{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T16:58:58Z","timestamp":1769101138502,"version":"3.49.0"},"reference-count":36,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T00:00:00Z","timestamp":1686787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: This study investigated the potential association between the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive infection, as well as vaccination, and the presentation of acute appendicitis in pediatric patients. It has been three years since the World Health Organization (WHO) declared the SARS-CoV-2 pandemic, and city lockdowns and self-protective measures have been applied worldwide. In an effort to contribute to the research on the probable long-term complications of the COVID-19 infection as well as the vaccination against SARS-CoV-2, the current study was designed and investigated patients\u2019 health records in the post-quarantine era. Methods: A retrospective analysis of patients admitted and treated surgically for acute appendicitis from January 2022 to June 2022 was conducted. Demographic and personal data, as well as the COVID-19 infection history of each child, were recorded. The patients who were negative for a previous COVID-19 infection were excluded. For the rest of the sample, the time-to-onset of acute appendicitis, the severity of appendicitis (complicated or uncomplicated), and the vaccination status of the patients were examined. Regarding the time-to-onset of appendicitis, we divided the patients into three groups: group A with a time-to-onset &lt; 3 months, group B with a time-to-onset of 3\u20136 months, and group C with a time-to-onset of &gt;6 months. Statistical analysis followed and was considered significant if p &lt; 0.05. Results: Sixty-six children with a mean age of 10.5 years (range 1\u201315 years) were admitted for acute appendicitis during the determined period. After excluding 30 children that were negative for previous COVID-19 infection, we divided the patients into three groups: group A-23 children, group B-7 children, and group C-6 children. A statistically significant incidence of acute appendicitis diagnosis in &lt;3 months after laboratory-confirmed COVID-19 infection (p &lt; 0.01) was found. The incidence of complicated appendicitis was greater in patients with a positive SARS-CoV-2 history, with an estimated odds ratio of 1.8 (p &gt; 0.05). The majority of the children (92%) had not received a COVID-19 vaccination. For the vaccinated children, the relative risk for complicated appendicitis was equal to 1.5 (p &gt; 0.05). Conclusions: The results of our study demonstrate a potential positive relationship between COVID-19 infection and subsequent acute appendicitis in pediatric patients. There are also some speculations on the presentation of complicated cases of appendicitis following COVID-19 infection or vaccination, but these need to be further proven. Further data are required to better understand this potential complication of COVID-19 infection as well as the role of vaccines in the current post-vaccine era.<\/jats:p>","DOI":"10.3390\/diagnostics13122070","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T02:03:19Z","timestamp":1686794599000},"page":"2070","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Acute Appendicitis Following COVID-19 Infection in Pediatric Patients: A Single Center\u2019s Study in Greece"],"prefix":"10.3390","volume":"13","author":[{"given":"Christos","family":"Kaselas","sequence":"first","affiliation":[{"name":"Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, \u201cPapageorgiou\u2019\u2019 General Hospital Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2166-4338","authenticated-orcid":false,"given":"Maria","family":"Florou","sequence":"additional","affiliation":[{"name":"Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, \u201cPapageorgiou\u2019\u2019 General Hospital Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Tsopozidi","sequence":"additional","affiliation":[{"name":"Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, \u201cPapageorgiou\u2019\u2019 General Hospital Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Spyridakis","sequence":"additional","affiliation":[{"name":"Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, \u201cPapageorgiou\u2019\u2019 General Hospital Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jclinepi.2012.09.004","article-title":"Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain","volume":"66","author":"Kulik","year":"2013","journal-title":"J. Clin. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s10140-015-1338-1","article-title":"Non-fecalith-induced appendicitis: Etiology, imaging, and pathology","volume":"22","author":"Swischuk","year":"2015","journal-title":"Emerg. Radiol."},{"key":"ref_3","first-page":"157","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","unstructured":"US Department of Health and Human Services\/Centers for Disease Control and Prevention (2020). Coronavirus Disease 2019 in Children\u2014United States, 12 February\u20132 April 2020. Morb. Mortal. Wkly. Rep. MMWR, 69, 422\u2013426. Available online: https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6914e4.htm?s_cid=mm6914e4_w.","DOI":"10.15585\/mmwr.mm6914e4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e20200702","DOI":"10.1542\/peds.2020-0702","article-title":"Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China","volume":"145","author":"Dong","year":"2020","journal-title":"Pediatrics"},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"e000417","DOI":"10.1136\/bmjgast-2020-000417","article-title":"Novelty in the gut: A systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19","volume":"7","author":"Kumar","year":"2020","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1093\/bjs\/znac127","article-title":"Risk of appendicitis after SARS-CoV-2 infection and SARS-CoV-2 vaccination","volume":"109","author":"Ljung","year":"2022","journal-title":"Br. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/01.NURSE.0000829880.68035.16","article-title":"COVID-19 and appendicitis in children","volume":"52","author":"Koloamatangi","year":"2022","journal-title":"Nursing"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e321","DOI":"10.1097\/INF.0000000000003575","article-title":"SARS-CoV-2 Infection Is Not Associated with Pediatric Appendicitis","volume":"41","author":"Jiang","year":"2022","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/ped.14456","article-title":"Incidence of appendicitis during SARS-CoV-2 pandemic quarantine","volume":"63","author":"Zampieri","year":"2021","journal-title":"Pediatr. