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1
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Zaman S, Hajibandeh S, Hajibandeh S, Mohamedahmed AYY, El‐Asrag ME, Quraishi N, Iqbal TH, Beggs AD. Meta-analysis of the demographic and prognostic significance of gastrointestinal symptoms in COVID-19 patients. JGH Open 2022; 6:JGH312812. [PMID: 36247233 PMCID: PMC9538713 DOI: 10.1002/jgh3.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
Background and Aim To evaluate the demographic and prognostic significance of gastrointestinal (GI) symptoms in patients with coronavirus disease 2019 (COVID-19). Methods A systematic search of electronic information sources was conducted. Combined overall effect sizes were calculated using random-effects models for baseline demographic factors and outcomes including mortality, intensive care unit (ICU) admission, and length of hospital stay. Results Twenty-four comparative observational studies reporting a total of 51 522 COVID-19 patients with (n = 6544) or without (n = 44 978) GI symptoms were identified. The patients with GI symptoms were of comparable age (mean difference [MD]: 0.25, 95% confidence interval [CI] -2.42 to 2.92, P = 0.86), rate of pre-existing hypertension (odds ratio [OR]: 1.11, 95% CI 0.86-1.42, P = 0.42), diabetes mellitus (OR: 1.14, 95% CI 0.91-1.44, P = 0.26), and coronary artery disease (OR: 1.00, 95% CI 0.86-1.16, P = 0.98) compared with those without GI symptoms. However, there were significantly more male patients in the GI symptoms group (OR: 0.85, 95% CI 0.75-0.95, P = 0.005). The presence of GI symptoms was associated with similar risk of mortality (OR: 0.73; 95% CI 0.47-1.13, P = 0.16), ICU admission (OR: 1.15; 95% CI 0.67-1.96, P = 0.62), and length of hospital stay (MD: 0.43; 95% CI -0.73 to 1.60, P = 0.47) when compared with their absence. Conclusion Meta-analysis of the best possible available evidence demonstrated that GI symptoms in COVID-19 patients do not seem to affect patients with any specific demographic patterns and may not have any important prognostic significance. Although no randomized studies can be conducted on this topic, future high-quality studies can provide stronger evidence to further understand the impact of GI symptoms on outcomes of COVID-19 patients.
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Affiliation(s)
- Shafquat Zaman
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery and Liver Transplant UnitUniversity Hospitals BirminghamBirminghamUK
| | - Shahab Hajibandeh
- Department of General SurgeryRoyal Glamorgan Hospital, Cwm Taf University Health BoardPontyclunUK
| | | | - Mohammed E El‐Asrag
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
- Faculty of ScienceBenha UniversityBenhaEgypt
| | - Nabil Quraishi
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Tariq H Iqbal
- Institute of Immunology and Immunotherapy, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Andrew D Beggs
- Institute of Cancer and Genomic Science, College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
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Zhao R, Shi J, Song Y, Zhang R. Comparison of laboratory characteristics of gastrointestinal symptoms and nongastrointestinal symptoms in patients infected with COVID-19: a systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848221116264. [PMID: 36035309 PMCID: PMC9403443 DOI: 10.1177/17562848221116264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic poses a massive crisis to global public health. Gastrointestinal (GI) symptoms are increasingly reported in COVID-19. The characteristics of laboratory findings of COVID-19 are critical for clinical diagnosis and treatment. Objectives The study aimed to summarize laboratory features in COVID-19 with GI symptoms and non-GI symptoms. Design This study was a systematic review and meta-analysis. Electronic literature searches were conducted for studies that included patients infected COVID-19 with GI symptoms and non-GI symptoms. GI symptoms included diarrhea, abdominal pain, nausea and vomiting, and anorexia. This study used a random-effects model to assess pooled data. Data sources and methods We systematically searched PubMed, Embase, Cochrane, Web of Science for studies through 31 October 2021, with no language restrictions. We used the following search terms: 'COVID-19' OR '2019-nCoV' OR 'SARS-CoV-2' OR 'coronavirus 2019' OR 'severe acute respiratory syndrome coronavirus 2' OR 'coronavirus' OR 'novel coronavirus' OR 'nCoV' AND 'gastrointestinal symptoms' OR 'digestive symptoms' AND 'clinical feature' OR 'clinical characteristics.' Data mostly originated from Chinese and American studies. Results Of 796 identified studies, 14 were eligible and were included in our analysis (N = 8396 participants). Meta-analysis showed that GI symptoms group had an elevated alanine aminotransferase (ALT) [pooled mean difference (MD), 4.5 U/L; 95% confidence interval, [0.45, 8.55]; p = 0.03; I 2 = 87%]. No publication bias was detected by Begg's and Egger's regression test (p = 0.130). COVID-19 with the GI symptoms also showed a trend toward decreased white blood cell count, lymphopenia, neutrophilia, thrombocytopenia and elevated total bilirubin. Conclusion GI symptoms are common in COVID-19. No significant differences were found in most laboratory indicators except elevated ALT. Registration CRD42020209039 (PROSPERO).
