Clinical features of pediatric patients with COVID-19: a report of two family cluster cases
Identifieur interne : 000089 ( Pmc/Corpus ); précédent : 000088; suivant : 000090Clinical features of pediatric patients with COVID-19: a report of two family cluster cases
Auteurs : Li-Na Ji ; Shuang Chao ; Yue-Jiao Wang ; Xue-Jun Li ; Xiang-Dong Mu ; Ming-Gui Lin ; Rong-Meng JiangSource :
- World Journal of Pediatrics [ 1708-8569 ] ; 2020.
Abstract
Coronovirus disease 2019 (COVID-19) has spread rapidly across the globe. People of all ages are susceptible to COVID-19. However, literature reports on pediatric patients are limited.
To improve the recognition of COVID-19 infection in children, we retrospectively reviewed two confirmed pediatric cases from two family clusters. Both clinical features and laboratory examination results of the children and their family members were described.
The two confirmed children only presented with mild respiratory or gastrointestinal symptoms. Both of them had normal chest CT images. After general and symptomatic treatments, both children recovered quickly. Both families had travel histories to Hubei Province.
Pediatric patients with COVID-19 are mostly owing to family cluster or with a close contact history. Infected children have relatively milder clinical symptoms than infected adults. We should attach importance to early recognition, early diagnosis, and early treatment of infected children.
Url:
DOI: 10.1007/s12519-020-00356-2
PubMed: NONE
PubMed Central: 7091281
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical features of pediatric patients with COVID-19: a report of two family cluster cases</title><author><name sortKey="Ji, Li Na" sort="Ji, Li Na" uniqKey="Ji L" first="Li-Na" last="Ji">Li-Na Ji</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Chao, Shuang" sort="Chao, Shuang" uniqKey="Chao S" first="Shuang" last="Chao">Shuang Chao</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Yue Jiao" sort="Wang, Yue Jiao" uniqKey="Wang Y" first="Yue-Jiao" last="Wang">Yue-Jiao Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Li, Xue Jun" sort="Li, Xue Jun" uniqKey="Li X" first="Xue-Jun" last="Li">Xue-Jun Li</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Mu, Xiang Dong" sort="Mu, Xiang Dong" uniqKey="Mu X" first="Xiang-Dong" last="Mu">Xiang-Dong Mu</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Respiratory Medicine,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Lin, Ming Gui" sort="Lin, Ming Gui" uniqKey="Lin M" first="Ming-Gui" last="Lin">Ming-Gui Lin</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Infectious Disease,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Jiang, Rong Meng" sort="Jiang, Rong Meng" uniqKey="Jiang R" first="Rong-Meng" last="Jiang">Rong-Meng Jiang</name><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.24696.3f</institution-id><institution-id institution-id-type="ISNI">0000 0004 0369 153X</institution-id><institution>Department of Infectious Disease,</institution><institution>Beijing Ditan Hospital Affiliated To Capital Medical University,</institution></institution-wrap>Jingshun East Street No.8, Chaoyang District, Beijing, 100011 China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7091281</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7091281</idno><idno type="RBID">PMC:7091281</idno><idno type="doi">10.1007/s12519-020-00356-2</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000089</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000089</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical features of pediatric patients with COVID-19: a report of two family cluster cases</title><author><name sortKey="Ji, Li Na" sort="Ji, Li Na" uniqKey="Ji L" first="Li-Na" last="Ji">Li-Na Ji</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Chao, Shuang" sort="Chao, Shuang" uniqKey="Chao S" first="Shuang" last="Chao">Shuang Chao</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Wang, Yue Jiao" sort="Wang, Yue Jiao" uniqKey="Wang Y" first="Yue-Jiao" last="Wang">Yue-Jiao Wang</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Li, Xue Jun" sort="Li, Xue Jun" uniqKey="Li X" first="Xue-Jun" last="Li">Xue-Jun Li</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Mu, Xiang Dong" sort="Mu, Xiang Dong" uniqKey="Mu X" first="Xiang-Dong" last="Mu">Xiang-Dong Mu</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Respiratory Medicine,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Lin, Ming Gui" sort="Lin, Ming Gui" uniqKey="Lin M" first="Ming-Gui" last="Lin">Ming-Gui Lin</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Infectious Disease,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</nlm:aff></affiliation></author><author><name sortKey="Jiang, Rong Meng" sort="Jiang, Rong Meng" uniqKey="Jiang