perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2022-67-5-123-129perinatology-1712Research ArticleК XVIII РОССИЙСКОМУ КОНГРЕССУ «ПЕДИАТРИЯ И ДЕТСКАЯ ХИРУРГИЯ В ПРИВОЛЖСКОМ ФЕДЕРАЛЬНОМ ОКРУГЕ». ОБЗОРЫ ЛИТЕРАТУРЫПоражение желудочно-кишечного тракта у детей с COVID-19: от патогенеза до клинических проявленийGastrointestinal tract lesion in children with COVID-19: from pathogenesis to clinical manifestationshttps://orcid.org/0000-0002-7853-3312ПозднякВ. А.PozdnyakV. A.

аспирант кафедры детских инфекций,

420012 Казань, ул. Бутлерова, д. 49

Kazan

valera.pozdnyak1996@gmail.comhttps://orcid.org/0000-0001-7763-5512ХалиуллинаС. В.KhaliullinaS. V.

д.м.н., доц. кафедры детских инфекций,

420012 Казань, ул. Бутлерова, д. 49

Kazan

https://orcid.org/0000-0003-1050-9081АнохинВ. А.AnokhinV. A.

д.м.н., проф., зав. кафедрой детских инфекций,

420012 Казань, ул. Бутлерова, д. 49

Kazan

ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical UniversityRussian Federation202218112022675123129Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20222022Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/1712

С начала пандемии новая коронавирусная инфекция расценивалась преимущественно как респираторное заболевание. К настоящему времени стало очевидным, что COVID-19 — системный инфекционный процесс с полиорганным поражением. Имея тропность к рецепторам ангиотензинпревращающего фермента 2-го типа, вирус способен поражать клетки как респираторного тракта, так и сердечно-сосудистой, и нервной систем, гладкомышечные структуры разных органов. Экспрессия ангиотензинпревращающего фермента 2-го типа энтероцитами тонкой кишки делает уязвимым желудочно-кишечный тракт при заболевании COVID-19 и приводит к манифестации симптомов его поражения, что нередко наблюдается в клинической практике. Симптоматика поражения желудочно-кишечного тракта обычно включает анорексию, тошноту, рвоту, диарею и боль в животе, которые могут проявляться как в дебюте, так и в ходе развития самого заболевания. Описывается несколько механизмов, объясняющих такого рода изменения при COVID-19. 

Since the beginning of the pandemic, the new coronavirus infection has been regarded primarily as a respiratory disease. By now, it has become obvious that COVID-19 is a systemic infectious process with multiple organ damage. Having affinity for ACE-2 receptors, the virus can infect the cells of the respiratory tract, as well as the cells of the cardiovascular and nervous systems and smooth muscle structures of various organs. Expression of ACE-2 by enterocytes of the small intestine makes the gastrointestinal tract vulnerable in COVID-19 disease and leads to the manifestation of symptoms of gastrointestinal damage, which is often observed in clinical practice. Gastrointestinal symptoms usually include anorexia, nausea, vomiting, diarrhea, and abdominal pain, which can occur both at the onset and during the disease. Several mechanisms are described to explain these changes in COVID-19. 

