevised>
<Year>2020</Year>
<Month>09</Month>
<Day>18</Day>
</DateRevised>
<Article PubModel="Electronic">
<Journal>
<ISSN IssnType="Electronic">1648-9144</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>56</Volume>
<Issue>9</Issue>
<PubDate>
<Year>2020</Year>
<Month>Sep</Month>
<Day>15</Day>
</PubDate>
</JournalIssue>
<Title>Medicina (Kaunas, Lithuania)</Title>
<ISOAbbreviation>Medicina (Kaunas)</ISOAbbreviation>
</Journal>
<ArticleTitle>Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review.</ArticleTitle>
<ELocationID EIdType="pii" ValidYN="Y">E474</ELocationID>
<ELocationID EIdType="doi" ValidYN="Y">10.3390/medicina56090474</ELocationID>
<Abstract>
<AbstractText>
<i>Background and objectives:</i>
Characterization of pediatric coronavirus disease 2019 (COVID-19) is necessary to control the pandemic, as asymptomatic or mildly infected children may act as carriers. To date, there are limited reports describing differences in clinical, laboratory, and radiological characteristics between asymptomatic and symptomatic infection, and between younger and older pediatric patients. The objective of this study is to compare characteristics among: (1) asymptomatic versus symptomatic and (2) less than 10 versus greater or equal to 10 years old pediatric COVID-19 patients.
<i>Materials and Methods:</i>
We searched for all terms related to pediatric COVID-19 in electronic databases (Embase, Medline, PubMed, and Web of Science) for articles from January 2020. This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
<i>Results:</i>
Eligible study designs included case reports and series, while we excluded comments/letters, reviews, and literature not written in English. Initially, 817 articles were identified. Forty-three articles encompassing 158 confirmed pediatric COVID-19 cases were included in the final analyses. Lymphocytosis and high CRP were associated with symptomatic infection. Abnormal chest CT more accurately detected asymptomatic COVID-19 in older patients than in younger ones, but clinical characteristics were similar between older and younger patients.
<i>Conclusions:</i>
Chest CT scan findings are untrustworthy in younger children with COVID-19 as compared with clinical findings, or significant differences in findings between asymptomatic to symptomatic children. Further studies evaluating pediatric COVID-19 could contribute to potential therapeutic interventions and preventive strategies to limit spreading.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y">
<Author ValidYN="Y">
<LastName>Yoon</LastName>
<ForeName>Sojung</ForeName>
<Initials>S</Initials>
<Identifier Source="ORCID">0000-0002-0594-6992</Identifier>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Li</LastName>
<ForeName>Han</ForeName>
<Initials>H</Initials>
<Identifier Source="ORCID">0000-0002-9800-9948</Identifier>
<AffiliationInfo>
<Affiliation>College of Medicine, University of Florida, Gainesville, FL 32610, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Lee</LastName>
<ForeName>Keum Hwa</ForeName>
<Initials>KH</Initials>
<Identifier Source="ORCID">0000-0002-1511-9587</Identifier>
<AffiliationInfo>
<Affiliation>Department of Pediatrics, College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Hong</LastName>
<ForeName>Sung Hwi</ForeName>
<Initials>SH</Initials>
<Identifier Source="ORCID">0000-0002-9781-4822</Identifier>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Kim</LastName>
<ForeName>Dohoon</ForeName>
<Initials>D</Initials>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Im</LastName>
<ForeName>Hyunjoon</ForeName>
<Initials>H</Initials>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Rah</LastName>
<ForeName>Woongchan</ForeName>
