Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis

Abstract In order to understand the clinical manifestations and incidence of gastrointestinal symptoms of coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.We retrospectively analyzed studies on gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 patients from January 1, 2020 to August 10, 2020, including prospective clinical studies and case reports. The results of fecal nucleic acid detection were analyzed systematically. Stata12.0 software was used for meta-analysis.The results showed that the most common gastrointestinal symptoms in children with COVID-19 were vomiting and diarrhea, with a total incidence of 17.7% (95% Cl 13.9–21.5%). However, the prevalence of gastrointestinal symptoms in other countries (21.1%, 95% CI 16.5–25.7%) was higher compared to China (12.9%, 95% CI 8–17.7%). In Wuhan, the pooled prevalence was much higher (41.3%, 95% CI 3.2–79.4%) compared to areas outside Wuhan in China (7.1%, 95% CI 4.0–10.3%). The positive rate of fecal nucleic acid testing in COVID-19 children was relatively high at 85.8% (91/106). Additionally, 71.2% (52/73) were still positive for fecal nucleic acid after respiratory tract specimens turned negative. One and two weeks after the respiratory tract specimens turned nucleic acid-negative, 45.2% (33/73) and 34.2% (25/73) patients, respectively, remained fecal nucleic acid-positive. The longest interval between the respiratory tract specimens turning negative and fecal specimens turning negative exceeded 70 days. Conclusions and relevance: gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.

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Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis

10.21203/rs.3.rs-34733/v3 ◽

2020 ◽

Author(s):

Ji-Gan Wang ◽

Hairong Cui ◽

Huabo Tang ◽

Xiu-li Deng

Keyword(s):

Nucleic Acid ◽

Respiratory Tract ◽

Case Reports ◽

Meta Analysis ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Nucleic Acid Detection ◽

Nucleic Acid Testing ◽

Pooled Prevalence ◽

Positive Rate

Abstract In order to understand the clinical manifestations and incidence of gastrointestinal symptoms of coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.We retrospectively analyzed studies on gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 patients from January 1, 2020 to August 10, 2020, including prospective clinical studies and case reports. The results of fecal nucleic acid detection were analyzed systematically. Stata12.0 software was used for meta-analysis.The results showed that the most common gastrointestinal symptoms in children with COVID-19 were vomiting and diarrhea, with a total incidence of 17.7% (95% Cl: 13.9%-21.5%). However, the prevalence of gastrointestinal symptoms in other countries (21.1%, 95% CI: 16.5%-25.7%) was higher compared to China (12.9%, 95% CI: 8%-17.7%). In Wuhan, the pooled prevalence was much higher (41.3%, 95 % CI: 3.2%-79.4%) compared to areas outside Wuhan in China (7.1%, 95 % CI: 4.0%-10.3%).The positive rate of fecal nucleic acid testing in COVID-19 children was relatively high at 85.8% (91/106). Additionally, 71.2% (52/73) were still positive for fecal nucleic acid after respiratory tract specimens turned negative. One and two weeks after the respiratory tract specimens turned nucleic acid-negative, 45.2% (33/73) and 34.2% (25/73) patients, respectively, remained fecal nucleic acid-positive. The longest interval between the respiratory tract specimens turning negative and fecal specimens turning negative exceeded 70 days.Conclusions and Relevance:Gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.

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Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis

10.21203/rs.3.rs-34733/v2 ◽

2020 ◽

Cited By ~ 1

Author(s):

Ji-Gan Wang ◽

Hairong Cui ◽

Huabo Tang ◽

Xiu-li Deng

Keyword(s):

Nucleic Acid ◽

Respiratory Tract ◽

Case Reports ◽

Meta Analysis ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Nucleic Acid Detection ◽

Nucleic Acid Testing ◽

Pooled Prevalence ◽

Positive Rate

Abstract In order to understand the clinical manifestations and incidence of gastrointestinal symptoms of coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.We retrospectively analyzed studies on gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 patients from January 1, 2020 to August 10, 2020, including prospective clinical studies and case reports. The results of fecal nucleic acid detection were analyzed systematically. Stata12.0 software was used for meta-analysis.The results showed that the most common gastrointestinal symptoms in children with COVID-19 were vomiting and diarrhea, with a total incidence of 17.7% (95% Cl: 13.9%-21.5%). However, the prevalence of gastrointestinal symptoms in other countries (21.1%, 95% CI: 16.5%-25.7%) was higher compared to China (12.9%, 95% CI: 8%-17.7%). In Wuhan, the pooled prevalence was much higher (41.3%, 95 % CI: 3.2%-79.4%) compared to areas outside Wuhan in China (7.1%, 95 % CI: 4.0%-10.3%).The positive rate of fecal nucleic acid testing in COVID-19 children was relatively high at 85.8% (91/106). Additionally, 71.2% (52/73) were still positive for fecal nucleic acid after respiratory tract specimens turned negative. One and two weeks after the respiratory tract specimens turned nucleic acid-negative, 45.2% (33/73) and 34.2% (25/73) patients, respectively, remained fecal nucleic acid-positive. The longest interval between the respiratory tract specimens turning negative and fecal specimens turning negative exceeded 70 days.Conclusions and Relevance:Gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.