детиCOVID-19желудочно-кишечный трактдиареяchildrenCOVID-19gastrointestinal tractdiarrheaРабота выполнена при финансовой поддержке ФГБОУ ВО Казанский ГМУ Минздрава России (Грант № 2/22–1 от 1.08.2022 года).The work was supported financially by the Kazan State Medical University of the Ministry of Healthcare of the Russian Federation (Grant No. 2/22–1 dated August 1, 2022).ReferencesSituation Report-183. World Health Organization. 2020. Available from: https://www.who.int/docs/default-source/wha-70-and-phe/20200721-covid-19-sitrep-183.pdf?sfvrsn=b3869b3_2. Ссылка активна на 9.06.2022Situation Report-183. World Health Organization. 2020. Available from: https://www.who.int/docs/default-source/wha-70-and-phe/20200721-covid-19-sitrep-183.pdf?sfvrsn=b3869b3_2. Ссылка активна на 9.06.2022Gu J., Han B., Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158: 1518-1519. DOI: 10.1053/j.gastro.2020.02.054Gu J., Han B., Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158: 1518-1519. DOI: 10.1053/j.gastro.2020.02.054Pousa P.A., Mendonça T.S., Oliveira E.A., Simões-E-Silva A.C. Extrapulmonary manifestations of, COVID-19 in children: a comprehensive review and pathophysiological considerations. J Pediatr (Rio J) 2021; 97(2): 116-139. DOI: 10.1016/j.jped.2020.08.007Pousa P.A., Mendonça T.S., Oliveira E.A., Simões-E-Silva A.C. Extrapulmonary manifestations of, COVID-19 in children: a comprehensive review and pathophysiological considerations. J Pediatr (Rio J) 2021; 97(2): 116-139. DOI: 10.1016/j.jped.2020.08.007Saif L.J., Jung K. Comparative Pathogenesis of Bovine and Porcine Respiratory Coronaviruses in the Animal Host Species and SARS-CoV-2 in Humans. J Clin Microbiol 2020; 58(8): e01355-1320. DOI: 10.1128/JCM.01355-20Saif L.J., Jung K. Comparative Pathogenesis of Bovine and Porcine Respiratory Coronaviruses in the Animal Host Species and SARS-CoV-2 in Humans. J Clin Microbiol 2020; 58(8): e01355-1320. DOI: 10.1128/JCM.01355-20Cheung K.S., Hung I.F., Chan P.P., Lung K.C., Tso E., Liu R. et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology 2020; 159(1): 81-95. DOI: 10.1053/j.gastro.2020.03.065Cheung K.S., Hung I.F., Chan P.P., Lung K.C., Tso E., Liu R. et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology 2020; 159(1): 81-95. DOI: 10.1053/j.gastro.2020.03.065Zhang C., Shi L., Wang F.S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020; 5: 428-430. DOI: 10.1016/S2468-1253(20)30057-1Zhang C., Shi L., Wang F.S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020; 5: 428-430. DOI: 10.1016/S2468-1253(20)30057-1Li J.Y., You Z., Wang Q., Zhou Z.J., Qiu Y., Luo R., Ge X.Y. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect 2020; 22(2): 80-85. DOI: 10.1016/j.micinf.2020.02.002Li J.Y., You Z., Wang Q., Zhou Z.J., Qiu Y., Luo R., Ge X.Y. