Credit WHO
#15,115
Although COVID-19 is a new virus in humans, it is related to other novel coronaviruses we've seen previously, such as SARS and MERS-CoV. And while all three are viewed primarily as respiratory viruses - they all appear to have gastrointestinal involvement as well.
In 2003, during the SARS epidemic, gastrointestinal symptoms were frequently observed in patients (see Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection). In the above Hong Kong Study, of `. . . 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness.'A little over a year ago, in J. Korean Med Sci: Atypical Presentation Of A MERS Case In A Returning Traveler From Kuwait, we looked at a case study where the patient's primary presenting symptoms were watery diarrhea and weakness, but no overt respiratory symptoms.
And a month ago today, in Emerg. Microbes & Infect: Multiple Shedding Routes Of 2019-nCoV, we saw a report from China that stated:
We detected the virus in oral swabs, anal swabs and blood, thus infected patients can potentially shed this pathogen through respiratory, fecal–oral or body fluid routes.All of which brings us to a new study, published yesterday in the American Journal of Gastroenterology, that finds that diarrhea is a prominent feature in COVID-19 patients, and that patients which experience gastrointestinal symptoms appear to have worse clinical outcomes and a higher risk of mortality,
First an excerpt from the open access study, then a link to a press release.
Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study
Lei Pan, MD, PhD 1,2 *, Mi Mu, MD 3,4 *, Hong Gang Ren, MD 5 *, Pengcheng Yang, MD 6 *, Yu Sun, MD 7 , Rungsheng Wang, MS 8 , Junhong Yan, MD 9 , Pibao Li, MD 10 , Baoguang Hu, MD, PhD 11 , Chaohu, MS 8 , Yuan Jin, MD 7 , Xun Niu, MD 7 , Rongyu Ping, MD 2 , Yingzhen Du, MD 8 , Tianzhi Li, MD 2 , Chengxia Liu, MD 12† , Guogang Xu, MD, PhD 2† , Qinyong Hu, MD 6† ,Lei Tu, MD, PhD 13†on behalf of Wuhan Medical Treatment Expert Group for COVID-19
ABSTRACT
Background: Since the outbreak of Corona Virus Disease 2019 (COVID-19) in December 2019, various digestive symptoms have been frequently reported in patients infected with the virus. In this study, we aimed to further investigate the prevalence and outcomes of COVID- 19 patients with digestive symptoms.
Methods: In this descriptive, cross-sectional, multicenter study, we enrolled confirmed patients with COVID-19 who presented to three hospitals from January 18 th to February 28 th , 2020. All patients were confirmed by real-time RT-PCR and were analyzed for clinical characteristics, laboratory data, and treatment. Data were followed up until March 5 th , 2020.
Results: In the present study, 204 patients with COVID-19 and full laboratory, imaging, and historical data were analyzed. The average age was 54.9 years (SD +15.4), including 107 men and 97 women. We found that 99 patients (48.5%) presented to the hospital with digestive symptoms as their chief complaint.
Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs. 7.3 days). Patients with digestive symptoms had a variety of manifestations, such as anorexia (83 [83.8%] cases), diarrhea (29 [29.3%] cases), vomiting (8 [0.8%] cases), and abdominal pain (4 [0.4%] cases). In 7 cases there were digestive symptoms but no respiratory symptoms.
As the severity of the disease increased, digestive symptoms became more pronounced. Patients without digestive symptoms were more likely to be cured and discharged than patients with digestive symptoms (60% vs. 34.3%). Laboratory data revealed no Significant liver injury in this case series.
Conclusion: We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these
findings.
(Continue . . . .)
And a snippet from the press release.
Study from The American Journal of Gastroenterology Reveals Diarrhea is a Prominent Symptom of COVID-19
Experience with COVID-19 in Wuhan, China shows up to half of patients present with a digestive symptom as chief complaint
NEWS PROVIDED BY American College of Gastroenterology
Mar 18, 2020, 12:40 ET
BETHESDA, Md., March 18, 2020 /PRNewswire/ -- Digestive symptoms are common in COVID-19, occurring as the chief complaint in nearly half of patients presenting to hospital according to a new descriptive, cross-sectional multicenter study from China by investigators from the Wuhan Medical Treatment Expert Group for COVID-19 published today in The American Journal of Gastroenterology, the official publication of the American College of Gastroenterology.
Most patients with COVID-19 present with typical respiratory symptoms and signs. However, early experience with the outbreak in Wuhan, China revealed that many patients experienced digestive symptoms as their chief complaint. "Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge," write the authors.
"In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of mortality compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop," said Brennan M.R. Spiegel, MD, MSHS, FACG, Co-Editor-in-Chief of The American Journal of Gastroenterology. "This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed."(Continue . . . )
