{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:39:57Z","timestamp":1760402397062,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,2]],"date-time":"2022-01-02T00:00:00Z","timestamp":1641081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children\u2019s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU\/mL (median, 425 BAU\/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children\u2019s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.<\/jats:p>","DOI":"10.3390\/children9010041","type":"journal-article","created":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T22:51:50Z","timestamp":1641250310000},"page":"41","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5716-3703","authenticated-orcid":false,"given":"D\u00e9sir\u00e9e","family":"Caselli","sequence":"first","affiliation":[{"name":"Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-1679","authenticated-orcid":false,"given":"Claudio","family":"Cafagno","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2057-9745","authenticated-orcid":false,"given":"Daniela","family":"Loconsole","sequence":"additional","affiliation":[{"name":"Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annamaria","family":"Giannini","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Tansella","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalisa","family":"Saracino","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1043-1256","authenticated-orcid":false,"given":"Maria","family":"Chironna","sequence":"additional","affiliation":[{"name":"Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1908-6671","authenticated-orcid":false,"given":"Maurizio","family":"Aric\u00f2","sequence":"additional","affiliation":[{"name":"Strategic Control, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8495","DOI":"10.4081\/pr.2020.8495","article-title":"2019-nCoV: Polite with children!","volume":"12","author":"Caselli","year":"2020","journal-title":"Pediatr. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1056\/NEJMc2005073","article-title":"SARS-CoV-2 Infection in Children","volume":"382","author":"Lu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Loske, J., R\u00f6hmel, J., Lukassen, S., Stricker, S., Magalh\u00e3es, V.G., Liebig, J., Chua, R.L., Th\u00fcrmann, L., Messingschlager, M., and Seegebarth, A. (2021). Pre-activated antiviral innate immunity in the upper airways controls early SARS-CoV-2 infection in children. Nat. Biotechnol.","DOI":"10.1101\/2021.06.24.21259087"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1016\/S0140-6736(21)01358-1","article-title":"SARS-CoV-2 Delta VOC in Scotland: Demographics, risk of hospital admission, and vaccine effectiveness","volume":"397","author":"Sheikh","year":"2021","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"CDC COVID-19 Response Team (2020). Coronavirus Disease 2019 in Children\u2014United States, February 12-April 2, 2020. MMWR Morb. Mortal. Wkly. Rep., 69, 422.","DOI":"10.15585\/mmwr.mm6914e4"},{"key":"ref_6","unstructured":"(2021, August 06). Coronavirus Disease 2019 (COVID-19): Clinical Manifestations and Diagnosis in Children. Available online: https:\/\/www.uptodate.com\/contents\/coronavirus-disease-2019-covid-19-clinical-manifestations-and-diagnosis-in-children."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1111\/bjd.19349","article-title":"No evidence of SARS-CoV-2 infection by polymerase chain reaction or serology in children with pseudo-chilblain","volume":"183","author":"Caselli","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.annder.2020.11.005","article-title":"Acute acral eruptions in children during the COVID-19 pandemic: Characteristics of 103 children and their family clusters","volume":"148","author":"Hubiche","year":"2021","journal-title":"Ann. Dermatol. Venereol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1001\/jama.2021.2091","article-title":"Characteristics and Outcomes of US Children and Adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C) Compared with Severe Acute COVID-19","volume":"325","author":"Feldstein","year":"2021","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Clark, J.A., and Pathan, N. (2021). Hide and seek in a pandemic: Review of SARS-CoV-2 infection and sequelae in children. Exp. Physiol., 1\u201312.","DOI":"10.1113\/EP089399"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2011335","DOI":"10.1001\/jamanetworkopen.2020.11335","article-title":"Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients with Coronavirus Disease 2019: A Systematic Review and Meta-analysis","volume":"3","author":"Parasa","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Concas, G., Barone, M., Francavilla, R., Cristofori, F., Dargenio, V.N., Giorgio, R., Dargenio, C., Fanos, V., and Marcialis, M.A. (2021). Twelve Months with COVID-19: What Gastroenterologists Need to Know. Dig. Dis. Sci., 1\u201321.","DOI":"10.1007\/s10620-021-07158-0"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1136\/gutjnl-2020-320926","article-title":"Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms","volume":"69","author":"Jin","year":"2020","journal-title":"Gut"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"China Medical Treatment Expert Group for COVID-19. Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_15","first-page":"436","article-title":"Comparative study of the clinical characteristics and epidemiological trend of 244 COVID-19 infected children with or without GI symptoms","volume":"70","author":"Xiong","year":"2021","journal-title":"Gut"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1038\/s41591-020-0817-4","article-title":"Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding","volume":"26","author":"Xu","year":"2020","journal-title":"Nat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1002\/ppul.24718","article-title":"Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults","volume":"55","author":"Xia","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e20200702","DOI":"10.1542\/peds.2020-0702","article-title":"Epidemiology of COVID-19 among children in China","volume":"145","author":"Dong","year":"2020","journal-title":"Pediatrics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e202430","DOI":"10.1001\/jamapediatrics.2020.2430","article-title":"Epidemiology, Clinical Features, and Disease Severity in Patients with Coronavirus Disease 2019 (COVID-19) in a Children\u2019s Hospital in New York City, New York","volume":"174","author":"Zachariah","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/MPG.0000000000003204","article-title":"Gastrointestinal Perspective of COVID-19 