Abstract
The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.
Highlights
Children have reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)infection rates and a substantially lower risk for developing severe coronavirus disease2019 (COVID-19) compared with adults [1,2]
Between February 2020 and August 2021, a total of 137 children and adolescents with a SARS-CoV-2 infection were admitted to our children hospital
Fifteen patients (11%) were unexpectedly found to be positive for SARS-CoV-2 upon screening preceding admission for one of the following conditions, with all considered to be not related to COVID-19: neuro-psychological disorders (n = 4), trauma (n = 3), bone pain (n = 2), cancer (n = 2), pancreatitis, ovary mass, hematuria, and isolated anemia
Summary
Children have reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)infection rates and a substantially lower risk for developing severe coronavirus disease2019 (COVID-19) compared with adults [1,2]. Children have reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection rates and a substantially lower risk for developing severe coronavirus disease. 2019 (COVID-19) compared with adults [1,2]. Loske et al provided evidence that the airway immune cells of children are primed for virus sensing, resulting in a stronger early innate antiviral response to SARS-CoV-2 infection than in adults [3]. The respiratory syndrome (fever, cough, respiratory difficulties) is the main feature and the main target for clinical screening of children with suspected COVID-19 [5,6,7,8,9,10]. Gastrointestinal (GI) symptoms related to COVID-19, such as vomiting, diarrhea, and abdominal pain, have emerged among extrapulmonary manifestations [11,12,13,14,15,16,17,18,19,20,21,22].
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