Discussion
Here we present 2 cases of COVID-19 in infants hospitalized for poorly
tolerated high fever and neurological symptoms in whom acute
bronchiolitis developed at a delay of 2 to 8 days. According to the
literature, the most frequent clinical features of COVID-19 among
symptomatic children are fever, cough, diarrhoea and
asthenia4,5.Isolated fever with neurological symptoms
such as axial hypotonia or drowsiness and moaning sounds is also the
clinical picture commonly associated with COVID-19 in
infants6,7. Pneumonia is the most common diagnosis
among symptomatic children with COVID-19 4.
High-resolution CT scan usually shows ground-glass opacities or
bilateral lung consolidations, especially in the periphery, and lung
ultrasonography, as in our case 1, reveals signs of lung involvement.
In contrast, to the best of our knowledge, acute bronchiolitis due to
SARS-CoV-2 infection has never been reported. The wheezing episodes
described in our patients were likely due toSARS-CoV-2 infection for the
following reasons: first, RT-PCR tests for RSV and IV were always
negative in both children, and second, the epidemic season for both
viruses was over and the lockdown in France was still active at the time
of the cases. Finally, previous study of virus repartition in positive
respiratory samples from infants with acute bronchiolitis detected close
to a 5% frequency of coronaviruses OC43 and 229E8.
Moreover, a recent experimental model of COVID-19 in ferrets showed lung
lesions compatible with bronchiolitis9. Our patients
showed bronchiolitis symptoms several days after those of COVID-19,
which may explain the lack of wheezing episodes reported in the
literature10.
Case 2 was diagnosed with recurrent wheezing presumably due to
SARS-CoV-2 infection. RSV as well as rhinovirus bronchiolitis is a risk
factor for recurrent wheezing and asthma11,12,but
little is known about the long-term impact of SARS-CoV-2 infection in
lung function trajectory, which emphasizes the need to follow these
children.
In conclusion, we describe the delayed occurrence of acute bronchiolitis
in infants with SARS-CoV-2 infection. Whether the infection in
symptomatic or asymptomatic infants may predispose to recurrent wheezing
or asthma remains to be determined.
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