COVID-19 in Children :

Up Date & Strategy to Fight

the New Great Imitator Disease

Finny Fitry Yani

Bagian Ilmu Kesehatan Anak
FK Unand/RS Dr. M.Djamil- Tim COVID-19
Webinar PDS PATKLIN – 18 Oktober 2020
 Dr. dr. Finny Fitry Yani SpA(K)
Education

• Medical Doctor, University of Andalas, 1992

• Pediatrician, University of Andalas, 2004
• Fellowship Training FKUI/RSCM, 2006
Current position • Respirology Pediatric Consultant : 2011
• Doctoral, 2017

•Academic Staff, Department of Child Health, Faculty of Medicine University of Andalas

/M.Djamil Hospital, Padang 2004
•Member of Indonesian Pediatrics College 2004
•Committee of Respirology Coordination Working Unit – Indonesian Pediatrics Society 2007
•Member of Pediatric TB Working Group – MOH 2010
•Executive Secretary of JetSet TB Indonesia – MOH 2017
•Expert TB Panel MOH 2020
 What this talk will cover:

COVID-19 the great imitator disease ?

Which children at high risk?

Is it MIS-C ?

Treat COVID-19

Fight COVID-19
Up date COVID-19 burden
Positif : 38.394.169
meninggal : 1.089.047 5 September 2020 16 Oktober 2020

Positif : 349.160
Meninggal : 12.268

Positif : 9.747
Meninggal :
5 September 2020 16 Oktober 2020
Anak positif : 18.112 org
0-5 tahun : 4575 org
6-18 tahun : 13.537 org

27.761 kasus/6 minggu

Anak positif : 45.793 org

0-5 tahun : 10.375 org
6-18 tahun :35.418 org
Sumbar : anak terkonfirmasi positif COVID-19
data 10 Oktober 2020 100
Covid-19 usia 12 -18 th

90

• Konfirmasi positif : 848 org 80

•
70

Usia 0 – 5 th : 179 org 60

• Usia 6 -11 th : 290 orang 50

Total 379 Remaja

•
40

Usia 12 sd 18 th : 379 org 30

20

10

0
12 th 13 th 14 th 15 th 16 th 17 th 18 th

Covid-19 usia 0 - 5 th
100 Covid-19 usia 6 - 11 th
100
80
80
60
Total 179 60
40
Total 290 Anak
40
20
20
0
0 th 1 th 2 th 3 th 4 th
0
5 th 6 th 7 th 8 th 9 th 10 th 11 th
 What this talk will cover:

COVID-19 the great imitator disease

Which Children at high Risk?

Is it MIS-C ?

Treat COVID-19

Fight COVID-19
The Virus

Interacting stretch of amino acids of the ACE2

receptor (red) with the viral spike RBD (cyan):
the ‘Hotspot’ zone.
Virus enter the cell
Clinical pathophysiology
Humoral respons profile
 Vol. 9, Supl. 2 Mayo-Agosto 2020. pp s167-s172
Sección 04 https://dx.doi.org/10.35366/94506

The New Great Imitator Disease ?

Recibido: 04-M ay-20
Acept ado: 30-M ay-20

Afección extrapulmonar en COVID-19.

¿Estamos ante la nueva y enésima gran imitadora?
Extrapulmonary manifestations in COVID-19.
Are we standing against the latest great imitator?
María Rodríguez-Armida,* Carlos A Nava-Santana*

* Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias

Médicas y Nutrición «Salvador Zubirán». Ciudad de México, México.

• The renal,RESU hepatic, cardiac, neurologic and ABST RACT

M EN

Desde que la enfermedad t uvo su pr imer r epor te en Wuhan en Si nce the di sease was fi r st r epor ted i n Wuhan i n December
dermatologic manifestations- have been
2019, unti l i t wasappropriately
fi nal l y deter mi ned as a pandemi c i n M ar ch
zo del pr esent e año, se han ido esclareciendo los mecanismos de 2020, the mechani sms associ ated wi th ti ssue damage pr esent
described
daño t isular present es en losand related
pacient es toLaworse
con COVI D-19. afec- inoutcomes,
COVI D -19 pati ents have become cl ear er. T he pul monar y
i nvol vement has been wi del y char acter i zed and even though

