{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T12:13:03Z","timestamp":1776859983542,"version":"3.51.2"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,6]],"date-time":"2024-07-06T00:00:00Z","timestamp":1720224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The clinical presentation, organ involvement, and severity of disease caused by SARS-CoV-2 are highly variable, ranging from asymptomatic or mild infection to respiratory or multi-organ failure and, in children and young adults, the life-threatening multisystemic inflammatory disease (MIS-C). SARS-CoV-2 enters cells via the angiotensin-converting enzyme-2 receptor (ACE-2), which is expressed on the cell surfaces of all organ systems, including the gastrointestinal tract. GI manifestations have a high prevalence in children with COVID-19. However, isolated terminal ileitis without other manifestations of COVID-19 is rare. In March 2023, two previously healthy boys (aged 16 months and 9 years) without respiratory symptoms presented with fever and diarrhea, elevated C-reactive protein levels, and low procalcitonin levels. Imaging studies revealed marked terminal ileitis in both cases. SARS-CoV-2 (Omicron XBB.1.9 and XBB.1.5 variants) was detected by nucleic acid amplification in throat and stool samples. Both patients recovered fast with supportive measures only. A differential diagnosis of acute abdominal pain includes enterocolitis, mesenteric lymphadenitis, appendicitis, and more. During SARS-CoV-2 epidemics, this virus alone may be responsible for inflammation of the terminal ileum, as demonstrated. Coinfection with Campylobacter jejuni in one of our patients demonstrates the importance of a complete microbiological workup.<\/jats:p>","DOI":"10.3390\/microorganisms12071377","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T04:52:49Z","timestamp":1720414369000},"page":"1377","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Terminal Ileitis as the Exclusive Manifestation of COVID-19 in Children"],"prefix":"10.3390","volume":"12","author":[{"given":"Lea Maria","family":"Schuler","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Regional Hospital St. Johann in Tirol, 6380 St. Johann in Tirol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Falkensammer","sequence":"additional","affiliation":[{"name":"Institute of Virology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Orlik","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Regional Hospital St. Johann in Tirol, 6380 St. Johann in Tirol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Auckenthaler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Regional Hospital St. Johann in Tirol, 6380 St. Johann in Tirol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christof","family":"Kranewitter","sequence":"additional","affiliation":[{"name":"Department of Radiology, Regional Hospital St. Johann in Tirol, 6380 St. Johann in Tirol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5617-8022","authenticated-orcid":false,"given":"David","family":"Bante","sequence":"additional","affiliation":[{"name":"Institute of Virology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothee","family":"von Laer","sequence":"additional","affiliation":[{"name":"Institute of Virology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz-Martin","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Regional Hospital St. Johann in Tirol, 6380 St. Johann in Tirol, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Eurosurveillance Editorial Team (2020). Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Eurosurveillance, 25, 200131e.","DOI":"10.2807\/1560-7917.ES.2020.25.5.200131e"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100433","DOI":"10.1016\/j.eclinm.2020.100433","article-title":"COVID-19 in 7780 pediatric patients: A systematic review","volume":"24","author":"Hoang","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_3","unstructured":"(2024, February 16). COVID-19 Treatment Guidelines, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1136\/gutjnl-2020-321013","article-title":"Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection","volume":"69","author":"Lin","year":"2020","journal-title":"Gut"},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1053\/j.gastro.2020.12.078","article-title":"COVID-19 Pediatric Patients: Gastrointestinal Symptoms, Presentations, and Disparities by Race\/Ethnicity in a Large, Multicenter US Study","volume":"160","author":"Ashktorab","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/pai.13373","article-title":"Gastrointestinal involvement in children with SARS-CoV-2 infection: An overview for the