Atypical Clinical Manifestations in Children, from Endemic Coronaviruses, During the Sars-Cov-2 Pandemic

Background: Human coronaviruses (HCOVs) include endemic and epidemic species, such as the newer SARS-COV-2. HCOVs may cause co-infections with each other or with other respiratory viruses, manifesting principally with symptoms from the respiratory system, while the gastrointestinal involvement is not common.

Objective: The aim of the study was to describe 2 cases of infection from the endemic HCOV-NL63 during the current pandemic, and its relevance to pediatric care.

Methods: HCOV-NL63 was detected in samples from 2 children admitted in the pediatric clinic during the pandemic from SARS-COV-2. Polymerase chain reaction for 20 pathogens on rhino-pharyngeal swab was used (multiplex PCR FilmArray Respiratory Panel 2 plus, Biomérieux, France).

Results: The first child, 7 months old, presented persistent (7 days) high fever, up to 40⁰C, with respiratory system findings (pharyngitis, nasal congestion) but also gastrointestinal involvement (greenish diarrhea). The laboratory examination revealed increased inflammatory markers, while the differential diagnosis included SARS-COV-2 and atypical Kawasaki disease, excluded by imaging, clinical and laboratory assessment. The second child, 3 years old, was admitted due to extensive cutaneous infection from methicillin-sensitive staphylococcus aureus, appeared on the second day of high fever, up to 39.6⁰C. Other findings were pruritic vesicular-papular rash spread throughout the trunk and the limbs and ill appearing child. The laboratory findings were within normal range. Both children were treated with intravenous antibiotics with complete recovery.

Conclusion: During the pandemic from SARS-COV-2, the “old” coronaviruses continue to cause infections in the community and lead to diagnostic dilemmas. We report two cases which highlight that infection from HCOV-NL63 should be considered in the presence of fever with combined symptoms from the respiratory and gastrointestinal system as well as in presence of fever and rash combined with bacterial infection. Further studies are required in order to understand the clinical profile of these viruses in children.