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Disease condition | Description | Differentiated by |
---|---|---|
Viral pneumonia | Numerous viral pathogens may result in an identical presentation including influenza, respiratory syncytial virus, adenovirus, parainfluenza, rhinovirus, human metapneumovirus, and human bocavirus Chest radiograph findings in patients with these pathogens may be quite similar to findings in those with acute COVID-19 | Positive SARS-CoV-2 test result does not completely exclude the possibility of coinfection with 1 or more additional viral pathogens Using clinical suspicion (eg, based on age, epidemiologic factors) to direct use of specific tests for additional viral pathogens can aid identification of additional and alternate viral pathogens. Multiplex nucleic acid amplification test panels (testing for multiple common pathogens in a single specimen) are available. Rapid antigen testing is available for some common pathogens (eg, respiratory syncytial virus, influenza) |
Atypical pneumonia | Pneumonia caused by atypical organisms (eg, Mycoplasma pneumonia, Chlamydia pneumoniae) may have a similar presentation with fever, cough, tachypnea, difficulty breathing, and possibly hypoxia Chest radiograph findings may be quite similar to those noted in patients with acute COVID-19 | Positive SARS-CoV-2 testing does not completely exclude the possibility of coinfection with atypical organism Improvement with empiric treatment for presumed atypical pneumonia may be consistent with diagnosis Diagnosis is confirmed by clinical presentation and clinical course in most cases Demonstration of pathogen by nucleic acid amplification test is possible with polymerase chain reaction testing of respiratory specimens. Multiplex nucleic acid amplification test panels (testing for multiple common pathogens in a single specimen) are available |
Bacterial pneumonia | Similar presentation with fever, cough, tachypnea, difficulty breathing, and possibly hypoxia Chest radiographic findings may be quite similar to those noted in patients with acute COVID-19 Pathogen responsible for disease is highly dependent on child's age, presence of underlying comorbidities (eg, sickle cell, immunosuppression), and potential exposures (eg, travel, community exposures) | Positive SARS-CoV-2 test result does not completely exclude possibility of bacterial coinfection Improvement with empiric treatment for presumed bacterial pneumonia may be consistent with diagnosis Diagnosis is confirmed by clinical presentation and clinical course in most cases |
Admission decisions consider a combination of clinical presentation, supportive care requirement, underlying medical comorbidity, and caregiver's ability to provide home care
Admit all children with severe COVID-19 for expedient management, preferably at regional center with critical care and extracorporeal membrane oxygenation capability r5
Febrile neonates (younger than 28 days) require admission for further diagnosis, management, and monitoring r63
Most children with mild to moderate COVID-19 do not need admission, but decisions should be individualized
Standard treatment includes infection control and supportive care for all patients and medications for certain children
Infection controlmeasures include isolation, source control, and transmission precautions
Supportive care is the mainstay of management for overwhelming majority of pediatric patients; most children can be managed safely in the home environment r69
Medications to treat COVID-19 and coinfections and to prevent complications are indicated in certain children
Many therapies are under investigation for treatment of COVID-19 in pediatric population; consider use of the following only within a clinical trial: r1
Avoid potential harmful therapies not supported by evidence for treatment of acute COVID-19 in pediatric patients, such as the following: r1r5
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