R" first="Rong-Meng" last="Jiang">Rong-Meng Jiang</name><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.24696.3f</institution-id><institution-id institution-id-type="ISNI">0000 0004 0369 153X</institution-id><institution>Department of Infectious Disease,</institution><institution>Beijing Ditan Hospital Affiliated To Capital Medical University,</institution></institution-wrap>Jingshun East Street No.8, Chaoyang District, Beijing, 100011 China</nlm:aff></affiliation></author></analytic><series><title level="j">World Journal of Pediatrics</title><idno type="ISSN">1708-8569</idno><idno type="eISSN">1867-0687</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">Coronovirus disease 2019 (COVID-19) has spread rapidly across the globe. People of all ages are susceptible to COVID-19. However, literature reports on pediatric patients are limited.</p></sec><sec><title>Methods</title><p id="Par2">To improve the recognition of COVID-19 infection in children, we retrospectively reviewed two confirmed pediatric cases from two family clusters. Both clinical features and laboratory examination results of the children and their family members were described.</p></sec><sec><title>Results</title><p id="Par3">The two confirmed children only presented with mild respiratory or gastrointestinal symptoms. Both of them had normal chest CT images. After general and symptomatic treatments, both children recovered quickly. Both families had travel histories to Hubei Province.</p></sec><sec><title>Conclusions</title><p id="Par4">Pediatric patients with COVID-19 are mostly owing to family cluster or with a close contact history. Infected children have relatively milder clinical symptoms than infected adults. We should attach importance to early recognition, early diagnosis, and early treatment of infected children.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Ns" uniqKey="Chen N">NS Chen</name></author><author><name sortKey="Zhou, M" uniqKey="Zhou M">M Zhou</name></author><author><name sortKey="Dong, X" uniqKey="Dong X">X Dong</name></author><author><name sortKey="Qu, Jm" uniqKey="Qu J">JM Qu</name></author><author><name sortKey="Gong, Fy" uniqKey="Gong F">FY Gong</name></author><author><name sortKey="Han, Y" uniqKey="Han Y">Y Han</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhu, N" uniqKey="Zhu N">N Zhu</name></author><author><name sortKey="Zhang, D" uniqKey="Zhang D">D Zhang</name></author><author><name sortKey="Wang, W" uniqKey="Wang W">W Wang</name></author><author><name sortKey="Li, X" uniqKey="Li X">X Li</name></author><author><name sortKey="Yang, B" uniqKey="Yang B">B Yang</name></author><author><name sortKey="Song, J" uniqKey="Song J">J Song</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, Cl" uniqKey="Huang C">CL Huang</name></author><author><name sortKey="Wang, Ym" uniqKey="Wang Y">YM Wang</name></author><author><name sortKey="Li, Xw" uniqKey="Li X">XW Li</name></author><author><name sortKey="Ren, Ll" uniqKey="Ren L">LL Ren</name></author><author><name sortKey="Zhao, Jp" uniqKey="Zhao J">JP Zhao</name></author><author><name sortKey="Hu, Y" uniqKey="Hu Y">Y Hu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chung, M" uniqKey="Chung M">M Chung</name></author><author><name sortKey="Bernheim, A" uniqKey="Bernheim A">A Bernheim</name></author><author><name sortKey="Mei, Xy" uniqKey="Mei X">XY Mei</name></author><author><name sortKey="Zhang, N" uniqKey="Zhang N">N Zhang</name></author><author><name sortKey="Huang, Mq" uniqKey="Huang M">MQ Huang</name></author><author><name sortKey="Zeng, Xj" uniqKey="Zeng X">XJ Zeng</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Jf" uniqKey="Chan J">JF Chan</name></author><author><name sortKey="Yuan, S" uniqKey="Yuan S">S Yuan</name></author><author><name sortKey="Kok, Kh" uniqKey="Kok K">KH Kok</name></author><author><name sortKey="Wang, Kk" uniqKey="Wang K">KK Wang</name></author><author><name sortKey="Chu, H" uniqKey="Chu H">H Chu</name></author><author><name sortKey="Yang, J" uniqKey="Yang J">J Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, F" uniqKey="Chen F">F Chen</name></author><author><name sortKey="Liu, Zs" uniqKey="Liu Z">ZS Liu</name></author><author><name sortKey="Zhang, Fr" uniqKey="Zhang F">FR Zhang</name></author><author><name sortKey="Xiong, Rh" uniqKey="Xiong R">RH Xiong</name></author><author><name sortKey="Chen, Y" uniqKey="Chen Y">Y Chen</name></author><author><name sortKey="Cheng, Xf" uniqKey="Cheng X">XF Cheng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Zm" uniqKey="Chen Z">ZM Chen</name></author><author><name sortKey="Fu, Jf" uniqKey="Fu J">JF Fu</name></author><author><name sortKey="Shu, Q" uniqKey="Shu Q">Q Shu</name></author><author><name sortKey="Chen, Yh" uniqKey="Chen Y">YH Chen</name></author><author><name sortKey="Hua, Cz" uniqKey="Hua