SARS-CoV-2-Related Parotitis in Children: A Narrative-Focused Review

Round 1

Reviewer 1 Report

The manuscript is well-written, with clear and concise language that enhances the accessibility of the content.

• What does the review reveal about the prevalence of unilateral parotitis in children with COVID-19?
• Are there any identified risk factors or demographic patterns associated with this manifestation?

Author Response

The manuscript is well-written, with clear and concise language that enhances the accessibility of the content.

What does the review reveal about the prevalence of unilateral parotitis in children with COVID-19?

Reply: Thank you for your questions. Our review has identified that this manifestation, while notably rare, has been increasingly reported in the pediatric population across various geographic regions. Although the exact prevalence is difficult to ascertain due to the sporadic nature of reporting and the novelty of the disease, our synthesis of the available literature suggests that unilateral parotitis represents a small but significant fraction of atypical COVID-19 presentations in children. The reviewed studies suggest sporadic cases rather than widespread occurrence, indicating the need for continued surveillance and reporting to better understand the prevalence.

Are there any identified risk factors or demographic patterns associated with this manifestation?

Reply: Thank you for your inquiry. Regarding risk factors and demographic patterns, the limited data available from the included studies do not conclusively point to specific risk factors beyond the general susceptibility to SARS-CoV-2. However, some patterns can be discerned from the aggregated case reports and cohort studies. The cases of unilateral parotitis have been documented across a diverse age range from infants to preadolescents, with a slight male predominance observed. This pattern aligns with the broader demographic distribution of COVID-19 in children but does not suggest a strong gender or age-specific susceptibility to this manifestation. Furthermore, no significant associations with underlying health conditions or other demographic factors have been consistently demonstrated, underscoring the necessity for more detailed epidemiological studies to identify potential risk factors that may predispose children to develop this rare complication. In summary, while our review highlights the occurrence of unilateral parotitis in pediatric COVID-19 patients, further research is needed to accurately define its prevalence and identify clear demographic patterns or risk factors. Enhanced data collection and more comprehensive studies will be crucial in elucidating these aspects, which will, in turn, improve diagnostic accuracy and patient management.

Reviewer 2 Report

The article provides a comprehensive review of SARS-CoV-2-associated unilateral parotitis in children. The review synthesizes available literature to understand the pathophysiological. I recommend the following before publishing:

·         I suggest expanding the introduction to include more details on the significance of studying SARS-CoV-2-related parotitis, specifically in children.

·         Please provide more details on the search strategy used in the literature review, including the specific databases searched, the search terms, and the inclusion/exclusion criteria. Also, please cite the framework used for the narrative approach.

·         Add a flow diagram that includes the sources initially found and how you narrowed down the selection.·      

·         Please revise incomplete sentences to ensure clarity and readability.

·         Please clarify the statistical methods used to analyze the data extracted from the reviewed studies. If no statistical analysis was performed, explicitly state this to avoid any confusion.

·         Ensure smooth transitions between sections, especially when moving from clinical presentation to diagnostic challenges and treatment strategies

·         Please add a dedicated section on the strengths and limitations of the reviewed studies and the review itself.

 

·         Expand the conclusion to summarize the key findings and their implications for clinical practice and public health. Provide clear recommendations for future research directions, focusing on gaps identified in the current literature.

The summary table of studies (Table 1) is very useful. However, please ensure that all terms are clearly defined, and consider adding a column for the study design (e.g., case report, cohort study) to provide additional context.

Author Response

Major comments

The article provides a comprehensive review of SARS-CoV-2-associated unilateral parotitis in children. The review synthesizes available literature to understand the pathophysiological.

I recommend the following before publishing:

I suggest expanding the introduction to include more details on the significance of studying SARS-CoV-2-related parotitis, specifically in children.

Reply: Thank you for your valuable opinion, we expanded our introduction section as you suggested.

Please provide more details on the search strategy used in the literature review, including the specific databases searched, the search terms, and the inclusion/exclusion criteria. Also, please cite the framework used for the narrative approach. Reply: We added the details you requested, thank you.

Add a flow diagram that includes the sources initially found and how you narrowed down the selection.

Reply: Thank you for the suggestion, we added what you requested.

Please revise incomplete sentences to ensure clarity and readability.

Reply: We checked and change some sentence within the text.

Please clarify the statistical methods used to analyze the data extracted from the reviewed studies. If no statistical analysis was performed, explicitly state this to avoid any confusion.

Reply: We explicated what you suggested in the results section.

Ensure smooth transitions between sections, especially when moving from clinical presentation to diagnostic challenges and treatment strategies.

Reply: We checked and changed what you suggested.

Please add a dedicated section on the strengths and limitations of the reviewed studies and the review itself.

Reply: We added what you pointed out. Thank you for the suggestion.