pediatrician","volume":"31","author":"Chiappini","year":"2020","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1053\/j.gastro.2020.05.079","article-title":"Gastrointestinal Symptoms as a Major Presentation Component of a Novel Multisystem Inflammatory Syndrome in Children That Is Related to Coronavirus Disease 2019: A Single Center Experience of 44 Cases","volume":"159","author":"Miller","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1097\/INF.0000000000003240","article-title":"Acute Abdomen and Appendicitis in 1010 Pediatric Patients with COVID-19 or MIS-C: A Multinational Experience from Latin America","volume":"40","author":"Lenzi","year":"2021","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2111417","DOI":"10.1001\/jamanetworkopen.2021.11417","article-title":"Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19: A Systematic Review","volume":"4","author":"Nasserie","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jiph.2023.03.005","article-title":"Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review","volume":"16","author":"Zheng","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1016\/S0140-6736(12)60026-9","article-title":"Crohn\u2019s disease","volume":"380","author":"Baumgart","year":"2012","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1038\/ajg.2017.182","article-title":"Backwash Is Hogwash: The Clinical Significance of Ileitis in Ulcerative Colitis","volume":"112","author":"Patil","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_15","first-page":"271","article-title":"Terminal ileitis is not always Crohn\u2019s disease","volume":"24","author":"Bojic","year":"2011","journal-title":"Ann. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s11894-010-0112-5","article-title":"Ileitis: When it is not Crohn\u2019s disease","volume":"12","author":"Dilauro","year":"2010","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14740\/gr698w","article-title":"Facing Terminal Ileitis: Going Beyond Crohn\u2019s Disease","volume":"9","author":"Goulart","year":"2016","journal-title":"Gastroenterol. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chela, H., Mir, F., Tahan, A., Schmidt, B., Ertugrul, H., Albarrak, A., Yousef, M.H., Shaffi, S.K., Daglilar, E., and Tahan, V. (2024). Isolated Terminal Ileitis- Crohn\u2019s Disease or Something Else?. Preprints, 2024011812.","DOI":"10.20944\/preprints202401.1812.v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s00436-023-07881-9","article-title":"A critical review of anisakidosis cases occurring globally","volume":"122","author":"Shamsi","year":"2023","journal-title":"Parasitol. Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Freed, N.E., Vlkov\u00e1, M., Faisal, M.B., and Silander, O.K. (2020). Rapid and inexpensive whole-genome sequencing of SARS-CoV-2 using 1200\u2009bp tiled amplicons and Oxford Nanopore Rapid Barcoding. Biol. Methods Protoc., 5.","DOI":"10.1093\/biomethods\/bpaa014"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kimpel, J., R\u00f6ssler, A., Bante, D., Borena, W., von Laer, D., Zehetner, C., Rauchegger, T., Seiwald, S., and Falkensammer, B. (2024). Detection of infectious SARS-CoV-2 in ocular samples is linked to viral load in the nasopharynx. Front. Cell Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1332157"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/s41587-020-0439-x","article-title":"The nf-core framework for community-curated bioinformatics pipelines","volume":"38","author":"Ewels","year":"2020","journal-title":"Nat. Biotechnol."},{"key":"ref_23","unstructured":"(2023, October 31). Artic Network. Available online: https:\/\/artic.network\/ncov-2019."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/S2352-4642(20)30165-6","article-title":"Gastrointestinal features in children with COVID-19: An observation of varied presentation in eight children","volume":"4","author":"Tullie","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.gastrohep.2020.10.001","article-title":"Ileitis as the exclusive manifestation of COVID-19. The first reported case","volume":"44","author":"Brunet","year":"2021","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_26","first-page":"80","article-title":"Reactive ileal lymphoid hyperplasia related to SARS-CoV-2 infection as a unique clinical feature resembling Crohn\u2019s disease","volume":"88","author":"Qanneta","year":"2023","journal-title":"Rev. Gastroenterol. Mex."