1
|
Padua-Zamora AP, Rey KLR, Tan-Lim CSC, Gregorio GEV. Gastrointestinal and Hepatic Manifestations of COVID-19 in Children: A Systematic Review and Meta-analysis. ACTA MEDICA PHILIPPINA 2024; 58:54-72. [PMID: 38882920 PMCID: PMC11168955 DOI: 10.47895/amp.v58i7.7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Children with COVID-19 may present with gastrointestinal (GI) symptoms and liver dysfunction. Objective To determine the type and prevalence of gastrointestinal (GI) and hepatic manifestations of COVID-19 in children and its association with severity of illness. Methods A systematic literature search was done from inception until January 4, 2021 using PubMed, Cochrane Library, Google Scholar and prepublication repositories with no language restrictions. Studies that reported the demographic and clinical features of children with COVID-19 and provided data on their GI and hepatic signs and symptoms were included. Prevalence of GI and hepatic manifestations were pooled using Stata14. Results We included 58 studies with total of 4497 participants. Overall, one-third of children with COVID-19 presented with at least one GI symptom (33.8%; 95% confidence interval (CI) 23.0, 45.4; I2 97.5%; 42 studies, 3327 participants) with abdominal pain, nausea or vomiting, and diarrhea each occurring in approximately 20%. Children with severe COVID-19 were more likely to present with GI symptoms (odds ratio 2.59; 95% CI 1.35, 4.99; I2 24%; 4 studies, 773 participants). The pooled prevalence of elevated transaminases was 11% for both AST (11.3%, 95% CI 4.9, 19.3; I2 74.7%; 11 studies, 447 participants) and ALT (11.2%, 95% CI 7.1, 16.0; I2 40.8%; 15 studies, 513 participants). Hepatic findings such as jaundice (2-17%), hepatomegaly (2%) or behavioral changes (2%) from hepatic encephalopathy were variably reported by a few studies.The degree of heterogeneity was not improved on exclusion of studies with poor quality, but markedly improved on subgroup analysis according to geographical region and presence of MIS-C. Studies from China showed that children with COVID-19 had significantly lower pooled prevalence for any of the GI symptoms with low degree of heterogeneity, particularly for diarrhea, nausea/vomiting, and abdominal pain, all of which had I2 of 0%. Those with multisystem inflammatory syndrome in children (MIS-C) had significantly more common GI symptoms and increased transaminases than those without. Conclusion One-third of children with COVID-19 exhibit at least one GI symptom and more likely present in those with severe disease. Elevated transaminases were present in 10%. Prevalence of GI and hepatic manifestations were higher among children with MIS-C.
Collapse
Affiliation(s)
- April P Padua-Zamora
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Katrina Loren R Rey
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Carol Stephanie C Tan-Lim
- Division of Allergy and Immunology, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Germana Emerita V Gregorio
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| |
Collapse
|
2
|
Safadieh GH, El Majzoub R, Abou Abbas L. Neuroimaging findings in children with COVID-19 infection: a systematic review and meta-analysis. Sci Rep 2024; 14:4790. [PMID: 38413808 PMCID: PMC10899172 DOI: 10.1038/s41598-024-55597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/26/2024] [Indexed: 02/29/2024] Open
Abstract