Expand the conclusion to summarize the key findings and their implications for clinical practice and public health. Provide clear recommendations for future research directions, focusing on gaps identified in the current literature.

Reply: Thank you for the suggestion, we changed the conclusion to address your point.

Detailed comments:

The summary table of studies (Table 1) is very useful. However, please ensure that all terms are clearly defined, and consider adding a column for the study design (e.g., case report, cohort study) to provide additional context.

Reply: Considering the reviewer 3 comments, we decided to remove the table and to cite it, only describing the studies. Thank you again for your comments.

Reviewer 3 Report

In this review the author showed SARS-CoV-2 related parotitis in children. It addresses the initial clinical presentation, diagnostic challenges, treatment strategies, and the wider epidemiological impacts of this unusual symptom. The study underscores the need for increased awareness and a broad differential diagnosis among clinicians. It also emphasizes the importance of continued research to delineate the full clinical spectrum of COVID-19 in children. This is a well-written manuscript, the author made a great effort, but I suggest some changes that must be made to the text, to contribute to a better understanding of the points they are trying to make.

Author use the same table and same case study as they used in their previous study SARS-CoV-2 associated unilateral parotitis in children: A case report and literature review”. The paper was published in BIOMEDICAL REPORTS

1.     In Table 1. Main study features reporting SARS-CoV-2 associated parotitis in children. Authors use the same table as they used in previous study “SARS-CoV-2 associated unilateral parotitis in children: A case report and literature review”. The paper was published in BIOMEDICAL REPORTS. Please explain.

2.     In line 117, the author uses 5 studies, and they discussed these same 5 studies in the previous paper. Please explain.

Author Response

Major comments

 In this review the author showed SARS-CoV-2 related parotitis in children. It addresses the initial clinical presentation, diagnostic challenges, treatment strategies, and the wider epidemiological impacts of this unusual symptom. The study underscores the need for increased awareness and a broad differential diagnosis among clinicians. It also emphasizes the importance of continued research to delineate the full clinical spectrum of COVID-19 in children. This is a well-written manuscript, the author made a great effort, but I suggest some changes that must be made to the text, to contribute to a better understanding of the points they are trying to make.

Authors use the same table and same case study as they used in their previous study SARS-CoV-2 associated unilateral parotitis in children: A case report and literature review”. The paper was published in BIOMEDICAL REPORTS

Detailed comments

In Table 1. Main study features reporting SARS-CoV-2 associated parotitis in children. Authors use the same table as they used in previous study “SARS-CoV-2 associated unilateral parotitis in children: A case report and literature review”. The paper was published in BIOMEDICAL REPORTS. Please explain.

In line 117, the author uses 5 studies, and they discussed these same 5 studies in the previous paper. Please explain.

Comprehensive Reply: Thank you very much for what you pointed out. Regarding the similarities between the data presented in the current manuscript and our previous publication, we acknowledge the overlap in the clinical studies discussed. Given the specificity of the condition (unilateral parotitis associated with COVID-19 in children), there have been no additional studies published since our last review that meet our inclusion criteria. This scarcity of new data underscores the rarity of the condition and the slow pace of new research in this specific area.

Considering this, and in an effort to maintain the distinctiveness of the current comprehensive review which addresses multiple aspects of unilateral parotitis in children beyond those previously published, we have decided to remove the table from this manuscript. Instead, we refer to it by citation. This approach allows us to focus on a broader analysis, including updated discussions on diagnostic challenges, treatment strategies, and the wider epidemiological impacts of this unusual symptom, thereby providing a more expansive view than the previous case report and literature review.

Our current work distinguishes itself by synthesizing available literature to provide insights into the pathophysiological mechanisms underlying this atypical manifestation and its implications for pediatric healthcare during the pandemic. Through rigorous analysis of reported cases, this study emphasizes the need for increased awareness and a broad differential diagnosis among clinicians, as well as highlighting the importance of continued research to delineate the full clinical spectrum of COVID-19 in children.

Thus, while the core clinical data have not changed, the context, analysis, and conclusions drawn in this comprehensive review offer new perspectives and contribute significantly to the existing body of knowledge on this topic.

Round 2

Reviewer 3 Report

In this review the author showed SARS-CoV-2 related parotitis in children. It addresses the initial clinical presentation, diagnostic challenges, treatment strategies, and the wider epidemiological impacts of this unusual symptom. The study underscores the need for increased awareness and a broad differential diagnosis among clinicians. It also emphasizes the importance of continued research to delineate the full clinical spectrum of COVID-19 in children. This is a well-written manuscript; the author made a great effort. It is clearly a big effort of the author for doing this study, the author made enough changes and gave every possible explanation. I am accepting this paper in present form.

This is a well-written manuscript; the author made a great effort. It is clearly a big effort of the author for doing this study, the author made enough changes and gave every possible explanation. I am accepting this paper in present form.