Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome

Vecchio, Andrea Lo; Garazzino, Silvia; Smarrazzo, Andrea; Venturini, Elisabetta; Poeta, Marco; Berlese, Paola; Denina, Marco; Meini, Antonella; Bosis, Samantha; Galli, Luisa; Cazzato, Salvatore; Nicolini, Giangiacomo; Vergine, Gianluca; Giacchero, Roberta; Ballardini, Giuseppina; Dodi, Icilio; Salvini, Filippo; Manzoni, Paolo; Ferrante, Giuliana; Quadri, Vera; Campaña, Andrea; Badolato, Raffaele; Villani, Alberto; Guarino, Alfredo; Gattinara, Guido Castelli; Montagnani, Carlotta; Pierantoni, Luca; Krzysztofiak, Andrzej; Donà, Daniele; Bianchini, Sonia; Castagnola, Elio; Lanari, Marcello; Peschiaroli, Emanuela; Corsello, Giovanni; Marchisio, Paola; Marchetti, Federico; Felici, Enrico; Pruccoli, Giulia; Caldarelli, Valeria; Barba, Paolo Del; Agostoni, Carlo; Ghizzi, Chiara; Riscassi, Sara; Rabbone, Ivana; Calitri, Carmelina; Abbagnato, L; Parola, Luciana; Banderali, Giuseppe; Pacati, Ilaria; Cherubini, Simonetta; Lippi, Paola; Guala, Andrea; Agostiniani, Rino; Kantar, Ahmad; Baroero, Luca; Rossi, Nadia; Dalmazzo, Cristina; Panigati, Laura; Vigo, Alessandro; Bezzio, Stefania; Comberiati, Pasquale; Battezzati, Giovanna; Verna, Paola; Tornese, Gianluca; Poma, Francesca; Bertacca, Luca; Zavarise, Giorgio; Marchione, Luigi; Gallia, Paola; Filippo, Paola Di; Centenari, Chiara; Iacono, Alessandra; Plebani, Alessandro; Ferretti, Marta; Rizzi, Sara; Rossin, Sara; Fanti, Alessandro De; Giacomo, Costantino De; Barera, Graziano; Pajno, Roberta; Martelossi, Stefano; Rocchi, Alessia; Francavilla, Rosa; Valin, Paola Sogno; Valentini, Piero; Magistà, Anna Maria; Saffioti, Carolina; Greco, Maria Cristina; Costenaro, Paola; Pietro, Maria Di; Esposito, Susanna; Pieri, Giovanni; Spartà, Maria Valentina; Maffini, Valentina; Licciardi, Francesco; Scolfaro, Carlo; Stera, Giacomo; Marolda, Agostina; Fiorica, Lorenzo; Sabatini, C

doi:10.1001/jamanetworkopen.2021.39974

Cited by 34 publications

(39 citation statements)

References 30 publications

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“…The differential diagnosis of acute watery diarrhoea includes viral gastroenteritis, most commonly due to norovirus, rotavirus, astrovirus, sapovirus and adenovirus serotypes 40 and 41. Clinicians should be cognizant that paediatric SARS-CoV-2 infection and the associated multisystem inflammatory syndrome in children (MIS-C) frequently presents with gastrointestinal symptoms, sometimes as the sole manifestation [36]. Intestinal complications of SARS-CoV-2 infection can include bloody diarrhoea, appendicitis, intussusception, pancreatitis, abdominal fluid collection and mesenteric adenitis.…”

