Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.

Gastrointestinal viral shedding in children with SARS-CoV-2: a systematic review and meta-analysis

“…However, based on the study by Cheung et al [ 40 ] on adult patients ( n = 4243), the pooled prevalence of fecal RNA was lower (54%). The lower prevalence might be due to the fact that children might present more often GI symptoms compared to adults, and a higher proportion of fecal SARS-CoV-2 RNA is observed in patients with GI manifestation [ 16 , 41 ].…”

“…SARS-CoV-2 RNA can be detected through GI specimens of children for more than 70 days. This prolonged shedding observed in pediatric cases also occurs in adults but to a less extent [ 41 ]. However, the duration of viral shedding might mainly be due to the host immune status leading to longer viral shedding [ 14 , 42 ].…”

The Infectious Bronchitis Coronavirus Pneumonia Model Presenting a Novel Insight for the SARS-CoV-2 Dissemination Route

“…Gastrointestinal manifestations are more common in patients with severe disease than in patients with non-severe disease. For approximately 48.1% of patients with severe acute respiratory syndrome COVID-19, a stool sample was positive for SARS-CoV-2 RNA virus [ 35 ]. This hypothesis [ 36 ] suggests that complications after COVID-19 could be caused by SARS-CoV-2-upregulated angiotensin II-caused disruption of mucosal barriers with following microbial and/or lipopolysaccharide movement from the gastrointestinal tract into various tissues.…”

SARS-CoV-2: Reinfection after 18 Months of a Previous Case with Multiple Negative Nasopharyngeal Swab Tests and Positive Fecal Molecular Test

“…On the other hand, many investigators have emphasized the importance of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors throughout the intestinal tract and how the virus can also replicate in the intestinal cells [ 16 , 17 , 18 ]. Some studies highlight this close connection between clinical manifestations and gastrointestinal or respiratory infection [ 19 , 20 , 21 ]. One of these is the case report of an 80-year-old man who was vaccinated and had gastrointestinal manifestations typical of severe acute respiratory syndrome coronavirus infection (SARS-CoV-2) but was nasopharyngeal molecular negative on tests obtained by real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR).…”