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Affiliation(s)
- Rui Zhao
- Department of Clinical Laboratory, Beijing
Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Jie Shi
- Department of Clinical Laboratory, Beijing
Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Yichuan Song
- Department of Clinical Laboratory, Beijing
Chaoyang Hospital, Capital Medical University, Beijing, PR China
| | - Rui Zhang
- Department of Clinical Laboratory, Beijing
Chaoyang Hospital, Capital Medical University, No. 8, Gongtinan Road,
Chaoyang District, Beijing 100020, PR China
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3
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Bacharaki D, Giannakopoulos P, Markakis K, Papas C, Theodorou A, Zoi V, Tsivgoulis G, Lionaki S. COVID-19 presenting with persistent hiccup and myocardial infarction in a peritoneal dialysis patient: A case report. World J Virol 2022; 11:198-203. [PMID: 36159613 PMCID: PMC9372788 DOI: 10.5501/wjv.v11.i4.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/01/2022] [Accepted: 06/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persistent hiccups, lasting more than 48 h, have been described as an atypical presentation of coronavirus disease 19 (COVID-19) in the general population. To the best of our knowledge, this is the first report of persistent hiccups and non-ST elevation myocardial injury (NSTEMI) as an atypical presentation of COVID-19 in a peritoneal dialysis (PD) patient. CASE SUMMARY A 70-year old man, who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction, presented for a scheduled radionuclide myocardial scan. Upon arrival, he complained of anorexia, nausea for 5 d, and unremitting hiccups for the previous 48 h. Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2. COVID-19 lung involvement was mild and was resolved without specific treatment. Myocardial injury was managed by coronary catheterization and stenting, while hiccups responded only to baclofen per os. CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients, which may be due to involvement of the central nervous system and myocardial injuries.
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Affiliation(s)
- Dimitra Bacharaki
- Department of Nephrology, Attikon University Hospital, Chaidari 12462, Greece
| | | | - Konstantinos Markakis
- Department of Internal Medicine, Attikon University Hospital, Chaidari 12462, Greece
| | - Christos Papas
- Department of Cardiology, Attikon University Hospital, Chaidari 12462, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vasiliki Zoi
- Department of Nephrology, Attikon University Hospital, Chaidari 12462, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Sophia Lionaki
- Department of Nephrology, Attikon University Hospital, Chaidari 12462, Greece
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Concas G, Barone M, Francavilla R, Cristofori F, Dargenio VN, Giorgio R, Dargenio C, Fanos V, Marcialis MA. Twelve Months with COVID-19: What Gastroenterologists Need to Know. Dig Dis Sci 2022; 67:2771-2791. [PMID: 34333726 PMCID: PMC8325547 DOI: 10.1007/s10620-021-07158-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Corona virus disease-19 (COVID-19) is the latest global pandemic. COVID-19 is mainly transmitted through respiratory droplets and, apart from respiratory symptoms, patients often present with gastrointestinal symptoms and liver involvement. Given the high percentage of COVID-19 patients that present with gastrointestinal symptoms (GIS), in this review, we report a practical up-to-date reference for the physician in their clinical practice with patients affected by chronic gastrointestinal (GI) diseases (inflammatory bowel disease, coeliac disease, chronic liver disease) at the time of COVID-19. First, we summarised data on the origin and pathogenetic mechanism of SARS-CoV-2. Then, we performed a literature search up to December 2020 examining clinical manifestations of GI involvement. Next, we illustrated and summarised the most recent guidelines on how to adhere to GI procedures (endoscopy, liver biopsy, faecal transplantation), maintaining social distance and how to deal with immunosuppressive treatment. Finally, we focussed on some special conditions such as faecal-oral transmission and gut microbiota. The rapid accumulation of information relating to this condition makes it particularly essential to revise the literature to take account of the most recent publications for medical consultation and patient care.
