key: cord-0884306-18pbd3hi authors: Lenoci, Giuseppe; Galante, Domenico; Ceci, Edmondo; Manzulli, Viviana; Moramarco, Angela Maria; Chiaromonte, Anna; Labarile, Giuseppina; Lattarulo, Simone; Resta, Annalisa; Pace, Lorenzo; Rondinone, Valeria; Parisi, Antonio; Cipolletta, Dora; Marino, Leonardo; Padalino, Iolanda; Serrecchia, Luigina; Aceti, Angela; Iatarola, Michela; Tolve, Francesco; Fasanella, Antonio title: Sars-CoV-2 isolation from a 10-day-old newborn in Italy: a case report date: 2020-09-17 journal: IDCases DOI: 10.1016/j.idcr.2020.e00960 sha: a6d5dae6fa826eb8e23c175024ffd5754b1b7b59 doc_id: 884306 cord_uid: 18pbd3hi This report describes the evolution of COVID-19 in a 10 day-old-baby. The mother developed the disease immediately after childbirth and therefore a vertical transmission can be excluded. The isolation of the virus in cell culture with a cytopathic effect already visible after 48 hours, indicates that the viral load of the newborn was quite high, but not serious course of the disease was observed. This paper wants to highlight the possible role of newborns and children in the spread of the disease. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. It is not yet clear why children, and especially newborns, are less susceptible to COVID-19 than adults [1] , despite viral infections being much more frequent from childhood onwards. One hypothesis is related to vaccinations that are carried out in the first weeks of life and which would favor an increase of a non-specific immunity related to an increase in inteleukin-2 (IL-2) or other factors not yet known [2] . Probably some interactions between the newborn and the most common respiratory viruses of childhood would stimulate an innate resistance to RNA viruses [3] . Another hypothesis concerns angiotensin-converting enzyme 2 (ACE2), a membrane-bound aminopeptidase which is highly expressed in pulmonary alveolar epithelial cells and small intestine enterocytes. Although ACE2 has been identified as a receptor for Sars-CoV-2, it is plausible that ACE2 tissue distribution differs between adults and children or that ACE2 binding capacity in children is lower than in adults [4] . One reason why infant do not develop severe forms of the disease could be due to the fact that the immune system of infants is not mature at all and therefore probably is not yet able to start the cytokine storm that occurs in COVID-19 infection of the adults [5] . In fact, from a clinical point of view, COVID-19 generally occurs in children with moderate or low fever accompanied by mild and non-specific symptoms. In some cases, gastrointestinal symptoms such as diarrhea, abdominal distension and aversion to food may occur in newborns [6] . Hypoxia and increased respiratory rate were recorded only in a small subgroup of children, which in severe cases does not respond to standard oxygen therapy and requires nasal cannula or mask. Based on the reported cases, most of these children have a benign course which resolves within 1-2 weeks after the onset of the disease. Infants with COVID-19 need more careful and cautious observation because they are more likely to present with non-specific symptoms such as lethargy and dehydration [4, 7, 8] . On 09 August 2020, a 34-year-old pregnant woman was admitted to the "Mater Dei" hospital (Bari, Apulia region, Italy) and following the standard procedures before the entrance was subjected to the nasopharyngeal swab for Sars-CoV-2 detection, resulting negative despite manifesting cold symptoms, but without fever. Also an internal reaction control was used in order to exclude a false negativity. On the same day the woman gave birth to a child weighing 3.100 Kg. Three days later mother and son came back home and after 10 days from the birth, the newborn developed lowgrade fever and mild respiratory symptoms. For this reason he was transferred to the pediatric hospital "Giovanni XXIII" (Bari, Apulia region, Italy), but he couldn't be hospitalized because he was less than 30 days old. On 20 August 2020 he was transferred to the neonatology department of The values of the complete blood count were normal e C reactive protein resulted negative. Moreover, was not revealed the presence of respiratory pathogens. Finally, it was decided to perform also the canonical nasopharyngeal swab to verify an eventual Sars-CoV-2 infection. The newborn manifested fever for 3 days following the admission and then the heath conditions resulted stable. The newborn almost certainly contracted Sars-CoV-2 from one member of the family, presumably the paternal grandmother who, most likely ,was infective in the days following the birth, when she went to visit the newborn at his home. We do not know if the newborn or another family member infected the others, but it's very interesting that the viral load of the newborn was very high as demonstrated either by PCR or by isolation of the virus. The cytopathic effect on the Vero E6 monolayer was already evident after 48 hours post inoculation and was much clearer after 72 hours ( Figure 1 ). Despite the high viral load, the newborn never showed serious symptoms except mild respiratory symptoms and a not high fever for 3 days following the admission to the pediatric hospital. This case confirms what has already been reported in other similar works, even in presence of high viral loads, newborns usually show relatively mild symptoms [9] . This case requires a reflection on the potentiality of Sars-CoV-2 transmission from newborns and children that, maybe, often is underestimated. Moreover, some traditional behaviors of the Italian population and in particular of Southern Italy, where it is customary to visit newborn children in the days immediately following the return home, can amplify the transmission of Sars-CoV-2 from unknown infected children. In fact, newborns living inside home environment can spreadlarge quantities of virus and lead to high levels of contamination, so as to be dangerous for anyone who comes into contact with them. It's unlikely that that infant would generate effective cough aerosols for infection, but however they can have infectious secretions such as stool or saliva as reported in literature [10, 11] . Therefore, the aim of this paper is to report that also from Sars-CoV-2 positive newborns is possible to isolate alive virus even in presence of moderate symptoms, as showed by the isolation on cell culture of this study, indicating that they could be dangerous for the dissemination of the virus. 2019-nCoV: polite with children! Pediatr Rep General non-specific morbidity is reduced after vaccination within the third month of life -the Greifswald study Innate immune evasion by human respiratory RNA viruses Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China epidemiology of COVID-19 among children in China Clinical features of patients infected with 2019 novel coronavirus in Wuhan SARS-CoV-2 infection in children: transmission dynamics and clinical characteristics Diagnosis and treatment recommendations for pediatric respiratory infection caused by the A Novel Coronavirus from Patients with Pneumonia in China Novel Coronavirus disease (COVID-19) in newborns and infants: what we know so far Detection of SARS-CoV-2 in different types of clinical specimens Consistent detection of 2019 novel coronavirus in saliva 1: Cytopathic effects consisting of rounding and detachment of cells in Vero E 6 cell cultures,72 hours after the inoculation of the virus from the swab medium All authors made substantial contributions to all of the following article, in particular: