Gastrointestinal manifestations of COVID-19-associated multisystem inflammatory response syndrome in children
DOI:
https://doi.org/10.14739/2310-1210.2022.2.244737Keywords:
COVID-19, systemic inflammatory response syndrome, COVID-19 related, MIS-C associated with COVID-19, PIMS-TS, childrenAbstract
Aim: analysis of the course of SARS-Cov-2-associated multisystem inflammatory response syndrome (MIS-C) with gastrointestinal disorders in comparison with MIS-C without gastrointestinal manifestations in children of the Lviv region.
Materials and methods. Analysis of medical records of children under the age of 15 years who were treated at the CNE LRC LRCCH “ОHMATDYТ” with a diagnosis of MIS-C associated with SARS-Cov-2.
Results. Gastrointestinal manifestations of MIS-C associated with SARS-Cov-2 were observed in 52.38 % of children, and other symptoms in this group of patients included headache and cough. Levels of specific SARS-Cov-2 IgG did not differ significantly in children with and without gastrointestinal symptoms. In contrast, patients with MIS-C without gastrointestinal manifestations were more likely to have myocardial dysfunction, requiring longer hospitalization. Children with gastrointestinal manifestations of MIS-C were more likely to be obese.
Conclusions. The severity of the clinical course of multi-inflammatory systemic response syndrome associated with SARS-Cov-2 did not depend on the severity and time elapsed since acute coronavirus disease and was not associated with gastrointestinal manifestations, which were observed in 52.38 % of patients. Cough and headache, even in the absence of such typical MIS-C manifestations as rash, scleral changes and swelling of the extremities, could be symptoms allowing a surgeon to think about conservative management of a patient with acute abdominal syndrome. MIS-C associated with SARS-Cov-2 should be included in clinical protocol guiding management of acute appendicitis in children.
References
- WHO. (2021, June 15). COVID-19 Weekly Epidemiological Update (44 ed.). World Health Organization. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---15-june-2021
- United Nations Inter-Agency Group for Child Mortality Estimation. (2021, December 12). Levels and trends in child mortality: report 2021. World Health Organization. https://www.who.int/publications/m/item/levels-and-trends-in-child-mortality-report-2021
- Lu, X., Zhang, L., Du, H., Zhang, J., Li, Y. Y., Qu, J., Zhang, W., Wang, Y., Bao, S., Li, Y., Wu, C., Liu, H., Liu, D., Shao, J., Peng, X., Yang, Y., Liu, Z., Xiang, Y., Zhang, F., Silva, R. M., … Chinese Pediatric Novel Coronavirus Study Team. (2020). SARS-CoV-2 Infection in Children. The New England Journal of Medicine, 382(17), 1663-1665. https://doi.org/10.1056/NEJMc2005073
- Abrams, J. Y., Godfred-Cato, S. E., Oster, M. E., Chow, E. J., Koumans, E. H., Bryant, B., Leung, J. W., & Belay, E. D. (2020). Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. The Journal of Pediatrics, 226, 45-54.E1. https://doi.org/10.1016/j.jpeds.2020.08.003
- Whittaker, E., Bamford, A., Kenny, J., Kaforou, M., Jones, C. E., Shah, P., Ramnarayan, P., Fraisse, A., Miller, O., Davies, P., Kucera, F., Brierley, J., McDougall, M., Carter, M., Tremoulet, A., Shimizu, C., Herberg, J., Burns, J. C., Lyall, H., Levin, M., … PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. (2020). Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA, 324(3), 259-269. https://doi.org/10.1001/jama.2020.10369
- Ministry of Health of Ukraine. (2021, November 11). Pro vnesennia zmin do protokolu «Nadannia medychnoi dopomohy dlia likuvannia koronavirusnoi khvoroby (COVID-19)» [On Amendments to the Protocol «Medical Care Provision for the Treatment of Coronavirus Disease (COVID-19)» (No. 2495)]. https://zakon.rada.gov.ua/rada/show/v2495282-21#top
- Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., Xiao, Y., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
- Song, Y., Liu, P., Shi, X. L., Chu, Y. L., Zhang, J., Xia, J., Gao, X. Z., Qu, T., & Wang, M. Y. (2020). SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut, 69(6), 1143-1144. https://doi.org/10.1136/gutjnl-2020-320891
- Hindson, J. (2020). COVID-19: faecal-oral transmission? Nature Reviews Gastroenterology & Hepatology, 17(5), Article 259. https://doi.org/10.1038/s41575-020-0295-7
- Xu, Y., Li, X., Zhu, B., Liang, H., Fang, C., Gong, Y., Guo, Q., Sun, X., Zhao, D., Shen, J., Zhang, H., Liu, H., Xia, H., Tang, J., Zhang, K., & Gong, S. (2020). Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nature Medicine, 26(4), 502-505. https://doi.org/10.1038/s41591-020-0817-4
