J Pediatr Infect Dis 2023; 18(01): 010-016
DOI: 10.1055/s-0042-1758743
Original Study

Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value

1   Medical Microbiology Laboratory, Department of Laboratory Medicine, Bursa City Hospital, Bursa, Türkiye
,
1   Medical Microbiology Laboratory, Department of Laboratory Medicine, Bursa City Hospital, Bursa, Türkiye
,
2   Department of Pediatrics, Bursa City Hospital, Bursa, Türkiye
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3   Division of Pediatric Emergency Diseases, Department of Pediatrics, Bursa City Hospital, Bursa, Türkiye
,
2   Department of Pediatrics, Bursa City Hospital, Bursa, Türkiye
,
4   Bursa City Department of Health, Bursa, Türkiye
› Author Affiliations

Abstract

Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection.

Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied.

Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower.

Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered.

Note

The data described and evaluated in this study is not under publication process or consideration for publication elsewhere.




Publication History

Received: 26 July 2022

Accepted: 13 October 2022

Article published online:
24 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Badal S, Bajgain KT, Badal S, Thapa R, Bajgain BB, Santana MJ. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: a systematic review and meta-analysis. J Clin Virol 2021; 135: 104715
  • 2 Henderson LA, Yeung RSM. MIS-C: early lessons from immune profiling. Nat Rev Rheumatol 2021; 17 (02) 75-76
  • 3 Sancho-Shimizu V, Brodin P, Cobat A. et al; MIS-C@CHGE. SARS-CoV-2-related MIS-C: a key to the viral and genetic causes of Kawasaki disease?. J Exp Med 2021; 218 (06) e20210446
  • 4 Rajyalakshmi B, Samavedam S, Reddy PR, Aluru N. Prognostic value of “Cycle Threshold” in confirmed COVID-19 patients. Indian J Crit Care Med 2021; 25 (03) 322-326
  • 5 Korkmaz MF, Türe E, Dorum BA, Kılıç ZB. The epidemiological and clinical characteristics of 81 children with COVID-19 in a pandemic hospital in Türkiye: an observational cohort study. J Korean Med Sci 2020; 35 (25) e236
  • 6 Gulec EY, Cesur NP, Fazlioğlu GY, Kazezoğlu C. Effect of different storage conditions on COVID-19 RT-PCR results. J Med Virol 2021; 93 (12) 6575-6581
  • 7 Accessed September 5, 2022 at: https://bioeksen.com.tr
  • 8 Yayla BCC, Özsürekçi Y, Aykaç K. et al. Characteristics and management of children with COVID-19 in Türkiye. Balkan Med J 2020; 37 (06) 341-347
  • 9 Sim JY, Wu PS, Cheng CF, Yiang GT, Yu CH. Characteristics, contacts, and relative risk of SARS-CoV-2 infection among children during school closures. J Microbiol Immunol Infect 2021; S1684-1182 (21)00274-7
  • 10 Chu MA, Jang YY, Lee DW. et al. Viral load and rebound in children with coronavirus disease 2019 during the first outbreak in Daegu city. Clin Exp Pediatr 2021; 64 (12) 652-660
  • 11 Yayla BCC, Aykac K, Ozsurekci Y, Ceyhan M. Characteristics and management of children with COVID-19 in a tertiary care hospital in Türkiye. Clin Pediatr (Phila) 2021; 60 (03) 170-177
  • 12 Sahin A, Dalgic N, Sancar M. et al. Pediatric patients with COVID-19: a retrospective single-center experience. Sisli Etfal Hastan Tip Bul 2022; 56 (01) 62-69
  • 13 Peaper DR, Murdzek C, Oliveira CR, Murray TS. Severe acute respiratory syndrome coronavirus 2 testing in children in a large regional US health system during the coronavirus disease 2019 pandemic. Pediatr Infect Dis J 2021; 40 (03) 175-181
  • 14 Cui X, Zhao Z, Zhang T. et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol 2021; 93 (02) 1057-1069
  • 15 Strutner J, Ramchandar N, Dubey S. et al. Comparison of reverse-transcription polymerase chain reaction cycle threshold values from respiratory specimens in symptomatic and asymptomatic children with severe acute respiratory syndrome Coronavirus 2 infection. Clin Infect Dis 2021; 73 (10) 1790-1794
