COVID-19 is caused by the SARS-CoV-2 virus. In adults, COVID-19 primarily manifests as a respiratory illness, but cardiovascular, neurological, and gastrointestinal symptoms have been reported. In children, the primary manifestations of the disease are fever and mild respiratory or gastrointestinal symptoms. A recent report suggests that acute appendicitis is associated with SARS-CoV-2 infection in children.

The report summarizes the case histories of four children who had acute appendicitis. The children ranged in age from 11 to 17 years and were either Hispanic (three) or white (one). Two of the children had obesity, and one of them had a serious underlying health condition (aplastic anemia). The children had concurrent or previous SARS-CoV-2 infection. All four children required surgical intervention, and all recovered.

The authors of the report proposed three reasons for the possible connection between SARS-CoV-2 infection and acute appendicitis: gastrointestinal symptoms of COVID-19 are fairly common in children; the SARS-CoV-2 virus tends to linger in the gut long after the initial infection; and the ACE-2 receptor (the means by which SARS-CoV-2 gains entry into cells) is present throughout the gut, including in the appendix.

They also noted that appendicitis is fairly common, especially among adolescents, so the link to COVID-19 may be coincidental. However, 31 percent of the children who presented with acute appendicitis during the study period were SARS-CoV-2 positive, whereas the positive rate among the general pediatric population was only 8 percent.

These case reports point to a possible link between SARS-CoV-2 viral infection and acute appendicitis in children and underscore the need for testing for the virus in children who present with severe gastrointestinal symptoms.

• Link to full report.

• Learn more about COVID-19 in these Q&As featuring Dr. Rhonda Patrick, released April 14 and June 10.