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Desconsi D, Araujo JP, Furtado MD, Pimenta RA, Zani AV. Relationship between gastrointestinal symptoms and COVID-19 infection in the pediatric population: a scoping review. Rev Esc Enferm USP 2024; 58:e20230365. [PMID: 38743953 DOI: 10.1590/1980-220x-reeusp-2023-0365en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/13/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To map the evidence in the literature about the relationship between gastrointestinal symptoms and COVID-19 in the pediatric population. METHOD This is a scoping review following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. The search was carried out on the following bases: Embase, Google Scholar, PubMed, Scopus, LILACS, CINAHL, Scielo, Web of Science and Virtual Health Library Portal, between July and August 2023. Original studies available in full, in any language, were included. RESULTS Ten studies were chosen that pointed to three premises: (1) the ACE2 receptor is found in the epithelial cells of the gastrointestinal tract; (2) gastrointestinal symptoms are mediated by stress and infection is justified by the gut-brain axis; (3) it develops the process of Multisystem Inflammatory Syndrome in children, affecting the gastrointestinal tract. CONCLUSION The synthesis of evidence provided three assumptions which guide the origin of gastrointestinal symptoms. The identification of gastrointestinal symptoms in children affected by COVID-19 can assist in the clinical approach and management of care and treatments.
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Aparicio C, Willis ZI, Nakamura MM, Wolf J, Little C, Maron GM, Sue PK, Anosike BI, Miller C, Bio LL, Singh P, James SH, Oliveira CR. Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis. medRxiv 2024:2024.01.17.24301452. [PMID: 38293040 PMCID: PMC10827273 DOI: 10.1101/2024.01.17.24301452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. Methods Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 2023 that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. Results Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs >2.00. Conclusions While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
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Affiliation(s)
- Camila Aparicio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Zachary I. Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mari M. Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Cordell Little
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gabriela M. Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Paul K. Sue
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Brenda I. Anosike
- Department of Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Christine Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Laura L. Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital, Stanford, CA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Scott H. James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Carlos R. Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Akkoyun EB, Ashraf B, Hanners N, Kahn J, Most Z. Gastrointestinal Manifestations Are Associated with Severe COVID-19 in Children. Healthcare (Basel) 2023; 12:81. [PMID: 38200987 PMCID: PMC10778896 DOI: 10.3390/healthcare12010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose: Although less severe than in adults, children can experience a range of COVID-19 symptoms, from asymptomatic to life-threatening, including respiratory and gastrointestinal symptoms. Medical conditions may also increase the severity of the disease in infected children. Methods: This study was performed at a single center, comparing cases and controls, and involving 253 pediatric patients who had been diagnosed with COVID-19. Two different outcomes were assessed. The first categorized symptomatic individuals who were hospitalized with COVID-19 (hospital) from those who were not (nonhospital). The second categorized admitted individuals who spent at least one day in the intensive care unit (ICU) from those who did not require intensive care (floor). Results: Ninety individuals (36%) had at least one underlying medical condition, the most common being pulmonary disorders, such as asthma (12%), followed by neurodevelopmental disorders (8%), gastrointestinal disorders (6%), and seizure disorders (6%). The hospital group was more likely to have a comorbidity, such as obstructive sleep apnea (OSA), diabetes mellitus, seizure disorder, hypertension, sickle cell disease, neurodevelopmental disorder, and immunocompromising conditions, including cancer, bone marrow transplant, and other immunodeficiencies, compared to the non-hospital group. Abdominal pain was more common in the hospital group. Shortness of breath (SOB) and diarrhea were significantly more common in the ICU group than in the floor group. Conclusions: Early identification of pediatric patients with severe COVID-19 is important to improve outcomes. In our single-center case-control study, we found that the presence of gastrointestinal symptoms on presentation was more commonly associated with severe COVID-19 in children.
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Affiliation(s)
- Esra Betul Akkoyun
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
| | - Bilal Ashraf
- Department of Internal Medicine/Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Natasha Hanners
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
| | - Jeffrey Kahn
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
| | - Zachary Most
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (N.H.); (J.K.); (Z.M.)
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Starvaggi CA, Travaglini N, Aebi C, Romano F, Steiner I, Sauter TC, Keitel K. www.coronabambini.ch: Development and usage of an online decision support tool for paediatric COVID-19-testing in Switzerland: a cross-sectional analysis. BMJ Open 2023; 13:e063820. [PMID: 36927586 PMCID: PMC10030280 DOI: 10.1136/bmjopen-2022-063820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To describe the development and usage of www.coronabambini.ch as an example of a paediatric electronic public health application and to explore its potential and limitations in providing information on disease epidemiology and public health policy implementation. DESIGN We developed and maintained a non-commercial online decision support tool, www.coronabambini.ch, to translate the Swiss Federal Office of Public Health (FOPH) paediatric (age 0-18 years) COVID-19 guidelines around testing and school/daycare attendance for caregivers, teachers and healthcare personnel. We analysed the online decision tool as well as a voluntary follow-up survey from October 2020 to September 2021 to explore its potential as a surveillance tool for public health policy and epidemiology. PARTICIPANTS 68 269 users accessed and 52 726 filled out the complete online decision tool. 3% (1399/52 726) filled out a voluntary follow-up. 92% (18 797/20 330) of users were parents. RESULTS Certain dynamics of the pandemic and changes in testing strategies were reflected in the data captured by www.coronabambini.ch, for example, in terms of disease epidemiology, gastrointestinal symptoms were reported more frequently in younger age groups (13% (3308/26 180) in children 0-5 years vs 9% (3934/42 089) in children ≥6 years, χ2=184, p≤0.001). As a reflection of public health policy, the proportion of users consulting the tool for a positive contact without symptoms in children 6-12 years increased from 4% (1415/32 215) to 6% (636/9872) after the FOPH loosened testing criteria in this age group, χ2=69, p≤0.001. Adherence to the recommendation was generally high (84% (1131/1352)) but differed by the type of recommendation: 89% (344/385) for 'stay at home and observe', 75% (232/310) for 'school attendance'. CONCLUSIONS Usage of www.coronabambini.ch was generally high in areas where it was developed and promoted. Certain patterns in epidemiology and adherence to public health policy could be depicted but selection bias was difficult to measure showing the potential and challenges of digital decision support as public health tools.
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Affiliation(s)
- Carl Alessandro Starvaggi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| | | | - Christoph Aebi
- Department of Pediatrics, Inselspital University Hospital, Bern, Switzerland
| | - Fabrizio Romano
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| | - Isabelle Steiner
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
| | | | - Kristina Keitel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital University Hospital, Bern, Switzerland
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Di Pietro GM, Ronzoni L, Meschia LM, Tagliabue C, Lombardi A, Pinzani R, Bosis S, Marchisio PG, Valenti L. SARS-CoV-2 infection in children: A 24 months experience with focus on risk factors in a pediatric tertiary care hospital in Milan, Italy. Front Pediatr 2023; 11:1082083. [PMID: 36873632 PMCID: PMC9981971 DOI: 10.3389/fped.2023.1082083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is characterized by a wide variety of expressions ranging from asymptomatic to, rarely, critical illness. The basis of this variability is not yet fully understood. The aim of this study was to identify clinical and genetic risk factors predisposing to disease susceptibility and progression in children. METHODS We enrolled 181 consecutive children aged less than 18 years hospitalized with or for SARS-CoV-2 infection during a period of 24 months. Demographic, clinical, laboratory, and microbiological data were collected. The development of coronavirus disease 2019 (COVID-19)-related complications and their specific therapies were assessed. In a subset of 79 children, a genetic analysis was carried out to evaluate the role of common COVID-19 genetic risk factors (chromosome 3 cluster; ABO-blood group system; FUT2, IFNAR2, OAS1/2/3, and DPP9 loci). RESULTS The mean age of hospitalized children was 5.7 years, 30.9% of them being under 1 year of age. The majority of children (63%) were hospitalized for reasons different than COVID-19 and incidentally tested positive for SARS-CoV-2, while 37% were admitted for SARS-CoV-2 infection. Chronic underlying diseases were reported in 29.8% of children. The majority of children were asymptomatic or mildly symptomatic; only 12.7% developed a moderate to critical disease. A concomitant pathogen, mainly respiratory viruses, was isolated in 53.3%. Complications were reported in 7% of children admitted for other reasons and in 28.3% of those hospitalized for COVID-19. The respiratory system was most frequently involved, and the C-reactive protein was the laboratory test most related to the development of critical clinical complications. The main risk factors for complication development were prematurity [relative risk (RR) 3.8, 95% confidence interval (CI) 2.4-6.1], comorbidities (RR 4.5, 95% CI 3.3-5.6), and the presence of coinfections (RR 2.5, 95% CI 1.1-5.75). The OAS1/2/3 risk variant was the main genetic risk factor for pneumonia development [Odds ratio (OR) 3.28, 95% CI 1-10.7; p value 0.049]. CONCLUSION Our study confirmed that COVID-19 is generally less severe in children, although complications can develop, especially in those with comorbidities (chronic diseases or prematurity) and coinfections. Variation at the OAS1/2/3 genes cluster is the main genetic risk factor predisposing to COVID-19 pneumonia in children.
