Clinico-Pathogenesis of COVID-19 in children

Abstract

The recent pandemic by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing Coronavirus disease-2019 (COVID-19) affects mainly adults and to a lesser extent children. The major route of spread is via droplets where the virus is released into the air in the form of droplets by an infected individual during coughing and sneezing. The virus primarily infects the respiratory tract epithelium. Its spike protein interacts via ACE-2 receptor and facilitates the entry of the virus into the cells by membrane fusion. The activated Cytotoxic T cells and other cells cause an exaggerated inflammatory response releasing huge amounts of pro-inflammatory cytokines like interleukins and interferon. Due to this surge in the cytokine levels leading to a storm like state, there is significant endothelial injury causing hyper-coaguable state and disseminated intravascular coagulation. The common presentation in children include involvement of respiratory system leading to pneumonia, severe pneumonia, acute respiratory distress syndrome and rarely multiorgan involvement.