The COVID-19 pandemic has impacted individuals differently, and there's been a growing body of evidence pointing to neurological complications caused by the virus. However, our understanding of the range of neurological issues linked to SARS-CoV-2 infection in children is limited. This systematic review and meta-analysis aimed to assess the abnormal neuroimaging findings in pediatric COVID-19 patients, shedding light on this crucial aspect of the disease's impact on children. We conducted an extensive search in the PubMed, Medline, and ScienceDirect databases for observational studies reporting neuroimaging findings of the brain and spinal cord in children with COVID-19 between December 1, 2019, and October 30, 2021. Grey literature sources, including medRxiv and Google Scholar, were also explored. Pooled proportions of abnormal neuroimaging findings, categorized into neurovascular findings, ADEM-like lesions, encephalitic pattern, myelitis, transient splenial lesions, and other anomalies, were calculated using a random-effects model. Between-study heterogeneity was assessed using the χ2 statistic for pooled proportions and the inconsistency index I2. The Quality of the studies was evaluated using the NIH Quality Assessment Tool and the adapted Newcastle-Ottawa Scale. Our search yielded 9,605 articles, with 96 studies (involving 327 pediatric patients) included in the qualitative analysis. Of these, five reports (encompassing 111 patients) underwent quantitative analysis. The pooled proportion of pediatric COVID-19 patients with neurological symptoms and exhibiting abnormal neuroimaging findings was 43.74%. These findings were further categorized into neurovascular findings (8.22%), ADEM-like lesions (7.69%), encephalitic pattern (13.95%), myelitis (4.60%), transient splenial lesions (16.26%), and other abnormalities (12.03%). Insignificant between-study heterogeneity was observed in all categories, and our analysis did not reveal significant publication bias. In conclusion, a substantial proportion of pediatric COVID-19 patients with neurological symptoms have abnormal neuroimaging findings, underscoring the need for vigilant monitoring of neurological complications in this vulnerable population. Standardized reporting and long-term follow-up studies are essential to fully understand the implications of these findings. Collaborative research efforts will deepen our understanding of COVID-19's neurological dimensions in children and enhance clinical care for this population.
Collapse
Affiliation(s)
- Ghida Hasan Safadieh
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, 1003, Lebanon.
| | - Rania El Majzoub
- School of Pharmacy (Department of Biomedical Sciences), Lebanese International University, Mazraa, 146404, Lebanon
| | - Linda Abou Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| |
Collapse
|
3
|
Sheng L, Hu M, Ji C, Xu X. Several laboratory variables indicate severity and prognosis of COVID-19. J Int Med Res 2024; 52:3000605231222428. [PMID: 38194472 PMCID: PMC10777798 DOI: 10.1177/03000605231222428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE While several laboratory variables have been used to assess COVID-19 disease, to our knowledge, no attempt has previously been made to compare differences across different patient groups. We attempted to evaluate the relationship between laboratory variables and severity of the disease as well as on prognosis. METHOD We searched BioLINCC database and identified three studies which had separately included outpatients, inpatients, and ICU patients. For this re-analysis, we extracted data on general demography, laboratory variables and outcome. RESULT In total, 2454 participants (496 outpatients [Study 1], 478 inpatients [Study 2], and 1480 ICU patients [Study 3]) were included in the analysis. We found three laboratory variables (i.e., creatinine, aspartate transferase, and albumin) were not only prognostic factors for outcome of inpatients with COVID-19, but also reflected disease severity as they were significantly different between inpatients and ICU patients. These three laboratory variables are an indication of kidney function, liver function, and nutritional status. CONCLUSION For patients with COVID-19, in addition to monitoring infectious disease indicators, we need to pay attention to liver function, renal function, and take timely measures to correct them to improve prognosis.
