A new study published by Frontiers has revealed that the first signs of COVID-19 in children are not always respiratory symptoms. The researchers are reporting that gastrointestinal symptoms are often early indications of COVID-19 infection among younger people.
The gastrointestinal symptoms observed in some children suggest that they are infected through the digestive tract. The same type of cell receptors that SARS-CoV-2 targets in the lungs can also be found in the intestines.
Study lead author Dr. Wenbin Li is an expert in the Department of Pediatrics at Tongji Hospital in Wuhan, China.
“Most children are only mildly affected by COVID-19 and the few severe cases often have underlying health issues,” said Dr. Li. “It is easy to miss its diagnosis in the early stage, when a child has non-respiratory symptoms or suffers from another illness.”
“Based on our experience of dealing with COVID-19, in regions where this virus is epidemic, children suffering from digestive tract symptoms, especially with fever and/or a history of exposure to this disease, should be suspected of being infected with this virus.”
Dr. Li and his team are describing the clinical features of children that were admitted to the hospital with non-respiratory symptoms, but were subsequently diagnosed with pneumonia and COVID-19.
“These children were seeking medical advice in the emergency department for unrelated problems. For example, one had a kidney stone, another a head trauma. All had pneumonia confirmed by chest CT scan before or soon after admission and then confirmed to have COVID-19,” said Dr. Li.
“While their initial symptoms may have been unrelated, or their COVID-19 symptoms were initially mild or relatively hidden before their admission to hospital, importantly, 4 of the 5 cases had digestive tract symptoms as the first manifestation of this disease.”
Dr. Li hopes that doctors will use this information to quickly diagnose and isolate patients with similar symptoms, which will facilitate early treatment and reduce transmission.
Gastrointestinal symptoms have also been documented in adult COVID-19 patients. The researchers propose that this signifies another potential route of infection.
“The gastrointestinal symptoms experienced by these children may be related to the distribution of receptors and the transmission pathway associated with COVID-19 infection in humans,” said Dr. Li.
“The virus infects people via the ACE2 receptor, which can be found in certain cells in the lungs as well as the intestines. This suggests that COVID-19 might infect patients not only through the respiratory tract in the form of air droplets, but also through the digestive tract by contact or fecal-oral transmission.”
Dr. Li cautions that more research is needed to confirm the findings.
“We report five cases of COVID-19 in children showing non-respiratory symptoms as the first manifestation after admission to hospital. The incidence and clinical features of similar cases needs further study in more patients.”
The research is published in the journal Frontiers in Pediatrics.