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Jamalvi SA, Rauf SA, Sherali A, Ali SK, Shah HH, Jamalvi F, Yogeeta F, Dave T. COVID-19 presenting as severe acute hepatitis in a pediatric patient with thalassemia minor: A case report. Clin Case Rep 2024; 12:e8955. [PMID: 38799536 PMCID: PMC11126642 DOI: 10.1002/ccr3.8955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical Message This case emphasizes the significance of COVID-19 in pediatric patients presenting with unusual hepatic manifestations, urging clinicians to broaden their diagnostic lens. The unexpected elevation of SARS-CoV-2 antibodies and the effective use of N-acetyl cysteine highlight the importance of adaptability in treatment strategies. Abstract This case report presents a unique manifestation of severe hepatic involvement in a 4-year-old girl with thalassemia minor and COVID-19. Despite the absence of prominent respiratory symptoms, the patient exhibited jaundice, elevated liver enzymes, and coagulopathy. Initial suspicion of viral hepatitis was replaced by the discovery of significantly elevated SARS-CoV-2 antibodies. A multidisciplinary approach, including gastroenterology consultation and an extensive workup, was pivotal in ruling out alternative etiologies. Unconventional use of N-acetyl cysteine contributed to clinical improvement, highlighting the need for adaptable treatment strategies. This case underscores the importance of heightened awareness in recognizing atypical presentations of COVID-19 in pediatric patients, especially those with underlying health conditions. Further exploration into nuanced manifestations and treatment approaches is warranted for comprehensive clinical management.
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Affiliation(s)
- Syed Abdan Jamalvi
- Department of Internal MedicineLiaquat National Medical CollegeKarachiPakistan
| | - Sameer Abdul Rauf
- Department of Internal MedicineLiaquat National Medical CollegeKarachiPakistan
| | - Atika Sherali
- Department of PediatricsLiaquat National Medical CollegeKarachiPakistan
| | - Syed Khizar Ali
- Department of Internal MedicineLiaquat National Medical CollegeKarachiPakistan
| | - Hussain Haider Shah
- Department of Internal MedicineLiaquat National Medical CollegeKarachiPakistan
| | - Filza Jamalvi
- Department of Internal MedicineLiaquat National Medical CollegeKarachiPakistan
| | - Fnu Yogeeta
- Department of Internal MedicineLiaquat National Medical CollegeKarachiPakistan
| | - Tirth Dave
- Bukovinian State Medical UniversityChernivtsiUkraine
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Trandafir LM, Spoiala EL, Ghiga G, Gimiga N, Budescu PD, Lupu VV, Butnariu L, Cojocaru E, Paduraru G. Impact of COVID-19 on Pediatric Inflammatory Bowel Diseases-From Expectations to Reality. J Pers Med 2024; 14:399. [PMID: 38673026 PMCID: PMC11051136 DOI: 10.3390/jpm14040399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Viral infections have always been considered a threat to global health, with numerous outbreaks across time. Despite the relative recent experience with coronavirus-associated diseases such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), severe acute respiratory syndrome-2's (SARS-CoV-2) continuous evolution displays a different behavior. With a tropism for both respiratory and digestive mucosa, coronavirus disease 2019 (COVID-19) and inflammatory bowel disease (IBD) seem to share a particular common background. Current literature offers evidence that viral alteration of the immune system, inflammatory intestinal tissue damage, increased intestinal permeability, incomplete viral clearance with viral antigen persistence, and intestinal dysbiosis, might explain SARS-CoV-2-IBD relationship in terms of etiopathogenesis and evolution. The hyperinflammatory state that both entities have in common explains the lack of success of current IBD therapy, raising the need for new personalized therapeutic options, with better outcomes for IBD and COVID-19 as well. This review aims to summarize the current available data on pediatric IBD evolution, management, and outcomes in the post-COVID period, with an emphasis on the particular aspects of the SARS-CoV-2-IBD relationship in children.
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Affiliation(s)
- Laura Mihaela Trandafir
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Elena Lia Spoiala
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Gabriela Ghiga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Nicoleta Gimiga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Paula-Diana Budescu
- Saint Mary Children Hospital, Vasile Lupu Street, no 62-64, 700309 Iasi, Romania;
| | - Vasile Valeriu Lupu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Lacramioara Butnariu
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Elena Cojocaru
- Morpho-Functional Sciences II Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Gabriela Paduraru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
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Ahmed IS, Tapponi SL, Widatallah ME, Alakkad YM, Haider M. Unmasking the enigma: An in-depth analysis of COVID-19 impact on the pediatric population. J Infect Public Health 2023; 16:1346-1360. [PMID: 37433256 PMCID: PMC10299956 DOI: 10.1016/j.jiph.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES COVID-19, caused by the novel coronavirus, has had a profound and wide-reaching impact on individuals of all age groups across the globe, including children. This review article aims to provide a comprehensive analysis of COVID-19 in children, covering essential topics such as epidemiology, transmission, pathogenesis, clinical features, risk factors, diagnosis, treatment, vaccination, and others. By delving into the current understanding of the disease and addressing the challenges that lie ahead, this article seeks to shed light on the unique considerations surrounding COVID-19 in children and contribute to a deeper comprehension of this global health crisis affecting our youngest population. METHODS A comprehensive literature search was conducted to gather the most recent and relevant information regarding COVID-19 in children. Multiple renowned databases, including MEDLINE, PubMed, Scopus, as well as authoritative sources such as the World Health Organization (WHO), the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the National Institutes of Health (NIH) websites and others were thoroughly searched. The search included articles, guidelines, reports, clinical trials results and expert opinions published within the past three years, ensuring the inclusion of the latest research findings on COVID-19 in children. Several relevant keywords, including "COVID-19," "SARS-CoV-2," "children," "pediatrics," and related terms were used to maximize the scope of the search and retrieve a comprehensive set of articles. RESULTS AND CONCLUSION Three years since the onset of the COVID-19 pandemic, our understanding of its impact on children has evolved, but many questions remain unanswered. While SAR-CoV-2 generally leads to mild illness in children, the occurrence of severe cases and the potential for long-term effects cannot be overlooked. Efforts to comprehensively study COVID-19 in children must continue to improve preventive strategies, identify high-risk populations, and ensure optimal management. By unraveling the enigma surrounding COVID-19 in children, we can strive towards safeguarding their health and well-being in the face of future global health challenges.
