Clinical and pathogenetic features of diarrheal syndrome in COVID-19 in children

SARS-CoV-2 is known to be able to infect the gastrointestinal tract, causing a variety of symptoms. Practice shows that the clinical presentation of diarrheal syndrome with COVID-19 does not fit into the classic manifestations of osmotic diarrhea. Cases of lesions of the lower intestine are often reported.
Purpose. The study aims at evaluation of the features of clinical manifestations and laboratory parameters of diarrheal syndrome to determine the possible mechanism of gastrointestinal damage in children with COVID-19.
Material and methods. 80 subjects were examined on the basis of the Kazan Regional Clinical Hospital. 40 patients were selected for the main group with diarrhea and a confirmed diagnosis of COVID-19, 40 for the control group with rota- or norovirus infection.
The examination included a daily examination, laboratory tests to assess the clinical features of the course, etiological decoding, study of the pathogenetic mechanisms of diarrhea in COVID-19.
Results. COVID-19 differs from classical viral diarrhea in more pronounced catarrhal respiratory syndrome (p<0.001), pyretic fever (p=0.001). Vomiting is more typical for rota- and norovirus infections (p<0.001). SARS-CoV-2 is statistically significantly more likely to cause clinical scenario of distal colitis (p=0.034). Patients with increased levels of carbohydrates in the feces were observed more often in the viral diarrhea group, and calprotectin — in the COVID-19 group (p<0.05). A significant qualitative and quantitative imbalance of the intestinal microflora is more typical for patients infected with SARS-CoV-2.
Conclusion. The conducted study suggests a complex genesis of gastrointestinal lesions in children with COVID-19, which includes signs of both osmotic and exudative (invasive) mechanisms of diarrhea formation. Clearly, GI lesion in COVID-19 is a multifactorial process.

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