The number of symptoms attributed to COVID-19 has been seeing continuous additions over the past few months. Among these are gastrointestinal symptoms that have been reported in several adults. Now, researchers from Wuhan — the original epicenter of the coronavirus pandemic —have found that children suffering from symptoms such as diarrhea along with fever and history of exposure to COVID-19 must be treated as potential COVID-19.
According to the study, gastrointestinal symptoms experienced by children initially could serve as clues to a possible infection via the digestive tract. This is because the cells that the novel coronavirus uses to gain entry into the body are not only found in the lungs but also the intestines.
"Most children are only mildly affected by COVID-19 and the few severe cases often have underlying health issues. It is easy to miss its diagnosis in the early stage, when a child has non-respiratory symptoms or suffers from another illness," said Wenbin Li, co-author of the study.
Examining children with exhibiting non-respiratory symptoms
For the study, the researchers examined five children from Wuhan — four boys and one girl —between the ages of two months to 5.6 years. They were admitted to the Wuhan Children's Hospital after exhibiting non-respiratory symptoms initially, and tested positive for the disease between 23 January and 20 February, 2020. Of these children, one had an evident history of exposure to the coronavirus, suspected history of exposure in one, while no such history of exposure was found among the rest.
Admitted for unrelated problems
Li narrated that these children had sought medical advice for problems that seemed unrelated to COVID-19. For example, a 1.2-year-old boy was admitted to the emergency department due to a kidney stone and an 8-month-old male infant hospitalized due to a head injury. All the five cases were confirmed to have pneumonia before or shortly after admission through a CT scan of the chest. Later, they were confirmed to have COVID-19.
What is interesting, however, is that nearly all of them had digestive symptoms that served as the initial expressions of the infection and were overlooked due to their nature. "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," Li highlighted.
Link between gastrointestinal symptoms and COVID-19
According to Li, the reason behind the children suffering from gastrointestinal symptoms could be the distribution of ACE2 receptor in their intestines. It has been proven that the coronavirus infects the body by binding with the ACE2 receptors found in the lungs. However, the enzyme is also found in the intestines.
Li posits: "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." He added that in regions where the virus is endemic, children experiencing digestive tract symptoms, accompanied with fever and/or history of exposure, or both, should be suspected as potential cases of the coronavirus infection.
Need for awareness and further research
By creating awareness about such cases, the researchers hope that doctors will be enabled in making an accurate diagnoses. They researchers highlight that the gastrointestinal symptoms that children were found to display were also found among adults. Therefore, the intestinal route may also serve as an infection pathway.
Calling for more research on the subject, the authors wrote: "The incidence and clinical features of similar cases needs further study in more patients."