ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Coinfected with SARS-CoV-2 and Influenza B: A 2-Week-Old Presenting with Apnea
Session Title
TP75 - TP075 PEDIATRIC LUNG INFECTION
Abstract
A3405 - Coinfected with SARS-CoV-2 and Influenza B: A 2-Week-Old Presenting with Apnea
Author Block: R. Maddali1, J. Raynor2, K. Cervellione3, L. Lew1; 1Pediatrics, Flushing Hospital Medical Center, Queens, NY, United States, 2Internal medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 3Department of Clinical Research, Medisys Health Network, Queens, NY, United States.
Introduction: Apnea in the first weeks of life in a term infant can lead to extensive evaluation. Several respiratory viral infections are known to be associated with apnea. A paucity of data exists on SARS-CoV-2 in infants. We describe a 2-week-old girl presenting with apnea coinfected with SARS-CoV-2 and influenza B.
Case: 2-week-old girl presented with an apneic episode lasting three minutes while lying supine after a feed with stiffening of the body and turning red in color. She experienced nasal congestion in preceding two days not associated with fever, cough or vomiting. She was born at term with birth weight 3365 grams (75%ile), length 48.9 cm (50%ile) and head circumference 33.5 cm (25-50%ile). The mother tested COVID-19 negative at time of delivery. Within the same household are two school age siblings. At admission, the weight was 4082 grams, temperature 37.2◦C, pulse 154 beats per minute and respiratory rate 33 breaths per minute. The heart and lung examinations were normal and there were no neurological deficits. Laboratory findings disclosed white blood cell count of 16.9 K/uL, serum glucose 113 mg/dL, calcium 11.3 mg/dL, total carbon dioxide 18 mmol/L, O2 saturation in room air 100% and CRP <0.05 mg/dL. Urinalysis was negative. Chest x-ray revealed hyperinflated lungs with prominent central markings, no focal consolidation, no pleural abnormality and unremarkable cardiothymic silhouette suggestive of a viral process. SARS-CoV-2 PCR-NP and influenza B tested positive. Influenza A, respiratory syncytial virus and human metapneumovirus were negative. Electrocardiogram traced normal sinus rhythm without abnormal QT interval. She had an uneventful clinical course and was subsequently discharged after two days of observation.
Discussion: Brief resolved unexplained event (BRUE) was the admitting diagnosis. BRUE is when an infant younger than 12 months stops breathing associated with change in muscle tone, color or is unresponsive, transient in nature and with no known cause. Positive SARS-CoV-2 and influenza B test results excluded this diagnosis. In house exposure to school age siblings or by community spread present likely modes of transmission. Since our patient is younger than six months, she was not protected by influenza vaccine. The patient did not have fever, cough, leukopenia or elevated CRP as previously reported in children with COVID-19. Effects of SARS-CoV-2 on young infants are not completely known. SARS-CoV-2 may also be the cause of apnea. Coinfection does not increase frequency of apnea. Full recovery was demonstrated.
Author Block: R. Maddali1, J. Raynor2, K. Cervellione3, L. Lew1; 1Pediatrics, Flushing Hospital Medical Center, Queens, NY, United States, 2Internal medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 3Department of Clinical Research, Medisys Health Network, Queens, NY, United States.
Introduction: Apnea in the first weeks of life in a term infant can lead to extensive evaluation. Several respiratory viral infections are known to be associated with apnea. A paucity of data exists on SARS-CoV-2 in infants. We describe a 2-week-old girl presenting with apnea coinfected with SARS-CoV-2 and influenza B.
Case: 2-week-old girl presented with an apneic episode lasting three minutes while lying supine after a feed with stiffening of the body and turning red in color. She experienced nasal congestion in preceding two days not associated with fever, cough or vomiting. She was born at term with birth weight 3365 grams (75%ile), length 48.9 cm (50%ile) and head circumference 33.5 cm (25-50%ile). The mother tested COVID-19 negative at time of delivery. Within the same household are two school age siblings. At admission, the weight was 4082 grams, temperature 37.2◦C, pulse 154 beats per minute and respiratory rate 33 breaths per minute. The heart and lung examinations were normal and there were no neurological deficits. Laboratory findings disclosed white blood cell count of 16.9 K/uL, serum glucose 113 mg/dL, calcium 11.3 mg/dL, total carbon dioxide 18 mmol/L, O2 saturation in room air 100% and CRP <0.05 mg/dL. Urinalysis was negative. Chest x-ray revealed hyperinflated lungs with prominent central markings, no focal consolidation, no pleural abnormality and unremarkable cardiothymic silhouette suggestive of a viral process. SARS-CoV-2 PCR-NP and influenza B tested positive. Influenza A, respiratory syncytial virus and human metapneumovirus were negative. Electrocardiogram traced normal sinus rhythm without abnormal QT interval. She had an uneventful clinical course and was subsequently discharged after two days of observation.
Discussion: Brief resolved unexplained event (BRUE) was the admitting diagnosis. BRUE is when an infant younger than 12 months stops breathing associated with change in muscle tone, color or is unresponsive, transient in nature and with no known cause. Positive SARS-CoV-2 and influenza B test results excluded this diagnosis. In house exposure to school age siblings or by community spread present likely modes of transmission. Since our patient is younger than six months, she was not protected by influenza vaccine. The patient did not have fever, cough, leukopenia or elevated CRP as previously reported in children with COVID-19. Effects of SARS-CoV-2 on young infants are not completely known. SARS-CoV-2 may also be the cause of apnea. Coinfection does not increase frequency of apnea. Full recovery was demonstrated.
