HealthDay News — Young children with COVID-19 may not present with respiratory symptoms, according to a case report published online May 12 in Frontiers in Pediatrics.

Xiaofang Cai, from the Wuhan Children’s Hospital in China, and colleagues detail the cases of five children presenting with nonrespiratory symptoms as the first manifestation of COVID-19 who were hospitalized with confirmed COVID-19 between Jan. 23 and Feb. 20, 2020.

The authors note that four of the five patients were male and ranged in age from 2 months to 5.6 years. Three of the five patients required an emergency operation or treatment, including intussusception, acute suppurative appendicitis perforation with local peritonitis, and traumatic subdural hemorrhage with convulsion. Two patients had acute gastroenteritis, including one with hydronephrosis and a stone in his left kidney. Four of the five patients had a fever during the course of the disease. Leukopenia was seen in two patients, with one also having lymphopenia. There were two cases of severe COVID-19 in which the levels of C-reactive protein, procalcitonin, serum ferritin, interleukin-6, and interleukin-10 were significantly increased, while CD3+, CD4+, CD8+ T lymphocytes, and CD16 + CD56 natural killer cells were decreased. The investigators also observed impaired liver, kidney, and myocardial functions; the presence of hypoproteinemia, hyponatremia, and hypocalcemia; and in one case, abnormal coagulation function.

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“In epidemic areas, the possibility of severe acute respiratory syndrome coronavirus 2 infection should be suspected when children show digestive tract symptoms, especially with fever and/or exposure history,” the authors write.

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