علایم و نشانه های ویروس کرونا در کودکان
🚩والدین و پزشکان ، مراقب نشانه های بیماری کرونا (کووید – ۱۹) در کودکان، مانند علامت “انگشتان کوویدی” ، در کودکان باشند .”
🔶 بر اساس اطلاعات گزارش شده از کشورها گوناگون ، شدت بیماری کرونا (کووید – ۱۹) در کودکان ، خفیف تر از بزرگسالان است ؛
◀️به عنوان نمونه در کشور چین ، حدود ۶ درصد از کودکان مبتلا به بیماری کرونا (کووید – ۱۹) در کودکان ، تابلوی “شدید” و “بدحال” بالینی داشتند ، در حالی که این عدد در بزرگسالان حدود ۱۹ درصد بوده است.
🔸بر این اساس ، احتمال مواجهه پزشکان با نشانه های بیماری شدید ، در کودکان کمتر است و پزشکان مراقبت کننده از کودکان علاوه بر نشانه های”شایع” بیماری کووید ، باید به نشانه های “ناشایع” نیز ، آگاهی و دقت داشته باشند.
🔻بر اساس هشدار انجمن پزشکان کودکان کانادا (CPS) ، شناسایی کودکان و نوجوانانی که دچار “تغییر رنگ” و “تورم” انگشتان شده اند ، رو به افزایش است.
🔸این تغییر رنگ به قرمز ، بنفش یا آبی ، در اکثر موارد در انگشتان “پا” بوده ، در مواردی در انگشتان “دست” نیز گزارش شده است.
🔸این تورم و تغییر رنگ در انگشتان پا ، به وضعیت قرارگیری پا در معرض “سرمای شدید” و “یخزدگی” انگشتان پا شباهت فراوانی دارد.
🔸در برخی از مبتلایان ، فقط “تغییر رنگ” گزارش شده است ، اما در مواردی، انگشتان درگیر ، “داغ” و “دردناک” هم بودند.
🔸در تعدادی از کودکان دچار “تغییر رنگ انگشت” ، نشانه های معمول بیماری کووید – ۱۹ مانند “تب” ، “لرز” ، “گلودرد” ، “سردرد” ، “درد عضلانی” و “سرفه” آشکار نشده است اما در تعدادی ، نشانه های معمول بیماری هم وجود داشت. در تعداد اندکی از کودکان، بروز علایم خفیف(اما نگران کننده) تنفسی، گزارش شده است.
🔻 از آنجا که وضعیت تورم و تغییر رنگ انگشتان پا ، در بیماران کووید – ۱۹ از جمله “کودکان مبتلا” مشاهده شده است ، این علامت را «انگشتان پای کوویدی» نامگذاری کردهاند.
🔻با توجه به این نکته ،که کودکان مبتلا به تغییر رنگ انگشتان ، ممکن است موارد “بدون علامت” یا “خفیف” بیماری کووید – ۱۹ باشند ؛ والدین و پزشکان ، بایستی به احتمال بیماری کووید – ۱۹ ، آگاهی و گمان بالینی داشته باشند.
🔻بسیار مهم است که پزشکان متخصص کودکان ، متخصص پوست و پزشکان خانواده، با مشاهده علامت”انگشتان کوویدی” در کودکان و نوجوانان فاقد علایم نگران کننده بیماری کووید – ۱۹ ، علاوه بر آموزش علایم خطر به والدین و آرامش بخشی به ایشان ، بر “ایزوله خانگی” ، پرهیز از تماس های نزدیک و رعایت فاصله گذاری اجتماعی، تاکید نمایند.
🚩احتمال وجود یک سندرم شبیه به کاوازاکی در اطفال مبتلا به کووید۱۹
🔸اخیرا تعداد ۱۵ بیمار (۲ تا ۱۵ سال) که بیشتر آنها تست مثبت کووید۱۹ داشتند در شهر نیویورک با علائمی شبیه به شوک توکسیک یا بیماری کاوازاکی، بستری شدند. این حالت شبیه به یک بیماری التهابی با درگیری عروق است که احتمالا با کووید۱۹ ارتباط دارد.
هیچکدام از این بیماران در شهر نیویورک فوت نکردند. همانطورکه میدانیم این بیماری در افراد مسن با علائم شدیدتر و مرگ و میر بیشتری همراه بوده است. اما این تظاهر از بیماری که در تعدادی از بیمارانِ اطفال کووید ۱۹ مشاهده شد باعث نیاز تعدادی از انها به ونتیلاتور و یا ساپورت فشار خون شد. دیده شده است که در تعدادی از کودکان که ممکن است دچار التهاب عروق شده اند علائمی شبیه به شوک توکسیک بروز میدهند.
🔸این نوع تظاهرات بیماری با علائمی مانند تب، راش پوستی، دل درد و استفراغ همراه بوده است.
تا امروز می دانیم که احتمالا این یک علامت نادر در جمعیت اطفال است که ممکن است با کووید۱۹ در ارتباط باشد. تا کنون مرگ و میری در اطفال با این علامت گزارش نشده است همچنین همهی افراد با این علائم تست مثبت کووید۱۹ نداشتند، اما این گروه اکثرا به مراقبت های ویژه نیاز پیدا کرده اند. این شکل از درگیری در بسیاری از کشور های اروپایی نیز گزارش شده است.
◀️متخصصین اطفال بر لزوم اطلاع رسانی به خانواده ها در مورد علائم تب، راش پوستی، دل درد و استفراغ تاکید کرده اند و لازم است در صورتی که کودکی این علامت ها را بروز داد سریعا به بیمارستان مراجعه کند.
✨باتشکر از آقای میثم دشتی (دانشجو پزشکی)
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