Modern Pediatrics. Ukraine. (2021). 5(117): 77-81. doi 10.15574/SP.2021.117.77
Pokhilko V. I.¹, Chernyavska Yu. I.¹, Rossokha Z. I.², Medvedeva N. L. ², Popova O. F.^2
1Poltava State Medical University, Ukraine
²SI «Reference Center for Molecular Diagnostics of the Ministry of Health of Ukraine», Kyiv

For citation: Pokhilko VI, Chernyavska YuI, Rossokha ZI, Medvedeva NL, Popova OF. (2021). Clinical case of severe coronavirus infection in a 6-month-old child. Modern Pediatrics. Ukraine. 5(117): 77-81. doi 10.15574/SP.2021.117.77
Article received: Jun 14, 2021. Accepted for publication: Sep 08, 2021.

Nowadays, the creation of treatment protocols for young children with COVID-19 is especially relevant, as some issues of pathogenesis and genetic determinism of severe lung damage are still unclear. COVID-19-induced respiratory distress syndrome is a predictable severe complication that requires early diagnosis and proper treatment. Given the pathogenetic mechanism of lung damage in COVID-19, surfactant replacement therapy may be useful in the treatment of this cohort of patients.
Clinical case. A clinical case of severe coronavirus infection caused by SARS-CoV-2 in a 6-month-old child is presented. The course of the disease was accompanied by severe damage to the lung parenchyma with the development of acute respiratory distress. The examination of the patient confirmed the genetic determinism of severe COVID-19, polymorphic risk alleles of the genes GSTM1, GSTP1, SFTP-B. The child's treatment included not only long-term mechanical ventilation, but also surfactant replacement therapy. The child recovered and was discharged without signs of respiratory failure.

Conclusions. This clinical case demonstrates the association of genetic polymorphism with severe virus-induced lung damage. Because severe respiratory failure in COVID-19 is likely to be due to the development of acute respiratory distress syndrome, administration of exogenous surfactant should be considered as a possible treatment option.

The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Key words: COVID-19, children, virus-induced respiratory distress syndrome, gene polymorphism, surfactant administration.

REFERENCES

1. Cattel F, Giordano S, Bertiond C et al. (2021). Use of exogenous pulmonary surfactant in acute respiratory distress syndrome (ARDS): Role in SARS-CoV-2-related lung injury. Respiratory Physiology and Neurobiology. 1: 288. https://doi.org/10.1016/j.resp.2021.103645; PMid:33657448 PMCid:PMC7916525

2. Fryer AA, Bianco A, Hepple M et al. (2000). Polymorphism at the glutathione S-transferase GSTP1 locus. A new marker for bronchial hyperresponsiveness and asthma. Am J Resp Crit Care Med. 161: 1437-1442. https://doi.org/10.1164/ajrccm.161.5.9903006; PMid:10806136

3. Khan MSI, Debnath CR, Nath PN et al. (2020). Ivermectin Treatment May Improve the Prognosis of Patients With COVID-19. Arch Bronconeumol (Engl Ed). 56 (12): 828-830. https://doi.org/10.1016/j.arbres.2020.08.007

4. Moradi M, Mojtahedzadeh M, Mandegari A et al. (2009). The role of glutathione-S-transferase polymorphisms on clinical outcome of ALI/ARDS patient treated with N-acetylcysteine, Respiratory Medicine. 103 (3): 434-441. https://doi.org/10.1016/j.rmed.2008.09.013; PMid:18993042

5. Skokic F, Hudic I, Hotic N et al. (2010). Surfactant replacement therapy in influenza A H1N1. The Pediatric infectious disease journal. 29 (4): 387. https://doi.org/10.1097/INF.0b013e3181cf2eaa; PMid:20351534

6. Tian S, Xiong Y, Liu H et al. (2020). Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol. 33: 1007-1014. https://doi.org/10.1038/s41379-020-0536-x; PMid:32291399 PMCid:PMC7156231

7. Wang J, Hajizadeh N, Moore EE et al. (2020). Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost. 18: 1752-1755. https://doi.org/10.1111/jth.14828; PMid:32267998 PMCid:PMC7262152

8. Xu Z, Shi L, Wang Y et al. (2020). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet. Respiratory medicine. 8 (4): 420-422. https://doi.org/10.1016/S2213-2600(20)30076-X

9. Ye Z, Zhang Y, Wang Y et al. (2020). Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 30: 4381-4389. https://doi.org/10.1007/s00330-020-06801-0; PMid:32193638 PMCid:PMC7088323

10. Znamenska TK, Kovaliova OM, Pokhylko VI et al. (2015). Association of genetic polymorphisms with risk factors for bronchopulmonary dysplasia in premature birth infants. New Armenian Medical Journal. 9 (3): 48-57.