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Affiliation(s)
- Giada Maria Di Pietro
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Ronzoni
- Precision Medicine Lab, Transfusion Medicine and Hematology, Biological Resource Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Maria Meschia
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Claudia Tagliabue
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Lombardi
- Precision Medicine Lab, Transfusion Medicine and Hematology, Biological Resource Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Giovanna Marchisio
- S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Luca Valenti
- Precision Medicine Lab, Transfusion Medicine and Hematology, Biological Resource Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
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Zhang M, Zhang P, Liang Y, Du B, Li L, Yu Z, Wang H, Wang Q, Zhang X, Zhang W. A systematic review of current status and challenges of vaccinating children against SARS-CoV-2. J Infect Public Health 2022; 15:1212-1224. [PMID: 36257126 PMCID: PMC9557115 DOI: 10.1016/j.jiph.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has inflicted immense damage to countries, economies and societies worldwide. Authorized COVID-19 vaccines based on different platforms have been widely inoculated in adults, showing up to 100% immunogenicity with significant efficacy in preventing SARS-CoV-2 infections and the occurrence of severe COVID-19. It has also greatly slowed the evolution of SARS-CoV-2 variants, as shown in clinical trials and real-world evidence. However, the total dosage of COVID-19 vaccines for children is much smaller than that for adults due to limitations from parental concern of vaccine safety, presenting a potential obstacle in ending the COVID-19 pandemic. SARS-CoV-2 not only increases the risk of severe multisystem inflammatory syndrome (MIS-C) in children, but also negatively affects children's psychology and academics, indirectly hindering the maintenance and progress of normal social order. Therefore, this article examines the clinical manifestations of children infected with SARS-CoV-2, the status of vaccination against COVID-19 in children, vaccination-related adverse events, and the unique immune mechanisms of children. In particular, the necessity and challenges of vaccinating children against SARS-CoV-2 were highlighted from the perspectives of society and family. In summary, parental hesitancy is unnecessary as adverse events after COVID-19 vaccination have been proven to be infrequent, comprise of mild symptoms, and have a good prognosis.
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Affiliation(s)
- Mengxin Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Pin Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Ying Liang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Bang Du
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Lifeng Li
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Zhidan Yu
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Huanmin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Qionglin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
| | - Xianwei Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
| | - Wancun Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
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Ataollahi M, Hamzavi SS, Dehghani SM, Haghighat M, Imanieh MH, Honar N, Jahanshahi KA, Darban B, Haghshenas H, Bagherzadeh MA, Avazpour A, Karbasian F, Ghandour FM. Prevalence of COVID-19 in Children with Gastrointestinal Manifestations: A Cross-Sectional Study of 184 Cases in 2020 - 2021. Arch Pediatr Infect Dis 2022; 10. [DOI: 10.5812/pedinfect-121640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has affected human life for more than a year. Coronavirus disease 2019 is well known for its respiratory manifestations; however, other important symptoms help with its diagnosis. Although clinical presentations in adults have been understood, clinical data in pediatric COVID-19 cases are still lacking. Objectives: We investigated gastrointestinal (GI) manifestations of COVID-19 in pediatric cases. Methods: This study included 184 cases with GI manifestations referred to the pediatric emergency department of Namazi hospital from 20 March to 20 November 2020. Their clinical and laboratory data were extracted and analyzed with SPSS22. Results: Of 184 patients, 51 had positive SARS-CoV-2 PCR results. The most common symptom in SARS-CoV-2-positive patients was vomiting in 22 (43%) patients, followed by watery diarrhea in 12 (23.5%) and dysentery in 11 (21%). Significantly elevated CRP (P value = 0.002), ESR (P value < 0.001), and lymphocyte count (P value = 0.037) were found in PCR-positive patients. Conclusions: Our result demonstrates that COVID-19 could present with different GI symptoms. Also, the symptoms and lab data could help clinicians diagnose COVID-19, besides other differential diagnoses in pediatric patients with GI symptoms.
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Dönmez Türkmen A, Ünlü G, Musayeva G, Akkuş E, Özen AG, Önal P, Kuşkucu M, Midilli K, Kılınç AA, Çokuğraş H, Çokuğraş FÇ, Beşer ÖF. Can the Prognosis of COVID-19 Disease Be Determined by Fecal Markers and Cytokines? J Interferon Cytokine Res 2022; 42:542-549. [PMID: 36179036 DOI: 10.1089/jir.2022.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected the entire world, and has a variety of clinical presentations. The aim of this study is to determine the relationships of fecal cytokines and markers with the symptoms and prognosis of children with COVID-19 infection, and to identify noninvasive markers during follow-up. In a cohort of 40 COVID-19-positive children and 40 healthy controls, fecal cytokines and markers were examined in stool samples. A binary logistic model was used to assess the potential of cytokines as risk factors for hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. A P-value <0.05 was accepted as statistically significant. Levels of fecal lysozyme, myeloperoxidase, hemoglobin, and interleukin-5 (IL-5) (P < 0.05) were significantly higher among the patients than controls. In a logistic regression analysis, fecal IL-2 (OR = 3.83; 95% CI: 1.44-15.92), IL-4 (OR = 2.96; 95% CI: 1.09-12.93), IL-5 (OR = 4.56; 95% CI: 1.18-27.88), IL-10 (OR = 2.71 95% CI: 1.19-7.94), interferon-gamma (IFN-γ) (OR = 4.03; 95% CI: 1.44-15.73), IFN-α (OR = 3.02; 95% CI: 1.08-11.65), calcium-binding protein B S100 (S100 B) (OR = 4.78; 95% CI: 1.31-27.82), neutrophil elastase (NE) 2 (OR = 4.07; 95% CI: 1.17-19.69), and matrix metalloproteinase 1 (MMP-1) (OR = 3.67; 95% CI: 1.1-18.82) levels were significantly higher in hospitalized patients with COVID-19 infection than outpatients. We demonstrated that various fecal cytokines and markers were increased in patients who had COVID-19. Fecal IL-2, IL-4, IL-5, IL-10, IFN-γ, IFN-α, S100 B, NE, and MMP-1 levels were significantly elevated in hospitalized patients. We suggest that the fecal and serum levels of cytokines could be used to predict the prognosis of COVID-19 disease, although more studies are needed to confirm this.