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.amjsurg.2020.09.026","article-title":"Increasing incidence of complicated appendicitis during COVID-19 pandemic","volume":"221","author":"Orthopoulos","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"rjac295","DOI":"10.1093\/jscr\/rjac295","article-title":"Acute appendicitis following the COVID-19 vaccine","volume":"2022","author":"Oganesyan","year":"2022","journal-title":"J. Surg. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0140-6736(22)00100-3","article-title":"COVID-19 will continue but the end of the pandemic is near","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_16","first-page":"764","article-title":"Acute Appendicitis in Childhood and Adulthood: An Everyday Clinical Challenge","volume":"117","author":"Rolle","year":"2020","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.jpedsurg.2007.03.049","article-title":"Nonoperative treatment of acute appendicitis in children","volume":"42","author":"Petik","year":"2007","journal-title":"J. Pediatr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3109\/08941939.2015.1065300","article-title":"Etiology of Appendicitis in Children: The Role of Bacterial and Viral Pathogens","volume":"29","author":"Richardsen","year":"2016","journal-title":"J. Investig. Surg."},{"key":"ref_19","first-page":"1261","article-title":"Mechanisms of virus-induced immune suppression","volume":"132","author":"Wainberg","year":"1985","journal-title":"Can. Med. Assoc. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/PL00000625","article-title":"Generalized immunosuppression: How viruses undermine the immune response","volume":"57","author":"Naniche","year":"2000","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"788769","DOI":"10.3389\/fimmu.2021.788769","article-title":"Perspective of HLA-G Induced Immunosuppression in SARS-CoV-2 Infection","volume":"12","author":"Lin","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"752214","DOI":"10.3389\/fmicb.2021.752214","article-title":"Coronavirus Nsp1: Immune Response Suppression and Protein Expression Inhibition","volume":"12","author":"Yuan","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/INF.0000000000002998","article-title":"Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2?","volume":"40","author":"Malhotra","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s42269-022-00798-w","article-title":"Appendicitis and COVID: Cause or effect?","volume":"46","author":"Raju","year":"2022","journal-title":"Bull. Natl. Res. Cent."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1089\/lap.2020.0749","article-title":"A Retrospective Analysis of the Trends in Acute Appendicitis During the COVID-19 Pandemic","volume":"31","author":"Finkelstein","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_26","first-page":"e3","article-title":"Incidence of Pediatric Perforated Appendicitis during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis","volume":"10","author":"Motazedian","year":"2021","journal-title":"Arch. Acad. Emerg. Med."},{"key":"ref_27","first-page":"40","article-title":"The Effect of COVID-19 Pandemic Period on Acute Appendicitis and Its Complications","volume":"29","author":"Alkan","year":"2022","journal-title":"Ulus Travma Acil Cerrahi Derg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"131","DOI":"10.54847\/cp.2022.03.16","article-title":"Have acute appendicitis complications increased in children as a result of SARS-CoV-2?","volume":"35","author":"Reyes","year":"2022","journal-title":"Cirug\u00eda Pedi\u00e1trica"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jpedsurg.2020.06.024","article-title":"Limiting hospital resources for acute appendicitis in children: Lessons learned from the U.S. epicenter of the COVID-19 pandemic","volume":"56","author":"Kvasnovsky","year":"2021","journal-title":"J. Pediatr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1177\/00333549221114346","article-title":"Parental COVID-19 Vaccine Hesitancy in the United States","volume":"137","author":"Ruiz","year":"2022","journal-title":"Public Health Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"950406","DOI":"10.3389\/fped.2022.950406","article-title":"Barriers and facilitators of childhood COVID-19 vaccination among parents: A systematic review","volume":"10","author":"Khan","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_32","first-page":"75","article-title":"Parents\u2019 and caregivers\u2019 role toward childhood vaccination in Albania: Assessment of predictors of vaccine hesitancy","volume":"35","author":"Gjini","year":"2023","journal-title":"Ann. Ig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1056\/NEJMoa2110475","article-title":"Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting","volume":"385","author":"Barda","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"n1435","DOI":"10.1136\/bmj.n1435","article-title":"Characterising the background incidence rates of adverse events of special interest for covid-19 vaccines in eight countries: Multinational network cohort study","volume":"373","author":"Li","year":"2021","journal-title":"BMJ"},{"key":"ref_35","first-page":"e30276","article-title":"Uncommon Side Effects of COVID-19 Vaccination in the Pediatric Population","volume":"14","author":"Pandit","year":"2022","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.jss.2022.06.040","article-title":"Exploring the Trends of Acute Appendicitis Following Recovery or Vaccination From COVID-19","volume":"279","author":"Tankel","year":"2022","journal-title":"J. Surg. Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/12\/2070\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:55:13Z","timestamp":1760126113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/12\/2070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,15]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["diagnostics13122070"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13122070","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,15]]}}}