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Gastrointestinal symptoms and fecal nucleic acid testing of children with coronavirus disease 2019: a systematic review and meta-analysis

10.21203/rs.3.rs-34733/v1 ◽

2020 ◽

Author(s):

Ji-Gan Wang ◽

Hairong Cui ◽

Huabo Tang

Keyword(s):

Nucleic Acid ◽

Respiratory Tract ◽

Case Reports ◽

Meta Analysis ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Nucleic Acid Detection ◽

Nucleic Acid Testing ◽

Negative Results ◽

Pooled Prevalence

Abstract Objective: To understand the clinical manifestations and incidence of gastrointestinal symptoms of Coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.Methods: Retrospective analysis of studies of gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 since the outbreak of COVID-19, as well as prospective clinical studies and case reports to understand the clinical characteristics of gastrointestinal symptoms and feces in children. Nucleic acid detection results were also analyzed.Results: 1. The clinical manifestations of gastrointestinal symptoms in children with COVID-19 are mostly vomiting and diarrhea, with a total incidence rate of 21.1% (95%Cl=0.14-0.28).2.When analyzing by country (studies from China versus studies from other countries), the pooled prevalence of gastrointestinal symptoms in studies from countries other than China was much lower at 18.2% (95% CI0.05 to 0.31). This is in comparison to studies from China where the prevalence was higher: 23.3% (95% CI 0.153 to 0.310) .3.In Wuhan patients, the pooled prevalence was much higher at 41.2% (95 % CI 0.147 to 0.678) as compared to areas outside Wuhan，China：15.1%(95 % CI 0.075 to 0.227).4.Fecal nucleic acid detection is as accurate as respiratory specimen nucleic acid detection. The positive rate of fecal nucleic acid testing in COVID-19 patients was 92.5% (25/27). In patients where nucleic acid tests of respiratory tract specimens produced negative results, a positive fecal nucleic acid test result was present in 83.3% (20/24); one week after the respiratory tract specimen was nucleic acid-negative, 54.1% (13/24) were fecal nucleic acid-positive; two weeks after the respiratory tract nucleic acid negative test, 37.5% (9/24) were fecal nucleic acid-positive. The longest interval between a negative respiratory system result and positive fecal specimen result exceeded 19 days.Conclusions and Relevance: Gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.

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Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

10.20944/preprints202002.0378.v2 ◽

2020 ◽

Author(s):

Alfonso J. Rodriguez-Morales ◽

Jaime A. Cardona-Ospina ◽

Estefanía Gutiérrez-Ocampo ◽

Rhuvi Villamizar-Peña ◽

Yeimer Holguin-Rivera ◽

...

Keyword(s):

Observational Studies ◽

Clinical Laboratory ◽

Case Reports ◽

Meta Analysis ◽

Fatal Outcome ◽

Clinical Manifestations ◽

Clinical Infectious Disease ◽

Imaging Features ◽

Pooled Prevalence ◽

Quantitative Analyses

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Measures of heterogeneity were estimated and reported. Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome. Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

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Gastrointestinal manifestations of COVID-19 in children: a systematic review and meta-analysis

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101529 ◽

2020 ◽

pp. flgastro-2020-101529 ◽

Cited By ~ 1

Author(s):

Anthony K Akobeng ◽

Ciaran Grafton-Clarke ◽

Ibtihal Abdelgadir ◽

Erica Twum-Barimah ◽

Morris Gordon

Keyword(s):

Systematic Review ◽

English Language ◽

Case Reports ◽

Meta Analysis ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Risk Of Bias ◽

Gastrointestinal Manifestations ◽

Published Evidence ◽

Pooled Prevalence

ObjectivesTo summarise the published evidence on the gastrointestinal manifestations of COVID-19 in children and to determine the prevalence of gastrointestinal symptoms.MethodsIn this systematic review and meta-analysis, we searched PubMed, Embase, CINAHL and the WHO’s database of publications on novel coronavirus. We included English language studies that had described original demographic and clinical characteristics of children diagnosed with COVID-19 and reported on the presence or absence of gastrointestinal symptoms. Meta-analysis was conducted using the random-effects model. The pooled prevalence of gastrointestinal symptoms was expressed as proportion and 95% CI.ResultsThe search identified 269 citations. Thirteen studies (nine case series and four case reports) comprising data for 284 patients were included. Overall, we rated four studies as having a low risk of bias, eight studies as moderate and one study as high risk of bias. In a meta-analysis of nine studies, comprising 280 patients, the pooled prevalence of all gastrointestinal symptoms was 22.8% (95% CI 13.1% to 35.2%; I2=54%). Diarrhoea was the most commonly reported gastrointestinal symptom followed by vomiting and abdominal pain.ConclusionsNearly a quarter of children with COVID-19 have gastrointestinal symptoms. It is important for clinicians to be aware of the gastrointestinal manifestation of COVID-19.PROSPERO registration numberCRD42020177569.