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect 2020; 22(2): 80-85. DOI: 10.1016/j.micinf.2020.02.002Yuan J., Chen Z., Gong C., Liu H., Li B., Li K. et al. Sewage as a Possible Transmission Vehicle During a Coronavirus Disease 2019 Outbreak in a Densely Populated Community: Guangzhou, China, April, 2020. Clinical Infectious Diseases 2021; 73(7): e1795-e1802. DOI: 10.1093/cid/ciaa1494Yuan J., Chen Z., Gong C., Liu H., Li B., Li K. et al. Sewage as a Possible Transmission Vehicle During a Coronavirus Disease 2019 Outbreak in a Densely Populated Community: Guangzhou, China, April, 2020. Clinical Infectious Diseases 2021; 73(7): e1795-e1802. DOI: 10.1093/cid/ciaa1494Carducci A., Federigi I., Liu D., Thompson J.R., Verani M. Making Waves: Coronavirus detection, presence and persistence in the water environment: State of the art and knowledge needs for public health. Water Res 2020; 179: 115907. DOI: 10.1016/j.watres.2020.115907Carducci A., Federigi I., Liu D., Thompson J.R., Verani M. Making Waves: Coronavirus detection, presence and persistence in the water environment: State of the art and knowledge needs for public health. Water Res 2020; 179: 115907. DOI: 10.1016/j.watres.2020.115907Bogler A., Packman A., Furman A. Rethinking wastewater risks and monitoring in light of the COVID-19 pandemic. Nat Sustain 2020; 3: 981-990. DOI: 10.1038/s41893-020-00605-2Bogler A., Packman A., Furman A. Rethinking wastewater risks and monitoring in light of the COVID-19 pandemic. Nat Sustain 2020; 3: 981-990. DOI: 10.1038/s41893-020-00605-2Galanopoulos M., Gkeros F., Doukatas A., Karianakis G., Pontas C., Tsoukalas N. et al. COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. World J Gastroenterol 2020; 26(31): 4579-4588. DOI: 10.3748/wjg.v26.i31.4579.Galanopoulos M., Gkeros F., Doukatas A., Karianakis G., Pontas C., Tsoukalas N. et al. COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract. World J Gastroenterol 2020; 26(31): 4579-4588. DOI: 10.3748/wjg.v26.i31.4579.Sahbudak Bal Z., Ozkul A., Bilen M., Kurugol Z., Ozkinay F. The Longest Infectious Virus Shedding in a Child Infected With the G614 Strain of SARS-CoV-2. Pediatr Infect Dis J 2021; 40(7): e263-e265. DOI: 10.1097/INF.0000000000003158Sahbudak Bal Z., Ozkul A., Bilen M., Kurugol Z., Ozkinay F. The Longest Infectious Virus Shedding in a Child Infected With the G614 Strain of SARS-CoV-2. Pediatr Infect Dis J 2021; 40(7): e263-e265. DOI: 10.1097/INF.0000000000003158Wang J.G., Cui H.R., Tang H.B., Deng X.L. Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis. Sci Rep 2020; 10(1): 17846. DOI: 10.1038/s41598-020-74913-0Wang J.G., Cui H.R., Tang H.B., Deng X.L. Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis. Sci Rep 2020; 10(1): 17846. DOI: 10.1038/s41598-020-74913-0Matthai J., Shanmugam N., Sobhan P. Indian Society of Pediatric Gastroenterology; Hepatology and Nutrition Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics. Coronavirus Disease (COVID-19) and the Gastrointestinal System in Children. Indian Pediatr 2020; 57: 533-535. DOI: 10.1007/s13312-020-1851-5Matthai J., Shanmugam N., Sobhan P. Indian Society of Pediatric Gastroenterology; Hepatology and Nutrition Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics. Coronavirus Disease (COVID-19) and the Gastrointestinal System in Children. Indian Pediatr 2020; 57: 533-535. DOI: 10.1007/s13312-020-1851-5Chiappini E., Licari A., Motisi M.A., Manti S., Marseglia G.L., Galli L., Lionetti P. Gastrointestinal involvement in children with SARS-COV-2 infection: An overview for the pediatrician. Pediatr Allergy Immunol 2020; 31(Suppl 26): 92-95. DOI: 10.1111/pai.13373Chiappini E., Licari A., Motisi M.A., Manti S., Marseglia G.L., Galli L., Lionetti P. Gastrointestinal involvement in children with