COVID-19 bei Kindern und Jugendlichen

ZUSAMMENFASSUNG

Das neuartige Coronavirus SARS-CoV-2 ist der Auslöser von COVID-19, einer Erkrankung, die Millionen von Menschenleben weltweit bedroht. Ca. 10–20 % aller Erwachsenen mit COVID-19 entwickeln schwere oder lebensbedrohliche Verläufe, die von Akutem Atemnotsyndrom (ARDS), Koagulopathie und/oder Zytokinsturm gekennzeichnet sind. Kinder und Jugendliche haben ein geringeres Risiko, symptomatisch zu erkranken und/oder schwere Verläufe zu entwickeln, was vermuten lässt, dass es altersabhängige Wirtsmechanismen gibt, die schweren Verläufen entgegenwirken könnten. Obwohl kürzlich hochinflammatorische, teils lebensbedrohliche Erkrankungen bei Kindern und Jugendlichen beschrieben wurden und viel Beachtung fanden, bleiben sie insgesamt bisher relativ selten. Ob Kinder signifikant zur Transmission auf Populationsebene beitragen, ist unklar, muss aber zumindest weiter angenommen werden. Mehrere Hypothesen versuchen Unterschiede im Hinblick auf klinischen Verlauf und Erkrankungsrisiko zwischen den Altersgruppen und einzelnen Individuen zu erklären. Dieser Artikel fasst den aktuellen Wissensstand zur Immunpathogenese von COVID-19 mit Fokus auf das Kindes- und Jugendalter zusammen.

SUMMARY

SARS-CoV-2 is the pathogen causing COVID-19, a pandemic threatening millions of lives globally. Children and young people (CYP) usually do not develop severe disease. However, a minority of CYP contracting SARS-CoV-2 infections have been reported to develop severe hyper-inflammatory phenotypes. Host mechanisms centrally contribute to disease pathology and resulting clinical phenotypes. Several hypotheses try to explain age-related differences in disease presentation and severity, including prevalence of seasonal coronavirus infections in CYP and cross-relative antibodies, and co-clearance with other virus infections. Furthermore, high expression of transmembrane ACE2 may modulate inflammation in children while mediating infection of epithelial cells. Further protective mechanisms in CYP may include recent vaccinations and a diverse T cell repertoire. Thus, it remains an important, but unanswered question whether CYP significantly contribute to community transmission. Here, the authors review age-related host factors in COVID-19, and address the confusion around seropositivity and immunity.

Schlüsselwörter

COVID - SARS-CoV-2 - Kinder - Inflammation - Therapie - Pathologie

Keywords

COVID - SARS-CoV-2 - children - inflammation - treatment - pathology

Publikationsverlauf

Artikel online veröffentlicht:
02. November 2020

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