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Affiliation(s)
- Iman Saad Ahmed
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Sara Luay Tapponi
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Marwa Eltahir Widatallah
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Yumna Mohamed Alakkad
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Mohamed Haider
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
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Bitar R, Elghoudi AA, Rawat D, Azaz A, Miqdady M, Narchi H. COVID-19-induced liver injury in infants, children, and adolescents. World J Clin Pediatr 2023; 12:57-67. [PMID: 37342451 PMCID: PMC10278079 DOI: 10.5409/wjcp.v12.i3.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 06/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms in children. Most children develop an asymptomatic and mild illness, with a minority requiring specialist medical care. Gastrointestinal manifestations and liver injury can also occur in children following infection. The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion, immune response, or medication effects. Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease. However, the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes. On the other hand, the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor. Respiratory, hemodynamic, and nutritional supportive therapies are the mainstay of management. Vaccination of children at increased risk of developing severe COVID-19 disease is indicated. This review describes the liver manifestations in children with COVID-19, detailing its epidemiology, basic mechanisms, clinical expression, management, and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.
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Affiliation(s)
- Rana Bitar
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ahmed A Elghoudi
- Department of Pediatric, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - David Rawat
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Amer Azaz
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohamad Miqdady
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Röckert Tjernberg A, Malmborg P, Mårild K. Coronavirus disease 2019 and gastrointestinal disorders in children. Therap Adv Gastroenterol 2023; 16:17562848231177612. [PMID: 37305380 PMCID: PMC10243097 DOI: 10.1177/17562848231177612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
During the past 3 years, the coronavirus disease 2019 (COVID-19) pandemic has had a great impact on people all over the world. However, it has become evident that disease manifestations and severity differ across age groups. Most children have a milder disease course than adults but possibly more pronounced gastrointestinal (GI) symptoms. Given the child's developing immune system, the impact of COVID-19 on disease development may differ compared to adults. This study reviews the potential bi-directional relationship between COVID-19 and GI diseases in children, focusing on common pediatric conditions such as functional GI disorders (FGID), celiac disease (CeD), and inflammatory bowel disease (IBD). Children with GI diseases, in general, and CeD and IBD, in particular, do not seem to have an increased risk of severe COVID-19, including risks of hospitalization, critical care need, and death. While infections are considered candidate environmental factors in both CeD and IBD pathogenesis, and specific infectious agents are known triggers for FGID, there is still not sufficient evidence to implicate COVID-19 in the development of either of these diseases. However, given the scarcity of data and the possible latency period between environmental triggers and disease development, future investigations in this field are warranted.
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Affiliation(s)
- Anna Röckert Tjernberg
- Department of Pediatrics, Kalmar County Hospital, Region Kalmar County, Kalmar S-391 85, Sweden
| | - Petter Malmborg
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karl Mårild
- Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
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Geng Y, Nie Q, Liu F, Pei Y, Chen Q, Zhang H, Zhou H, Zhou J, Jiang H, Xu J. Understanding clinical characteristics influencing adverse outcomes of Omicron infection: a retrospective study with propensity score matching from a Fangcang hospital. Front Cell Infect Microbiol 2023; 13:1115089. [PMID: 37228665 PMCID: PMC10203467 DOI: 10.3389/fcimb.2023.1115089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives The epidemic of coronavirus disease 2019 (COVID-19) is causing global health concerns. The aim of this study was to evaluate influence of clinical characteristics on outcomes during the Omicron outbreak. Methods A total of 25182 hospitalized patients were enrolled, including 39 severe patients and 25143 non-severe patients. Propensity score matching (PSM) was applied to balance the baseline characteristics. Logistic regression analysis was used to assess the risk of severe disease, as well as the risk of prolonged viral shedding time (VST) and increased length of hospital stay (LOS). Results Before PSM, patients in the severe group were older, had higher symptom scores, and had a higher proportion of comorbidities (p<0.001). After PSM, there were no significant differences in age, gender, symptom score and comorbidities between severe (n=39) and non-severe (n=156) patients. Symptoms of fever (OR=6.358, 95%CI 1.748-23.119, p=0.005) and diarrhea (OR=6.523, 95%CI 1.061-40.110, p=0.043) were independent risk factors for development of severe disease. In non-severe patients, higher symptom score was associated with prolonged VST (OR=1.056, 95% CI 1.000-1.115, p=0.049) and LOS (OR=1.128, 95% CI 1.039-1.225, p=0.004); older age was associated with longer LOS (OR=1.045, 95% CI 1.007-1.084, p=0.020). Conclusion The overall condition of the Shanghai Omicron epidemic was relatively mild. Potential risk factors for fever, diarrhea, and higher symptom score can help clinicians to predict clinical outcomes in COVID-19 patients.