in Children\u2014An Updated Review","volume":"73","author":"Assa","year":"2021","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.3748\/wjg.v27.i16.1716","article-title":"Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications","volume":"27","author":"Saeed","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3303","DOI":"10.3748\/wjg.v27.i23.3303","article-title":"Gastrointestinal involvement in paediatric COVID-19\u2014From pathogenesis to clinical management: A comprehensive review","volume":"27","author":"Calitri","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1136\/flgastro-2020-101529","article-title":"Gastrointestinal manifestations of COVID-19 in children: A systematic review and meta-analysis","volume":"12","author":"Akobeng","year":"2020","journal-title":"Frontline Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Loconsole, D., Caselli, D., Centrone, F., Morcavallo, C., Campanella, S., Aric\u00f2, M., and Chironna, M. (2020). SARS-CoV-2 Infection in Children in Southern Italy: A Descriptive Case Series. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17176080"},{"key":"ref_25","unstructured":"(2021, August 25). Available online: https:\/\/regione.puglia.it\/web\/speciale-coronavirus\/-\/bollettino-epidemiologico-del-24-agosto-2021."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3390\/pediatric13010017","article-title":"Effectiveness of Preventive Measures in Keeping Low Prevalence of SARS-CoV-2 Infection in Health Care Workers in a Referral Children\u2019s Hospital in Southern Italy","volume":"13","author":"Caselli","year":"2021","journal-title":"Pediatr. Rep."},{"key":"ref_27","first-page":"18","article-title":"Clinical and epidemiological characteristics of children with SARS-CoV-2 infection: A case series in Sinaloa","volume":"78","year":"2021","journal-title":"Bol. Med. Hosp. Infant. Mex."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1016\/j.jiph.2020.10.008","article-title":"COVID-19 infection prevalence in pediatric population: Etiology, clinical presentation, and outcome","volume":"13","author":"Alsohime","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_29","first-page":"CD013665","article-title":"Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19","volume":"2","author":"Struyf","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.12998\/wjcc.v8.i14.2950","article-title":"Clinical characteristics of patients with COVID-19 presenting with gastrointestinal symptoms as initial symptoms: Retrospective case series","volume":"8","author":"Yang","year":"2020","journal-title":"World J. Clin. Cases."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1007\/s00431-021-03999-z","article-title":"A cross-sectional study of screening for coronavirus disease 2019 (COVID-19) at the pediatric emergency department in Vilnius during the first wave of the pandemic","volume":"180","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1056\/NEJMcibr2011679","article-title":"Trained Innate Immunity, Epigenetics, and COVID-19","volume":"383","author":"Mantovani","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1038\/s41591-021-01263-3","article-title":"Humoral signatures of protective and pathological SARS-CoV-2 infection in children","volume":"27","author":"Bartsch","year":"2021","journal-title":"Nat. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1038\/s41591-020-0965-6","article-title":"Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections","volume":"26","author":"Long","year":"2020","journal-title":"Nat. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1056\/NEJMc2025179","article-title":"Rapid Decay of Anti-SARS-CoV-2 Antibodies in Persons with Mild COVID-19","volume":"383","author":"Ibarrondo","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1038\/s41590-020-00826-9","article-title":"Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum","volume":"22","author":"Weisberg","year":"2021","journal-title":"Nat. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e458","DOI":"10.1097\/INF.0000000000002937","article-title":"Sequelae of COVID-19 in Hospitalized Children: A 4-Months Follow-Up","volume":"39","author":"Denina","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1136\/archdischild-2020-320558","article-title":"Seroprevalence of SARS-CoV-2 antibodies in children: A prospective multicentre cohort study","volume":"106","author":"Waterfield","year":"2020","journal-title":"Arch Dis. Child."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S1473-3099(20)30943-9","article-title":"Persistence of IgG response to SARS-CoV-2","volume":"21","author":"Duysburgh","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e142","DOI":"10.1016\/S1473-3099(20)30910-5","article-title":"A case of SARS-CoV-2 reinfection in Ecuador","volume":"21","author":"Guadalupe","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/s41586-020-2380-z","article-title":"Human neutralizing antibodies elicited by SARS-CoV-2 infection","volume":"584","author":"Ju","year":"2020","journal-title":"Nature"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100355","DOI":"10.1016\/j.xcrm.2021.100355","article-title":"Impact of SARS-CoV-2 variants on the total CD4+ and CD8+ T cell reactivity in infected or vaccinated individuals","volume":"2","author":"Tarke","year":"2021","journal-title":"Cell Rep. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1007\/s10875-021-01046-y","article-title":"Robust Antibody and T Cell Responses to SARS-CoV-2 in Patients with Antibody Deficiency","volume":"41","author":"Kinoshita","year":"2021","journal-title":"J. Clin. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"95","DOI":"10.3390\/pediatric13010013","article-title":"SARS-CoV-2 Vaccination for Children-An Open Issue","volume":"13","author":"Caselli","year":"2021","journal-title":"Pediatr. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Walter, E.B., Talaat, K.R., Sabharwal, C., Gurtman, A., Lockhart, S., Paulsen, G.C., Barnett, E.D., Mu\u00f1oz, F.M., Maldonado, Y., and Pahud, B.A. (2021). Evaluation of the BNT162b2 COVID-19 Vaccine in Children 5 to 11 Years of Age. N. Engl. J. Med.","DOI":"10.1056\/NEJMoa2116298"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/1\/41\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:35:55Z","timestamp":1760362555000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/1\/41"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,2]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["children9010041"],"URL":"https:\/\/doi.org\/10.3390\/children9010041","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2022,1,2]]}}}