  • 16 Berksoy E, Kanik A, Çiçek A. et al. Clinical and laboratory characteristics of children with SARS-CoV-2 infection. Pediatr Pulmonol 2021; 56 (12) 3674-3681
  • 17 Alp EE, Dalgic N, Yilmaz V, Altuntas Y, Ozdemir HM. Evaluation of patients with suspicion of COVID-19 in pediatric emergency department. Sisli Etfal Hastan Tip Bul 2021; 55 (02) 179-187
  • 18 Sedighi I, Fahimzad A, Pak N. et al. A multicenter retrospective study of clinical features, laboratory characteristics, and outcomes of 166 hospitalized children with coronavirus disease 2019 (COVID-19): A preliminary report from Iranian Network for Research in Viral Diseases (INRVD). Pediatr Pulmonol 2022; 57 (02) 498-507
  • 19 Molteni E, Sudre CH, Canas LS. et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health 2021; 5 (10) 708-718
  • 20 Garazzino S, Montagnani C, Donà D. et al; Italian SITIP-SIP Pediatric Infection Study Group, Italian SITIP-SIP SARS-CoV-2 paediatric infection study group*. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Euro Surveill 2020; 25 (18) DOI: 10.2807/1560-7917.es.2020.25.18.2000600.
  • 21 Zheng S, Fan J, Yu F. et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 2020; Published online DOI: 10.1136/bmj.m1443.
  • 22 Alkan G, Sert A, Emiroglu M, Tuter Oz SK, Vatansev H. Evaluation of hematological parameters and inflammatory markers in children with COVID-19. Ir J Med Sci 2022; 191 (04) 1725-1733
  • 23 Henry BM, Benoit SW, de Oliveira MHS. et al. Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): a pooled analysis and review. Clin Biochem 2020; 81: 1-8
  • 24 Yildiz E, Cigri E, Dincer Z, Narsat MA, Calisir B. High neutrophil/lymphocyte ratios in symptomatic pediatric COVID-19 patients. J Coll Physicians Surg Pak 2021; 31 (07) S93-S98
  • 25 Bari A, Ch A, Bano I, Saqlain N. Is leukopenia and lymphopenia a characteristic feature of COVID-19 in children?. Pak J Med Sci 2021; 37 (03) 869-873
  • 26 Liu XP, Guo MMH, Liu SF, Kuo HC. Comparison of laboratory data between children with COVID-19 and influenza. Kaohsiung J Med Sci 2021; 37 (02) 158-159
  • 27 Böncüoğlu E, Coşkun M, Kıymet E. et al. Can laboratory findings predict pulmonary involvement in children with COVID-19 infection?. Pediatr Pulmonol 2021; 56 (08) 2489-2494
  • 28 Chung E, Chow EJ, Wilcox NC. et al. Comparison of symptoms and RNA levels in children and adults with SARS-CoV-2 infection in the community setting. JAMA Pediatr 2021; 175 (10) e212025
  • 29 Polese-Bonatto M, Sartor ITS, Varela FH. et al; COVIDa Study Group. Children have similar reverse transcription polymerase chain reaction cycle threshold for severe acute respiratory syndrome Coronavirus 2 in comparison with adults. Pediatr Infect Dis J 2021; 40 (11) e413-e417
  • 30 Fox-Lewis A, Fox-Lewis S, Beaumont J. et al. SARS-CoV-2 viral load dynamics and real-time RT-PCR cycle threshold interpretation in symptomatic non-hospitalised individuals in New Zealand: a multicentre cross sectional observational study. Pathology 2021; 53 (04) 530-535
  • 31 Bullard J, Funk D, Dust K. et al. Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults. CMAJ 2021; 193 (17) E601-E606
  • 32 Liu Y, Yan LM, Wan L. et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis 2020; 20 (06) 656-657
  • 33 Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19). JAMA Pediatr 2020; 174 (09) 902-903
  • 34 Tom MR, Mina MJ. To interpret the SARS-CoV-2 test, consider the cycle threshold value. Clin Infect Dis 2020; 71 (16) 2252-2254
  • 35 Katsuta T, Shimizu N, Okada K. et al. The clinical characteristics of pediatric coronavirus disease 2019 in 2020 in Japan. Pediatr Int 2022; 64 (01) e14912