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Affiliation(s)
- Yanxia Geng
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Qingfang Nie
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Feifei Liu
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yinghao Pei
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Qiuhua Chen
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haidong Zhang
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Haiqi Zhou
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jiang Zhou
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Hua Jiang
- Department of Intensive Care Unit, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jing Xu
- Department of Nosocomial Infection Control, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
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Saviano A, Brigida M, Petruzziello C, Zanza C, Candelli M, Morabito Loprete MR, Saleem F, Ojetti V. Intestinal Damage, Inflammation and Microbiota Alteration during COVID-19 Infection. Biomedicines 2023; 11:biomedicines11041014. [PMID: 37189632 DOI: 10.3390/biomedicines11041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The virus SARS-CoV-2 is responsible for respiratory disorders due to the fact that it mainly infects the respiratory tract using the Angiotensin-converting enzyme 2 (ACE2) receptors. ACE2 receptors are also highly expressed on intestinal cells, representing an important site of entry for the virus in the gut. Literature studies underlined that the virus infects and replicates in the gut epithelial cells, causing gastrointestinal symptoms such as diarrhea, abdominal pain, nausea/vomiting and anorexia. Moreover, the SARS-CoV-2 virus settles into the bloodstream, hyperactivating the platelets and cytokine storms and causing gut–blood barrier damage with an alteration of the gut microbiota, intestinal cell injury, intestinal vessel thrombosis leading to malabsorption, malnutrition, an increasing disease severity and mortality with short and long-period sequelae. Conclusion: This review summarizes the data on how SARS-CoV-2 effects on the gastrointestinal systems, including the mechanisms of inflammation, relationship with the gut microbiota, endoscopic patterns, and the role of fecal calprotectin, confirming the importance of the digestive system in clinical practice for the diagnosis and follow-up of SARS-CoV-2 infection.
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Abstract
SARS-CoV-2 is the viral agent of COVID-19, a pandemic that surfaced in 2019. Although predominantly a respiratory ailment, patients with COVID-19 can have gastrointestinal (GI) and hepatobiliary manifestations. These manifestations are often mild and transient, but they can be severe and consequential. In the GI tract, ischemic enterocolitis is the most common and significant consequence of COVID-19. In the liver, the reported pathologic findings may often be related to consequences of severe systemic viral infection, but reports of hepatitis presumed to be due to SARS-CoV-2 suggest that direct viral infection of the liver may be a rare complication of COVID-19. In both the GI tract and liver, lingering symptoms of GI or hepatic injury after resolution of pulmonary infection may be part of the evolving spectrum of long COVID.
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Affiliation(s)
- Angela R Shih
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Joseph Misdraji
- Department of Pathology, Yale New Haven Hospital, Yale University, New Haven, CT, 06510, USA.
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10
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Bacorn M, Romero-Soto HN, Levy S, Chen Q, Hourigan SK. The Gut Microbiome of Children during the COVID-19 Pandemic. Microorganisms 2022; 10:microorganisms10122460. [PMID: 36557713 PMCID: PMC9783902 DOI: 10.3390/microorganisms10122460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
The gut microbiome has been shown to play a critical role in maintaining a healthy state. Dysbiosis of the gut microbiome is involved in modulating disease severity and potentially contributes to long-term outcomes in adults with COVID-19. Due to children having a significantly lower risk of severe illness and limited sample availability, much less is known about the role of the gut microbiome in children with COVID-19. It is well recognized that the developing gut microbiome of children differs from that of adults, but it is unclear if this difference contributes to the different clinical presentations and complications. In this review, we discuss the current knowledge of the gut microbiome in children with COVID-19, with gut microbiome dysbiosis being found in pediatric COVID-19 but specific taxa change often differing from those described in adults. Additionally, we discuss possible mechanisms of how the gut microbiome may mediate the presentation and complications of COVID-19 in children and the potential role for microbial therapeutics.