SARS-COV-2 infection: An overview for the pediatrician. Pediatr Allergy Immunol 2020; 31(Suppl 26): 92-95. DOI: 10.1111/pai.13373Natarajan A., Han A., Zlitni S., Brooks E.F., Vance S.E., Wolfe M. et al. Standardized preservation, extraction and quantification techniques for detection of fecal SARS-CoV-2 RNA. Nat Commun 2021; 12(1): 5753. DOI: 10.1038/s41467-021-25576-6Natarajan A., Han A., Zlitni S., Brooks E.F., Vance S.E., Wolfe M. et al. Standardized preservation, extraction and quantification techniques for detection of fecal SARS-CoV-2 RNA. Nat Commun 2021; 12(1): 5753. DOI: 10.1038/s41467-021-25576-6Patel K.P., Patel P.A., Vunnam R.R., Hewlett A.T., Jain R., Jing R., Vunnam S.R. Gastrointestinal, hepatobiliary, and pancreatic manifestations of COVID-19. J Clin Virol 2020; 128: 104386. DOI: 10.1016/j.jcv.2020.104386.Patel K.P., Patel P.A., Vunnam R.R., Hewlett A.T., Jain R., Jing R., Vunnam S.R. Gastrointestinal, hepatobiliary, and pancreatic manifestations of COVID-19. J Clin Virol 2020; 128: 104386. DOI: 10.1016/j.jcv.2020.104386.Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020; 158:1831-1833. DOI: 10.1016/j.jcv.2020.104386Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020; 158:1831-1833. DOI: 10.1016/j.jcv.2020.104386Jothimani D., Venugopal R., Abedin M.F., Kaliamoorthy I., Rela M. COVID-19 and the liver. J Hepatol 2020; 73: 1231- 1240. DOI: 10.1016/j.jhep.2020.06.006Jothimani D., Venugopal R., Abedin M.F., Kaliamoorthy I., Rela M. COVID-19 and the liver. J Hepatol 2020; 73: 1231- 1240. DOI: 10.1016/j.jhep.2020.06.006Zippi M., Hong W., Traversa G., Maccioni F., De Biase D., Gallo C., Fiorino S. Involvement of the exocrine pancreas during COVID-19 infection and possible pathogenetic hypothesis: a concise review. Infez Med 2020; 28(4): 507-515Zippi M., Hong W., Traversa G., Maccioni F., De Biase D., Gallo C., Fiorino S. Involvement of the exocrine pancreas during COVID-19 infection and possible pathogenetic hypothesis: a concise review. Infez Med 2020; 28(4): 507-515Al-Sadi R., Ye D., Boivin M., Guo S., Hashimi M., Ereifej L., Ma T.Y. Interleukin-6 modulation of intestinal epithelial tight junction permeability is mediated by JNK pathway activa tion of claudin-2 gene. PLoS One 2014; 9(3): e85345. DOI: 10.1371/journal.pone.0085345Al-Sadi R., Ye D., Boivin M., Guo S., Hashimi M., Ereifej L., Ma T.Y. Interleukin-6 modulation of intestinal epithelial tight junction permeability is mediated by JNK pathway activa tion of claudin-2 gene. PLoS One 2014; 9(3): e85345. DOI: 10.1371/journal.pone.0085345Kuhn K.A., Manieri N.A., Liu T.C., Stappenbeck T.S. IL-6 stimulates intestinal epithelial proliferation and repair after injury. PLoS One 2014; 9:e114195. DOI: 10.1371/journal.pone.0114195Kuhn K.A., Manieri N.A., Liu T.C., Stappenbeck T.S. IL-6 stimulates intestinal epithelial proliferation and repair after injury. PLoS One 2014; 9:e114195. DOI: 10.1371/journal.pone.0114195Lorén V., Cabré E., Ojanguren I., Domènech E., Pedrosa E., García-Jaraquemada A. et al. Interleukin-10 Enhances the Intestinal Epithelial Barrier in the Presence of Corticosteroids through p38 MAPK Activity in Caco-2 Monolayers: A Possible Mechanism for Steroid Responsiveness in Ulcerative Colitis. PLoS One 2015; 10(6): e0130921. DOI: 