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Affiliation(s)
- Giulia Concas
- School of Paediatrics, University of Cagliari, 09124 Cagliari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, University Hospital “Policlinico”, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Ruggiero Francavilla
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Fernanda Cristofori
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vanessa Nadia Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Rossella Giorgio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Costantino Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
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Okita Y, Morita T, Kumanogoh A. Duration of SARS-CoV-2 RNA positivity from various specimens and clinical characteristics in patients with COVID-19: a systematic review and meta-analysis. Inflamm Regen 2022; 42:16. [PMID: 35642011 PMCID: PMC9156361 DOI: 10.1186/s41232-022-00205-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positivity will be important to prevent the spread of coronavirus disease 2019 (COVID-19). A systematic review and meta-analysis were conducted following PRISMA to determine the duration from several parts of the body and clinical characteristics affecting it. MAIN TEXT PubMed, Web of Science, Scopus, and CENTRAL were searched for original studies reporting the duration from COVID-19 onset to the disappearance of viral RNA. Of the 1682 studies identified, 100 met the selection criteria and 13,431 patients were included in this study. The duration of SARS-CoV-2 RNA positivity was 18.29 [95% confidence interval: 17.00-19.89] days in the upper respiratory tract samples, 23.79 [20.43-27.16] days in the sputum, 14.60 [12.16-17.05] days in the blood, and 22.38 [18.40-26.35] days in the stool. Sensitivity analysis revealed that the duration was positively correlated with age, comorbidities, severity, and usage of glucocorticoid. Subgroup analysis indicated that the presence or absence of complications had the greatest impact on the difference in DSRP. CONCLUSIONS The duration of SARS-CoV-2 RNA positivity was 18.29 days in the upper respiratory tract samples. The duration in the sputum and the stool was longer, while that in the blood was shorter. The duration in the upper respiratory tract samples was longer in older, with any comorbidities, severer, and treated with glucocorticoid. These results provide the basic data for the duration of SARS-CoV-2 RNA positivity, and in the future, the effect of vaccination against SARS-CoV-2 and the SARS-CoV-2 variants on the duration of RNA positivity should be assessed.
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Affiliation(s)
- Yasutaka Okita
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Immunopathology, World Premier International Immunology Frontier Research Center (iFReC), Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
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6
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Delavari A, Asgari S, Alimohamadi Y, Vosoogh-Moghaddam A, Sadeghi A, Shahrousvand S, Zakeri A, Moradzadeh R, Akbarpour S. xsGastrointestinal symptoms are associated with a lower risk of hospitalization and mortality and Outcomes in COVID-19. BMC Gastroenterol 2022; 22:119. [PMID: 35272613 PMCID: PMC8908290 DOI: 10.1186/s12876-022-02190-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to find the association between gastrointestinal (GI) and respiratory symptoms with mortality and hospitalization among COVID-19 patients. Methods We analyzed the registered data of COVID-19 patients from February 20, 2020, to March 10, 2021. Depending on the patients’ disease symptoms, four categories were defined: patients with only GI symptoms, patients with only respiratory symptoms, patients with both symptoms, and patients with other symptoms. Logistic regression analysis was used to assess the association of groups with outcomes. Results A total of 42,964 patients from 23 hospitals were included, of which 26.5% patients had at least one or more GI symptoms. Of total patients, 51.58% patients were hospitalized among which 22.8% had at least one or more GI symptoms. GI symptoms significantly decreased the odds of mortality (OR 0.72, 95% CI 0.56–0.92), but respiratory symptoms increased the odds for mortality (1.36: 1.24–1.50), compared with patients with other symptoms. Moreover, the odds ratio of patients who had both respiratory and GI symptoms increased (1.52: 1.31–1.78) compared with patients with other symptoms. The same results were observed for hospitalization as the outcome. Conclusions Our study showed that the presence of GI symptoms in COVID-19 at the time of admission was associated with a lower odds of hospitalization and mortality; however, this association had higher odds for respiratory symptoms.