<Initials>W</Initials>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Kim</LastName>
<ForeName>Eunseol</ForeName>
<Initials>E</Initials>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Cha</LastName>
<ForeName>Seungyeon</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Yang</LastName>
<ForeName>Jinho</ForeName>
<Initials>J</Initials>
<AffiliationInfo>
<Affiliation>College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Kronbichler</LastName>
<ForeName>Andreas</ForeName>
<Initials>A</Initials>
<Identifier Source="ORCID">0000-0002-2945-2946</Identifier>
<AffiliationInfo>
<Affiliation>Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Kresse</LastName>
<ForeName>Daniela</ForeName>
<Initials>D</Initials>
<AffiliationInfo>
<Affiliation>Department of Internal Medicine, St. Johann County Hospital, 6380 St. Johann, Austria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Koyanagi</LastName>
<ForeName>Ai</ForeName>
<Initials>A</Initials>
<Identifier Source="ORCID">0000-0002-9565-5004</Identifier>
<AffiliationInfo>
<Affiliation>Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Jacob</LastName>
<ForeName>Louis</ForeName>
<Initials>L</Initials>
<Identifier Source="ORCID">0000-0003-1071-1239</Identifier>
<AffiliationInfo>
<Affiliation>Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Ghayda</LastName>
<ForeName>Ramy Abou</ForeName>
<Initials>RA</Initials>
<Identifier Source="ORCID">0000-0002-5170-3983</Identifier>
<AffiliationInfo>
<Affiliation>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Division of Urology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Shin</LastName>
<ForeName>Jae Il</ForeName>
<Initials>JI</Initials>
<Identifier Source="ORCID">0000-0003-2326-1820</Identifier>
<AffiliationInfo>
<Affiliation>Department of Pediatrics, College of Medicine, Yonsei University, Seoul 03722, Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Smith</LastName>
<ForeName>Lee</ForeName>
<Initials>L</Initials>
<Identifier Source="ORCID">0000-0002-5340-9833</Identifier>
<AffiliationInfo>
<Affiliation>The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge CB1 1PT, UK.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList>
<PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic">
<Year>2020</Year>
<Month>09</Month>
<Day>15</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo>
<Country>Switzerland</Country>
<MedlineTA>Medicina (Kaunas)</MedlineTA>
<NlmUniqueID>9425208</NlmUniqueID>
<ISSNLinking>1010-660X</ISSNLinking>
</MedlineJournalInfo>
<CitationSubset>IM</CitationSubset>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="N">SARS-CoV-2</Keyword>
<Keyword MajorTopicYN="N">asymptomatic</Keyword>
<Keyword MajorTopicYN="N">characteristics</Keyword>
<Keyword MajorTopicYN="N">child</Keyword>
<Keyword MajorTopicYN="N">coronavirus disease 2019 (COVID-19)</Keyword>
<Keyword MajorTopicYN="N">infant</Keyword>
<Keyword MajorTopicYN="N">novel coronavirus 2019</Keyword>
<Keyword MajorTopicYN="N">radiography</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData>
<History>
<PubMedPubDate PubStatus="received">
<Year>2020</Year>
<Month>08</Month>
<Day>08</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="revised">
<Year>2020</Year>
<Month>09</Month>
<Day>08</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted">
<Year>2020</Year>
<Month>09</Month>
<Day>12</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez">
<Year>2020</Year>
<Month>9</Month>
<Day>18</Day>
<Hour>1</Hour>
<Minute>2</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed">
<Year>2020</Year>
<Month>9</Month>
<Day>19</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline">
<Year>2020</Year>
<Month>9</Month>