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Einerhand AWC, van Loo-Bouwman CA, Weiss GA, Wang C, Ba G, Fan Q, He B, Smit G. Can Lactoferrin, a Natural Mammalian Milk Protein, Assist in the Battle against COVID-19? Nutrients 2022; 14:nu14245274. [PMID: 36558432 PMCID: PMC9782828 DOI: 10.3390/nu14245274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Notwithstanding mass vaccination against specific SARS-CoV-2 variants, there is still a demand for complementary nutritional intervention strategies to fight COVID-19. The bovine milk protein lactoferrin (LF) has attracted interest of nutraceutical, food and dairy industries for its numerous properties-ranging from anti-viral and anti-microbial to immunological-making it a potential functional ingredient in a wide variety of food applications to maintain health. Importantly, bovine LF was found to exert anti-viral activities against several types of viruses, including certain SARS-CoV-2 variants. LF's potential effect on COVID-19 patients has seen a rapid increase of in vitro and in vivo studies published, resulting in a model on how LF might play a role during different phases of SARS-CoV-2 infection. Aim of this narrative review is two-fold: (1) to highlight the most relevant findings concerning LF's anti-viral, anti-microbial, iron-binding, immunomodulatory, microbiota-modulatory and intestinal barrier properties that support health of the two most affected organs in COVID-19 patients (lungs and gut), and (2) to explore the possible underlying mechanisms governing its mode of action. Thanks to its potential effects on health, bovine LF can be considered a good candidate for nutritional interventions counteracting SARS-CoV-2 infection and related COVID-19 pathogenesis.
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Affiliation(s)
| | | | | | - Caiyun Wang
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot 010110, China
| | - Genna Ba
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Qicheng Fan
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Baoping He
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot 010110, China
| | - Gerrit Smit
- Yili Innovation Center Europe, 6708 WH Wageningen, The Netherlands
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12
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Shakeel F, Asad M, Zafar F, akhtar N, Ahmad H, Shafiq Z. Bioinspired NC Coated BM‐ZIF for Electrochemical Monitoring of Adrenaline from Blood and Pharmaceutical Samples. ELECTROANAL 2022. [DOI: 10.1002/elan.202200128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Farhan Zafar
- COMSATS Institute of Information Technology - Lahore Campus PAKISTAN
| | - Naeem akhtar
- COMSATS University Islamabad - Lahore Campus PAKISTAN
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13
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Ailioaie LM, Ailioaie C, Litscher G, Chiran DA. Celiac Disease and Targeting the Molecular Mechanisms of Autoimmunity in COVID Pandemic. Int J Mol Sci 2022; 23:ijms23147719. [PMID: 35887067 PMCID: PMC9322892 DOI: 10.3390/ijms23147719] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/16/2022] Open
Abstract
Celiac disease (CD) comprises over 1% of the world’s population and is a chronic multisystem immune-mediated condition manifested by digestive and/or extradigestive symptoms caused by food intake of gluten. This review looked at the risk of children diagnosed with CD developing SARS-CoV-2 infection and possible severe forms of COVID-19. A better understanding of the interaction and effects of SARS-CoV-2 infection in CD is very important, as is the role of environmental and genetic factors, but especially the molecular mechanisms involved in modulating intestinal permeability with impact on autoimmunity. CD inspired the testing of a zonulin antagonist for the fulminant form of multisystem inflammatory syndrome in children (MIS-C) and paved the way for the discovery of new molecules to regulate the small intestine barrier function and immune responses. Original published works on COVID-19 and CD, new data and points of view have been analyzed because this dangerous virus SARS-CoV-2 is still here and yet influencing our lives. Medical science continues to focus on all uncertainties triggered by SARS-CoV-2 infection and its consequences, including in CD. Although the COVID-19 pandemic seems to be gradually extinguishing, there is a wealth of information and knowledge gained over the last two years and important life lessons to analyze, as well as relevant conclusions to be drawn to deal with future pandemics. Zonulin is being studied extensively in immunoengineering as an adjuvant to improving the absorption of new drugs and oral vaccines.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, Traditional Chinese Medicine (TCM) Research Center Graz, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-83907
| | - Dragos Andrei Chiran
- Department of Morpho-Functional Sciences I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii St., 700115 Iasi, Romania;
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Ailioaie LM, Ailioaie C, Litscher G, Chiran DA. Celiac Disease and Targeting the Molecular Mechanisms of Autoimmunity in COVID Pandemic. Int J Mol Sci 2022. [PMID: 35887067 DOI: 10.3390/ijms23147719.pmid:35887067;pmcid:pmc9322892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Celiac disease (CD) comprises over 1% of the world's population and is a chronic multisystem immune-mediated condition manifested by digestive and/or extradigestive symptoms caused by food intake of gluten. This review looked at the risk of children diagnosed with CD developing SARS-CoV-2 infection and possible severe forms of COVID-19. A better understanding of the interaction and effects of SARS-CoV-2 infection in CD is very important, as is the role of environmental and genetic factors, but especially the molecular mechanisms involved in modulating intestinal permeability with impact on autoimmunity. CD inspired the testing of a zonulin antagonist for the fulminant form of multisystem inflammatory syndrome in children (MIS-C) and paved the way for the discovery of new molecules to regulate the small intestine barrier function and immune responses. Original published works on COVID-19 and CD, new data and points of view have been analyzed because this dangerous virus SARS-CoV-2 is still here and yet influencing our lives. Medical science continues to focus on all uncertainties triggered by SARS-CoV-2 infection and its consequences, including in CD. Although the COVID-19 pandemic seems to be gradually extinguishing, there is a wealth of information and knowledge gained over the last two years and important life lessons to analyze, as well as relevant conclusions to be drawn to deal with future pandemics. Zonulin is being studied extensively in immunoengineering as an adjuvant to improving the absorption of new drugs and oral vaccines.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, Traditional Chinese Medicine (TCM) Research Center Graz, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