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Affiliation(s)
- Ahsen Dönmez Türkmen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gülçin Ünlü
- Department of Pediatric Health and Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulustan Musayeva
- Department of Pediatric Health and Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erkan Akkuş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybüke Gurup Özen
- Department of Pediatric Health and Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pınar Önal
- Department of Pediatric Infectious Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Kuşkucu
- Department of Microbiology, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Infectious Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fügen Çullu Çokuğraş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ömer Faruk Beşer
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Khemiri H, Ayouni K, Triki H, Haddad-Boubaker S. SARS-CoV-2 infection in pediatric population before and during the Delta (B.1.617.2) and Omicron (B.1.1.529) variants era. Virol J 2022; 19:144. [PMID: 36076271 PMCID: PMC9452867 DOI: 10.1186/s12985-022-01873-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/27/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19, the coronavirus disease that emerged in December 2019, caused drastic damage worldwide. At the beginning of the pandemic, available data suggested that the infection occurs more frequently in adults than in infants. In this review, we aim to provide an overview of SARS-CoV-2 infection in children before and after B.1.617.2 Delta and B.1.1.529 Omicron variants emergence in terms of prevalence, transmission dynamics, clinical manifestations, complications and risk factors. METHODS Our method is based on the literature search on PubMed, Science Direct and Google Scholar. From January 2020 to July 2022, a total of 229 references, relevant for the purpose of this review, were considered. RESULTS The incidence of SARS-CoV-2 infection in infants was underestimated. Up to the first half of May, most of the infected children presented asymptomatic or mild manifestations. The prevalence of COVID-19 varied from country to another: the highest was reported in the United States (22.5%). COVID-19 can progress and become more severe, especially with the presence of underlying health conditions. It can also progress into Kawasaki or Multisystem Inflammatory Syndrome (MIS) manifestations, as a consequence of exacerbating immune response. With the emergence of the B.1.617.2 Delta and B.1.1.529 Omicron variants, it seems that these variants affect a large proportion of the younger population with the appearance of clinical manifestations similar to those presented by adults with important hospitalization rates. CONCLUSION The pediatric population constitutes a vulnerable group that requires particular attention, especially with the emergence of more virulent variants. The increase of symptomatic SARS-CoV-2 infection and hospitalization rate among children highlights the need to extend vaccination to the pediatric population.
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Affiliation(s)
- Haifa Khemiri
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia
- LR 20 IPT 02 Laboratory of Virus, Host and Vectors, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kaouther Ayouni
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia
- LR 20 IPT 02 Laboratory of Virus, Host and Vectors, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia
| | - Sondes Haddad-Boubaker
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia.
- LR 20 IPT 02 Laboratory of Virus, Host and Vectors, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.
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10
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Sayed IA, Bhalala U, Strom L, Tripathi S, Kim JS, Michaud K, Chiotos K, Dapul HR, Gharpure VP, Bjornstad EC, Heneghan JA, Irby K, Montgomery V, Gupta N, Gupta M, Boman K, Bansal V, Kashyap R, Walkey AJ, Kumar VK, Gist KM. Gastrointestinal Manifestations in Hospitalized Children With Acute SARS-CoV-2 Infection and Multisystem Inflammatory Condition: An Analysis of the VIRUS COVID-19 Registry. Pediatr Infect Dis J 2022; 41:751-758. [PMID: 35622434 PMCID: PMC9359679 DOI: 10.1097/inf.0000000000003589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C). METHODS Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational, multicenter international cohort study of hospitalized children with acute COVID-19 or MIS-C from March 2020 to November 2020. The primary outcome measure was critical COVID-19 illness. Multivariable models were performed to assess for associations of GI involvement with the primary composite outcome in the entire cohort and a subpopulation of patients with MIS-C. Secondary outcomes included prolonged hospital length of stay defined as being >75th percentile and mortality. RESULTS Of the 789 patients, GI involvement was present in 500 (63.3%). Critical illness occurred in 392 (49.6%), and 18 (2.3%) died. Those with GI involvement were older (median age of 8 yr), and 18.2% had an underlying GI comorbidity. GI symptoms and liver derangements were more common among patients with MIS-C. In the adjusted multivariable models, acute COVID-19 was no associated with the primary or secondary outcomes. Similarly, despite the preponderance of GI involvement in patients with MIS-C, it was also not associated with the primary or secondary outcomes. CONCLUSIONS GI involvement is common in hospitalized children with acute COVID-19 and MIS-C. GI involvement is not associated with critical illness, hospital length of stay or mortality in acute COVID-19 or MIS-C.
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Affiliation(s)
- Imran A. Sayed
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | - Utpal Bhalala
- The Children’s Hospital of San Antonio, San Antonio and Baylor College of Medicine, Houston, Texas
| | - Larisa Strom
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Sandeep Tripathi
- Department of Pediatrics, OSF Saint Francis Medical Centre/University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - John S. Kim
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | - Kristina Michaud
- The Children’s Hospital of San Antonio, San Antonio and Baylor College of Medicine, Houston, Texas
| | - Kathleen Chiotos
- Division of Critical Care and Anesthesia, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heda R. Dapul
- Division of Critical Care Medicine, Department of Pediatrics, NYU Langone Medical Center, New York, New York
| | - Varsha P. Gharpure
- Division of Critical Care Medicine, Department of Pediatrics, Advocate Children’s Hospital, Park Ridge, Illinois
| | - Erica C. Bjornstad
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julia A. Heneghan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Katherine Irby
- Division of Critical Care Medicine, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Vicki Montgomery
- Division of Critical Care Medicine, Department of Pediatrics, University of Louisville and Norton Children’s Hospital, Louisville, Kentucky
| | - Neha Gupta
- Division of Critical Care Medicine, Department of Pediatrics, NYU Langone Medical Center, New York, New York
| | - Manoj Gupta
- Division of Pediatric Cardiology, Department of Pediatrics, Lincoln Hospital, Bronx, New York
| | - Karen Boman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rahul Kashyap
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Allan J. Walkey
- Division of Pulmonary and Critical Care, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Vishakha K. Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - Katja M. Gist
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
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11
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Elias C, Feteira-Santos R, Camarinha C, de Araújo Nobre M, Costa AS, Bacelar-Nicolau L, Furtado C, Nogueira PJ. COVID-19 in Portugal: a retrospective review of paediatric cases, hospital and PICU admissions in the first pandemic year. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001499. [PMID: 36053592 PMCID: PMC9438012 DOI: 10.1136/bmjpo-2022-001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19 is considered by WHO a pandemic with public health emergency repercussions. Children often develop a mild disease with good prognosis and the recognition of children at risk is essential to successfully manage paediatric COVID-19. Quality epidemiological surveillance data are required to characterise and assess the pandemic. METHODS Data on all reported paediatric COVID-19 cases, in Portugal, were retrospectively assessed from a fully anonymised dataset provided by the Directorate General for Health (DGS). Paediatric hospital admission results were obtained from the DGS vaccine recommendations and paediatric intensive care unit (PICU) admission results from the EPICENTRE.PT group. Reported cases and PICU admissions from March 2020 to February 2021 and hospital admissions between March and December 2020 were analysed. RESULTS 92 051 COVID-19 cases were studied, 50.5% males, average age of 10.1 years, corresponding to 5.4% of children in Portugal. The most common symptoms were cough and fever, whereas gastrointestinal symptoms were infrequent. The most common comorbidity was asthma. A high rate of missing surveillance data was noticed, on presentation of disease and comorbidity variables, which warrants a cautious interpretation of results. Hospital admission was required in 0.93% of cases and PICU on 3.48 per 10 000 cases. PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C) was more frequent in children with no comorbidities and males, severe COVID-19 was rarer and occurred mainly in females and infants. Case fatality rate and mortality rates were low, 1.8 per 100 000 cases and 1.2 per 1 000 000 cases, respectively. CONCLUSIONS The overall reported case incidence was 5.4 per 100 children and adolescents and <1% of cases required hospital admission. MIS-C was more frequent in patients with no comorbidities and males. Mortality and case fatality rates were low. Geographic adapted strategies, and information systems to facilitate surveillance are required to improve surveillance data quality.