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Improved Early Recognition of Coronavirus Disease-2019 (COVID-19): Single-Center Data from a Shanghai Screening Hospital

Archives of Iranian Medicine ◽

10.34172/aim.2020.10 ◽

2020 ◽

Vol 23 (4) ◽

pp. 272-276 ◽

Cited By ~ 6

Author(s):

Ling Peng ◽

Kang-Yong Liu ◽

Fei Xue ◽

Ya-Fang Miao ◽

Ping-An Tu ◽

...

Keyword(s):

Nucleic Acid ◽

Clinical Laboratory ◽

Clinical Symptoms ◽

Early Recognition ◽

Case Reports ◽

Clinical Manifestations ◽

Nucleic Acid Testing ◽

Single Center ◽

Cross Sectional ◽

Epidemiological Characteristics

Background: In December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was reported in Wuhan, Hubei province, China, which has subsequently affected more than 200 countries worldwide including Europe, North America, Oceania, Africa and other places. The number of infected people is rapidly increasing, while the diagnostic method of COVID-19 is only by nucleic acid testing. Objective: To explain the epidemiological characteristics, clinical features, imaging manifestations and to judge diagnostic value of COVID-19 by analyzing the clinical data of COVID-19 suspected and confirmed patients in a non-outbreak, Shanghai, China. To clarify the early epidemiology and clinical characteristics about COVID-19. Methods: Cross-sectional, single-center case reports of the 86 patients screened at Zhoupu Hospital in Pudong New District, Shanghai, China, from January 23 to February 16, 2020. Epidemiology, demography, clinical, laboratory and chest CTs were collected and analyzed. The screened patients were divided into COVID-19 and non-COVID-19 based on nucleic acid test results. Results: Of the 86 screened patients, 11 were confirmed (12.8%) by nucleic acid testing (mean age 40.73 ± 11.32, 5 males). No significant differences were found in clinical symptoms including fever, cough, dyspnea, sore throat, and fatigue (P > 0.05). No statistical difference was observed in plasma C-reactive protein (CRP) between the two groups (COVID-19 and non-COVID-19 ) of patients (P = 0.402), while the white blood cell count and lymphocyte count of the confirmed patients were slightly lower than those of the suspected patients (P < 0.05). Some non-COVID-19 chest CTs also showed subpleural lesions, such as ground-glass opacities (GGO) combined with bronchiectasis; or halo nodules distributed under the pleura with focal GGO; consolidation of subpleural distribution or combined with air bronchi sign and vascular bundle sign, etc. Conclusion: The early clinical manifestations and imaging findings of COVID-19 are not characteristic in non-outbreak areas. Etiological testing should be performed as early as possible for clinically suspected patients.

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Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

10.20944/preprints202002.0378.v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Alfonso J. Rodriguez-Morales ◽

Jaime A. Cardona-Ospina ◽

Estefanía Gutiérrez-Ocampo ◽

Rhuvi Villamizar-Peña ◽

Yeimer Holguin-Rivera ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Clinical Laboratory ◽

Case Reports ◽

Meta Analysis ◽

Clinical Manifestations ◽

Clinical Infectious Disease ◽

Primary Concern ◽

Imaging Features ◽

Pooled Prevalence

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing primary concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic review of the literature with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included. The case reports were analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95%CI. Measures of heterogeneity, including Cochran’s Q statistic, the I2 index, and the τ2 test, were estimated and reported.Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For >656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required ICU, with 32.8% presenting ARDS (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome.Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

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COVID-19 and Influenza Co-infection: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.681469 ◽

2021 ◽

Vol 8 ◽

Author(s):

Masoud Dadashi ◽

Saeedeh Khaleghnejad ◽

Parisa Abedi Elkhichi ◽

Mehdi Goudarzi ◽

Hossein Goudarzi ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Influenza Infection ◽