- Lu, R., Zhao, X., Li, J., Niu, P., Yang, B., Wu, H., Wang, W., Song, H., Huang, B., Zhu, N., Bi, Y., Ma, X., Zhan, F., Wang, L., Hu, T., Zhou, H., Hu, Z., Zhou, W., Zhao, L., Chen, J., … Tan, W. (2020). Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet, 395(10224), 565-574. https://doi.org/10.1016/S0140-6736(20)30251-8
- Zou, X., Chen, K., Zou, J., Han, P., Hao, J., & Han, Z. (2020). Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine, 14(2), 185-192. https://doi.org/10.1007/s11684-020-0754-0
- Varga, Z., Flammer, A. J., Steiger, P., Haberecker, M., Andermatt, R., Zinkernagel, A. S., Mehra, M. R., Schuepbach, R. A., Ruschitzka, F., & Moch, H. (2020). Endothelial cell infection and endotheliitis in COVID-19. The Lancet, 395(10234), 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5
- Khesrani, L. S., Chana, K., Sadar, F. Z., Dahdouh, A., Ladjadj, Y., & Bouguermouh, D. (2020). Intestinal ischemia secondary to Covid-19. Journal of Pediatric Surgery Case Reports, 61, Article 101604. https://doi.org/10.1016/j.epsc.2020.101604
- Lawrensia, S., Henrina, J., Wijaya, E., Suciadi, L. P., Saboe, A., & Cool, C. J. (2020). Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: a New Challenge amid the Pandemic. SN Comprehensive Clinical Medicine, 2, 2077-2085. https://doi.org/10.1007/s42399-020-00602-8
- Cabrero-Hernández, M., García-Salido, A., Leoz-Gordillo, I., Alonso-Cadenas, J. A., Gochi-Valdovinos, A., González Brabin, A., De Lama Caro-Patón, G., Nieto-Moro, M., de-Azagra-Garde, A. M., & Serrano-González, A. (2020). Severe SARS-CoV-2 Infection in Children With Suspected Acute Abdomen: A Case Series From a Tertiary Hospital in Spain. The Pediatric Infectious Disease Journal, 39(8), e195-e198. https://doi.org/10.1097/INF.0000000000002777
- Toubiana, J., Poirault, C., Corsia, A., Bajolle, F., Fourgeaud, J., Angoulvant, F., Debray, A., Basmaci, R., Salvador, E., Biscardi, S., Frange, P., Chalumeau, M., Casanova, J. L., Cohen, J. F., & Allali, S. (2020). Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ, 369, Article m2094. https://doi.org/10.1136/bmj.m2094
- Valverde, I., Singh, Y., Sanchez-de-Toledo, J., Theocharis, P., Chikermane, A., Di Filippo, S., Kuciñska, B., Mannarino, S., Tamariz-Martel, A., Gutierrez-Larraya, F., Soda, G., Vandekerckhove, K., Gonzalez-Barlatay, F., McMahon, C. J., Marcora, S., Napoleone, C. P., Duong, P., Tuo, G., Deri, A., Nepali, G., … AEPC COVID-19 Rapid Response Team*. (2021). Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in Europe. Circulation, 143(1), 21-32. https://doi.org/10.1161/CIRCULATIONAHA.120.050065
- Chiotos, K., Bassiri, H., Behrens, E. M., Blatz, A. M., Chang, J., Diorio, C., Fitzgerald, J. C., Topjian, A., & John, A. (2020). Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series. Journal of the Pediatric Infectious Diseases Society, 9(3), 393-398. https://doi.org/10.1093/jpids/piaa069
- Blumfield, E., Levin, T. L., Kurian, J., Lee, E. Y., & Liszewski, M. C. (2021). Imaging Findings in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With Coronavirus Disease (COVID-19). American Journal of Roentgenology, 216(2), 507-517. https://doi.org/10.2214/AJR.20.24032
- Godfred-Cato, S., Bryant, B., Leung, J., Oster, M. E., Conklin, L., Abrams, J., Roguski, K., Wallace, B., Prezzato, E., Koumans, E. H., Lee, E. H., Geevarughese, A., Lash, M. K., Reilly, K. H., Pulver, W. P., Thomas, D., Feder, K. A., Hsu, K. K., Plipat, N., Richardson, G., … California MIS-C Response Team. (2020). COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. Morbidity and Mortality Weekly Report, 69(32), 1074-1080. https://doi.org/10.15585/mmwr.mm6932e2
- Ahmed, M., Advani, S., Moreira, A., Zoretic, S., Martinez, J., Chorath, K., Acosta, S., Naqvi, R., Burmeister-Morton, F., Burmeister, F., Tarriela, A., Petershack, M., Evans, M., Hoang, A., Rajasekaran, K., Ahuja, S., & Moreira, A. (2020). Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine, 26, Article 100527. https://doi.org/10.1016/j.eclinm.2020.100527
- Huang, Y., Lu, Y., Huang, Y. M., Wang, M., Ling, W., Sui, Y., & Zhao, H. L. (2020). Obesity in patients with COVID-19: a systematic review and meta-analysis. Metabolism Clinical and Experimental, 113, Article 154378. https://doi.org/10.1016/j.metabol.2020.154378
- Pouletty, M., Borocco, C., Ouldali, N., Caseris, M., Basmaci, R., Lachaume, N., Bensaid, P., Pichard, S., Kouider, H., Morelle, G., Craiu, I., Pondarre, C., Deho, A., Maroni, A., Oualha, M., Amoura, Z., Haroche, J., Chommeloux, J., Bajolle, F., Beyler, C., … Melki, I. (2020). Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Annals of the Rheumatic Diseases, 79(8), 999-1006. https://doi.org/10.1136/annrheumdis-2020-217960
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 