• Proven to be associated with damage

produced by SARS-CoV-2, it --highlights
specifically
the hi stol ogi cal damage obser ved has been r el ated to di r ect
vi r al cytopathi c effect, i t has al so been associ ated wi th the

pati ents. T hethe importance

dysr egul ated i nfl ammati on and coagul ati on obser ved i n these
cytopathi c effect, i s caused by the i nter acti on
na S (spi ke between the S (spi ke) pr otei n wi th the angi otensi n conver ter
to consider that this is a multisystemic disease.
obstant e, COVI D-19 ha demost rado capacidad par a afect ar vir -
enzyme 2, wi th the r esul tant apoptosi s of the l ung epi thel i al
cel l s. Al though thi s has been pr oven i mpor tant for the l ungs,
t ualmente cualquier apar ato y sistema de los pacient es afectados COVI D-19 has shown i ts capaci ty to affect vi r tual l y any or gan
of pati ents wi th thi s di sease, whi l e some of them devel op
mul ti pl e or gan fai l ur e associ ated wi th thei r cr i ti cal state, new
i nfor mati on has been obtai ned that shows that ther e ar e other
de alteraciones relacionadas dir ectamente con la enfermedad. La types of di stur bances di r ectl y r el ated to thi s vi r us and di sease.
T he r enal , hepati c, car di ac, neur ol ogi c and der matol ogi c
mani festati ons have been appr opr i atel y descr i bed and some of
han asociado con peor es desenlaces en los pacientes. A pesar de them have even been r el ated to wor se outcomes, and though
que no en t odas ellas se ha demost r ado que el daño est é produ- not al l of them have been di r ectl y pr oven to be associ ated wi th
damage speci fi cal l y pr oduced by SARS-CoV-2, i t hi ghl i ghts the
Cutaneus Oral & Olfactory Ocular Airway &Lung

• Anosmia : olfactory Bluring of vision

disfunction Photopobia • Fever
• Facial pain Itching • ILI
• Taste Dry eye • Cough
• Dry mouth Chemosis, follicular
• Masticatory muscle pain • Breathlessness
Keratoconjuctivitis
• Exanthema, Rash
 Brain Myocardial Digestive Systems Renal Involvement

• Cardiogenic shock • Diarrheal and vomiting, initial

• Myocarditis symptom

• Arrhytmia • Abnormal levels of ALT & AST,

• Cerebral ischemia • Mild elevation in serum • AKI
• Increase troponin
• Intracerebral hemorrhage bilirubin.
• Glomerulonephritis
• Stroke • Direct viral infection of
hepatocytes, .
• Leucoencephalopathy
• Immune-related injury, or drug
• Cerebral venous thrombosis hepatotoxicity.
• Bind to cholangiocytes ACE2
receptor
 What this talk will cover:

COVID-19 the great imitator disease

Which children at high risk?

Is it MIS-C ?

Treat COVID-19

Fight COVID-19
 Case : MS/Perempuan/8 th

• Dikenal PGK Stage V dengan CAPD

• Demam 8 hari , kejang berulang 2 hari
• Sesak nafas 1 hari
• RR 30x/i, T : 38,6 C
• Thorak : retraksi (+),rhonki (-/-), wheezing
(-/-)
• Swab 1 : positif

Kontak : Pneumonia Lobaris + PGK Stage V +

tak jelas, 1 minggu di rumah singgah CAPD
Children at high risk for COVID-19

• To get infected : teenager >12

years old
• To get severe form of COVID-19 :
- underfive,
- immunocompromise
condition,
- have comorbid
Case Definition of COVID-19
 What this talk will cover:

COVID-19 the great imitator disease

Which children at high risk?

Is it MIS-C ?

Treat COVID-19

Fight COVID-19
Case : R/girl/16 yo EEG, ECG, Brain CT, Chest Xray

• Fever for 3 days 10 days ago

• Recurrent seizure since 6
days , follow by focal seizure
• No respiratori symptoms
• (Cardiogenic) Shock ?
No contact history for COVID-19 case Is it MIS-C?
PCR SAR-Cov-2 positif

Blood routine was normal limite

Prokalsitonin : 14.49 ng/ml
Feritin : 175.79 ng/ml
• EEG, ECG, Brain CT normal
limite
LDH : 47 U/L
Troponin I : <1.5 ng/L (normal) • Chest Xray: Minimal infiltrat &
slightly cardiomegaly
New Entity Diagnosis Multisystem Inflammatory Syndrome in Children (MIS-C)
in COVID-19 children

MIS - C
 What this talk will cover:

COVID-19 the great imitator disease

Which children at high risk?

