Gastrointestinal symptoms in COVID-19 patients: a case series

Authors

  • Shahida Naghma Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
  • Deepak Kumar Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20203870

Keywords:

Gastrointestinal, Global threat, Nasal and pharyngeal swabs, Severe acute respiratory syndrome coronavirus 2

Abstract

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents an ongoing global threat. Common clinical features reported in early confirmed infections included fever, cough, and myalgias or fatigue. But as testing capacity and case numbers have increased worldwide, gastrointestinal (GI) symptoms such as diarrhoea, nausea/vomiting, abdominal pain, and loss of appetite have been increasingly recognized. Authors present a case series of gastrointestinal symptoms in COVID-19 patients and how they were managed at the hospital. However, correlations between the presence of fecal virus RNA and severity of digestive symptoms, namely, diarrhoea severity could not be established due to unavailability of the test in the hospital setting. Although knowledge about the viability of SARS-CoV-2 is limited, the virus could remain viable in the environment for days, which could lead to faeco-oral transmission. Various studies conducted on COVID-19 patients recommended routine stool sample testing with real-time RT-PCR after the clearance of viral RNA in a patient’s respiratory samples. Strict precautions to prevent transmission should be taken for patients who are in hospital or self-quarantined if their faecal samples test positive. Optimally, testing for COVID-19 should be performed using both respiratory and stool samples, if available.

References

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterol. 2020;158(6):1831-3.

Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterol. 2020;158(6):1518-9.

Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020:115.

Qiu Y, Zhao YB, Wang Q, Li JY, Zhou ZJ, Liao CH, et al. Predicting the angiotensin converting enzyme 2 (ACE2) utilizing capability as the receptor of SARS-CoV-2. Microb Infect. 2020;22(4-5):221-5.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med. 2020;382(18):1708-20.

Li Z, Wu M, Guo J, Yao J, Liao X, Song S, et al. Caution on kidney dysfunctions of 2019-nCoV patients. Med Rxiv. 2020.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Luo S, Zhang X, Xu H. Don't overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19). Clin Gastroenterol Hepatol. 2020;18(7):1636.

Cholankeril G, Podboy A, Aivaliotis VI, Tarlow B, Pham EA, Spencer S, et al. High prevalence of concurrent gastrointestinal manifestations in patients with SARS-CoV-2: early experience from California. Gastroenterol. 2020.

Cheung KS, Hung IF, Chan PP, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterol. 2020;159(1):81-95.

Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and Is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-80.e8.

Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020:1-8.

Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.

Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. Genomics BioRxiv. 2020:30029.

Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, et al. Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes. Am J Gastroenterol. 2020:In press.

Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-4.

Wu Y, Guo C, Tang L, Hong Z, Zhou J, Dong X, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatology. 2020;5(5):434-5.

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Published

2020-08-27

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Section

Case Series