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Affiliation(s)
- Cecilia Elias
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal .,Unidade de Saúde Pública Francisco George, Lisboa, Portugal
| | - Rodrigo Feteira-Santos
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Camarinha
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel de Araújo Nobre
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Clinica Universitaria Estomatologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Silva Costa
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Potugal.,CRC-W-Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Leonor Bacelar-Nicolau
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cristina Furtado
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Paulo Jorge Nogueira
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Potugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa; Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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12
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Concas G, Barone M, Francavilla R, Cristofori F, Dargenio VN, Giorgio R, Dargenio C, Fanos V, Marcialis MA. Twelve Months with COVID-19: What Gastroenterologists Need to Know. Dig Dis Sci 2022; 67:2771-2791. [PMID: 34333726 PMCID: PMC8325547 DOI: 10.1007/s10620-021-07158-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Corona virus disease-19 (COVID-19) is the latest global pandemic. COVID-19 is mainly transmitted through respiratory droplets and, apart from respiratory symptoms, patients often present with gastrointestinal symptoms and liver involvement. Given the high percentage of COVID-19 patients that present with gastrointestinal symptoms (GIS), in this review, we report a practical up-to-date reference for the physician in their clinical practice with patients affected by chronic gastrointestinal (GI) diseases (inflammatory bowel disease, coeliac disease, chronic liver disease) at the time of COVID-19. First, we summarised data on the origin and pathogenetic mechanism of SARS-CoV-2. Then, we performed a literature search up to December 2020 examining clinical manifestations of GI involvement. Next, we illustrated and summarised the most recent guidelines on how to adhere to GI procedures (endoscopy, liver biopsy, faecal transplantation), maintaining social distance and how to deal with immunosuppressive treatment. Finally, we focussed on some special conditions such as faecal-oral transmission and gut microbiota. The rapid accumulation of information relating to this condition makes it particularly essential to revise the literature to take account of the most recent publications for medical consultation and patient care.
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Affiliation(s)
- Giulia Concas
- School of Paediatrics, University of Cagliari, 09124 Cagliari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, University Hospital “Policlinico”, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Ruggiero Francavilla
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Fernanda Cristofori
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vanessa Nadia Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Rossella Giorgio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Costantino Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
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13
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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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14
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Zamberlan P, Carlotti APDCP, Viani KHC, Rodriguez IS, Simas JDC, Silvério AB, Volpon LC, de Carvalho WB, Delgado AF. Increased nutrition risk at admission is associated with longer hospitalization in children and adolescents with COVID-19. Nutr Clin Pract 2022; 37:393-401. [PMID: 35226766 PMCID: PMC9088697 DOI: 10.1002/ncp.10846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated the association of nutritional risk and inflammatory marker level with length of stay (LOS) in children and adolescents hospitalized for COVID-19 infection in two pediatric teaching hospitals in a developing country. METHODS This was a cross-sectional analytical retrospective study performed in two pediatric hospitals. We included the data from all children and adolescents who were hospitalized with a SARS-CoV-2 infection between March and December 2020. Demographic, anthropometric, clinical, and laboratory data were extracted from electronic medical records. Nutritional risk was assessed according to the STRONGkids tool within 24 hours of admission and was categorized into two levels: ≥4 (high risk) and <4 (moderate or low risk). Means or medians were compared between nutritional risk groups using the t test and Mann-Whitney U test, respectively. The association of nutritional risk and inflammatory markers with LOS was estimated using the Kaplan-Meier method and log-rank test. Cox proportional-hazard and linear regression models were performed, and adjusted for sex, age, and respiratory symptoms. RESULTS From a total of 73 patients, 20 (27.4%) had a STRONGkids score ≥4 at admission, which was associated with a longer LOS even after adjusting (β = 12.30; 1.74-22.9 95% CI; P = 0.023). The same association was observed between LOS and all laboratory markers except for D-dimer. CONCLUSION Among children and adolescents with COVID-19, a STRONGkids score ≥4 at admission, lower values of albumin, lymphocytes, and hemoglobin, and higher CRP values were associated with longer LOS.
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Affiliation(s)
- Patrícia Zamberlan
- Division of NutritionInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | | | - Karina Helena Canton Viani
- Division of NutritionInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Isadora Souza Rodriguez
- Pediatric Intensive Care UnitInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Josiane de Carvalho Simas
- Pediatric Intensive Care UnitInstituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São PauloSão PauloBrazil
| | - Ariadne Beatriz Silvério
- Department of PediatricsFaculdade de Medicina de Ribeirão Preto, Universidade de São PauloSão PauloBrazil
| | - Leila Costa Volpon
- Department of PediatricsFaculdade de Medicina de Ribeirão Preto, Universidade de São PauloSão PauloBrazil
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15
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Pegoraro F, Trapani S, Indolfi G. Gastrointestinal, hepatic and pancreatic manifestations of COVID-19 in children. Clin Res Hepatol Gastroenterol 2022; 46:101818. [PMID: 34607068 PMCID: PMC8486685 DOI: 10.1016/j.clinre.2021.101818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a well-established respiratory tract pathogen. Recent studies in adults and children have shown an increasing number of patients reporting gastrointestinal manifestations of SARS-CoV-2 infection such as diarrhoea, nausea, vomiting and abdominal pain. SARS-CoV-2 RNA can be detected in faeces for an extended period, even after respiratory samples have tested negative and patients are asymptomatic. However, faecal-oral transmission has not yet been proven. In this article, the latest evidence on gastrointestinal, hepato-biliary, and pancreatic manifestations in children with coronavirus disease-19 and multisystem inflammatory syndrome will be analysed.
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Affiliation(s)
| | - Sandra Trapani
- Department of Health Science, Meyer Children's Hospital, Firenze, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, Meyer Children's Hospital, Firenze, Italy,Correspondence to: NEUROFARBA Department, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy
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16
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Ankermann T, Brinkmann F. Comorbidities in Children with COVID-19 and MIS-C/PIMS-TS and Risk Factors for Hospitalization, Severe Disease, Intensive Care and Death. Klin Padiatr 2022; 234:257-266. [PMID: 35114705 DOI: 10.1055/a-1727-5895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This narrative review sums up data from the SARS-CoV-2-pandemia on preexisting disease/underlying conditions/comorbidities and risk factors in children for severe COVID-19 and MIS-C/PIMS-TS as well as hospitalization and mortality. Young infants and adolescents are at highest risk of hospital and PICU admission. Two or more comorbidities rather than single entities pose a risk for more severe courses of SARS-CoV-2 infection in children. Asthma and malignancy do not increase complication rates. MIS-C/PIMS-TS is not associated with any specific underlying disease.