<Day>19</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>epublish</PublicationStatus>
<ArticleIdList>
<ArticleId IdType="pubmed">32942705</ArticleId>
<ArticleId IdType="pii">medicina56090474</ArticleId>
<ArticleId IdType="doi">10.3390/medicina56090474</ArticleId>
</ArticleIdList>
</PubmedData>
</pubmed>
<affiliations>
<list>
<country>
<li>Autriche</li>
<li>Corée du Sud</li>
<li>Espagne</li>
<li>France</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region>
<li>Catalogne</li>
<li>Floride</li>
<li>Massachusetts</li>
<li>Région capitale de Séoul</li>
<li>Île-de-France</li>
</region>
<settlement>
<li>Séoul</li>
<li>Versailles</li>
</settlement>
</list>
<tree>
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<region name="Région capitale de Séoul">
<name sortKey="Yoon, Sojung" sort="Yoon, Sojung" uniqKey="Yoon S" first="Sojung" last="Yoon">Sojung Yoon</name>
</region>
<name sortKey="Cha, Seungyeon" sort="Cha, Seungyeon" uniqKey="Cha S" first="Seungyeon" last="Cha">Seungyeon Cha</name>
<name sortKey="Hong, Sung Hwi" sort="Hong, Sung Hwi" uniqKey="Hong S" first="Sung Hwi" last="Hong">Sung Hwi Hong</name>
<name sortKey="Im, Hyunjoon" sort="Im, Hyunjoon" uniqKey="Im H" first="Hyunjoon" last="Im">Hyunjoon Im</name>
<name sortKey="Kim, Dohoon" sort="Kim, Dohoon" uniqKey="Kim D" first="Dohoon" last="Kim">Dohoon Kim</name>
<name sortKey="Kim, Eunseol" sort="Kim, Eunseol" uniqKey="Kim E" first="Eunseol" last="Kim">Eunseol Kim</name>
<name sortKey="Lee, Keum Hwa" sort="Lee, Keum Hwa" uniqKey="Lee K" first="Keum Hwa" last="Lee">Keum Hwa Lee</name>
<name sortKey="Rah, Woongchan" sort="Rah, Woongchan" uniqKey="Rah W" first="Woongchan" last="Rah">Woongchan Rah</name>
<name sortKey="Shin, Jae Il" sort="Shin, Jae Il" uniqKey="Shin J" first="Jae Il" last="Shin">Jae Il Shin</name>
<name sortKey="Yang, Jinho" sort="Yang, Jinho" uniqKey="Yang J" first="Jinho" last="Yang">Jinho Yang</name>
</country>
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<region name="Floride">
<name sortKey="Li, Han" sort="Li, Han" uniqKey="Li H" first="Han" last="Li">Han Li</name>
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<name sortKey="Ghayda, Ramy Abou" sort="Ghayda, Ramy Abou" uniqKey="Ghayda R" first="Ramy Abou" last="Ghayda">Ramy Abou Ghayda</name>
<name sortKey="Ghayda, Ramy Abou" sort="Ghayda, Ramy Abou" uniqKey="Ghayda R" first="Ramy Abou" last="Ghayda">Ramy Abou Ghayda</name>
<name sortKey="Hong, Sung Hwi" sort="Hong, Sung Hwi" uniqKey="Hong S" first="Sung Hwi" last="Hong">Sung Hwi Hong</name>
</country>
<country name="Autriche">
<noRegion>
<name sortKey="Kronbichler, Andreas" sort="Kronbichler, Andreas" uniqKey="Kronbichler A" first="Andreas" last="Kronbichler">Andreas Kronbichler</name>
</noRegion>
<name sortKey="Kresse, Daniela" sort="Kresse, Daniela" uniqKey="Kresse D" first="Daniela" last="Kresse">Daniela Kresse</name>
</country>
<country name="Espagne">
<region name="Catalogne">
<name sortKey="Koyanagi, Ai" sort="Koyanagi, Ai" uniqKey="Koyanagi A" first="Ai" last="Koyanagi">Ai Koyanagi</name>
</region>
<name sortKey="Jacob, Louis" sort="Jacob, Louis" uniqKey="Jacob L" first="Louis" last="Jacob">Louis Jacob</name>
<name sortKey="Koyanagi, Ai" sort="Koyanagi, Ai" uniqKey="Koyanagi A" first="Ai" last="Koyanagi">Ai Koyanagi</name>
</country>
<country name="France">
<region name="Île-de-France">
<name sortKey="Jacob, Louis" sort="Jacob, Louis" uniqKey="Jacob L" first="Louis" last="Jacob">Louis Jacob</name>
</region>
</country>
<country name="Royaume-Uni">
<noRegion>
<name sortKey="Smith, Lee" sort="Smith, Lee" uniqKey="Smith L" first="Lee" last="Smith">Lee Smith</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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