10.1371/journal.pone.0130921Lorén V., Cabré E., Ojanguren I., Domènech E., Pedrosa E., García-Jaraquemada A. et al. Interleukin-10 Enhances the Intestinal Epithelial Barrier in the Presence of Corticosteroids through p38 MAPK Activity in Caco-2 Monolayers: A Possible Mechanism for Steroid Responsiveness in Ulcerative Colitis. PLoS One 2015; 10(6): e0130921. DOI: 10.1371/journal.pone.0130921Megyeri K., Dernovics Á., Al-Luhaibi Z., Rosztóczy A. COVID-19-associated diarrhea. World J Gastroenterol 2021; 27(23): 3208-3222. DOI: 10.3748/wjg.v27.i23.3208Megyeri K., Dernovics Á., Al-Luhaibi Z., Rosztóczy A. COVID-19-associated diarrhea. World J Gastroenterol 2021; 27(23): 3208-3222. DOI: 10.3748/wjg.v27.i23.3208Brooks E.F., Bhatt A.S. The gut microbiome: a missing link in understanding the gastrointestinal manifestations of COVID-19? Cold Spring Harb Mol Case Stud 2021; 7(2): a006031. DOI: 10.1101/mcs.a006031Brooks E.F., Bhatt A.S. The gut microbiome: a missing link in understanding the gastrointestinal manifestations of COVID-19? Cold Spring Harb Mol Case Stud 2021; 7(2): a006031. DOI: 10.1101/mcs.a006031He Y., Wang J., Li F., Shi Y. Main clinical features of COVID-19 and potential prognostic and therapeutic value of the microbiota in SARS-CoV-2 infections. Front. Microbiol 2020; 11: 1302. DOI:10.3389/fmicb.2020.01302He Y., Wang J., Li F., Shi Y. Main clinical features of COVID-19 and potential prognostic and therapeutic value of the microbiota in SARS-CoV-2 infections. Front. Microbiol 2020; 11: 1302. DOI:10.3389/fmicb.2020.01302Puoti M.G., Rybak A., Kiparissi F., Gaynor E., Borrelli O. SARS-CoV-2 and the Gastrointestinal Tract in Children. Front Pediatr 2021; 9: 617980. DOI: 10.3389/fped.2021.617980Puoti M.G., Rybak A., Kiparissi F., Gaynor E., Borrelli O. SARS-CoV-2 and the Gastrointestinal Tract in Children. Front Pediatr 2021; 9: 617980. DOI: 10.3389/fped.2021.617980Zuo T., Zhang F., Lui G.C., Yeoh Y.K., Li A.Y., Zhan H. et al. Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization. Gastroenterology 2020; 159(3): 944-955.e8. DOI: 10.1053/j.gastro.2020.05.048Zuo T., Zhang F., Lui G.C., Yeoh Y.K., Li A.Y., Zhan H. et al. Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization. Gastroenterology 2020; 159(3): 944-955.e8. DOI: 10.1053/j.gastro.2020.05.048Li N., Ma W.T., Pang M., Fan Q.L., Hua J.L. The commensal microbiota and viral infection: a comprehensive review. Front Immunol 2019; 10: 1551. DOI: 10.3389/fimmu.2019.01551Li N., Ma W.T., Pang M., Fan Q.L., Hua J.L. The commensal microbiota and viral infection: a comprehensive review. Front Immunol 2019; 10: 1551. DOI: 10.3389/fimmu.2019.01551Oba J., Carvalho W.B., Silva C.A., Delgado A.F. Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians. Einstein (Sao Paulo) 2020; 18: eRW5774. DOI: 10.31744/einstein_journal/2020RW5774Oba J., Carvalho W.B., Silva C.A., Delgado A.F. Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians. Einstein (Sao Paulo) 2020; 18: eRW5774. DOI: 10.31744/einstein_journal/2020RW5774Xu Y., Li X., Zhu B., Liang H., Fang C., Gong Y. et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020; 26(4): 502-505. DOI: 10.1038/s41591-020-0817-4Xu Y., Li X., Zhu B., Liang H., Fang C., Gong Y. et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020; 26(4): 502-505. DOI: 10.1038/s41591-020-0817-4Vuille-dit-Bille R., Liechty K., Verrey F., Guglielmetti L. SARS-CoV-2 receptor ACE2 gene expression in small intestine correlates with age. Amino Acids 2020; 52: 1063- 1065. DOI: 10.1007/s00726-020-02870-zVuille-dit-Bille R., Liechty K., Verrey F., Guglielmetti L. SARS-CoV-2 receptor ACE2 gene expression in small intestine correlates with age. Amino Acids 2020; 52: 1063- 1065. DOI: 10.1007/s00726-020-02870-zTian Y., Rong L., Nian W., He Y. Review article: gastrointestinal features in COVID-19 and the possibility of fecal transmission. Aliment Pharmacol Ther 2020; 51: 843-851. DOI: 10.1111/apt.15731Tian Y., Rong L., Nian W., He Y. Review article: gastrointestinal features in COVID-19 and the possibility of fecal transmission. Aliment Pharmacol Ther 2020; 51: 843-851. DOI: 10.1111/apt.15731Ungaro R.C., Sullivan T., Colombel J.F., Patel G. What Should Gastroenterologists and Patients Know About COVID-19? Clin Gastroenterol Hepatol 2020; 18: 1409- 1411. DOI: 10.1016/j.cgh.2020.03.020Ungaro R.C., Sullivan T., Colombel J.F., Patel G. What Should Gastroenterologists and Patients Know About COVID-19? Clin Gastroenterol Hepatol 2020; 18: 1409- 1411. DOI: 10.1016/j.cgh.2020.03.020Pan L., Mu M., Yang P., Sun Y., Wang R., Yan J. et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol 2020; 115(5): 766-773. DOI: 10.14309/ajg.0000000000000620.Pan L., Mu M., Yang P., Sun Y., Wang R., Yan J. et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol 2020; 115(5): 766-773. DOI: 10.14309/ajg.0000000000000620.Santos M.O., Gonçalves L.C., Silva P.A., Moreira A.L., Ito C.R., Peixoto F.A. et al. Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes. J Pediatr (Rio J) 2022; 98(4): 338-349. DOI: 10.1016/j.jped.2021.08.006.Santos M.O., Gonçalves L.C., Silva P.A., Moreira A.L., Ito C.R., Peixoto F.A. et al. Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes. J Pediatr (Rio J) 2022; 98(4): 338-349. DOI: 10.1016/j.jped.2021.08.006.Martins M.M., Prata-Barbosa A., da Cunha A.J. Update on SARS-CoV-2 infection in children. Paediatr Int Child Health 2021; 41(1): 56-64. DOI: 10.1080/20469047.2021.1888026Martins M.M., Prata-Barbosa A., da Cunha A.J. Update on SARS-CoV-2 infection in children. Paediatr Int Child Health 2021; 41(1): 56-64. DOI: 10.1080/20469047.2021.1888026Bolia R., Dhanesh G.A., Badkur M., Jain V. Gastrointestinal Manifestations of Pediatric Coronavirus Disease and Their Relationship with a Severe Clinical Course: A Systematic Review and Meta-analysis. J Trop Pediatr 2021; 67(2): 51. DOI: 10.1093/tropej/fmab051Bolia R., Dhanesh G.A., Badkur M., Jain V. Gastrointestinal Manifestations of Pediatric Coronavirus Disease and Their Relationship with a Severe Clinical Course: A Systematic Review and Meta-analysis. J Trop Pediatr 2021; 67(2): 51. DOI: 10.1093/tropej/fmab051Mantovani A., Rinaldi E., Zusi C., Beatrice G., Saccomani M.D., Dalbeni A. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res 2021; 89(4): 733-737. DOI: 10.1038/s41390-020- 1015-2.Mantovani A., Rinaldi E., Zusi C., Beatrice G., Saccomani M.D., Dalbeni A. