Findings from the impact of COVID19 pandemic on pediatric patients are few. However, children seem to present more often gastrointestinal symptoms than adults, with reported vomiting, abdominal pain and diarrhea. Additionally viral shedding has also been reported in children without gastrointestinal symptoms and has been linked to a possible long-term fecal-oral transmission.
In March 2020, 2 infants with SARS-CoV-2 infection were admitted to Pediatrics Department. The first one, a 5-month-old boy, presented respiratory and gastrointestinal symptoms with diarrhea. Nasopharyngeal and rectal swabs were taken, with a positive result. He was discharged in mandatory home isolation, afebrile, and asymptomatic.
The second one, 2-months-old, presented only mild respiratory symptoms. After COVID-19 infection was confirmed with a nasopharyngeal swab, despite the absence of gastrointestinal symptoms and based on the findings of the previous case, he also underwent a rectal swab, that tested positive for SARS-CoV-2 on day 3 from the onset.
Since gastrointestinal symptoms seem to be more frequently reported in children than adults, and in view of current evidence of fecal shedding, there are implications for every child being admitted or home-isolated, and for household contacts. Indeed, rectal swabs should be considered especially in children for diagnosis as well as to better define the duration of isolation, along with findings from nasopharyngeal swabs. Further evidence on gastrointestinal involvement and excretion of SARS-CoV-2 in stools is necessary to confirm fecal viral loads regardless of enteric symptoms, and to better explore viral RNA detection in the early incubation or late convalescence stages.
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