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/MPG.0000000000002953","article-title":"Features of Intestinal Disease Associated With COVID-Related Multisystem Inflammatory Syndrome in Children","volume":"72","author":"Sahn","year":"2021","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"rjac457","DOI":"10.1093\/jscr\/rjac457","article-title":"A complicated case of terminal ileitis post-COVID-19 infection requiring bowel resection","volume":"2022","author":"Tong","year":"2022","journal-title":"J. Surg. Case Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.1016\/j.pathol.2021.12.136","article-title":"Severe terminal ileitis following SARS-CoV-2 infection: A histopathological case report","volume":"54","author":"Fivelman","year":"2022","journal-title":"Pathology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/jpn3.12070","article-title":"Evaluation of acute terminal ileitis in children before and during the COVID-19 pandemic","volume":"78","author":"Koyuncu","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_31","first-page":"e10722","article-title":"A Case of Multisystem Inflammatory Syndrome in Children Mimicking Acute Appendicitis in a COVID-19 Pandemic Area","volume":"12","author":"Jackson","year":"2020","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102171","DOI":"10.1016\/j.epsc.2021.102171","article-title":"Emergency diagnostic laparoscopy for multisystem inflammatory syndrome in a child","volume":"77","author":"Panko","year":"2022","journal-title":"J. Pediatr. Surg. Case Rep."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Davoodi, M., Pouladfar, G., Kadivar, M.R., Dehghan, A., Askarisarvestani, A., and Hamzavi, S.S. (2023). Terminal ileitis and cytotoxic lesion of corpus callosum as the presenting features of Multisystem inflammatory syndrome in children (MIS-C): A case report. BMC Pediatr., 23.","DOI":"10.1186\/s12887-022-03707-2"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1007\/s12098-020-03544-0","article-title":"A Pediatric COVID-19 Case with Suspected Acute Abdomen, Hyperferritinemic Sepsis and Developing MIS-C and Pancreatitis","volume":"88","author":"Aslan","year":"2021","journal-title":"Indian J. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s12098-020-03508-4","article-title":"COVID Abdomen: SARS-CoV-2 Infection Presenting as \u2018Acute Abdomen\u2019 in a Child","volume":"88","author":"Periyakaruppan","year":"2021","journal-title":"Indian J. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Puoti, M.G., Rybak, A., Kiparissi, F., Gaynor, E., and Borrelli, O. (2021). SARS-CoV-2 and the Gastrointestinal Tract in Children. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.617980"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"942","DOI":"10.14309\/ajg.0000000000000667","article-title":"SARS-CoV-2 Gastrointestinal Infection Causing Hemorrhagic Colitis: Implications for Detection and Transmission of COVID-19 Disease","volume":"115","author":"Carvalho","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s00247-020-04789-9","article-title":"Severe COVID-19 initially presenting as mesenteric adenopathy","volume":"51","author":"Noda","year":"2021","journal-title":"Pediatr. Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s003300050098","article-title":"Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: Clinical, radiological and US findings","volume":"7","author":"Puylaert","year":"1997","journal-title":"Eur. Radiol."},{"key":"ref_40","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_41","doi-asserted-by":"crossref","first-page":"2201157","DOI":"10.1080\/19490976.2023.2201157","article-title":"Gut microbiota in COVID-19: New insights from inside","volume":"15","author":"Zhou","year":"2023","journal-title":"Gut Microbes"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Brogna, C., Costanzo, V., Brogna, B., Bisaccia, D.R., Brogna, G., Giuliano, M., Montano, L., Viduto, V., Cristoni, S., and Fabrowski, M. (2023). Analysis of Bacteriophage Behavior of a Human RNA Virus, SARS-CoV-2, through the Integrated Approach of Immunofluorescence Microscopy, Proteomics and D-Amino Acid Quantification. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24043929"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4166\/kjg.2022.144","article-title":"Two Case Reports of Newly Diagnosed Crohn\u2019s Disease after COVID-19 in Pediatric Patients","volume":"81","author":"Kim","year":"2023","journal-title":"Korean J. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"72s","DOI":"10.1007\/BF01296981","article-title":"Coronavirus-like particles and Campylobacter in marmosets with diarrhea and colitis","volume":"30","author":"Russell","year":"1985","journal-title":"Dig. Dis. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e2139974","DOI":"10.1001\/jamanetworkopen.2021.39974","article-title":"Factors Associated with Severe Gastrointestinal Diagnoses in Children with SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome","volume":"4","author":"Garazzino","year":"2021","journal-title":"JAMA Netw. 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