To date, most of the data available on the clinical and treatment of severe acute respiratory syndrome (SARS, SARS) relate to adult patients. The April issue of Lancet magazine published the results of a descriptive study of suspected SARS cases in ten children hospitalized in hospitals in Hong Kong from March 13 to 28, 2003.

All children received combination therapy, including antivirals, glucocorticoids, and antibiotics.

When a suspected diagnosis of SARS was made, the following drugs were prescribed for children: cefotaxime iv, clarithromycin inside and ribavirin inside (40 mg / kg per day in 2-3 doses). If the fever persisted for more than 48 hours, oral prednisone was administered at a dose of 0.5 mg / kg per day in one clinic and 2.0 mg / kg per day in a second clinic. In addition, patients with severe symptoms of the disease from the time of admission were prescribed iv ribavirin (20 mg / kg daily in three doses) and hydrocortisone (2 mg / kg every 6 hours). Patients in whom the fever persisted for a long time and a progressive worsening of clinical and radiological symptoms were noted, were prescribed pulse therapy with methylprednisolone iv (10-20 mg / kg). Ribavirin was prescribed for 1 to 2 weeks and the dose of glucocorticoids decreased after 2 to 4 weeks.

The clinic for all the children fully met the criteria for SARS recommended by the WHO and all the children had already been in contact with sick adults. Fever was a characteristic symptom of all patients and lasted an average of 6 days (3 to 11 days). In 8 patients, the fever persisted and glucocorticoids were required. Impulse therapy with methylprednisolone was prescribed for a young child and four adolescents. Within 2 days of glucocorticoid therapy in all but one patient, the fever stopped. However, the same four adolescents developed signs of respiratory failure (respiratory distress syndrome) and a decrease in blood oxygen saturation 4 to 7 days after the onset of fever.

Nine children showed diffuse darkening of lung tissue during an X-ray examination. Four out of five patients under the age of 12 showed local black-out areas in the segments on the x-rays, and another showed focal black-out. All patients showed an increase in radiological symptoms during the dynamics study, but complete radiological resolution was observed within 14 days. In 3 out of 5 cases, bilateral vision cuts in the lower lobes of the lungs were revealed on x-rays, which progressed rapidly over several days. Despite clinical improvement, the radiological signs persisted for 2 weeks after the onset of the disease.

For all patients, lymphopenia was observed (white blood cell number 0.3 to 3.0 x 109 / l) and, in adolescents, lymphopenia was more pronounced than in young children. Lymphopenia developed 3 to 7 days after the onset of the fever.

A culture study found a coronavirus in nasopharyngeal aspirations in two patients. Reverse transcriptase PCR revealed the presence of the virus in nasopharyngeal aspirations in 4 of 6 patients. The patients were completely isolated on the 21st day and at the time of their discharge, they showed no symptoms of the disease.

During the study, two characteristic forms of the evolution of SARS in children were noted, the development of which depended on the age of the patient. For adolescents, general malaise, myalgia, chills, similar to that of adult patients, were characteristic, while for young children, characteristic symptoms were coughing and runny nose in the absence of chills and myalgia. The clinical manifestations of SARS in young children compared to adolescents were less pronounced and less prolonged, the radiological changes were also less pronounced and their resolution occurred in a shorter time. All patients had clinically significant lymphopenia, which was even more pronounced in adolescents. However, as normal in young children in the blood contains a higher number of lymphocytes than in adults, when interpreting this indicator, the age of the patient should be taken into account. Subsequently, lymphopenia disappeared with clinical improvement. In the treatment of SARS in children, a regimen widely used in adults with ribavirin and glucocorticoids has been used. This study showed that short periods of treatment with high doses of ribavirin are well tolerated and do not cause the development of serious side effects, such as severe hemolytic anemia. During treatment with ribavirin, no marked decrease in hemoglobin levels was observed. In addition, high doses of glucocorticoids have been used in combination with the antiviral drug, as severe immunological damage to lung tissue has been observed in biopsies of deceased patients with SARS.

Eight in ten children continued to go to school when they were already showing symptoms of the disease. Nevertheless, there was no sign of infection from their classmates, i.e. there may be differences in the infectivity of the children compared to the very high level of infectivity established characteristic of the patients adults with SARS. During the observation, no deaths of children with SARS were noted.

Studies conducted suggest that young children are characterized by the development of a moderate to severe form of the disease with a less aggressive course than in older children and adults.