Characteristics of diarrhea of various etiologies in children with COVID-19

Against the background of the COVID-19 pandemic, an increase in the total proportion of viral diarrhea in the etiological structure of acute intestinal infections in children has been recorded. Currently, the differential diagnosis of COVID-19 with gastrointestinal syndrome and acute intestinal infections is difficult, which requires the development of an algorithm for their diagnosis, treatment and prediction of the risks of complications.

Objective. To evaluate the clinical and epidemiological features of diarrhea of  various etiologies during the COVID-19 pandemic in children hospitalized with COVID-19 with gastrointestinal symptoms.

Materials and methods. We examined 105 patients under 18 years old with COVID-19 and gastrointestinal syndrome. The examination included daily examination, laboratory tests to assess the clinical features of the course. Diagnosis of acute intestinal infections was carried out using PCR methods and bacteriological examination of feces. 

Results. Of 105 hospitalized patients diagnosed with COVID-19 with gastrointestinal syndrome, 57 (55%) had concomitant viral (41%) and bacterial (13.3%) intestinal infections. In the COVID-19 + viral infections group, a high rate of maximum frequency of vomiting per day was revealed (p=0.04). In the gastrointestinal form of COVID-19, as well as a combination of COVID-19 with bacterial intestinal infections, an increase in creatinine levels to 119 and 80 μmol / L was noted in 20.8% and 35.7% of patients, respectively (p=0.01). In the COVID-19 with bacterial intestinal infections group, 57.1% had a risk of developing acute kidney injury. The likelihood of developing the initial stage of acute kidney injury is higher in the COVID-19 with gastrointestinal syndrome group.

Conclusion. The obtained data indicate a frequent (30%) occurrence of gastrointestinal manifestations in COVID-19 in children. The course of the disease in groups of children with COVID-19 and gastrointestinal syndrome and COVID-19 with bacterial intestinal infections is complicated by the risk of developing acute kidney injury, which requires further research for early prediction of kidney damage and timely treatment.

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