| | - Dragos Andrei Chiran
- Department of Morpho-Functional Sciences I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii St., 700115 Iasi, Romania
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15
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Akaishi T, Takahashi T, Sato S, Jin X, Masamune A, Ishii T. Prolonged Diarrhea Following COVID-19 Vaccination: A Case Report and Literature Review. TOHOKU J EXP MED 2022; 257:251-259. [PMID: 35644543 DOI: 10.1620/tjem.2022.j043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Vaccination against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently underway across countries worldwide. However, the prevalence and characteristics of prolonged adverse events lasting for several months after receiving the vaccine remain largely unknown. We herein report a 46-year-old woman with prolonged diarrhea and vomiting after receiving the BNT162b2 mRNA vaccine for COVID-19. She had no notable medical history, including that of gastrointestinal diseases. She developed vomiting several hours after receiving the first vaccine dose and further developed severe diarrhea after 7 days. Several days after the second vaccine dose, her condition deteriorated, unrelieved by symptomatic therapies, including anti-diarrheal drugs. Abdominal computed tomography (CT) revealed inflammatory changes in the entire segment of the small intestine with wall thickening. The upper and lower gastrointestinal and capsule endoscopies were unremarkable. The patient's symptoms persisted for more than 6 months after the second vaccine dose. A Vaccine Adverse Event Reporting System (VAERS) database search suggested that diarrhea is observed in approximately 3% of all vaccine recipients, but a literature review indicated that prolonged gastrointestinal symptoms lasting for several months is very rare. In summary, a case of prolonged unexplained gastrointestinal symptoms, possibly based on inflammatory changes in the small intestine, is described. A literature search revealed that this type of manifestation is very rare, and further evidence is needed to determine the causality between vaccination and gastrointestinal symptoms.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Division of General Medicine, Tohoku University Hospital
| | - Takahiro Takahashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Satoko Sato
- Department of Pathology, Tohoku University Hospital
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Division of General Medicine, Tohoku University Hospital
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16
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Uribe M, Panduro A, DuPont G, Fierro NA. Clues to decipher the origin of severe acute hepatitis in children: a new enigma during the COVID-19 pandemic. Ann Hepatol 2022; 27:100731. [PMID: 35786447 DOI: 10.1016/j.aohep.2022.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050 Mexico City, Mexico
| | - Arturo Panduro
- Department of Genomic Medicine in Hepatology, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Hospital Civil de Guadalajara, Hospital278, Col. El Retiro Z.C. 44280 Guadalajara, Jalisco, Mexico
| | - Gisela DuPont
- Department of Immunology, Biomedical Research Institute, National Autonomous University of Mexico, Ciudad Universitaria Z.C. 045210 Mexico City, Mexico
| | - Nora A Fierro
- Department of Immunology, Biomedical Research Institute, National Autonomous University of Mexico, Ciudad Universitaria Z.C. 045210 Mexico City, Mexico.
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17
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Masachessi G, Castro G, Cachi AM, Marinzalda MDLÁ, Liendo M, Pisano MB, Sicilia P, Ibarra G, Rojas RM, López L, Barbás G, Cardozo D, Ré VE, Nates SV. Wastewater based epidemiology as a silent sentinel of the trend of SARS-CoV-2 circulation in the community in central Argentina. WATER RESEARCH 2022; 219:118541. [PMID: 35584586 PMCID: PMC9066365 DOI: 10.1016/j.watres.2022.118541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 05/08/2023]
Abstract
Monitoring wastewater for the traces of viruses allows effective surveillance of entire communities, including symptomatic and asymptomatic infected individuals, providing information on whether a specific pathogen is circulating in a population. In the context of the COVID-19 pandemic, 261 wastewater samples from six communities of the province of Córdoba, Argentina were analyzed. From mid-May 2020 to the end of August 2021, raw sewage samples were collected from the central network pipe that enters into the Wastewater Treatment Plants (WWTP) in Córdoba city and five communities in the Punilla Valley. SARS-CoV-2 was concentrated by using the polyethylene glycol-6000 precipitation method. Viral genomes were extracted from concentrated samples, and N- and E-SARS-CoV-2 genes were detected by using real time RT-PCR. Wastewater samples that resulted positive for SARS-CoV-2 genome detection were subjected to viral variants of concern (VOCs) identification by real time RT-PCR. Overall, just by using the identification of the N gene or E gene, the rates of viral genome detection were 43.4% (86/198) and 51.5% (102/198) respectively, and by using both methodologies (positivity criterion: detection of N and / or E gene), the detection rate was 71.2% (141/198). Thereby, the optimal strategy to study the SARS-CoV-2 genome in wastewater would be the use of the combined detection of both genes. Detection of SARS-CoV-2 variants in wastewater reflected their circulation in the community, showing no VOCs detection in the first COVID-19 wave and their co-circulation with Gamma, Alpha and Delta VOCs during 2021. Therefore, SARS-CoV-2 Wastewater Based Epidemiology (WBE) described the introduction, permanence and/or the co-circulation of viral variants in the community. In geographical areas with a stable population, SARS-CoV-2 WBE could be used as an early warning sign of new COVID-19 cases, whereas in localities with a low number of inhabitants and high tourist influx, WBE may only be useful to reflect the circulation of the virus in the community. Overall, the monitoring of SARS-CoV-2 in wastewater can become a silent sentinel of the trend of viral circulation in the community, providing supplementary information for clinical surveillance to support public health measures.