C">CZ Hua</name></author><author><name sortKey="Li, Fb" uniqKey="Li F">FB Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shen, Kl" uniqKey="Shen K">KL Shen</name></author><author><name sortKey="Yang, Yh" uniqKey="Yang Y">YH Yang</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Pediatr</journal-id><journal-id journal-id-type="iso-abbrev">World J Pediatr</journal-id><journal-title-group><journal-title>World Journal of Pediatrics</journal-title></journal-title-group><issn pub-type="ppub">1708-8569</issn><issn pub-type="epub">1867-0687</issn><publisher><publisher-name>Springer Singapore</publisher-name><publisher-loc>Singapore</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7091281</article-id><article-id pub-id-type="publisher-id">356</article-id><article-id pub-id-type="doi">10.1007/s12519-020-00356-2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Brief Report</subject></subj-group></article-categories><title-group><article-title>Clinical features of pediatric patients with COVID-19: a report of two family cluster cases</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Ji</surname><given-names>Li-Na</given-names></name><address><email>jlna01103@btch.edu.cn</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Chao</surname><given-names>Shuang</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Yue-Jiao</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Xue-Jun</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Mu</surname><given-names>Xiang-Dong</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lin</surname><given-names>Ming-Gui</given-names></name><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Jiang</surname><given-names>Rong-Meng</given-names></name><xref ref-type="aff" rid="Aff4">4</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Pediatrics,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Respiratory Medicine,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.12527.33</institution-id><institution-id institution-id-type="ISNI">0000 0001 0662 3178</institution-id><institution>Department of Infectious Disease,</institution><institution>Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University,</institution></institution-wrap>Litang Road No.168, Changping District, Beijing, 102218 China</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="GRID">grid.24696.3f</institution-id><institution-id institution-id-type="ISNI">0000 0004 0369 153X</institution-id><institution>Department of Infectious Disease,</institution><institution>Beijing Ditan Hospital Affiliated To Capital Medical University,</institution></institution-wrap>Jingshun East Street No.8, Chaoyang District, Beijing, 100011 China</aff></contrib-group><pub-date pub-type="epub"><day>16</day><month>3</month><year>2020</year></pub-date><fpage>1</fpage><lpage>4</lpage><history><date date-type="received"><day>24</day><month>2</month><year>2020</year></date><date date-type="accepted"><day>5</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© Children's Hospital, Zhejiang University School of Medicine 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p id="Par1">Coronovirus disease 2019 (COVID-19) has spread rapidly across the globe. People of all ages are susceptible to COVID-19. However, literature reports on pediatric patients are limited.</p></sec><sec><title>Methods</title><p id="Par2">To improve the recognition of COVID-19 infection in children, we retrospectively reviewed two confirmed pediatric cases from two family clusters. Both clinical features and laboratory examination results of the children and their family members were described.</p></sec><sec><title>Results</title><p id="Par3">The two confirmed children only presented with mild respiratory or gastrointestinal symptoms. Both of them had normal chest CT images. After general and symptomatic treatments, both children recovered quickly. Both families had travel histories to Hubei Province.</p></sec><sec><title>Conclusions</title><p id="Par4">Pediatric patients with COVID-19 are mostly owing to family cluster or with a close contact history. Infected children have relatively milder clinical symptoms than infected adults. We should attach importance to early recognition, early diagnosis, and early treatment of infected children.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Children</kwd><kwd>Coronavirus</kwd><kwd>COVID-19</kwd><kwd>Wuhan</kwd></kwd-group></article-meta></front><body><sec id="Sec1"><title>Introduction</title><p id="Par5">Since the outbreak of the coronovirus disease 2019 (COVID-19) in Wuhan City, China, a total of 82,488 confirmed cases have been reported globally as of February 27, 2020 [<xref ref-type="bibr" rid="CR1">1</xref>]. Of these cases, 78,824 were from China and 3664 were from 46 other countries [<xref ref-type="bibr" rid="CR1">1</xref>]. Among the confirmed cases, 2788 died in China and 57 died in other countries [<xref ref-type="bibr" rid="CR1">1</xref>]. The novel coronavirus has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), whereas the disease associated with it is referred to as COVID-19 [<xref ref-type="bibr" rid="CR2">2</xref>].