Is it MIS-C ?

Treat COVID-19

Fight COVID-19
Therapeutic strategy
• Antiviral medication
• Monoclonal antibody
• Plasma Convalens therapy
• Multivitamins
supplementation
• Vitamin D3
• Vitamin C high dose
• Zink
Antiviral medication
• Blockages virus into the host cells : Chloroquine &
hydroxychloroquine
• Inhibitor viral RNA synthesis : Remdesivir, Favipiravir (Avigan)
• Viral replication inhibitor : Liponavir-ritonavir (Aluvia)

• Interferon based therapy ?

Monoclonal Antibody Plasma Convalescens
Therapy
Strategy treatment in children
• General : not aggresif
• Mostly asymptomatic, mild symptom : no spesific therapy ,
multivitamin supplementation, if suspect co incidence with bacterial
infection  Azythromycin
• Severe form : pneumonia  antibiotic plus antiviral
• Critical ill : antiviral & antibiotic, other supplemen
 What this talk will cover:

COVID-19 the great imitator disease

Which children at high risk?

Is it MIS-C ?

Treat COVID-19

Fight COVID-19
Strategy to fight COVID-19

• Individual strategy
• Community strategy
Individual risk management strategies to reduce the risk of
COVID-19.

• Personal hygiene : regular hands

washing, avoidance eye, face,
nose, mouth, touching
• Social distancing : prevent contact
with aerosol droplets , using face
mask and face covered
 determine the individual risk of
SARS-CoV-II infection
Improving individual condition
• The host metabolic status : age, sex, medical conditions, life
style, microbiota determines the clinical course of COVID-19
• The host macro- and micronutrient status as the preventive
measures for COVID-19  Numerous micronutrients are
essential for immunocompetence, particularly vitamin A, C, D,
E, Bs, iron, selenium, and zinc.
Potencial Mechanism
of vaccine
• DNA-based vaccine
• mRNA-based vaccine
• Virus like particle vaccine
• Protein-based vaccine
• Live attenuated vaccine
• Inactivated or killed
antigen vaccine
 Avoid your underfive from COVID-19

Ajari anak tidak

menyentuh wajah karena
Pastikan anak tetap di
mulut, hidung, mata Ajari anak cuci tangan. Jaga daya tahan tubuh.
rumah.
dapat menjadi pintu
masuk virus.

Rutin bersihkan
Pantau kesehatan anak Hindari kontak fisik (jaga Dapatkan sinar matahari mainan dengan
dengan buku KIA. jarak minimal 1 meter). pagi dari teras rumah pembersih rumah
tangga / alkohol 70%
Community & goverment strategy
focus for children/teenager
• Postponed to opening
school, especially in red
zone
• Study training (Bimbel)
• Café
• Playground
Family Clusters
School cluster
‘Bimbel’ cluster\
“Resto/Café”’ cluster
 Elaborasi Riwayat Kontak
• Sebagian besar anak 0 – 18 tahun memiliki riwayat kontak dengan
kasus positif, hasil dari ‘contact tracing’
• Sumber kontak : anggota keluarga positif  Family Cluster
• Sumatera Barat : Extended family  ayah, ibu, kakek, nenek, om,
tante, dll
• Tempat tinggal berdekatan
• Sharing kamar mandi
• Kebiasaan berkumpul di warung
 Stigma Hilangkan

https://doi.org/10.1080/10841806.2020.1782128

Published online: 25 Jun 2020.

Submit your article to this journal

 To keep in mind :

COVID-19 is the great imitator disease

Children at high risk, especially underfive, comorbid

MIS-C is the spesific severe form in children

Treat COVID-19 in children not too aggresif, unless n severe form,

in teenager & adolescent
Fight COVID-19 at individual level and community level with high
adherence
Thank You