Abstract:
Introduction
Pneumonia remains a major cause of pediatric hospitalization worldwide. Over
the past decade, the incidence of viral pneumonia in children has increased,
especially during the COVID-19 pandemic. SARS-CoV-2 has affected all age
groups and contributed to severe lung inflammation and multisystem
complications, highlighting the need for detailed clinical characterization.
Materials/Methods
This study included 134 children aged 6 to 18 years with severe communityacquired pneumonia (CAP). Based on SARS-CoV-2 status, patients were
divided into two groups: Group 1 (n=86) had confirmed SARS-CoV-2
infection; Group 2 (n=48) tested negative. Clinical history, symptoms, physical
exams, and laboratory and imaging data (X-ray, ultrasound) were assessed per
national pediatric pneumonia guidelines. Statistical analysis was conducted
using Microsoft Excel and an online calculator. Informed parental consent was
obtained for all participants in accordance with the Declaration of Helsinki.
Results
At the time of admission, all patients reported elevated body temperature.
Subfebrile fever was observed in 73 children (54.5 %), including 45 from
Group I. Febrile temperatures were noted in 35 cases (26.1 %), with 24 patients
in the SARS-CoV-2 group. Pyretic fever was present in 26 patients (19.4 %),
including 18 in Group I. General weakness and malaise were reported by all
patients, regardless of SARS-CoV-2 status. Sleep disturbances and drowsiness
were recorded in 39 cases (29.1 %). Appetite loss was found in 89 children
(66.4 %): 54 in Group I and 35 in Group II. Reduced appetite was reported by
36 children (26.8%), significantly more often in Group I (p<0.01). Three
children in Group I reported loss of smell and taste. Chest pain was noted in 11
cases (8.2%). Cough was the most frequent respiratory symptom (109 cases;
81.3 %). Absence of cough was observed in 25 children (18.6 %), significantly
more often in Group I – 23 cases (26.7 %) vs. 2 cases (4.1 %) in Group II
(p<0.001). Gastrointestinal symptoms (abdominal pain, nausea, vomiting, stool disorders) were reported by 11 children (12.7 %) in Group I and 5 (10.4 %) in
Group II (p>0.05).
No percussion changes were found in 82 patients (61.1 %), more frequently in
Group I – 68 cases (79 %; p<0.001). In Group II, percussion abnormalities
(dullness or hyperresonance) were noted in 32 cases (66.7 %; p<0.001). On
auscultation, harsh breath sounds with prolonged expiration were found in 109
cases (81.3 %). Decreased breath sounds were noted in 25 patients (18.8 %).
Pleural friction rub was detected in 10 children (7.4 %), with no significant
intergroup difference (p>0.05). Harsh breath sounds were more frequent in
Group I – 74 cases (86 %) vs. 35 (73 %) in Group II. Decreased breath sounds
were noted in 12 children (14 %) in Group I and 13 (25 %) in Group II
(p<0.001). Moist rales were auscultated in 56 children (41.7 %), and dry rales
in 16 (11.9 %). No rales were heard in 62 children (46.2 %). Absence of rales
was significantly more frequent in Group I – 52 cases (60.5 %; p<0.001), while
33 children (68.8 %) in Group II had moist rales (p<0.001).
Conclusions
Fever, general malaise, and respiratory symptoms were common across all
patients. SARS-CoV-2-positive cases were distinguished by dyspeptic
symptoms, absent percussion changes, and harsh breath sounds without rales.
In contrast, SARS-CoV-2-negative patients more often exhibited percussion
dullness and moist rales. These differences may assist in clinical differentiation
and management of viral versus non-viral pneumonia in children.