• Julija Ivanovska Institute for Respiratory Diseases in Children-Kozle, Skopje, North Macedonia
  • Hristijan Nestorov Institute for Respiratory Diseases in Children-Kozle, Skopje, North Macedonia
  • Gorica Popova Institute for Respiratory Diseases in Children-Kozle, Skopje, Faculty of Medicine, Goce Delcev University in Stip, North Macedonia
  • Irena Chakalarovska Institute for Respiratory Diseases in Children-Kozle, Skopje, Faculty of Medicine, ss. Cyril and Methodius University in Skopje, North Macedonia
  • Sandra Petlichkovska Institute for Respiratory Diseases in Children-Kozle, Skopje, North Macedonia
  • Katerina Boskovska Institute for Respiratory Diseases in Children-Kozle, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje,North Macedonia


Down syndrome (DS) is the most common genetic disease and presents with cognitive impairment, cardiac and gastrointestinal abnormalities, increased risk of hematological malignancy and several autoimmune conditions in addition to other miscellaneous clinical conditions. Children with DS are at increased risk for more severe presentations of COVID-19 because of that efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population. The aim of these case reports is to show if the comorbidities that these children have, including cardiovascular anomalies, obesity, and/or obstructive sleep apnoea [7,8], were risk factors for more severe form of COVID-19. Case number 1:In September 2021 , a 14 year old girl with Down Sy was admitted to our hospital due to fever, cough, myalgia and shortness of breath . She tested positive for SARS-CoV-2. The patient had foramen ovale apertum after birth with spontaneous closure, and recurrent respiratory infections. At admission she was afebrile, pale, with frequent productive cough, dyspnеic with low Oxygen saturation, auscultatory with bilateral pneumonic finding. She had chest X-ray with bilateral pericardial areas of consolidation (multifocal opacities) in peripheral and in the lower lobes, and elevated IL6. She was treated for 20 days with antibiotics, broncholidators, Remdesivir, LMWH, and oxygen therapy. There was slow withdrawal of the the auscultatory lung finding. Case number 2: In March 2022 , a 5 year old boy with Down Sy was admitted to our hospital due to fever, rhinorrhea, vomiting , dehydratation , cough, tested positive for SARS-CoV-2 . At admission he was subfebrile, pale with moderate dehydration with dry buccal mucous membranes, tachycardia, sunken eyes ,hypotonic auscultatory on the lungs with pneumonic finding. Chest X-ray showed patchy areas of consolidation in right pericardial area. He was treated with intravenous (IV) fluid, antibiotic and inhaled bronchodilator. There was withdrawal of the auscultatory lung finding during the 10 days of hospital stay. Case number 3: In March 2022, a 6 year old boy with Down Sy was admitted to our hospital due to fever, laryngitis with hoarseness, dry cough, dehydratation, He had Type 1 insulin-dependent, diabetes mellitus (Type 1 DM) diagnosed at age of 5. He was febrile, pale , dehydrated with hoarseness, laryngeal cough auscultatory vesicular breathing with bubbly crackles. Blood gases (ABG) was suggestive of compensatory metabolic acidosis , urine with ketonuria and glycosuria. Chest X-ray: patchy areas of consolidation in right lower lung zones. Treatment was started with IV fluid, topic corticosteroids and the regular insulin therapy. There was withdrawal of the symptoms during the 8 days of hospital stay.
Conclusion: Children with Down Sy are always a high risk group for more severe and prolonged course of disease, which are partially attributed to defects of the immune system.

Key words: children, Covid - 19, Down syndrom



1. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al.Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol. (2010).
2. Ni She R, Filan PM. Trisomy 21–incidence and outcomes in the first year, in Ireland today. Ir Med J. (2014) 107:248–9.88:1008–16. doi: 10.1002/bdra.2073511.
3. van Trotsenburg AS, Heymans HS, Tijssen JG, de Vijlder JJ, Vulsma T. Comorbidity, hospitalization, and medication use and their influence on mental and motor development of young infants with Down syndrome. Pediatrics. (2006) 118:1633–9. doi: 10.1542/peds.2006-1136.
4.da Rosa Utiyama SR, Nisihara RM, Nass FR, Oliveira NP, Fiedler PT, de Messias-Reason IT. Autoantibodies in patients with Down Syndrome: early senescence of the immune system or precocious markers for immunological diseases? J Paediatr Child Health. (2008) 44:182–6. doi: 10.1111/j.1440-1754.2007.01229.x.
5. de Weerd NA, Nguyen T. The interferons and their receptors- istribution and regulation. Immunol Cell Biol. 2012;90:48391
6 Altable M, de la Serna JM. Down’s syndrome and COVID-19: risk or protection factor against infection? A molecular and genetic approach.Neurol Sci. 2021;42(2):407–13. https://doi. org/10.1007/s10072-020-04880-x.
7. Kantar A., Mazza A., Bonanomi E., Odoni M., Seminara M., Verde I.D., Lovati C., Bolognini S., D’Antiga L. COVID-19 and children with Down Syndrome: Is there any real reason to worry? Two case reports with severe course. BMC Pediatr. 2020;20:561. doi: 10.1186/s12887-020-02471-5. [PMC free article] [PubMed] [CrossRef] [Google Scholar].
8. Newman A.M., Jhaveri R., Patel A.B., Tan T.Q., Toia J.M., Arshad M. Trisomy 21 and Coronavirus Disease 2019 in Pediatric Patients. J. Pediatr. 2021;228:294–296. doi: 10.1016/j.jpeds.2020.08.067. [PMC free article] [PubMed] [CrossRef] [Google Scholar].
9. Hüls, A.; Costa, A.; Dierssen, M.; Baksh, A.; Bargagna, S.; Baumer, N. An International Survey on the Impact of COVID-19 in Individuals with Down Syndrome. MedXRiv (Preprint) 2020.
10. Palaiodimos, L.; Kokkinidis, D.G.; Li, W.; Karamanis, D.; Ognibene, J.; Arora, S.; Southern, W.N.; Mantzoros, C.S. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism 2020, 108, 154262. [CrossRef].
11. Docherty, A.B.; Harrison, E.M.; Green, C.A.; Hardwick, H.E.; Pius, R.; Norman, L.; Holden, K.A.; Read, J.M.; Dondelinger, F.; Carson, G.; et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ 2020, 369, m1985. [CrossRef] [PubMed] .
12. U. S. Krishnan, S. S. Krishnan, S. Jain et al., “SARS-CoV-2 infection in patients with Down syndrome, congenital heart disease, and pulmonary hypertension: is Down syndrome a risk factor?” =e Journal of Pediatrics, vol. 225, pp. 246–248, 2020.
How to Cite
IVANOVSKA, Julija et al. COVID-19 IN CHILDREN WITH DOWN SYNDROME - CASE SERIES. Journal of Morphological Sciences, [S.l.], v. 6, n. 2, p. 93-97, nov. 2023. ISSN 2545-4706. Available at: <>. Date accessed: 19 june 2024.