Meta Analysis ◽

Clinical Manifestations ◽

Case Series ◽

Influenza Viruses ◽

Original Research ◽

Respiratory Pathogens ◽

Prevalence Studies

Background and Aim: Co-infection of COVID-19 with other respiratory pathogens which may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge new concern. The overlap of COVID-19 and influenza, as two epidemics at the same time can occur in the cold months of the year. The aim of current study was to evaluate the rate of such co-infection as a systematic review and meta-analysis.Methods: A systematic literature search was performed on September 28, 2019 for original research articles published in Medline, Web of Science, and Embase databases from December 2019 to September 2020 using relevant keywords. Patients of all ages with simultaneous COVID-19 and influenza were included. Statistical analysis was performed using STATA 14 software.Results: Eleven prevalence studies with total of 3,070 patients with COVID-19, and 79 patients with concurrent COVID-19 and influenza were selected for final evaluation. The prevalence of influenza infection was 0.8% in patients with confirmed COVID-19. The frequency of influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and 0.4% in the America. Four prevalence studies reported the sex of patients, which were 30 men and 31 women. Prevalence of co-infection with influenza in men and women with COVID-19 was 5.3 and 9.1%, respectively. Eight case reports and 7 case series with a total of 123 patients with COVID-19 were selected, 29 of them (16 men, 13 women) with mean age of 48 years had concurrent infection with influenza viruses A/B. Fever, cough, and shortness of breath were the most common clinical manifestations. Two of 29 patients died (6.9%), and 17 out of 29 patients recovered (58.6%). Oseltamivir and hydroxychloroquine were the most widely used drugs used for 41.4, and 31% of patients, respectively.Conclusion: Although a low proportion of COVID-19 patients have influenza co-infection, however, the importance of such co-infection, especially in high-risk individuals and the elderly, cannot be ignored. We were unable to report the exact rate of simultaneous influenza in COVID-19 patients worldwide due to a lack of data from several countries. Obviously, more studies are needed to evaluate the exact effect of the COVID-19 and influenza co-infection in clinical outcomes.

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Prevalence and characteristics of fever in adult and paediatric patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of 17515 patients

PLoS ONE ◽

10.1371/journal.pone.0249788 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249788

Author(s):

Md Asiful Islam ◽

Shoumik Kundu ◽

Sayeda Sadia Alam ◽

Tareq Hossan ◽

Mohammad Amjad Kamal ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Clinical Manifestations ◽

Sensitivity Analyses ◽

Clinical Feature ◽

High Grade ◽

High Grade Fever ◽

Paediatric Patients ◽

Pooled Prevalence ◽

Significant Difference

Background Coronavirus disease 2019 (COVID-19), a pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 started to spread globally since December 2019 from Wuhan, China. Fever has been observed as one of the most common clinical manifestations, although the prevalence and characteristics of fever in adult and paediatric COVID-19 patients is inconclusive. We aimed to conduct a systematic review and meta-analysis to estimate the overall pooled prevalence of fever and chills in addition to fever characteristics (low, medium, and high temperature) in both adult and paediatric COVID-19 patients. Methods The protocol of this systematic review and meta-analysis was registered with PROSPERO (CRD42020176327). PubMed, Scopus, ScienceDirect and Google Scholar databases were searched between 1st December 2019 and 3rd April 2020 without language restrictions. Both adult (≥18 years) and paediatric (<18 years) COVID-19 patients were considered eligible. We used random-effects model for the meta-analysis to obtain the pooled prevalence and risk ratio (RR) with 95% confidence intervals (CIs). Quality assessment of included studies was performed using the Joanna Briggs Institute critical appraisal tools. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Robustness of the pooled estimates was checked by different subgroups and sensitivity analyses. Results We identified 2055 studies, of which 197 studies (n = 24266) were included in the systematic review and 167 studies with 17142 adults and 373 paediatrics were included in the meta-analysis. Overall, the pooled prevalence of fever in adult and paediatric COVID-19 patients were 79.43% [95% CI: 77.05–81.80, I2 = 95%] and 45.86% [95% CI: 35.24–56.48, I2 = 78%], respectively. Besides, 14.45% [95% CI: 10.59–18.32, I2 = 88%] of the adult COVID-19 patients were accompanied with chills. In adult COVID-19 patients, the prevalence of medium-grade fever (44.33%) was higher compared to low- (38.16%) and high-grade fever (14.71%). In addition, the risk of both low (RR: 2.34, 95% CI: 1.69–3.22, p<0.00001, I2 = 84%) and medium grade fever (RR: 2.79, 95% CI: 2.21–3.51, p<0.00001, I2 = 75%) were significantly higher compared to high-grade fever, however, there was no significant difference between low- and medium-grade fever (RR: 1.17, 95% CI: 0.94–1.44, p = 0.16, I2 = 87%). 88.8% of the included studies were of high-quality. The sensitivity analyses indicated that our findings of fever prevalence for both adult and paediatric patients are reliable and robust. Conclusions The prevalence of fever in adult COVID-19 patients was high, however, 54.14% of paediatric COVID-19 patients did not exhibit fever as an initial clinical feature. Prevalence and risk of low and medium-grade fevers were higher compared to high-grade fever.

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