COVID-19 pandemic: Pathophysiology and manifestations from the gastrointestinal tract

Table 1 Direct comparison between severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus 2, based on receptor usage, primary and intermediate host, incubation period, number of cases and deaths, and basic reproduction number (R0)

Virus	Receptor	Primary host	Intermediate host	Incubation period	Number of cases (Globally)	Number of deaths (Globally)	Fatality	R0
SARS-CoV	ACE2	Bats	Raccoon dogs and civets	Approximately between 2 d and 10 d, and up to 14 d	8000	800	10%	2-5
MERS-CoV	DPP4 (CD26)	Bats	Camels	Typically, between 2 d and 14 d	2500	800	35%	2-5
SARS-CoV-2	Most likely ACE2	Bats	Pangolin (Manis pentadactyla)	Current estimates between 3d to 7 d, and up to 14 d	Over 3349786 as of 03 May, 2020	Over 238628 as of 03 May, 2020	3.4% as of 3 March, 2020[37]	2-3.5

SARS-CoV: Severe acute respiratory syndrome coronavirus; MERS-CoV: Middle East respiratory syndrome coronavirus; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; ACE2: Angiotensin converting enzyme type 2.

Table 2 Pulmonary findings in patients with coronavirus disease 2019

Ref.	Number of patients	Cough (n, %)	Dyspnea (n, %)	Sputum production (n, %)	Chest pain/ Tightness (n, %)
Wang et al[21]	138	82 (59.4%)	43 (31.2%)	37 (26.8)	NA
Guan et al[19]	1099	745 (67.8%)	205 (18.7%)	370 (33.7%)	NA
Chen et al[38]	99	81 (82%)	31 (31%)	NA	2 (2%)
Zhang et al[39]	140	90/120 (75%)	NA	NA	44/120 (36.7%)
Xu et al[7]	10	5 (50%)	NA	NA	NA
Jin et al[40]	651	53/74 (71.62%) in patients with GI symptoms 382/577 (66.2%) in patients without GI symptoms	NA	29/74 (39.19%) in patients with GI symptoms 198/577 (34.32%) in patients without GI symptoms	NA
Cheung et al[28]	59	22 (37.3%)	4 (6.8%)	NA	NA

GI: Gastrointestinal; NA: Not applicable.

Table 3 Presentation of laboratory findings in coronavirus disease 2019 patients

Author	Number of patients	Most common findings	Notes/comments
Wang et al[21]	138	↓Lymphocytes; ↑PT; ↑LDH	Differences between ICU and non-ICU patients
Guan et al[19]	1099	↓Lymphocytes; ↑CRP; ↑D-dimers	Lymphopenia is common, severe in some cases
Zhang et al[39]	140	↓Lymphocytes; ↓Eosinophils; ↑CRP; ↑D-dimers	Correlation between blood eosinophil and lymphocyte count
Chen et al[38]	99	↓Hb; ↓Alb; ↑D-dimers; ↑LDH	Damage in lymphocytes, changes in immune cells
Chen et al[41]	113	↓Lymphocytes; ↑WBC; ↑D-dimers	Substantial differences between deceased and recovered patients

WBC: White blood cells; PT: Prothrombin time; LDH: Lactate dehydrogenase; ICU: Intensive care unit; CRP: C-reactive protein; Alb: Albumin; Hb: Hemoglobin.

Table 4 Gastrointestinal findings in patients with coronavirus disease 2019

Ref.	Number of patients	Anorexia / Loss of appetite (n, %)	Diarrhea (n, %)		Nausea (n, %)	Vomiting (n, %)	Abdominal pain/ discomfort (n, %)	GI bleeding (n, %)
Wang et al[21]	138	55 (39.9%)	14 (10.1%)		14 (10.1%)	5 (3.6%)	3 (2.2%)	NA
Guan et al[19]	1099	NA	42 (3.8%)	55 (5%) both for nausea and vomiting			NA	NA
Pan et al[22]	103	81 (78.64%)	35 (33.98%)		NA	4 (3.88%)	2 (1.94%)	NA
Zhang et al[39]	140	17/139 (12.2%)	18/139 (12.9%)		24/139 (17.3%)	7/139 (5%)	8/139 (5.8%)	NA
Fang et al[30]	305	101/201 (50.2%)	146/295 (49.5%)		59/201 (29.4%)	32/201 (15.9%)	12/201 (6%)	NA
Lin et al[42]	95 (58 with GI manifestations)	17 (17.9%)	23 (24.2%)		17 (17.9%)	4 (4.2%)	2 (2.1%)	2 (2.1%)
Cheung et al[28]	59 (15 with GI manifestations)	NA	13 (22%)		NA	1 (1.7%)	7 (11.9%)	NA
Xia et al[43]	20	NA	3 (15%)		NA	2 (10%)	NA	NA
Xiao et al[8]	73	NA	26 (35.6%)		NA	NA	NA	10 (13.7%)

GI: Gastrointestinal.