Collapse
Affiliation(s)
- Lingxiang Sheng
- Department of Critical Medicine, Tongde Hospital of Zhejiang Province, China
| | - Mahong Hu
- Department of Critical Medicine, Tongde Hospital of Zhejiang Province, China
| | - Conghua Ji
- School of Public Health, Zhejiang Chinese Medical University, China
- Institute of Respiratory Diseases, Zhejiang Chinese Medical University, China
| | - Xiujuan Xu
- Department of Critical Medicine, Tongde Hospital of Zhejiang Province, China
| |
Collapse
|
4
|
Beltran DM, Villamil Osorio M, Fonseca SLG, Restrepo-Gualteros SM, Garcia MJR, Rodriguez-Martinez CE. Predictors of severity in severe respiratory infection in children with COVID-19 respiratory infection in a developing country. J Med Virol 2023; 95:e28453. [PMID: 36594415 DOI: 10.1002/jmv.28453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
On March 11, 2020, the WHO declared the COVID-19 pandemic. This name was given to the disease caused by the SARS-CoV 2 virus at its outbreak in December 2019 in Wuhan, Hubei, China. In Colombia, a significant number of cases have been confirmed. The aim of this study was to evaluate children with respiratory symptoms caused by SARS-CoV2 infection, identifying independent predictors of risk of having a severe illness, thus leading to an early approach and intervention in our patients, especially in children with comorbidities. An analytical cross-sectional study was conducted between April 1, 2020 and March 31, 2021 at a fourth-level referral institution in Bogotá on patients under 18 years of age with respiratory symptoms and a COVID-19 diagnosis confirmed in the laboratory. An explanatory binary logistic regression model was performed with an outcome variable of admission to the intensive care unit. A total of 385 children were included in the study, with ages between 9 months and 17 years of age; 50.1% were male, and the ICR was 9.75 years. 41.6% had some comorbidity, 13.5% were admitted to the pediatric ICU, and 3.6% of the total number of patients died. The predictor variables were: use of antibiotics in the first 24 h, neurological comorbidity, and consolidation shown in the chest X-ray. This explains 38.7% of the variability of the variable. In this cohort of patients with COVID-19-associated respiratory symptoms, we identified predictors of severity, so we consider that these patients require a risk approach that allows timely and adequate care.
Collapse
Affiliation(s)
| | | | | | | | | | - Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogotá, Colombia
| |
Collapse
|
5
|
Wang L, Li G, Yuan C, Yang Y, Ling G, Zheng J, Zhou Y, Zhang T, Lin W, Lin Z. Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review. Int J Gen Med 2021; 14:8097-8108. [PMID: 34795516 PMCID: PMC8594783 DOI: 10.2147/ijgm.s335888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been circulating in many countries around the world, characterized by long incubation period, strong infectivity, strong variability, high population susceptibility and diversified transmission methods. Its causative agent is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Compared with adult patients, the clinical manifestations of COVID-19 in children are often dominated by mild or asymptomatic infections, but children are also important virus carriers and play an important role in the transmission of the virus. In addition, some children will show excessive inflammatory response and experience serious complications such as multisystem inflammatory syndrome in children (MIS-C). At present, the research on COVID-19 in children is still imperfect. This article will review epidemiological characteristics, the mechanism of action, variant characteristics, clinical manifestations, auxiliary examinations and treatment of children with COVID-19, in order to provide help for the diagnosis, treatment and research of children with COVID-19.
Collapse
Affiliation(s)
- Libo Wang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Gan Li
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Chang Yuan
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yuele Yang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Gongxia Ling
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jinyu Zheng
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yiyang Zhou
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Tianlei Zhang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wei Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zhenlang Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| |
Collapse
|
6
|
Ebrahimpour L, Marashi M, Zamanian H, Abedi M. Computed tomography findings in 3,557 COVID-19 infected children: a systematic review. Quant Imaging Med Surg 2021; 11:4644-4660. [PMID: 34737930 DOI: 10.21037/qims-20-1410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
Background Although it was assumed in the early stages of the coronavirus disease 2019 (COVID-19) outbreak that the novel coronavirus infection was uncommon among children, the number of infected children has since been increasing significantly. Real-time polymerase chain reaction (RT-PCR) is the gold standard modality for the diagnosis of COVID-19 infection. In adults, chest CT is performed as an adjunct for identifying suspected COVID-19 cases along with patients' management and follow-up. However, CT findings in COVID-19 children studies have shown a diverse incidence of abnormal CT and finding patterns that made CT scan necessity to have remained controversial. The aim of the present review was to comprehensively determine the imaging findings of chest CT scans of confirmed COVID-19-infected pediatric patients through a systematic review of the available published studies. Methods A systematic literature search was performed in the PubMed, Embase, Scopus, and Web of Science core collection databases (four databases including SSCI, SCIE, AHCI, and ESCI) to find original articles containing chest CT findings in children with COVID-19 through May 7, 2021. This review included 81 articles published in English that in total included 3,557 pediatric patients. Results This review included 81 articles published in English that in total included 3,557 pediatric patients. Among the total confirmed coronavirus-infected cases (via RT-PCR test), two-thirds had abnormal chest CT findings; among these patients, 549 (37.8%) had bilateral lung involvement, and 475 (32.7%) had unilateral disease. Regarding the types of lung lesions, ground glass opacities were observed in 794 (54.7%) of patients, and consolidation was observed in 10.2%; moreover, halo sign, discrete pulmonary nodules, interstitial abnormalities or reticulations, and vascular thickening shadows were reported in 7.4%, 2.6%, 9.7% and 1.7% of the patients, respectively. Discussion This review revealed that chest CT scan manifestations in majority of COVID-19 positive children are mild, so regarding the risk of radiation exposure, it is reasonable to confine CT scan to individual cases that its benefits outweigh the risks.
