Gastrointestinal symptoms and fecal nucleic acid testing of children with coronavirus disease 2019: a systematic review and meta-analysis

Abstract

Objective: To understand the clinical manifestations and incidence of gastrointestinal symptoms of Coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.Methods: Retrospective analysis of studies of gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 since the outbreak of COVID-19, as well as prospective clinical studies and case reports to understand the clinical characteristics of gastrointestinal symptoms and feces in children. Nucleic acid detection results were also analyzed.Results: 1. The clinical manifestations of gastrointestinal symptoms in children with COVID-19 are mostly vomiting and diarrhea, with a total incidence rate of 21.1% (95%Cl=0.14-0.28).2.When analyzing by country (studies from China versus studies from other countries), the pooled prevalence of gastrointestinal symptoms in studies from countries other than China was much lower at 18.2% (95% CI0.05 to 0.31). This is in comparison to studies from China where the prevalence was higher: 23.3% (95% CI 0.153 to 0.310) .3.In Wuhan patients, the pooled prevalence was much higher at 41.2% (95 % CI 0.147 to 0.678) as compared to areas outside Wuhan，China：15.1%(95 % CI 0.075 to 0.227).4.Fecal nucleic acid detection is as accurate as respiratory specimen nucleic acid detection. The positive rate of fecal nucleic acid testing in COVID-19 patients was 92.5% (25/27). In patients where nucleic acid tests of respiratory tract specimens produced negative results, a positive fecal nucleic acid test result was present in 83.3% (20/24); one week after the respiratory tract specimen was nucleic acid-negative, 54.1% (13/24) were fecal nucleic acid-positive; two weeks after the respiratory tract nucleic acid negative test, 37.5% (9/24) were fecal nucleic acid-positive. The longest interval between a negative respiratory system result and positive fecal specimen result exceeded 19 days.Conclusions and Relevance: Gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.

Implications of SARS-COV-2 infection in the diagnosis and management of the pediatric gastrointestinal disease

“…A recent systematic review showed that digestive symptoms were present in 17.7% of a total of 3028 infected pediatric patients. Vomiting, nausea, diarrhea, and anorexia were the most common gastrointestinal symptoms [4]. Another very recent systematic review with meta-analysis reported an overall prevalence of anorexia of 18%, followed by diarrhea (15%), nausea and vomiting (10%), and abdominal pain (6%) [5].…”

“…Many pediatric COVID-19 patients have nasal obstruction, fever, runny nose, pharyngalgia, whereas signs of respiratory failure rarely occur [3]. Conversely, gastrointestinal symptoms have been demonstrated to be relatively common in pediatric COVID-19 patients [4]. Here we present a summary of: i) the current understanding of the gastrointestinal involvement in SARS-CoV-2 infected children and adolescents, and ii) the impact of COVID-19 on the clinical approach to patients with gastrointestinal disease, including diagnosis and treatment, and iii) the role and limited access to the instrumental diagnosis such as digestive endoscopy, in order to provide an overview of the clinical implications of COVID-19 for the pediatric gastroenterologist.…”

Misleading Results of Typhi Dot Test in COVID-19 Pandemic

“…Performing a typhi-dot test misleads the diagnosis of COVID-19 by cross-reactivity of antibodies and comes up as IgM positive for "Salmonella typhi". [7] The false positive of COVID-19 serological testing kits is raising false alarms. [7] In conclusion, we would like to advise as microbiologists and clinicians, that prescribing the correct test is an art and the latest guidelines should be followed by all registered medical and dental practitioners.…”

“…[7] The false positive of COVID-19 serological testing kits is raising false alarms. [7] In conclusion, we would like to advise as microbiologists and clinicians, that prescribing the correct test is an art and the latest guidelines should be followed by all registered medical and dental practitioners. Antibodies testing is flawed and presently no antibody testing is properly valid for COVID-19 and results of serology testing…”