COVID-19 Şüphesi Olan Çocuklarda Gastrointestinal Sistem Tutulumu: Türkiye’ den Tek Merkez Deneyimi

Abstract

Amaç: Çalışmanın amacı pediyatrik COVİD-19 hastalarının klinik olarak sadece gastrointestinal semptomlar sergileyebileceğine dikkat çekerek, gastrointestinal sistem ile solunum sistemi tutulumu arasındaki ilişkiyi ortaya koymaktır.
Materyal ve Metot: Çalışmaya 1-18 yaş arasında 300 hasta dahil edildi. Hastalar semptomlarına göre; gastrointestinal semptomları, solunum semptomları ve gastrointestinal semptomları ile solunumsal semptomları olanlar şeklinde 3 gruba ayrıldı. PCR testi pozitif hastalar COVID-19 tanısı aldı. PCR negatif saptanan hastaların tanısı klinik semptomlara ve temas öyküsüne göre konuldu. Hastalar demografik özellikler, laboratuvar ve görüntüleme bulguları açısından analiz edildi.
Bulgular: COVID-19 tanısı alan 300 hastanın 29' unda PCR pozitif saptandı. Sadece gastrointestinal semptomları olan 58 hastanın tümünde yakın temas öyküsü vardı, ellisekiz hastanın 24'ünde PCR pozitifliği (%41.3) saptandı. Yedi hastanın ikisinde (%12) görüntüleme bulguları COVID ile uyumluydu, 7 hastanın ikisinde PCR negatifti. Medyan nötrofil lökosit oranı ve CRP gastrointestinal semptomları olan grupta solunum semptomları olan gruba göre daha yüksek bulundu (sırasıyla p = 0.034, p = 0.028).
Sonuç: Solunumsal şikayetler içermeyen, sadece gastrointestinal semptom bulguları olan ve PCR testi negatif saptanan hastalar, olası COVİD-19’un erken solunum tutulumu açısından dikkatle değerlendirilmelidir.

Keywords

• COVID-19
• çocuk
• gastrointestinal semptom

Gastrointestinal System Involvement in Children suspected for COVID-19: A Single Tertiary Center Experience from Turkey

Abstract

Objective: The aim of our study is to present the association between respiratory system disorders and gastrointestinal system involvement through showing that pediatric COVİD 19 patients can only display gastrointestinal symptoms.
Materials and Methods: Three hundered COVID-19 patients between 1-18 years of age were included into the study. The patients were divided into 3 groups according to symptoms which are classified gastrointestinal, respiratory and gastrointestinal and respiratory groups. Diagnosis of COVID-19 were made by PCR testing. In patients with negative PCR testing, diagnosis was made according to clinical symptoms and contact history. Patients were analyzed in terms of demographic features, laboratory and imaging findings.
Results: There were 300 patients diagnosed with COVID-19. PCR testing was positive in 129 of 300 children. All patients with only gastrointestinal symptoms had close contact history, 24 of 58 patients had PCR positivity (41.3%) and in 7 patients (12%), chest X- Ray findings were compatible with COVID-19. Two of 7 patients had negative PCR testing. Median NRL and CRP was higher in gastrointestinal group than respiratory group (p=0.034, p=0.028 respectively).
Conclusions: Patients with gastrointestinal symptom and negative PCR testing should be evaluated carefully for early respiratory involvement without symptoms.

Keywords

• children
• COVID-19
• gastrointestinal symptom

References

1. Li LQ, Huang T, Wang YQ, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-583. doi: 10.1002/jmv.25757
2. Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020:83(6): 521-523. doi: 10.1097/JCMA.0000000000000319
3. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
4. Mao R , Qiu Y, He JS, et al. Manifestations and Prognosis of gastrointestinal and liver involvement in patients with COVID-19: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667-678. doi: 10.1016/S2468-1253(20)30126-6
5. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020 doi: 10.1001/jamacardio.2020.1096
6. Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-CoV2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606. doi: 10.1136/bmj.m606
7. Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020;S0889-1591(20)30465-7. doi: 10.1016/j.bbi.2020.04. 017
8. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;138:575–8. doi: 10.1001/jamaophthalmol.2020. 1291

9. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020 34(5):212-213. doi: 10.1111/jdv. 16387
10. Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: time to change the paradigm of computed tomography. Thromb Res. 2020;190:58–59. doi: 10.1016/j.thromres.2020.04.011
11. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5:428-30. doi: 10.1016/ S2468-1253(20)30057-1
12. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;215:108427. doi: 10.1016/j.clim.2020.108427
13. Lai CC, Ko WC, Lee PI, Jean SS, Hsueh PR. Extra-respiratory manifestations of COVID-19. Int J Antimicrob Agents. 2020:106024. doi: 10.1016/j.ijantimicag.2020.106024
14. Wang D, Ju X, Xie F, et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi. 2020;58(4):269-274. doi: 10.3760/cma.j.cn112140-20200225-00138
15. Zachariah P, Johnson CL, Halabi KC, et al. Epidemiology, clinical features, and disease severity in patients with coronavirus Disease 2019 (COVID-19) in a children's hospital in New York City, New York. Columbia Pediatric COVID-19 Management Group. JAMA Pediatr. 2020;e202430. doi: 10.1001/jamapediatrics.2020.2430
16. Garazzino S, Montagnani C, Donà D, et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. The Italian SitipSip Pediatric Infection Study Group. Euro Surveill. 2020;25(18):2000600. doi: 10.2807/1560-7917.ES.2020.25.18.2000600
17. Nicoletti A, Talarico V, Sabetta L, et al. Screening of COVID-19 in children admitted to the hospital for acute problems: preliminary data. Acta Biomed. 2020;91(2):75-79. doi: 10.23750/abm.v91i2.9607
18. Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol. 2020;55(5):1169-1174. doi: 10.1002/ppul.24718
19. Tian Y, Rong L , Nian W , He Y. Review Article: Gastrointestinal features in COVID-19 and the possibility of faecal transmission. Alient Pharmacol Ther. 2020;51(9):843-851. doi: 10.1111/apt.15731
20. Ng SC, Tilg H. COVID-19 and the gastrointestinal tract: more than meets the eye. Gut. 2020;69(6):973-974. doi: 10.1136/gutjnl-2020-321195
21. Ping A, Hongbin C, Xiaoda J, Honggang Y. Clinical features of 2019 novel coronavirus pneumonia presented gastrointestinal symptoms but without fever onset. Lancet. 2020. https:// ssrn.com/abstract=3532530. Accessed March 15, 20020.
22. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6): e20200702. doi: 10.1542/peds.2020-0702
23. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;S1473-3099(20)30198-5. doi: 10.1016/S1473-3099(20)30198-5
24. Drescher B, Bai F. Neutrophil in viral infections, friend or foe?. Virus Res. 2013;171(1):1-7. doi: 10.1016/j.virusres.2012.11.002