Collapse
Affiliation(s)
- Laleh Ebrahimpour
- Department of Radiology, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahdis Marashi
- Department of Radiology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hadi Zamanian
- School of Health, Qom University of Medical Sciences, Qom, Iran
| | - Mahboubeh Abedi
- Radiology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Russo T, Pizuorno A, Oskrochi G, Latella G, Massironi S, Schettino M, Aghemo A, Pugliese N, Brim H, Ashktorab H. Gastrointestinal Manifestations, Clinical Characteristics and Outcomes of COVID-19 in Adult and Pediatric Patients. SOJ MICROBIOLOGY & INFECTIOUS DISEASES 2021; 8:109. [PMID: 35611315 PMCID: PMC9126507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Italy was the first country in Europe to report a SARS-CoV-2 case. Since then, the country has suffered a large number of COVID-19 infections both in adults and children. This disease has been shown to lead to different outcomes in these two groups, which often present varying symptoms and comorbidities. AIM Therefore, we aimed to evaluate the symptoms, comorbidities and laboratory values in adults and children. METHODS We present the characteristics of 1,324 adults and 563 pediatric COVID-19 Italian patients. The data was retrieved from studies published in Italy and found via PubMed and Google Scholar. RESULTS The virus appeared to affect adults more than children and men more than women, and to result in more severe outcomes in patients with abnormal laboratory values and a higher number of comorbidities. Adults are at higher risk for complications and death, and they usually present with fever, respiratory symptoms, cough, fatigue, diarrhea, myalgia, and/or loss of taste, smell, or appetite. Children usually have a milder disease progression and usually present with fever, cough, rhinorrhea, pharyngitis, sore throat, pneumonia, GI symptoms (diarrhea, vomiting, abdominal pain), fatigue, and dyspnea. CONCLUSION Our findings support early reports that showed that SARS-CoV-2 is associated with more common asymptomatic cases and milder clinical outcome in children than in adults. Acute respiratory distress syndrome and Multisystem inflammatory syndrome in children (systemic vasculitis) are the most severe disease progressions for adults and children, respectively.
Collapse
Affiliation(s)
- Tiziano Russo
- Department of Medicine, Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC
| | - Antonio Pizuorno
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - Giovanni Latella
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Mario Schettino
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Hassan Brim
- Department of Medicine, Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC
| | - Hassan Ashktorab
- Department of Medicine, Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC
| |
Collapse
|
8
|
Sah P, Fitzpatrick MC, Zimmer CF, Abdollahi E, Juden-Kelly L, Moghadas SM, Singer BH, Galvani AP. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A 2021; 118:e2109229118. [PMID: 34376550 PMCID: PMC8403749 DOI: 10.1073/pnas.2109229118] [Citation(s) in RCA: 255] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.
Collapse
Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Charlotte F Zimmer
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| |
Collapse
|