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Affiliation(s)
- Tobias Ankermann
- Klinik für Kinder- und Jugendmedizin, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Folke Brinkmann
- Abteilung Pädiatrische Pneumologie, Allergologie und CF-Zentrum, Universitätskinderklinik Bochum, Bochum, Germany
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17
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Harwood R, Yan H, Talawila Da Camara N, Smith C, Ward J, Tudur-Smith C, Linney M, Clark M, Whittaker E, Saatci D, Davis PJ, Luyt K, Draper ES, Kenny SE, Fraser LK, Viner RM. Which children and young people are at higher risk of severe disease and death after hospitalisation with SARS-CoV-2 infection in children and young people: A systematic review and individual patient meta-analysis. EClinicalMedicine 2022; 44:101287. [PMID: 35169689 PMCID: PMC8832134 DOI: 10.1016/j.eclinm.2022.101287] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to describe pre-existing factors associated with severe disease, primarily admission to critical care, and death secondary to SARS-CoV-2 infection in hospitalised children and young people (CYP), within a systematic review and individual patient meta-analysis. METHODS We searched Pubmed, European PMC, Medline and Embase for case series and cohort studies published between 1st January 2020 and 21st May 2021 which included all CYP admitted to hospital with ≥ 30 CYP with SARS-CoV-2 or ≥ 5 CYP with PIMS-TS or MIS-C. Eligible studies contained (1) details of age, sex, ethnicity or co-morbidities, and (2) an outcome which included admission to critical care, mechanical invasive ventilation, cardiovascular support, or death. Studies reporting outcomes in more restricted groupings of co-morbidities were eligible for narrative review. We used random effects meta-analyses for aggregate study-level data and multilevel mixed effect models for IPD data to examine risk factors (age, sex, comorbidities) associated with admission to critical care and death. Data shown are odds ratios and 95% confidence intervals (CI).PROSPERO: CRD42021235338. FINDINGS 83 studies were included, 57 (21,549 patients) in the meta-analysis (of which 22 provided IPD) and 26 in the narrative synthesis. Most studies had an element of bias in their design or reporting. Sex was not associated with critical care or death. Compared with CYP aged 1-4 years (reference group), infants (aged <1 year) had increased odds of admission to critical care (OR 1.63 (95% CI 1.40-1.90)) and death (OR 2.08 (1.57-2.86)). Odds of death were increased amongst CYP over 10 years (10-14 years OR 2.15 (1.54-2.98); >14 years OR 2.15 (1.61-2.88)).The number of comorbid conditions was associated with increased odds of admission to critical care and death for COVID-19 in a step-wise fashion. Compared with CYP without comorbidity, odds ratios for critical care admission were: 1.49 (1.45-1.53) for 1 comorbidity; 2.58 (2.41-2.75) for 2 comorbidities; 2.97 (2.04-4.32) for ≥3 comorbidities. Corresponding odds ratios for death were: 2.15 (1.98-2.34) for 1 comorbidity; 4.63 (4.54-4.74) for 2 comorbidities and 4.98 (3.78-6.65) for ≥3 comorbidities. Odds of admission to critical care were increased for all co-morbidities apart from asthma (0.92 (0.91-0.94)) and malignancy (0.85 (0.17-4.21)) with an increased odds of death in all co-morbidities considered apart from asthma. Neurological and cardiac comorbidities were associated with the greatest increase in odds of severe disease or death. Obesity increased the odds of severe disease and death independently of other comorbidities. IPD analysis demonstrated that, compared to children without co-morbidity, the risk difference of admission to critical care was increased in those with 1 comorbidity by 3.61% (1.87-5.36); 2 comorbidities by 9.26% (4.87-13.65); ≥3 comorbidities 10.83% (4.39-17.28), and for death: 1 comorbidity 1.50% (0.00-3.10); 2 comorbidities 4.40% (-0.10-8.80) and ≥3 co-morbidities 4.70 (0.50-8.90). INTERPRETATION Hospitalised CYP at greatest vulnerability of severe disease or death with SARS-CoV-2 infection are infants, teenagers, those with cardiac or neurological conditions, or 2 or more comorbid conditions, and those who are obese. These groups should be considered higher priority for vaccination and for protective shielding when appropriate. Whilst odds ratios were high, the absolute increase in risk for most comorbidities was small compared to children without underlying conditions. FUNDING RH is in receipt of a fellowship from Kidney Research UK (grant no. TF_010_20171124). JW is in receipt of a Medical Research Council Fellowship (Grant No. MR/R00160X/1). LF is in receipt of funding from Martin House Children's Hospice (there is no specific grant number for this). RV is in receipt of a grant from the National Institute of Health Research to support this work (grant no NIHR202322). Funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.
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Affiliation(s)
- Rachel Harwood
- Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, Liverpool L69 3BX, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
- Corresponding author at: Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, University of Liverpool, Liverpool L69 3BX, United Kingdom.
| | - Helen Yan
- Medical School, UCL, London, United Kingdom
| | | | - Clare Smith
- NHS England and NHS Improvement, London, United Kingdom
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Joseph Ward
- UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Catrin Tudur-Smith
- Department of Statistics, University of Liverpool, Liverpool, United Kingdom
| | - Michael Linney
- Royal College of Paediatrics and Child Health, London, United Kingdom
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Matthew Clark
- NHS England and NHS Improvement, London, United Kingdom
| | - Elizabeth Whittaker
- Department of Paediatric Infectious Diseases, St Mary's Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
| | | | - Peter J. Davis
- NHS England and NHS Improvement, London, United Kingdom
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elizabeth S. Draper
- PICANet, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Simon E Kenny
- Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, Liverpool L69 3BX, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
- NHS England and NHS Improvement, London, United Kingdom
| | - Lorna K. Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, United Kingdom
| | - Russell M. Viner
- UCL Great Ormond St. Institute of Child Health, London, United Kingdom
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Biharie A, Keuning MW, Wolthers KC, Pajkrt D. Comorbidities, clinical characteristics and outcomes of COVID-19 in pediatric patients in a tertiary medical center in the Netherlands. World J Pediatr 2022; 18:558-563. [PMID: 35622313 PMCID: PMC9136553 DOI: 10.1007/s12519-022-00564-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Amrita Biharie
- Department of Pediatric Infectious Diseases, Rheumatology and Immunology, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Maya W. Keuning
- Department of Pediatric Infectious Diseases, Rheumatology and Immunology, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Katja C. Wolthers
- Department of Medical Microbiology, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Rheumatology and Immunology, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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19
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Totadri S, Srinivasan HN, Joseph LL, Boddu D, Suresh Kochath P, Moorthy M, Mathew LG, John RR. The Unique Balancing Act of Managing Children With Cancer and COVID-19 Infection: A Single Center Experience From South India. J Pediatr Hematol Oncol 2022; 44:e287-e292. [PMID: 33769391 DOI: 10.1097/mph.0000000000002148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
Children with cancer are vulnerable to severe infections. Balancing the intensive treatment of cancer, with the potential risk of coronavirus disease-2019 (COVID-19) related morbidity and mortality is a unique challenge. Children with cancer testing positive for severe acute respiratory syndrome coronavirus 2 virus by reverse-transcription polymerase chain reaction at our center were studied. Thirty-seven children tested positive for COVID-19 during the study period. The severity of the illness was mild, moderate, severe, and critical in 10 (27%), 13 (35%), 12 (32%), and 2 (5%) patients, respectively. Of the 14 patients with a severe/critical illness, 2 had oncological emergencies, 4 had dengue co-infection, and 1 had an inguinal bacterial abscess. All patients were discharged in a stable condition. Modification of the treatment protocol was performed in 11 (33%) of 33 patients who were on active treatment for cancer. There was a median delay of 32.5 days to administer the next cycle of chemotherapy in patients who acquired COVID-19 during cancer treatment. Six of 7 patients who were retested after 14 days remained positive by reverse-transcription polymerase chain reaction. Children with cancer with COVID-19 recover with good supportive care. Curative chemotherapy can be administered safely with appropriate modifications in children with cancer with COVID-19.
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Affiliation(s)
| | | | - Leenu L Joseph
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
| | - Deepthi Boddu
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
| | | | - Mahesh Moorthy
- Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni G Mathew
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
| | - Rikki R John
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Sumner MW, Kanngiesser A, Lotfali-Khani K, Lodha N, Lorenzetti D, Funk AL, Freedman SB. Severe Outcomes Associated With SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:916655. [PMID: 35757137 PMCID: PMC9218576 DOI: 10.3389/fped.2022.916655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the proportion of SARS-CoV-2 infected children experiencing hospitalization, intensive care unit (ICU) admission, severe outcomes, and death. DATA SOURCES PubMed, Embase, and MedRxiv were searched for studies published between December 1, 2019 and May 28, 2021. References of relevant systematic reviews were also screened. STUDY SELECTION We included cohort or cross-sectional studies reporting on at least one outcome measure (i.e., hospitalization, ICU admission, severe outcomes, death) for ≥100 children ≤21 years old within 28 days of SARS-CoV-2 positivity; no language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed data extraction and risk of bias assessment. Estimates were pooled using random effects models. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MAIN OUTCOMES AND MEASURES Percentage of SARS-CoV-2 positive children experiencing hospitalization, ICU admission, severe outcome, and death. RESULTS 118 studies representing 3,324,851 SARS-CoV-2 infected children from 68 countries were included. Community-based studies (N = 48) reported that 3.3% (95%CI: 2.7-4.0%) of children were hospitalized, 0.3% (95%CI: 0.2-0.6%) were admitted to the ICU, 0.1% (95%CI: 0.0-2.2%) experienced a "severe" outcome and 0.02% (95%CI: 0.001-0.05%) died. Hospital-based screening studies (N = 39) reported that 23.9% (95%CI: 19.0-29.2%) of children were hospitalized, 2.9% (95%CI: 2.1-3.8%) were admitted to the ICU, 1.3% (95%CI: 0.5-2.3%) experienced a severe outcome, and 0.2% (95%CI: 0.02-0.5%) died. Studies of hospitalized children (N = 31) reported that 10.1% (95%CI: 6.1-14.9%) of children required ICU admission, 4.2% (95%CI: 0.0-13.8%) had a severe outcome and 1.1% (95%CI: 0.2-2.3%) died. Low risk of bias studies, those from high-income countries, and those reporting outcomes later in the pandemic presented lower estimates. However, studies reporting outcomes after May 31, 2020, compared to earlier publications, had higher proportions of hospitalized patients requiring ICU admission and experiencing severe outcomes. CONCLUSION AND RELEVANCE Among children tested positive for SARS-CoV-2, 3.3% were hospitalized, with rates being higher early in the pandemic. Severe outcomes, ICU admission and death were uncommon, however estimates vary by study population, pandemic timing, study risk of bias, and economic status of the country. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier [CRD42021260164].