</p><p id="Par6">A series of recent published articles have reported the epidemiological and clinical characteristics of the hospitalized patients in Wuhan with COVID-19 [<xref ref-type="bibr" rid="CR3">3</xref>–<xref ref-type="bibr" rid="CR5">5</xref>]. Most patients reported in the literature were adults, and adult patients commonly presented as pneumonia with abnormal findings on chest CT [<xref ref-type="bibr" rid="CR3">3</xref>–<xref ref-type="bibr" rid="CR6">6</xref>]. Elderly men with comorbidities were more likely to exacerbate with severe and even fatal respiratory diseases such as acute respiratory distress syndrome (ARDS) [<xref ref-type="bibr" rid="CR3">3</xref>–<xref ref-type="bibr" rid="CR5">5</xref>]. The Chinese Center for Disease Control and Prevention reported 72,314 COVID-19 patients as of February 11, 2020. Among the 44,672 confirmed cases, 416 cases were aged 0–10 years [<xref ref-type="bibr" rid="CR7">7</xref>]. However, literature reports on pediatric patients are limited [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR9">9</xref>]. Herein, we report two children with confirmed COVID-19 from two family clusters. This paper will help pediatricians early recognize pedaitric cases with COVID-19.</p></sec><sec id="Sec2"><title>Methods</title><p id="Par7">We retrospectively reviewed two pediatric patients confirmed with COVID-19. Epidemiological features, physical examinations, laboratory studies and clinical outcome were described. We also collected data of their family members including clinical manifestations and laboratory examinations. Oropharyngeal swab tests were collected for detecting SARS-CoV-2, and chest CT examinations were done for the two pediatric patients and their family members.</p></sec><sec id="Sec3"><title>Results</title><sec id="Sec4"><title>Case 1</title><p id="Par8">A 15-year-old boy presented with a 1-day history of fever and was admitted to our hospital on January 25, 2020. He was previously healthy. History inquiry revealed that he had a travel history to Wuhan City (the epicenter of COVID-19 outbreak) with his parents one week ago. In Wuhan City, the boy’s entire family had dinner with several friends, and one of these friends was confirmed with COVID-19 three days later.</p><p id="Par9">Upon admission, his body temperature was 37.9 °C (100.2°F), and he only had pharyngeal congestion. Breath sounds of both lungs were normal at auscultation. Laboratory studies showed elevated white blood cell count (11.82 × 10<sup>9</sup>/L; normal range, 4–10 × 10<sup>9</sup>/L), with 67.3% neutrophils and 25.7% lymphocytes, and elevated C-reactive protein level (34.64 mg/L; normal range, 0–10 mg/L). The oropharyngeal swab tested positive for SARS-CoV-2. No other pathogens were found. Unenhanced chest CT results were normal (Fig. <xref rid="Fig1" ref-type="fig">1</xref>a).<fig id="Fig1"><label>Fig. 1</label><caption><p><bold>a</bold> Unenhanced CT images of Case 1 showing normal results; <bold>b</bold> Unenhanced CT images of Case 1’s father showing bilateral pneumonia with ground-glass opacities especially in the left lung</p></caption><graphic xlink:href="12519_2020_356_Fig1_HTML" id="MO1"></graphic></fig></p><p id="Par10">His family members displayed similar symptoms. His father had a low fever of 37.8 °C for one day, with no cough or other discomforts. His mother had a mild cough for one week without fever. His father's chest CT showed bilateral pneumonia with ground-glass opacities especially in the left lung (Fig. <xref rid="Fig1" ref-type="fig">1</xref>b), and his mother's chest CT was normal. They both tested positive for SARS-CoV-2.</p><p id="Par11">Symptomatic treatment was given to the patient, and symptoms disappeared after treatment for two days.</p></sec><sec id="Sec5"><title>Case 2</title><p id="Par12">A 9-year-old boy was admitted to the hospital because of a history of mild diarrhea for two days on February 3, 2020. He was previously healthy. He did not experience fever or cough. History inquiry showed that he had traveled with his family to Xiaogan City, China (the subcenter of COVID-19 outbreak neighboring Wuhan City in Hubei Province) 10 days ago. Both the physical and laboratory examinations of the boy were unremarkable. White blood cell count was normal of 6.6 × 10<sup>9</sup>/L, with 34.1% neutrophils and 52% lymphocytes. C-reactive protein was also normal (3.49 mg/L; normal range, 0–10 mg/L). Unenhanced chest CT results were normal (Fig. <xref rid="Fig2" ref-type="fig">2</xref>a). The oropharyngeal swab tested positive for SARS-CoV-2.