Abstract
Background: The global pandemic caused by novel Coronavirus SARS-CoV-2 disease (COVID-19) is a major threat to the general population and for patients with pre-existing chronic conditions. We report data concerning SARS-CoV-2 infection in children with chronic liver disease (CLD).Methods: A literature review using the online database PubMed was performed to summarize available findings on the association between pre-existing liver disease and COVID-19 infection in children.Results: Children with COVID-19 have preserved effector and immunosuppressive components resulting in a milder disease compared to adults. The most common hepatic manifestation is an elevation of hepatic transaminases. Liver damage may be directly caused by viral infection of liver cells, by medications or by the chronic hypoxia seen in COVID-19 patients. A multicenter study reported that the majority of children with a CLD remained healthy during the outbreak. Similarly, studies reported that children on immunosuppressive treatment, including patients with autoimmune liver disease (AILD) and liver transplantation (LT), maintained good health during the outbreak without experiencing major complications even if infected with COVID-19.Conclusion: COVID-19-related liver injury presents with a mild elevation of transaminases, although its clinical significance is unclear. Children with CLD, including those with AILD and post-LT, do not have an increased risk for severe disease course of SARS-CoV-2 infection with little or no liver dysfunction. These data highlight the necessity to ensure normal standards of care while adhering to national Covid-19 guidelines, and particularly to maintain immunosuppressive medication to prevent relapse or rejection. Further research is required to evaluate the differences in clinical course between immunosuppressed adults and children and in particular whether asymptomatic infection is a concern.
Highlights
The novel Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) disease (COVID-19) is a newly identified illness characterized by symptoms of viral pneumonia, abnormal coagulation, and potentially long term damage to heart, liver and kidneys [1]
Emerging data have documented different patterns of infection and disease outcome between adults and children, perhaps related to the difference in their innate and adaptive immunity
The initial impression that children with or without chronic disease are less likely to have severe or symptomatic disease appears confirmed in many reports worldwide
Summary
The novel Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) disease (COVID-19) is a newly identified illness characterized by symptoms of viral pneumonia, abnormal coagulation, and potentially long term damage to heart, liver and kidneys [1]. COVID-19 in Children co-morbidity and from a minority ethnic back ground It appears that children have a milder illness with significantly less need for inpatient admission or respiratory support as was demonstrated in previous pandemics including influenza A H1N1 [2]. Children are less likely to have the multiple comorbidities present in older adults [4]. Immunocompromised children, such as children with liver disease are considered to be more at risk of Covid-19 initial experience in Italy has not demonstrated significant problems as yet. The global pandemic caused by novel Coronavirus SARS-CoV-2 disease (COVID-19) is a major threat to the general population and for patients with pre-existing chronic conditions. We report data concerning SARS-CoV-2 infection in children with chronic liver disease (CLD)
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