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Affiliation(s)
- Madeleine W Sumner
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alicia Kanngiesser
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kosar Lotfali-Khani
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Nidhi Lodha
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Diane Lorenzetti
- Health Sciences Library and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anna L Funk
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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22
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Lo Vecchio A, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P, Denina M, Meini A, Bosis S, Galli L, Cazzato S, Nicolini G, Vergine G, Giacchero R, Ballardini G, Dodi I, Salvini FM, Manzoni P, Ferrante G, Quadri V, Campana A, Badolato R, Villani A, Guarino A, Gattinara GC. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021; 4:e2139974. [PMID: 34928354 PMCID: PMC8689385 DOI: 10.1001/jamanetworkopen.2021.39974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. MAIN OUTCOMES AND MEASURES The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. RESULTS Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). CONCLUSIONS AND RELEVANCE In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | | | | | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Berlese
- Department of Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Gianluca Vergine
- Unità Operativa Complessa Pediatria, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Roberta Giacchero
- Unità Operativa Complessa Pediatria, Azienda Sanitaria Territoriale di Lodi, Lodi, Italy
| | | | - Icilio Dodi
- Emergency and General Paediatric Unit, Pietro Barilla Children’s Hospital, Parma, Italy
| | - Filippo Maria Salvini
- Paediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Manzoni
- Division of Paediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, Azienda Sanitaria Locale Biella, Ponderano, Biella, Italy
| | - Giuliana Ferrante
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Vera Quadri
- Azienda Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
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23
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Shi Q, Wang Z, Liu J, Wang X, Zhou Q, Li Q, Yu Y, Luo Z, Liu E, Chen Y. Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2021; 41:101155. [PMID: 34693233 PMCID: PMC8523335 DOI: 10.1016/j.eclinm.2021.101155] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. METHODS We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI). FINDINGS We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39-526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.42-46.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.69-68.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26-483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.66-37.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.30-11.60), C-reactive protein (CRP) level ≥80 mg/L (OR=11.70, 95% CI 4.37-31.37) and D-dimer level ≥0.5ug/mL (OR=20.40, 95% CI 1.76-236.44) increased the odds of progression to severe or critical disease. INTERPRETATION Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.
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Affiliation(s)
- Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
| | - Zijun Wang
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Jiao Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Xingmei Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Qi Zhou
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Yang Yu
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Yaolong Chen
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China
- Lanzhou University GRADE Center, Lanzhou 730000, China
- Guideline International Network Asia, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
- Affiliate of the Cochrane China Network, Lanzhou University, Lanzhou 730000, China
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24
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Assa A, Benninga MA, Borrelli O, Broekaert I, de Carpi JM, Saccomani MD, Dolinsek J, Mas E, Miele E, Thomson M, Tzivinikos C; Gastrointestinal Committee of ESPGHAN. Gastrointestinal Perspective of Coronavirus Disease 2019 in Children-An Updated Review. J Pediatr Gastroenterol Nutr 2021; 73:299-305. [PMID: 34117195 DOI: 10.1097/MPG.0000000000003204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.
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25
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Seth S, Rashid F, Khera K. An overview of the COVID-19 complications in paediatric population: A pandemic dilemma. Int J Clin Pract 2021; 75:e14494. [PMID: 34115913 PMCID: PMC8420266 DOI: 10.1111/ijcp.14494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022] Open
Abstract
AIM The primary objective of this article is to understand the various complications caused by the coronavirus in the paediatric population. METHOD An electronic search was conducted using PubMed and incorporated forward and backward research methods on clinical trials, case reports, case series, guidelines and reports from the centre for disease control and prevention (CDC), and the keywords included COVID-19, paediatrics, multisystem inflammatory syndrome in children (MIS-C), complications, acute kidney injury and heart failure. Secondary resources included one study from preprint servers (www.preprints.org), last search 8 May 2021, with notion of nonpeer review status. Data were collected and analysed to stay current with the most recent alerts and guidelines for the best care for children during the COVID-19 pandemic. RESULTS Evaluation and analysis of literature revealed MIS-C to be the most prevalent followed by neurological complications. Whereas the least prevalent were septic shock and ophthalmic complications. CONCLUSION Even though COVID-19 is known to be a less severe in the paediatric population, the complications of the virus have caused a great deal of stress to the paediatric patients' parents and paediatricians worldwide, and hence, emphasis should be given to the management of coronavirus complications in paediatrics.
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Affiliation(s)
- Shrey Seth
- Department of Pharmacy PracticeManipal College of Pharmaceutical Sciences, Manipal Academy of Higher EducationManipalIndia
| | - Femida Rashid
- Department of Pharmacy PracticeManipal College of Pharmaceutical Sciences, Manipal Academy of Higher EducationManipalIndia
| | - Kanav Khera
- Department of Pharmacy PracticeManipal College of Pharmaceutical Sciences, Manipal Academy of Higher EducationManipalIndia
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26
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Musa OAH, Chivese T, Bansal D, Abdulmajeed J, Ameen O, Islam N, Xu C, Sallam MA, Albayat SS, Khogali HS, Ahmed SNN, Himatt SM, Nour M, Elberdiny AA, Musa A, Furuya-Kanamori L, Al-Romaihi HE, Doi SAR, Al-Thani MHJ, Abu Baker Abd Farag E. Prevalence and determinants of symptomatic COVID-19 infection among children and adolescents in Qatar: a cross-sectional analysis of 11 445 individuals. Epidemiol Infect 2021; 149:e193. [PMID: 34210371 DOI: 10.1017/S0950268821001515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There is a paucity of evidence about the prevalence and risk factors for symptomatic infection among children. This study aimed to describe the prevalence of symptomatic coronavirus disease 2019 (COVID-19) and its risk factors in children and adolescents aged 0-18 years in Qatar. We conducted a cross-sectional study of all children aged 0-18 years diagnosed with COVID-19 using polymerase chain reaction in Qatar during the period 1st March to 31st July 2020. A generalised linear model with a binomial family and identity link was used to assess the association between selected factors and the prevalence of symptomatic infection. A total of 11 445 children with a median age of 8 years (interquartile range (IQR) 3-13 years) were included in this study. The prevalence of symptomatic COVID-19 was 36.6% (95% confidence interval (CI) 35.7-37.5), and it was similar between children aged <5 years (37.8%), 5-9 years (34.3%) and 10 + years (37.3%). The most frequently reported symptoms among the symptomatic group were fever (73.5%), cough (34.8%), headache (23.2%) and sore throat (23.2%). Fever (82.8%) was more common in symptomatic children aged <5 years, while cough (38.7%) was more prevalent in those aged 10 years or older, compared to other age groups. Variables associated with an increased risk of symptomatic infection were; contact with confirmed cases (RD 0.21; 95% CI 0.20-0.23; P = 0.001), having visited a health care facility (RD 0.54; 95% CI 0.45-0.62; P = 0.001), and children aged under 5 years (RD 0.05; 95% CI 0.02-0.07; P = 0.001) or aged 10 years or older (RD 0.04; 95% CI 0.02-0.06; P = 0.001). A third of the children with COVID-19 were symptomatic with a higher proportion of fever in very young children and a higher proportion of cough in those between 10 and 18 years of age.
