Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children

Tullie, Lucinda; Ford, Kathryn; Bisharat, May; Watson, Tom; Thakkar, Hemanshoo; Mullassery, Dhanya; Giuliani, Stefano; Blackburn, Simon; Cross, Kate; Coppi, Paolo De; Curry, Joe

doi:10.1016/s2352-4642(20)30165-6

Cited by 174 publications

(182 citation statements)

References 5 publications

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“…Interestingly, none of our sonograms demonstrated abnormalities of the liver, spleen or kidneys although many patients suffered from multi-organ failure evident clinically. Similar ndings of right lower quadrant intestinal in ammation were reported in a cohort of patients with COVID-19 from the United Kingdom who presented with symptoms of atypical appendicitis before rapidly deteriorating as part of a hyperin ammatory syndrome [9].…”

Section: Discussionsupporting

confidence: 81%

“…This syndrome has quickly emerged as a serious delayed manifestation of COVID-19 infection in children, and radiologists should be aware of the associated clinical features and imaging ndings to better aid clinicians in making a timely diagnosis of a syndrome whose presentation can mimic other pathologies. Independent studies and consensus statements have evaluated imaging ndings in acute COVID-19 infections in children [7,8], and a small cohort study has reported terminal ileitis in the associated hyperin ammatory syndrome [9]. We sought to review the extracardiac imaging ndings of COVID-19 associated MIS-C in a cohort of children with a con rmed diagnosis of the syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Extracardiac Imaging Findings in COVID-19 Associated Multisystem Inflammatory Syndrome in Children

Fenlon

Chen

Ruzal-Shapiro

et al. 2020

Preprint

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Background – COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) is an emerging disease that presents with inflammation of multiple organs. The extracardiac radiographic manifestations of this syndrome are not well understood.Objective – We reviewed the radiologic findings of MIS-C in a cohort of children with a confirmed diagnosis of the syndrome.Materials and methods – In a retrospective study from 4/1/2020 to 5/22/2020, we reviewed imaging studies of 38 children with MIS-C, 21 females (55%) and 17 males (45%), with an average age of 9.2 years (range 1.3 – 20 years). Thirty six had chest radiographs, 6 had abdominal radiographs, 12 had abdominal sonograms or MRI, 2 had neck sonograms, and 3 had brain MRI.Results – 28 patients had pulmonary disease, with 24 (86%) having bilateral opacities, mostly diffuse (n=16, 57%). The most common abnormalities were peribronchial thickening (n=19, 68%), ground glass opacities (n=15, 54%) and consolidation (n=5, 18%). Pleural effusions were only present in children 10 years of age and under, and ground glass opacities were seen more often in older patients (59% vs. 26%, P<0.05). On abdominal imaging, small volume ascites was the most common finding (n=6, 50%). Other findings included right lower quadrant bowel wall thickening (n=3, 25%), gallbladder wall thickening (n=3, 25%), and cervical (n=2) or abdominal (n=2) lymphadenophathy. Of 3 patients with brain MRI, one had bilateral parietooccipital abnormalities and another papilledema.Conclusion – COVID-19 associated MIS-C causes a constellation of findings in the chest and abdomen, most often showing bilateral diffuse pulmonary abnormalities and small volume ascites.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Extracardiac Imaging Findings in COVID-19 Associated Multisystem Inflammatory Syndrome in Children

Fenlon

Chen

Ruzal-Shapiro

et al. 2020

Preprint

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“…The main extrapulmonary manifestations found were gastrointestinal (GI), with high prevalence of diarrhea, abdominal pain, and vomiting. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Other GI symptoms found were related to inflammatory process, such as pharyngeal erythema, 19 swollen tongue, and pronounced lingual papillae. 31 Reduced feeding, 21 , 32 odynophagia, 15 , 26 and feeding intolerance 33 were also reported and are important signs for pediatric cases.…”

Section: Resultsmentioning

confidence: 99%

“… 12 However, due to the outrageous number of infected children, some fatal cases are being reported, associated with extrapulmonary complications, pointing to a need of medical and scientific attention. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 …”

Section: Introductionmentioning

confidence: 99%

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

Pousa¹,

Mendonça²,

Oliveira³

et al. 2021

Jornal de Pediatria

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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.

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“…All children present with persistent fever. Typically, a substantial proportion of children present with abdominal symptoms, with some having symptoms of such severity that they had US and CT imaging, and some undergoing surgical procedures ( 10 , 11 , 31 ). The PIMS-TS spectrum includes disease entities that need urgent recognition and treatment, such as a toxic shock like presentation with hypovolaemia and shock, as well as Kawasaki-like disease with involvement of the coronary arteries ( 4 – 6 ).…”

Section: Statementmentioning

confidence: 99%

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

et al. 2020

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A rise in cases with a new hyperinflammatory disease in children has been reported in Europe and in the Unites States of America, named the Pediatric Inflammatory Multisystem Syndrome—temporally associated with SARS-CoV-2 (PIMS-TS). There appears to be a wide spectrum of signs and symptoms with varying degrees of severity, including a toxic shock like presentation with hypovolaemia and shock, and a Kawasaki-like presentation with involvement of the coronary arteries. Most of these children have evidence of a previous infection with SARS-CoV-2, or a history of significant exposure, but not all. Limited data exist on the incidence of PIMS-TS, but it remains a rare condition. Early recognition and escalation of care is important to prevent the development of serious sequelae, such as coronary artery aneurysms. Clinicians assessing febrile children in primary and secondary care should include PIMS-TS in their differential diagnoses. In children fulfilling the case definition, additional investigations should be undertaken to look for evidence of inflammation and multiorgan involvement. Suspected cases should be discussed with experts in pediatric infectious diseases at an early stage, and advice should be sought from critical care in more severe cases early. There is limited consensus on treatment; but most children have been treated with immunoglobulins or steroids, and with early consideration of biologicals such anti-TNF and anti-IL1 agents. Treatment should ideally be within the context of controlled treatment trials. Clinicians are encouraged to document and share their cases using research registries.

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Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children

Cited by 174 publications

References 5 publications

Extracardiac Imaging Findings in COVID-19 Associated Multisystem Inflammatory Syndrome in Children

Extracardiac Imaging Findings in COVID-19 Associated Multisystem Inflammatory Syndrome in Children

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

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

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