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Affiliation(s)
- Gisela Masachessi
- Instituto de Virología Dr. J. M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gómez s/n, Ciudad Universitaria, Córdoba X5000, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, CABA C1425FQB, Argentina.
| | - Gonzalo Castro
- Departamento Laboratorio Central, Ministerio de Salud de la Provincia de Córdoba, T. Cáceres de Allende 421, Córdoba X5000HVE, Argentina
| | - Ariana Mariela Cachi
- Instituto Nacional de Medicina Aeronáutica y Espacial, FAA, Av. Fuerza Aérea Argentina Km 6 1/2 S/N B.0 Civico, Córdoba X5010, Argentina; Facultad de la Fuerza Aérea, Universidad de la Defensa Nacional, Av. Fuerza Aerea Argentina 5011, Córdoba X5000, Argentina
| | - María de Los Ángeles Marinzalda
- Instituto Nacional de Medicina Aeronáutica y Espacial, FAA, Av. Fuerza Aérea Argentina Km 6 1/2 S/N B.0 Civico, Córdoba X5010, Argentina; Facultad de la Fuerza Aérea, Universidad de la Defensa Nacional, Av. Fuerza Aerea Argentina 5011, Córdoba X5000, Argentina
| | - Matías Liendo
- Instituto de Virología Dr. J. M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gómez s/n, Ciudad Universitaria, Córdoba X5000, Argentina
| | - María Belén Pisano
- Instituto de Virología Dr. J. M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gómez s/n, Ciudad Universitaria, Córdoba X5000, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, CABA C1425FQB, Argentina
| | - Paola Sicilia
- Departamento Laboratorio Central, Ministerio de Salud de la Provincia de Córdoba, T. Cáceres de Allende 421, Córdoba X5000HVE, Argentina
| | - Gustavo Ibarra
- Planta Municipal de tratamiento de efluente cloacales Bajo Grande-Laboratorio de análisis fisicoquímicos, bacteriológicos EDAR Bajo Grande, Cam. Chacra de la Merced 901, Córdoba X5000, Argentina
| | - Ricardo Manuel Rojas
- Cooperativa Integral Regional de Provisión de Servicios Públicos, Vivienda y Consumo Limitada (COOPI), Moreno 78, Villa Carlos Paz, X5152 Córdoba, Argentina
| | - Laura López
- Área de Epidemiología, Ministerio de Salud de la Provincia de Córdoba, Av. Vélez Sarsfield 2311 Ciudad Universitaria, Córdoba X5016 GCH, Argentina
| | - Gabriela Barbás
- Secretaría de Prevención y Promoción de la Salud, Ministerio de Salud de la Provincia de Córdoba, Av. Vélez Sarsfield 2311 Ciudad Universitaria, Córdoba X5016 GCH, Argentina
| | - Diego Cardozo
- Ministerio de Salud de la Provincia de Córdoba, Argentina Av. Vélez Sarsfield 2311 Ciudad Universitaria, Córdoba X5016 GCH, Argentina
| | - Viviana Elisabeth Ré
- Instituto de Virología Dr. J. M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gómez s/n, Ciudad Universitaria, Córdoba X5000, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, CABA C1425FQB, Argentina
| | - Silvia Viviana Nates
- Instituto de Virología Dr. J. M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gómez s/n, Ciudad Universitaria, Córdoba X5000, Argentina
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18
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The Impact of SARS-CoV-2 Infection in Patients with Inborn Errors of Immunity: the Experience of the Italian Primary Immunodeficiencies Network (IPINet). J Clin Immunol 2022; 42:935-946. [PMID: 35445287 PMCID: PMC9020753 DOI: 10.1007/s10875-022-01264-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/27/2022] [Indexed: 12/13/2022]
Abstract
COVID-19 manifestations range from asymptomatic to life-threatening infections. The outcome in different inborn errors of immunity (IEI) is still a matter of debate. In this retrospective study, we describe the experience of the of the Italian Primary Immunodeficiencies Network (IPINet). Sixteen reference centers for adult or pediatric IEI were involved. One hundred fourteen patients were enrolled including 35 pediatric and 79 adult patients. Median age was 32 years, and male-to-female ratio was 1.5:1. The most common IEI were 22q11.2 deletion syndrome in children (26%) and common variable immunodeficiency (CVID) in adults (65%). Ninety-one patients did not require hospital admission, and among these, 33 were asymptomatic. Hospitalization rate was 20.17%. Older age (p 0.004) and chronic lung disease (p 0.0008) represented risk factors for hospitalization. Hospitalized patients mainly included adults suffering from humoral immunodeficiencies requiring immunoglobulin replacement therapy and as expected had lower B cell counts compared to non-hospitalized patients. Infection fatality rate in the whole cohort was 3.5%. Seroconversion was observed is 86.6% of the patients evaluated and in 83.3% of CVID patients. 16.85% of the patients reported long-lasting COVID symptoms. All but one patient with prolonged symptoms were under IgRT. The fatality rate observed in IEI was slightly similar to the general population. The age of the patients who did not survive was lower compared to the general population, and the age stratified mortality in the 50-60 age range considerable exceeded the mortality from 50 to 60 age group of the Italian population (14.3 vs 0.6%; p < 0.0001). We hypothesize that this is due to the fact that comorbidities in IEI patients are very common and usually appear early in life.