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res 2021; 89(4): 733-737. DOI: 10.1038/s41390-020- 1015-2.Brunet E., Casabella A., Calzado S., Villoria A. Ileitis as the exclusive manifestation of COVID-19. The first reported case. Gastroenterol Hepatol 2021; 44(8): 561-563. DOI: 10.1016/j.gastrohep.2020.10.001Brunet E., Casabella A., Calzado S., Villoria A. Ileitis as the exclusive manifestation of COVID-19. The first reported case. Gastroenterol Hepatol 2021; 44(8): 561-563. DOI: 10.1016/j.gastrohep.2020.10.001Suresh Kumar V.C., Mukherjee S., Harne P.S., Subedi A., Ganapathy M.K., Patthipati V.S., Sapkota B. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastroenterol 2020; 7(1): e000417. DOI: 10.1136/bmjgast-2020-000417.Suresh Kumar V.C., Mukherjee S., Harne P.S., Subedi A., Ganapathy M.K., Patthipati V.S., Sapkota B. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastroenterol 2020; 7(1): e000417. DOI: 10.1136/bmjgast-2020-000417.Mehl S.C., Whitlock R.S., Marcano D.C., Rialon K.L., Arrington A.S., Naik-Mathuria B. Necrotizing Enterocolitis-like Pneumatosis Intestinalis in an Infant With COVID-19. Pediatr Infect Dis J 2021; 40(2): e85-e86. DOI: 10.1097/INF.0000000000002968Mehl S.C., Whitlock R.S., Marcano D.C., Rialon K.L., Arrington A.S., Naik-Mathuria B. Necrotizing Enterocolitis-like Pneumatosis Intestinalis in an Infant With COVID-19. Pediatr Infect Dis J 2021; 40(2): e85-e86. DOI: 10.1097/INF.0000000000002968Fang D., Ma J.D., Guan J.L. Manifestations of Digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Zhonghua Xiaohua Zazhi 2020; 40: E005-E005.Fang D., Ma J.D., Guan J.L. Manifestations of Digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Zhonghua Xiaohua Zazhi 2020; 40: E005-E005.Wang D., Ju X.L., Xie F., Lu Y., Li F.Y., Huang H.H. et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi 2020; 58(4): 269-274. Chinese. DOI: 10.3760/cma.j.cn112140-20200225-00138Wang D., Ju X.L., Xie F., Lu Y., Li F.Y., Huang H.H. et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi 2020; 58(4): 269-274. Chinese. DOI: 10.3760/cma.j.cn112140-20200225-00138Oran D.P., Topol E.J. The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review. Ann Intern Med 2021; 174(5): 655-662. DOI: 10.7326/M20-6976Oran D.P., Topol E.J. The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review. Ann Intern Med 2021; 174(5): 655-662. DOI: 10.7326/M20-6976Bai Y., Yao L., Wei T., Tian F., Jin D.Y., Chen L., Wang M. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 323(14): 1406-1407. DOI: 10.1001/jama.2020.2565Bai Y., Yao L., Wei T., Tian F., Jin D.Y., Chen L., Wang M. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 323(14): 1406-1407. DOI: 10.1001/jama.2020.2565van Doremalen N., Bushmaker T., Morris D.H., Holbrook M.G., Gamble A., Williamson B.N. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARSCoV-1. N Engl J Med 2020; 382(16): 1564-1567. DOI: 10.1056/NEJMc2004973van Doremalen N., Bushmaker T., Morris D.H., Holbrook M.G., Gamble A., Williamson B.N. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARSCoV-1. N Engl J Med 2020; 382(16): 1564-1567. DOI: 10.1056/NEJMc2004973Natarajan A., Zlitni S., Brooks E.F., Vance S.E., Dahlen A., Hedlin H. et al. Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection. Med (NY) 2022; 3(6): 371-387.e9. DOI: 10.1016/j. medj.2022.04.001.Natarajan A., Zlitni S., Brooks E.F., Vance S.E., Dahlen A., Hedlin H. et al. Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection. Med (NY) 2022; 3(6): 371-387.e9. DOI: 10.1016/j. medj.2022.04.001.uo M., Tao W., Flavell R.A., Zhu S. Potential intestinal infection and faecal-oral transmission of SARS-CoV-2. Nat Rev Gastroenterol Hepatol 2021; 18(4): 269-283. DOI: 10.1038/s41575-021-00416-6uo M., Tao W., Flavell R.A., Zhu S. Potential intestinal infection and faecal-oral transmission of SARS-CoV-2. Nat Rev Gastroenterol Hepatol 2021; 18(4): 269-283. DOI: 10.1038/s41575-021-00416-6Jeong H.W., Kim S.M., Kim H.S., Kim Y.I., Kim J.H. Viable SARS-CoV-2 in various specimens from COVID-19 patients. Clin Microbiol Infect 2020; 26(11): 1520-1524. DOI: 10.1016/j.cmi.2020.07.020Jeong H.W., Kim S.M., Kim H.S., Kim Y.I., Kim J.H. Viable SARS-CoV-2 in various specimens from COVID-19 patients. Clin Microbiol Infect 2020; 26(11): 1520-1524. DOI: 10.1016/j.cmi.2020.07.020Zhang Y., Chen C., Song Y., Zhu S., Wang D., Zhang H. et al. Excretion of SARS-CoV-2 through faecal specimens. Emerg Microbes Infect 2020; 9(1): 2501-2508. DOI: 10.1080/22221751.2020.1844551Zhang Y., Chen C., Song Y., Zhu S., Wang D., Zhang H. et al. Excretion of SARS-CoV-2 through faecal specimens. Emerg Microbes Infect 2020; 9(1): 2501-2508. DOI: 10.1080/22221751.2020.1844551Wölfel R., Corman V.M., Guggemos W., Seilmaier M., Zange S., Müller M.A. et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581(7809): 465-469. DOI: 10.1038/s41586-020-2196-x.Wölfel R., Corman V.M., Guggemos W., Seilmaier M., Zange S., Müller M.A. et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581(7809): 465-469. DOI: 10.1038/s41586-020-2196-x.Albert S., Ruíz A., Pemán J., Salavert M., Domingo-Calap P. Lack of evidence for infectious SARS-CoV-2 in feces and sewage. Eur J Clin Microbiol Infect Dis 2021; 40(12): 2665- 2667. DOI: 10.1007/s10096-021-04304-4Albert S., Ruíz A., Pemán J., Salavert M., Domingo-Calap P. Lack of evidence for infectious SARS-CoV-2 in feces and sewage. Eur J Clin Microbiol Infect Dis 2021; 40(12): 2665- 2667. DOI: 10.1007/s10096-021-04304-4Saif L.J., Jung K. Comparative Pathogenesis of Bovine and Porcine Respiratory Coronaviruses in the Animal Host Species and SARS-CoV-2 in Humans. J Clin Microbiol 2020; 58(8): e01355-20. DOI: 10.1128/JCM.01355-20Saif L.J., Jung K. Comparative Pathogenesis of Bovine and Porcine Respiratory Coronaviruses in the Animal Host Species and SARS-CoV-2 in Humans. J Clin Microbiol 2020; 58(8): e01355-20. DOI: 10.1128/JCM.01355-20Gaebler C., Wang Z., Lorenzi J.C., Muecksch F., Finkin S., Tokuyama M. et al. Evolution of antibody immunity to SARS-CoV-2. Nature 2021; 591(7851): 639-644. DOI: 10.1038/s41586-021-03207-w.Gaebler C., Wang Z., Lorenzi J.C., Muecksch F., Finkin S., Tokuyama M. et al. Evolution of antibody immunity to SARS-CoV-2. Nature 2021; 591(7851): 639-644. DOI: 10.1038/s41586-021-03207-w.Weng J., Li Y., Li J., Shen L., Zhu L., Liang Y. et al. Gastrointestinal sequelae 90 days after discharge for COVID-19. Lancet Gastroenterol Hepatol 2021; 6(5): 344-346. DOI: 10.1016/S2468-1253(21)00076-5Weng J., Li Y., Li J., Shen L., Zhu L., Liang Y. et al. Gastrointestinal sequelae 90 days after discharge for COVID-19. Lancet Gastroenterol Hepatol 2021; 6(5): 344-346. DOI: 10.1016/S2468-1253(21)00076-5

The authors declare that there are no conflicts of interest present.