Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Abstract

Objective The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children. Source of data An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as “Novel coronavirus” or “Novel coronavirus 2019” or “2019 nCoV” or “COVID-19” or “SARS-CoV-2” were searched on PubMed database, associated either with age filters or generic pediatric terms. Summary of findings A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non-pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki-like disease were also described. Conclusions Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease.

The neurological symptoms of COVID-19: a systematic overview of systematic reviews, comparison with other neurological conditions and implications for healthcare services

“…Finally, 45 systematic reviews met the inclusion criteria and were included in this overview. 11 – 55 …”

Clinical Patterns and Morphology of COVID-19 Dermatology

“…Cutaneous lesions of COVID-19 occur in more than 8% of hospitalized children 115 and are the 7 th most common extrapulmonary manifestation. 116 There are several case reports and case series of various cutaneous eruptions in COVID positive children. Children with COVID-19 and skin manifestations carry an overall better prognosis than those without.…”

Evaluation of cutaneous symptoms in children infected with COVID‐19

“…Severe acute respiratory syndrome causing coronavirus (SARS‐CoV‐2) is a new coronavirus responsible for the pandemic named coronavirus disease 2019(COVID‐19). Although the pathogenesis of the disease has not been completely understood yet, it may cause clinical pictures with various degrees of multisystem involvement 1,2 …”

“…Studies have indicated that coronavirus can also cause cutaneous lesions; however, specific cutaneous symptoms of COVID‐19 infection have not been disclosed yet. The prevalence of cutaneous manifestations in COVID‐19 patients was between 0.2% and 20.4% in the recently published studies 1,3‐6 and 3.4% in a review including 28 studies where the patients aged between 0 and 18 years age had COVID‐19 2 . In this respect, we aimed to analyze the incidence and the types of cutaneous manifestations associated with COVID‐19 infections in pediatric patients.…”