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19
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Duman M, Şık N, Tekşam Ö, Akça H, Kurt F, Çağlar AA, Yıldız LA, Taşar MA, Fidancı İ, Yayla BCC, Yılmaz D, Güngör E, Demir Ş, Çokuğraş H, Cebeci SO, Önal P, Saz EU, Yurtseven A, Uysalol M, Yıldız R, Gümüş S, Bal A, Bayturan SŞ, Zengin N, Atik S, Çiftdoğan DY, Berksoy E, Çiçek A, Şahin S, Kızıl MC, Kara Y, Apa H, Ulusoy E, Kara AA, Yesil E, Erdem M, Turan C, Arslanoglu S, Duyu M, Besli GE, Arslan G, Oflu AT, Çeleğen M, Buldu E, Pişkin İE, Kardeş H, Yılmaz HL, Yıldızdaş D, Gökulu G, Çay P, Özer U, Güleryüz OD, Çolak Ö, Güneysu ST. COVID-19 disease in children presenting to the pediatric emergency department: A multicenter study with 8886 cases from Turkey. Am J Emerg Med 2022; 59:133-140. [PMID: 35849960 PMCID: PMC9181308 DOI: 10.1016/j.ajem.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population. Methods This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded. Results A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0–15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9–10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU. Conclusion Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.
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Affiliation(s)
- Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
| | - Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Özlem Tekşam
- Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halise Akça
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Funda Kurt
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Ayla Akca Çağlar
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Leman Akcan Yıldız
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Medine Ayşin Taşar
- University of Health Sciences, Ankara Training and Research Hospital, Pediatric Emergency Department, Ankara, Turkey
| | - İlknur Fidancı
- University of Health Sciences, Ankara Training and Research Hospital, Pediatric Emergency Department, Ankara, Turkey
| | - Burcu Ceylan Cura Yayla
- University of Health Sciences, Ankara Training and Research Hospital, Pediatric Emergency Department, Ankara, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Emre Güngör
- Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Şule Demir
- Aydın Gynecology and Childhood Hospital, Pediatric Emergency Department, Aydın, Turkey
| | - Haluk Çokuğraş
- Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinem Oral Cebeci
- Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pınar Önal
- Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Metin Uysalol
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Istanbul, Turkey
| | - Raif Yıldız
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Istanbul, Turkey
| | - Süheyla Gümüş
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Istanbul, Turkey
| | - Alkan Bal
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Semra Şen Bayturan
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Neslihan Zengin
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Sinem Atik
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Dilek Yılmaz Çiftdoğan
- Pediatric Emergency Medicine Clinic, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emel Berksoy
- Pediatric Emergency Medicine Clinic, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Alper Çiçek
- Pediatric Emergency Medicine Clinic, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Sabiha Şahin
- Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mahmut Can Kızıl
- Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Yalçın Kara
- Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Hurşit Apa
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Emel Ulusoy
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Aybüke Akaslan Kara
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Edanur Yesil
- Mersin City Training and Research Hospital, Mersin, Turkey
| | - Meltem Erdem
- Mersin City Training and Research Hospital, Mersin, Turkey
| | - Caner Turan
- Mersin City Training and Research Hospital, Mersin, Turkey
| | - Sertac Arslanoglu
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Muhterem Duyu
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Gulser Esen Besli
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Gazi Arslan
- Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ayşe Tolunay Oflu
- Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Pediatrics, Afyon, Turkey
| | - Mehmet Çeleğen
- Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Pediatrics, Afyon, Turkey
| | - Ebru Buldu
- Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Pediatrics, Afyon, Turkey
| | - İbrahim Etem Pişkin
- Zonguldak Bulent Ecevit University Faculty of Medicine, Department of Pediatrics, Zonguldak, Turkey
| | - Hakan Kardeş
- Zonguldak Bulent Ecevit University Faculty of Medicine, Department of Pediatrics, Zonguldak, Turkey
| | | | | | - Gamze Gökulu
- Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Pınar Çay
- Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Utku Özer
- Cukurova University, Faculty of Medicine, Adana, Turkey
| | | | - Özlem Çolak
- Gazi University, Faculty of Medicine, Department of Pediatric Emergency, Ankara, Turkey
| | - Songül Tomar Güneysu
- Gazi University, Faculty of Medicine, Department of Pediatric Emergency, Ankara, Turkey
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Antala S, Diamond T, Kociolek LK, Shah AA, Chapin CA. Severe Hepatitis in Pediatric Coronavirus Disease 2019. J Pediatr Gastroenterol Nutr 2022; 74:631-635. [PMID: 35149651 PMCID: PMC9117453 DOI: 10.1097/mpg.0000000000003404] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/01/2022] [Indexed: 02/07/2023]
Abstract
ABSTRACT Hepatic involvement in coronavirus disease 2019 (COVID-19) is typically characterized as mild hepatitis with preserved synthetic function in children. Severe hepatitis is a rare complication of COVID-19 infection that has not been extensively described in the pediatric population. We report a case series of four previously healthy children who presented with significant hepatitis as the primary manifestation of COVID-19 infection. Two of these patients met criteria for acute liver failure. None of the patients had respiratory symptoms. One patient was found to have complement dysfunction resulting in microangiopathic features and was treated successfully with eculizumab. This case is in line with adult post-mortem data showing that more severe cases of hepatic dysfunction secondary to COVID-19 infection may be associated with complement activation and microangiopathic features. Liver function should be evaluated in cases of severe COVID-19, and severe acute respiratory syndrome coronavirus 2 infection should be considered as a cause of acute severe hepatitis even in patients without significant respiratory or other systemic symptoms.
