Title : COVID-19 in Children with Rheumatic Heart Disease: A Case Series
Abstract:
Background
Rheumatic Heart Disease (RHD) is the most commonly acquired heart disease in the young population, affecting more than 33 million persons around the world. The onset of the COVID-19 pandemic has posed a significant challenge for this group of patients because they are highly vulnerable to respiratory infections and to the complications that can occur with signs and symptoms of both cardiac and respiratory conditions overlapping. COVID-19, which is primarily a respiratory infection, may potentially trigger worsening of symptoms of this group of patients, leading to heart failure decompensation. At the other end of the spectrum, the increased severity of RHD may also result to poor outcome and mortality of a COVID-19 patient. Notwithstanding the interplay of symptoms of the said diseases, this case series highlights the clinical course and outcome of COVID-19 in children with RHD admitted at one of the COVID-19 referral centers in Metro Manila, Philippines.
Case Presentation Summary
This is a case series of three patients, two (2) female and one (1) male, aged 10 to 15 years old, who were admitted in a COVID-19 referral center from March 2020 to April 2021, diagnosed with RHD and reported to have contracted COVID-19 after being tested through Reverse Transcription Polymerase Chain Reaction. Only one (1) out of our three (3) patients had fever upon admission. All patients showed common symptoms of COVID-19 which were cough and difficulty of breathing. They likewise experienced orthopnea which was one of the symptoms of RHD. The common finding in their chest X-ray results was pneumonia which is a potential complication of COVID-19. All patients had elevated Anti-Streptolysin O and one had elevated white blood cells. The three (3) patients had elevated inflammatory markers such as C-Reactive Protein and Erythrocyte Sedimentation Rate, but it was difficult to distinguish their primary cause because they were both present in RHD and COVID-19. Two (2) out of three (3) patients had more severe RHD as evidenced by having more heart valve damage and higher New York Heart Association classification of heart failure. This is further supported by the longer stay in the hospital of one of the two patients due to further medical needs and the demise of the other patient as a result of congestive heart failure despite oxygen support, inotropes, medications, and high-quality resuscitative measures. Learning points/Discussion In this case series, the author describes the clinical course and outcome of COVID-19 infection in three (3) pediatric patients with RHD. While there are some international publications on the characteristics and clinical course of children diagnosed with RHD who contracted COVID-19, no studies on such subject matter have been published in the Philippines. Additionally, little is known thus far about the effect of COVID 19 in children with RHD. At the outset, after prudent research on the course of illness and outcome of COVID-19 on children with RHD, no local or international case reports and case series on the subject matter per se were found. What were only gathered were general reviews and studies on the risk factors of RHD for COVID-19. Due to the limited studies on the establishment of the course of illness and outcome of COVID-19 on children with RHD, the notion that the increased severity of RHD may result to poor patient outcome mortality should still be further studied. This case series may pave the way for the conduct of an exhaustive research thereon.