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Almuzaini Y, Alsohime F, Subaie SA, Temsah MH, Alsofayan Y, Alamri F, Alahmari A, Alahdal H, Sonbol H, Almaghrabi R, Nahhas M, Khan A. Clinical profiles associated with SARS-CoV-2 infection and complications from coronavirus disease-2019 in children from a national registry in Saudi Arabia. Ann Thorac Med 2021; 16:280-286. [PMID: 34484444 PMCID: PMC8388572 DOI: 10.4103/atm.atm_709_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/21/2021] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Exploring clinical characteristics of coronavirus disease-19 (COVID-19) in children may help in prevention and treatment guidelines. AIMS The aim of the to describe the spectrum of pediatric COVID-19 in Saudi Arabia. SETTINGS AND DESIGN A multicenter, retrospective, cross-sectional study involving pediatric COVID-19 patients across all Saudi regions. METHODS All patients aged between 2 months and 18 years with a confirmed diagnosis of COVID-19 were included. The primary end point was the hospitalization. STATISTICAL ANALYSIS USED Descriptive statistics were used to describe the baseline demographic data and clinical characteristics. Numerical data were explored using Kolmogorov-Smirnov test and Shapiro-Wilk test, while Chi-square or Fisher's exact test were used for categorical data. RESULTS Among the 654 pediatric COVID-19 patients, 4.7% (n = 31) were hospitalized, with one patient only needing pediatric intensive care admission. Sex, breastfeeding, birth status, and the patients' living environment showed no significant association with hospitalization. Most children (80.3%, n = 525) were symptomatic, with two symptoms that were significantly associated with admission, namely, vomiting (P = 0.007) and nausea (P = 0.026). History of admission within the last year was identified in 10.4% (n = 68) children but had no association with worse outcome. The median duration of hospitalization for the entire group was 5.5 days, with longest hospital stay for age group 7-12 years (median 6 days). CONCLUSIONS COVID-19 is usually a milder disease in children. Although having preexisting medical conditions was linked to a longer hospitalization, it was not associated with worse outcome. Continuous surveillance will allow additional characterization of the burden and outcomes of pediatric COVID-19-associated hospitalizations.
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Affiliation(s)
- Yasir Almuzaini
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fahad Alsohime
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Pediatric, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sarah Al Subaie
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Pediatric, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad Hani Temsah
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Pediatric, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yousef Alsofayan
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fahad Alamri
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmed Alahmari
- Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Hadil Alahdal
- Department of Biology, Faculty of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Hana Sonbol
- Department of Biology, Faculty of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Rana Almaghrabi
- Department of Pediatric, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mahmoud Nahhas
- School Health Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Anas Khan
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Bolia R, Dhanesh Goel A, Badkur M, Jain V. Gastrointestinal Manifestations of Pediatric Coronavirus Disease and Their Relationship with a Severe Clinical Course: A Systematic Review and Meta-analysis. J Trop Pediatr 2021; 67:6288463. [PMID: 34050766 PMCID: PMC8244720 DOI: 10.1093/tropej/fmab051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on the gastrointestinal (GI) manifestations of Pediatric Corona Virus Disease (COVID-19) are conflicting and the relationship between GI involvement and the severity of COVID-19 disease has not been evaluated. The objectives of this systematic review were to determine the GI manifestations of pediatric COVID-19 and to evaluate their role as risk factors for a severe clinical course. METHODS : A systematic literature search was carried out in PubMed and Scopus for studies published before 31 December 2020 with information about the GI manifestations of pediatric COVID-19. Patients with a severe and nonsevere clinical course were compared using the inverse variance heterogeneity model and odds ratio (OR) as the effect size. A sensitivity analysis was performed if the heterogeneity was high among studies. RESULTS A total of 811 studies were identified through a systematic search of which 55 studies (4369 patients) were included in this systematic review. The commonest GI symptoms were diarrhea-19.08% [95% confidence interval (CI) 10.6-28.2], nausea/vomiting 19.7% (95% CI 7.8-33.2) and abdominal pain 20.3% (95% CI 3.7-40.4). The presence of diarrhea was significantly associated with a severe clinical course with a pooled OR of 3.97 (95% CI 1.80-8.73; p < 0.01). Abdominal pain and nausea/vomiting were not associated with disease severity. CONCLUSIONS Diarrhea, nausea/vomiting or abdominal pain are present in nearly one-fifth of all children with COVID-19. The presence of diarrhea portends a severe clinical course.
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Affiliation(s)
- Rishi Bolia
- Division of Paediatric Gastroenterology, Department of
Paediatrics, All India Institute of Medical
Sciences—, Rishikesh, Uttarakhand, 249201, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine,
All India Institute of Medical Sciences, Jodhpur,
Rajasthan, 342005, India,Corresponding Author: Dr. Akhil Dhanesh
Goel, Address: C214, Academic Block, Department of Community Medicine and Family
Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
342005, Mobile No:
+91-9643158274
| | - Mayank Badkur
- Department of General Surgery, All India Institute
of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of
Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Spolidoro GCI, Azzolino D, Shamir R, Cesari M, Agostoni C. Joint Effort towards Preventing Nutritional Deficiencies at the Extremes of Life during COVID-19. Nutrients 2021; 13:1616. [PMID: 34065864 PMCID: PMC8150599 DOI: 10.3390/nu13051616] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 (Coronavirus disease 2019) pandemic is posing a threat to communities and healthcare systems worldwide. Malnutrition, in all its forms, may negatively impact the susceptibility and severity of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection in both children and older adults. Both undernutrition and obesity have been evoked as conditions associated with a higher susceptibility to the infection and poor prognosis. In turn, the COVID-19 infection may worsen the nutritional status through highly catabolic conditions, exposing individuals to the risk of malnutrition, muscle wasting, and nutritional deficiencies. Accordingly, the relationship between malnutrition and COVID-19 is likely to be bidirectional. Furthermore, the modification of nutritional behaviors and physical activity, required to limit the spread of the virus, are posing a challenge to health at both the extremes of life. Thus far, even the most advanced healthcare systems have failed to address the alarming consequences of malnutrition posed by this pandemic. If not properly addressed, we may run the risk that new and old generations will experience the consequences of COVID-19 related malnutrition.
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Affiliation(s)
- Giulia C. I. Spolidoro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
| | - Domenico Azzolino
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Raanan Shamir
- Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Institute of Gastroenterology, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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30
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de Paula CSY, Palandri GG, Fonseca TS, Vendramini TCA, Farhat SCL, Pereira MFB, Litvinov N, Toma RK, de Sá FVM, Rodrigues KR, Schvartsman C, Forsait S, Sakita NK, Kanunfre KA, Rocha MC, Dos Santos EH, Okay TS, Pinho JRR, de Carvalho WB, Carneiro-Sampaio M, Almeida Silva CA, Marques HHDS. Gastrointestinal manifestations are associated with severe pediatric COVID-19: A study in tertiary hospital. J Infect 2021; 83:e22-e25. [PMID: 33940088 PMCID: PMC8084879 DOI: 10.1016/j.jinf.2021.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Taiane Siraisi Fonseca
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas HCFMUSP, São Paulo, Brasil.
| | | | | | | | - Nadia Litvinov
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas HCFMUSP, São Paulo, Brasil.
| | - Ricardo Katsuya Toma
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas HCFMUSP, São Paulo, Brasil.
| | | | | | - Cláudio Schvartsman
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas HCFMUSP, São Paulo, Brasil.
| | - Silvana Forsait
- Instituto de Tratamento do Câncer Infantil - ICr HCFMUSP, São Paulo, Brasil.
| | - Neusa Keico Sakita
- Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas HCFMUSP, São Paulo, Brasil.
| | | | | | | | - Thelma Suely Okay
- Instituto de Medicina Tropical de São Paulo - USP, IMT-SP-USP, Brasil.