<fig id="Fig2"><label>Fig. 2</label><caption><p><bold>a</bold> Unenhanced CT images of Case 2 showing normal results; <bold>b</bold> Unenhanced CT images of Case 2’s mother of C showing multiple peripheral ground-glass opacities in bilateral lungs</p></caption><graphic xlink:href="12519_2020_356_Fig2_HTML" id="MO2"></graphic></fig></p><p id="Par13">His mother presented with fever and cough two days earlier than the boy. Although her oropharyngeal swab tests for SARS-CoV-2 were negative during two consecutive times, she was still suspected with COVID-19 because she had a travel history and multiple peripheral ground-glass opacities in both lungs on chest CT (Fig. <xref rid="Fig2" ref-type="fig">2</xref>b). The boy’s father had a mild cough for four days, and his two-year-old sister had a transient low fever for two days. Chest CT results of the father and sister were normal, and oropharyngeal swab tests were negative for SARS-CoV-2.</p><p id="Par14">Oral probiotic was given to the boy, and his symptoms disappeared after two days of treatment.</p></sec></sec><sec id="Sec6"><title>Discussion</title><p id="Par15">The two pediatric patients in this series were family cluster cases. Both families had a travel history to Hubei Province, the epicenter of this outbreak. The two patients had different clinical presentations; however, both tested positive for SARS-CoV-2. Case 1 presented as an upper respiratory tract infection, and Case 2 presented with mild diarrhea only. Compared with their parents and to previous reported adults with COVID-19, the two cases in our study showed relatively mild clinical manifestations and recovered soon. Their chest CTs were normal. The clinical features in these two patients are different from previous reports in pediatric cases. A report of a family cluster demonstrated an asymptomatic child (aged 10 years) had radiological ground-glass lung opacities and positive SARS-CoV-2 test [<xref ref-type="bibr" rid="CR8">8</xref>]. And another report demonstrated an infected case with very severe pneumonia [<xref ref-type="bibr" rid="CR9">9</xref>]. These reports showed that children infected with SARS-CoV-2 may have variable symptoms, which may be partly related to the previous health status and interval from onset to consultation and comorbidities. Experts recently have formulated a recommendation for the diagnosis and treatment of COVID-19 in children, which is of paramount important for clinical practice [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR11">11</xref>]. Owing to the limited number of pediatric cases and experiences, these recommendations or guidelines were based mainly on standards and experiences with adult patients [<xref ref-type="bibr" rid="CR10">10</xref>]. Additional data from pediatric cases need to be collected to further recognize the clinical features of COVID-19 in children.</p><p id="Par16">In conclusion, pediatric patients with COVID-19 are mostly from family cluster with clear travel histories to Hubei Province, the epicenter of the outbreak. Close contact in the family is the main transmission way of infection in children. Pediatric patients may present as asymptomatic or only with mild symptoms of respiratory or gastrointestinal system with normal chest CT images, and thus easily be missed. Our study highlights the importance that pediatricians be vigilant in treating patients with a travel history to areas of the epidemic, or with family cluster, to ensure an early diagnosis, early quarantine and early treatment.</p></sec></body><back><fn-group><fn><p><bold>Publisher's Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><notes notes-type="author-contribution"><title>Author contributions</title><p>LNJ and SC are the principle investigators of this manuscript. LNJ drafted the manuscript. YJW and XJL conducted the data collection. XDM, MGL and RMJ analyzed the data. All authors have approved submission of the manuscript.</p></notes><notes notes-type="funding-information"><title>Funding</title><p>None.</p></notes><notes notes-type="ethics"><title>Compliance with ethical standards</title><notes><title>Ethical approval</title><p id="Par19">This study was approved by the Institution Review Board (IRB) of Beijing Tsinghua Changgung Hospital. Written consents were obtained from the parents of the patients for publication.</p></notes><notes notes-type="COI-statement"><title>Conflict of interest</title><p id="Par18">No financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.</p></notes></notes><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><mixed-citation publication-type="other">Real-time reporting of 2019-nCoV outbreak. 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