The American Journal of Gastroenterology published today a new study that reveals digestive symptoms, including diarrhea, are common in COVID-19 patients.
The study comes from the Wuhan Medical Treatment Expert Group for COVID-19 in China.
Nearly half of COVID-19 patients enrolled in the study conducted in the Hubei province of China presented digestive symptoms, such as diarrhea and anorexia, and cited it as their chief complaint.
The study also reveals that patients with digestive symptoms had a longer gap between the onset of symptoms and hospital admission than patients presenting only respiratory symptoms and were less likely to be cured and discharged than those without digestive symptoms.
The authors recommend that “the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge.”
Clinical presentation in children
The predominant signs and symptoms of COVID-19 reported to date among all patients are similar to other viral respiratory infections. These include fever, cough, and difficulty breathing. Gastrointestinal symptoms, including abdominal pain, diarrhea, nausea, and vomiting, were reported in a minority of adult patients.
In a report of nine hospitalized infants in China with confirmed COVID-19, only half presented with fever. At least one child to date had primarily gastrointestinal symptoms of vomiting, diarrhea, and anorexia at initial presentation.
There have been multiple reports to date of children with asymptomatic SARS-CoV-2 infection.
Data from pediatric cases of SARS and MERS also show milder symptoms among children compared with adults, and adolescents with SARS had more severe symptoms compared with younger children.
Co-detection of other respiratory pathogens (influenza, respiratory syncytial virus, Mycoplasma pneumoniae) have been described in children with COVID-19.
Signs and symptoms of COVID-19 in children may be similar to those for common viral respiratory infections or other childhood illnesses.
It is important for pediatric providers to have an appropriate suspicion of COVID-19, but also to continue to consider and test for other diagnoses, such as influenza (see CDC’s Flu Information for Healthcare Professionals for more information).
Clinical course and complications in children
Complications of COVID-19 appear to be milder among children compared with adults based on limited reports from China. Severe complications (e.g., acute respiratory distress syndrome, septic shock) were reported in one case of a 13-month old with confirmed COVID-19.
Other reports describe a mild disease course, including in infants. As of February 20, 2020, just one of the 2,114 deaths among 55,924 confirmed COVID-19 cases in China occurred among children younger than 20 years old. No further details were provided about this patient.
Chest X-rays of children with COVID-19 show patchy infiltrates consistent with viral pneumonia, and chest CT scans have shown nodular ground glass opacities.
During the 2003-2004 SARS outbreak, patients younger than 12 years old had milder and shorter illnesses than adults, and no deaths were reported.
Death was rare among children with MERS. One pediatric death from MERS was reported in a child with cystic fibrosis who had respiratory specimens also positive for influenza A(H1N1)pdm09 and multidrug-resistant Pseudomonas.
Though symptoms and disease course for COVID-19 may be milder in children than adults, it is unknown if children with underlying medical conditions are at increased risk of severe disease.
Wolters Kluwer Health