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Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y. Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications. World J Gastroenterol 2021; 27:1716-1727. [PMID: 33967552 PMCID: PMC8072196 DOI: 10.3748/wjg.v27.i16.1716] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
- Department of Microbiology, Royal College of Surgeons in Ireland - Bahrain, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Yasser El-Sawaf
- Department of Tropical Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Gastroenterology, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
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Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y. Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications. World J Gastroenterol 2021. [PMID: 33967552 DOI: 10.3748/wjg.v27.i16.1716.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
| | - Nermin Kamal Saeed
- Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Tanta University, Tanta 31527, Algharbia, Egypt
| | - Yasser El-Sawaf
- Department of Tropical Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
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33
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Lim KH, Soong FSJ, Low YF, Goh XL, Amin Z, Ng YPM. Clinical features and outcomes of neonatal COVID-19: A systematic review. J Clin Virol 2021; 139:104819. [PMID: 33862544 PMCID: PMC8032401 DOI: 10.1016/j.jcv.2021.104819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Faith Si Jia Soong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Fen Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Lei Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zubair Amin
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yvonne Peng Mei Ng
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abstract
Coronavirus disease 2019 (COVID-19), caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is predominantly a respiratory disease. However, its significant impact on the gastrointestinal (GI) system is now well-known. SARS-CoV-2 enters cells via the angiotensin-converting enzyme-2 (ACE-2) receptor, which is abundantly expressed on lung cells, but also on enterocytes. Several etiopathogenetic mechanisms have been postulated to explain the GI involvement in COVID-19, including loss in intestinal absorption, microscopic mucosal inflammation and impaired ACE-2 function, which plays a significant role in maintaining gut homeostasis. In children the GI manifestations include anorexia, nausea, vomiting, diarrhea and abdominal pain, which may represent the earliest presenting symptoms of the disease. However, although rare, a significant GI mucosal inflammation, such as terminal ileitis mimicking an atypical appendicitis, and other GI manifestations have been reported. COVID-19 pandemic has posed a significant challenge in healthcare provision in term of ability in providing safe diagnostic procedures, face-to-face consultations, and offering comprehensive care. For instance, changes in health services have raised the risk of empirical or sub-optimal management of chronic GI disorders such as inflammatory bowel disease (IBD) due to delayed endoscopic and clinical assessment. This review will discuss the acute GI involvement in COVID-19 in children and reflect on challenges and major changes observed in clinical practice during COVID-19 pandemic by sharing both the published literature and personal experience. We also suggest potential strategies for providing optimal gastroenterology care during this unprecedented era.
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Berni Canani R, Comegna M, Paparo L, Cernera G, Bruno C, Strisciuglio C, Zollo I, Gravina AG, Miele E, Cantone E, Gennarelli N, Nocerino R, Carucci L, Giglio V, Amato F, Castaldo G. Age-Related Differences in the Expression of Most Relevant Mediators of SARS-CoV-2 Infection in Human Respiratory and Gastrointestinal Tract. Front Pediatr 2021; 9:697390. [PMID: 34395341 PMCID: PMC8355889 DOI: 10.3389/fped.2021.697390] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection seem to differ in children compared to that in adults. It has been hypothesized that the lower clinical severity in children could be influenced by differential expression of the main host functional receptor to SARS-CoV-2, the angiotensin-converting enzyme 2 (ACE2), but data are still conflicting. To explore the origin of age-dependent clinical features of coronavirus disease 2019 (COVID-19), we comparatively evaluated the expression in children and adult subjects of the most relevant mediators of the SARS-CoV-2 infection: ACE2, angiotensin-converting enzyme 1 (ACE1), transmembrane serine protease-2 (TMPRSS2), and neuropilin-1 (NRP1), at upper respiratory tract and small intestine level. Methods: The expression of ACE2, ACE1, TMPRSS2, and NRP1 in nasal epithelium and in small intestine epithelium was investigated by quantitative real-time PCR analysis. Results: We found no differences in ACE2, ACE1, and TMPRSS2 expression in the nasal epithelium comparing children and adult subjects. In contrast, nasal epithelium NRP1 expression was lower in children compared to that in adults. Intestinal ACE2 expression was higher in children compared to that in adults, whereas intestinal ACE1 expression was higher in adults. Intestinal TMPRSS2 and NRP1 expression was similar comparing children and adult subjects. Conclusions: The lower severity of SARS-CoV-2 infection observed in children may be due to a different expression of nasal NRP1, that promotes the virus interaction with ACE2. However, the common findings of intestinal symptoms in children could be due to a higher expression of ACE2 at this level. The insights from these data will be useful in determining the treatment policies and preventive measures for COVID-19.
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Affiliation(s)
- Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy.,European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy.,Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Marika Comegna
- CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Cristina Bruno
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Immacolata Zollo
- CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Antonietta Gerarda Gravina
- Division of Hepatogastroenterology, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Erasmo Miele
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Ear, Nose and Throat (ENT) Section, University of Naples Federico II, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy
| | - Veronica Giglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy
| | - Felice Amato
- CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate s.c.ar.l., University of Naples Federico II, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
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Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA, Jacobson K. Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis. Int J Infect Dis 2020; 103:246-256. [PMID: 33227520 PMCID: PMC7679116 DOI: 10.1016/j.ijid.2020.11.163] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE There is limited information on the severity of COVID-19 infection in children with comorbidities. We investigated the effects of pediatric comorbidities on COVID-19 severity by means of a systematic review and meta-analysis of published literature. METHODS PubMed, Embase, and Medline databases were searched for publications on pediatric COVID-19 infections published January 1st to October 5th, 2020. Articles describing at least one child with and without comorbidities, COVID-19 infection, and reported outcomes were included. RESULTS 42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities. Random-effects analysis revealed a higher risk of severe COVID-19 among children with comorbidities than for healthy children; relative risk ratio 1.79 (95% CI 1.27 - 2.51; I2 = 94%). Children with underlying conditions also had a higher risk of COVID-19-associated mortality; relative risk ratio 2.81 (95% CI 1.31 - 6.02; I2 = 82%). Children with obesity had a relative risk ratio of 2.87 (95% CI 1.16 - 7.07; I2 = 36%). CONCLUSIONS Children with comorbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Additional studies are required to further evaluate this relationship.
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Affiliation(s)
- Boyan K Tsankov
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada; Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada; Department of Immunology, University of Toronto, Toronto, ON, Canada.
| | - Joannie M Allaire
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada; Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Michael A Irvine
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Alison A Lopez
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada; Division of Infectious Diseases, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Laura J Sauvé
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada; Division of Infectious Diseases, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Bruce A Vallance
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada; Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Kevan Jacobson
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada; Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada; Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada.
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Akin H, Kurt R, Tufan F, Swi A, Ozaras R, Tahan V, Hammoud G. Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis. Diseases 2020; 8:E41. [PMID: 33182651 PMCID: PMC7709133 DOI: 10.3390/diseases8040041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIM Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. METHODS We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman-Tukey's transforming random effect model. RESULTS A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16-0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10-0.27) followed by diarrhea at 15% (95%CI, 0.12-0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the "inpatient-only" studies when compared with studies that included outpatients only and those including both inpatients and outpatients. CONCLUSIONS In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.
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Affiliation(s)
- Hakan Akin
- Birinci International Hospital, Istanbul 34525, Turkey;
| | - Ramazan Kurt
- Sondurak Medical Center, Istanbul 34764, Turkey;
| | - Fatih Tufan
- Independent Investigator, Istanbul 34107, Turkey;
| | - Ahmed Swi
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Resat Ozaras
- Medilife International Hospital, Istanbul 34523, Turkey;
| | - Veysel Tahan
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Ghassan Hammoud
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
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