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Affiliation(s)
- Swati Antala
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tamir Diamond
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Larry K. Kociolek
- Division ofinfectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amit A. Shah
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Catherine A. Chapin
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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21
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Sansotta N, Norsa L, D'Antiga L. Gastrointestinal coronavirus disease 2019 manifestations in childhood. Curr Opin Clin Nutr Metab Care 2022; 25:195-202. [PMID: 35199658 DOI: 10.1097/mco.0000000000000825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF THE REVIEW The pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged and caused a massive global health crisis. The aim of this review is first, to provide the latest evidence on what is known about the pathophysiology and the transmission of SARS-CoV-2 and then to focus on the manifestations of the gastrointestinal (GI) tract in children with COVID-19. Lastly, we summarise the impact of COVID-19 on patients with preexisting GI diseases. RECENT FINDINGS Even though the virus is mostly transmitted from human to human via respiratory droplets, ACE2 is known to be expressed throughout the GI tract, and SARS-CoV-2 ribonucleic acid has been isolated from patients' stools. GI symptoms including abdominal pain, diarrhoea and vomiting are frequently reported in paediatric patients. Interestingly, a small number of patients seem to exhibit solely GI symptoms. In addition, a multisystem inflammatory syndrome in children (MIS-C) related to SARS-COV-2 described in children, has a high rate of GI involvement. Several etiopathogenetic mechanisms have been postulated to explain the GI involvement of COVID-19. SUMMARY Clinicians should not underestimate or disregard these early or mild GI symptoms, because the patients may be infected and transmit the virus, or develop a more severe condition such as MIS-C.
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Affiliation(s)
- Naire Sansotta
- Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
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22
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Caselli D, Cafagno C, Loconsole D, Giannini A, Tansella F, Saracino A, Chironna M, Aricò M. Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19. CHILDREN 2022; 9:children9010041. [PMID: 35053666 PMCID: PMC8773987 DOI: 10.3390/children9010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023]
Abstract
The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.
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Affiliation(s)
- Désirée Caselli
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Claudio Cafagno
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Daniela Loconsole
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy; (D.L.); (M.C.)
| | - Annamaria Giannini
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Francesco Tansella
- Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy; (D.C.); (C.C.); (A.G.); (F.T.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy;
| | - Maria Chironna
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy; (D.L.); (M.C.)
| | - Maurizio Aricò
- Strategic Control, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy
- Correspondence:
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23
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Jaramillo-Esparza CM, Vázquez-Frias R. Risk of pediatric inflammatory multi-system syndrome (PIMS or MIS-C) in pediatric patients with COVID-19 presenting with gastrointestinal symptoms. Front Pediatr 2022; 10:904793. [PMID: 35911826 PMCID: PMC9334698 DOI: 10.3389/fped.2022.904793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Pediatric inflammatory multisystem syndrome (PIMS) is a life-threatening complication in pediatric patients with SARS-CoV-2 infection. An increase in the association of gastrointestinal symptoms and the presence of PIMS has been observed. The objective of this study was to analyze whether pediatric patients with COVID-19, who debut with gastrointestinal symptoms, have a higher risk of developing PIMS. MATERIAL AND METHODS An observational, analytical and retrolective study was carried out with a review of the records of patients diagnosed with COVID-19. Demographic, clinical and laboratory variables were recorded. RESULTS A total of 248 patients who met the selection criteria were included. Of Those 40% were female, with a mean age of 7 +/- 5.8 years. Gastrointestinal symptoms were the initial presentation in 103 patients, with vomiting being the most frequent symptom, followed by abdominal pain and diarrhea. In total 52 patients developed PIMS, 30 of whom presented with gastrointestinal symptoms. A RR of 1.57 (97% CI of 1.17-2.11) was found for the presentation of PIMS in patients positive for SARS-CoV-2 who present with gastrointestinal symptoms. CONCLUSIONS There is an increased risk of developing pediatric multisystem inflammatory syndrome when there are gastrointestinal symptoms in pediatric patients with COVID-19.
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Affiliation(s)
- Carlos Mauricio Jaramillo-Esparza
- Pediatric COVID-19 Care Unit, National Institute of Health Children's Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Rodrigo Vázquez-Frias
- Department of Gastroenterology and Nutrition, National Institute of Health Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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