Section: Differential Diagnosismentioning

confidence: 99%

Bacterial diarrhoea

Kotloff¹

2022

Current Opinion in Pediatrics

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Purpose of reviewThis review describes recent findings about the burden of bacterial diarrhoea and its potential complications, newer diagnostics, the emerging threat of multidrug resistance, and the promise of vaccines in development.Recent findingsIntroduction of rotavirus vaccines in over 110 countries has changed the landscape of diarrheal pathogens. In upper middle and high-income countries, the incidence of rotavirus-specific and all-cause gastroenteritis has declined substantially, and norovirus has become the major pathogen in many settings. Bacterial pathogens cause approximately 10–15% of episodes, most often Shigella, nontyphoidal Salmonella (NTS) Campylobacter and Shiga toxin-producing Escherichia coli (STEC). In lower income countries, bacterial pathogens remain a major cause of medically attended diarrhoea with Shigella, Campylobacter and enterotoxigenic Escherichia coli (ETEC) predominating. Multidrug-resistant strains of Shigella, NTS and, Campylobacter have emerged globally requiring judicious use of antibiotics according to current guidance.SummaryManagement of bacterial diarrhoea includes standard fluid and electrolyte therapy, vigilance for potential complications, and use of antibiotics for children who have moderate-severe illness due to pathogens for which efficacy has been demonstrated, or for those at high risk for severe disease. The threat of multiply resistant strains provides impetus for preventive strategies such as development of vaccines.

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Section: Differential Diagnosismentioning

confidence: 99%

Bacterial diarrhoea

Kotloff¹

2022

Current Opinion in Pediatrics

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“…Although data on younger adults and/or patients not requiring hospitalization are lacking to confirm this association, it has been observed on pediatric patients where studies show that GI involvement is very frequent. 31 , 32 …”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal manifestations of SARS-CoV-2 infection in an Italian population of hospitalized patients

Milano

Efthymakis

D’Ardes

et al. 2022

Therap Adv Gastroenterol

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters the cells via angiotensin-converting enzyme 2 receptor; therefore, tissues expressing this receptor are potential targets for infection. Although many studies have observed gastrointestinal (GI) symptoms in coronavirus disease 2019 (COVID-19) patients, prevalence and clinical impact are still uncertain due to the heterogeneity of reports and obstacles to generalization. Methods: In this cross-sectional study, we included symptomatic patients requiring hospital admission, with a confirmed diagnosis of COVID-19 by nasopharyngeal polymerase chain reaction test, between 18 March and 30 May 2020. Demographic data, symptoms at onset, vital signs, and laboratory tests at admission were recorded. Results: In all, 300 patients were included (57%M, 43%F). GI symptoms were mainly diarrhea (13%), anorexia (4.3%), vomiting (3%), and abdominal pain (2.3%). Overall, males were younger (68 years versus 76 years; p = 0.01); patients with GI manifestations at disease onset required significantly faster hospital admission and showed larger GI complication rates. GI symptoms were associated with abnormal high aspartate aminotransferase and alanine aminotransferase serum titers, especially in male patients. Conclusion: Our study on an Italian population during the outbreak of the COVID-19 pandemic shows that GI symptoms are part of the spectrum of the SARS-CoV-2 infection and could be the only manifestations at disease onset. Although patients with GI symptoms were associated with faster hospital admission and liver involvement, prognosis was not affected.

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“…In a retrospective cohort study of 685 children with either acute COVID-19 and MIS-C across primary and secondary care in Italy, severe gastrointestinal manifestations were a common feature of MIS-C, presenting in 49.2 per cent of patients. 3 This compared with just 5.3 per cent of children presenting with acute COVID-19 infection. In a systematic review evaluating 385 cases of MIS-C, gastrointestinal symptoms were a feature of a patient’s presentation in 60.5 per cent of cases.…”

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confidence: 94%

COVID-19 and the paediatric acute abdomen—the emerging dilemma of PIMS-TS

et al. 2022

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PIMS-TS is a newly emerging complication of COVID-19 infection in paediatric patients. A common presenting complaint is that of the 'acute abdomen', however only a small proportion of patients are eventually diagnosed with a GI pathology requiring surgical intervention. A high level of suspicion and close working with the MDT is therefore required by surgical teams involved in the care of these patients.

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Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome

Cited by 34 publications

References 30 publications

Bacterial diarrhoea

Bacterial diarrhoea

Gastrointestinal manifestations of SARS-CoV-2 infection in an Italian population of hospitalized patients

COVID-19 and the paediatric acute abdomen—the emerging dilemma of PIMS-TS

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