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May 12: Children suffering from non-respiratory disease symptoms like diarrhea and fever, or those with a history of exposure to the novel coronavirus, should be suspected of having COVID-19, a new study says.

According to the research, published in the journal Frontiers in Pediatrics, gastrointestinal symptoms first suffered by some children hints at potential infection with SARS-CoV-2 through the digestive tract.

"This case series is the first report to describe the clinical features of COVID-19 with non-respiratory symptoms as the first manifestation in children," the scientists from Tongji Hospital in China wrote in the study.

They explained that the gastrointestinal symptoms could be arising since the type of receptors in lung cells targeted by the virus can also be found in the intestines.

Most children are only mildly affected by COVID-19, and the few severe cases often have underlying health issues, the researchers said.

"It is easy to miss its diagnosis in the early stage, when a child has non-respiratory symptoms, or suffers from another illness," said study co-author Wenbin Li, who works at the Department of Pediatrics, Tongji Hospital.

"Based on our experience of dealing with COVID-19, in regions where this virus is epidemic, children suffering from digestive tract symptoms, especially with fever and/or a history of exposure to this disease, should be suspected of being infected with this virus," Li said.

In the study, the scientists described the clinical features of children admitted to hospital with non-respiratory symptoms, who were subsequently diagnosed with pneumonia and COVID-19.

"These children were seeking medical advice in the emergency department for unrelated problems, for example, one had a kidney stone, another a head trauma," Li said.

The study noted that all the children had pneumonia, which was confirmed by chest X-ray scan before or soon after admission.

These children were then confirmed to have COVID-19.

While their COVID-19 symptoms were initially mild or relatively hidden before their hospital admission, four out of the five cases had digestive tract symptoms as the first manifestation of this disease, the researchers said.

Li hopes that doctors will use the findings to quickly diagnose and isolate patients with similar symptoms, which may aid early treatment and reduce transmission.

According to the researchers, the children's gastrointestinal symptoms, which have also been recorded in adult patients, could be an additional route of infection.

"The gastrointestinal symptoms experienced by these children may be related to the distribution of receptors and the transmission pathway associated with COVID-19 infection in humans," Li explained.

Since the virus infects people via the ACE2 receptor, which can be found in certain cells in the lungs as well as the intestines, COVID-19 might infect patients not only through the respiratory tract in the form of air droplets, but also through the digestive tract by contact or fecal-oral transmission, the study noted.

While COVID-19 tests can occasionally produce false positive readings, Li said all the five children assessed in the study were infected with the disease.

However, he cautioned that more research is needed to confirm their findings.

"We report five cases of COVID-19 in children showing non-respiratory symptoms as the first manifestation after admission to hospital. The incidence and clinical features of similar cases needs further study in more patients," he said.

Bengaluru, Jul 1: Karnataka Primary and Secondary Education Minister S Suresh Kumar on Wednesday played down reports about confusion regarding valuation of Second Pre- University and the Secondary School Leaving Certificate exam papers.

"Creating confusion has become a habit. There was confusion before the exam, during the exam and now confusion about the valuation of the exam papers," Kumar told reporters in Ramanagara when asked about the confusion over the valuation of answer sheets.

He had gone there to inspect a few centres where the SSLC or the 10th standard exams are underway.

The minister reminded people not to speak about the abilities of the students with contempt.

"Our students have toiled hard and are enthusiastically appearing for the examination. They are eligible for the marks they will score. So we should not speak about our children with disrespect," Kumar said.

The Education Minister said he had spoken to many leaders including former chief ministers Siddaramaiah and H D Kumaraswamy on conducting the examinations.

"Kumaraswamy had insisted on postponing the examination. I personally spoke to him and apprised him about the steps taken by us. I told him that we will work with more sincerity to ensure the safety of the children," Kumar said.

The SSLC exam was scheduled to take place from March 27 but due to the coronavirus-induced lockdown, it was postponed.

While the CBSE and a few other states either decided to give marks based on the students' performance in the previous examinations such as quarterly and half-yearly exams or gave general promotion to the students, Karnataka went ahead to hold the exam.

According to Karnataka Secondary Education Examination Board officials, around 8.5 lakh students have enrolled this year for the SSLC examination.

The exams are being held at 2,879 exam centres across the state.

Prior to the SSLC examination, the last exam of the Second PUC was also conducted on June 18, which was also put on hold due to the lockdown.