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Affiliation(s)
- Alireza Delavari
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yousef Alimohamadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbass Vosoogh-Moghaddam
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Sadeghi
- Department of Internal Medicine, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shokouh Shahrousvand
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Zakeri
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Rahmatollah Moradzadeh
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Samaneh Akbarpour
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran. .,Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Zhang H, Shao B, Dang Q, Chen Z, Zhou Q, Luo H, Yuan W, Sun Z. Pathogenesis and Mechanism of Gastrointestinal Infection With COVID-19. Front Immunol 2021; 12:674074. [PMID: 34858386 PMCID: PMC8631495 DOI: 10.3389/fimmu.2021.674074] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
As a new infectious disease, COVID-19 is spread through the respiratory tract in most cases. Its source and pathological mechanism are not clear. The most common clinical feature is pulmonary infection. Also, a lot patients have gastrointestinal symptoms. Angiotensin-converting enzyme 2 (ACE2) is a functional cellular receptor for SARS-CoV-2, which is like SARS-CoV, a coronavirus associated with severe acute respiratory syndrome (SARS) outbreak in 2003. The tissues and cells expressing ACE2 are potential targets for SARS-CoV-2 infection, and the high expression of ACE2 in intestinal epithelial cells marks that SARS-CoV-2 may directly infect intestinal epithelial cells. Recent studies also suggest that SARS-CoV-2 existed and replicated in intestinal environment for a long time. The interaction between SARS-CoV-2 and RAS system leads to the decrease of local anti-inflammatory ability. The virus cycle leads to excessive imbalance of immune response and cytokine release. The downregulation of ACE2 after viral infection leads to gastrointestinal dysfunction. The above are the causes of gastrointestinal symptoms. Here, we reviewed the possible causes and mechanisms of gastrointestinal symptoms caused by COVID-19. Additionally, we discussed the influence of gastrointestinal symptoms on the prognosis of patients.
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Affiliation(s)
- Hao Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Shao
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qin Dang
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuang Chen
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Quanbo Zhou
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hong Luo
- Department of Hepatobiliary and Pancreatic Surgery, Guangshan County People's Hospital, Xinyang, China
| | - Weitang Yuan
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenqiang Sun
- Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
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8
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Zhang MM, Chen LN, Qian JM. Gastrointestinal manifestations and possible mechanisms of COVID-19 in different periods. J Dig Dis 2021; 22:683-694. [PMID: 34738727 PMCID: PMC8652439 DOI: 10.1111/1751-2980.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a pandemic worldwide. Although COVID-19 mainly affects the respiratory system, gastrointestinal (GI) manifestations have been frequently reported in such cases, even as initial symptoms. There have been several studies on different GI manifestations in patients with mild and severe disease or in remission. In this review article we summarized different GI manifestations of COVID-19 at various disease stages and the possible mechanisms based on published literatures, as well as the significance of GI manifestations in systemic inflammatory injury.
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Affiliation(s)
- Meng Meng Zhang
- Department of GastroenterologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lu Ni Chen
- Department of Microbiology and Tumor and Cell BiologyKarolinska InstituteSolnaSweden
| | - Jia Ming Qian
- Department of GastroenterologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Zoghi G, Moosavy SH, Yavarian S, HasaniAzad M, Khorrami F, Sharegi Brojeni M, Kheirandish M. Gastrointestinal implications in COVID-19. BMC Infect Dis 2021; 21:1135. [PMID: 34736412 PMCID: PMC8567726 DOI: 10.1186/s12879-021-06824-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19 patients mostly present with respiratory symptoms; however, gastrointestinal (GI) manifestations can also be seen either alone or along with respiratory symptoms. We aimed to evaluate the GI symptoms related to COVID-19. Methods This cross-sectional study retrospectively evaluated the medical files of 507 patients with confirmed or highly probable COVID-19. Based on their symptoms, patients were categorized into four groups: with GI symptoms alone (GIA), with respiratory symptoms alone (RA), with both GI and respiratory symptoms (GIR), and without GI or respiratory symptoms (WGIR). Results Of the 507 COVID-19 patients, 47.9% had at least one GI symptom; the most common was nausea and/or vomiting (31.6%). Patients in the GIA group were significantly older than those in the RA (P = 0.041) and GRI (P = 0.004) groups (54.70 ± 18.14 vs. 48.68 ± 14.67 and 46.80 ± 17.17 years, respectively). Groups were homogeneous with respect to gender. Leukopenia and lymphopenia were both less frequent in patients with GI symptoms compared to those without GI symptoms. Positive RT-PCR was significantly less frequent among patients with GI symptoms (44% vs. 100%, P < 0.001). Although mortality was lower in patients with GI symptoms (9.1%) in comparison with those without GI symptoms (13.3%), the difference was not statistically significant (P = 0.134). Conclusion The typical respiratory symptoms of COVID-19 are quite commonly accompanied by GI symptoms, with nausea and/or vomiting being the most prevalent. A subgroup of COVID-19 patients may exclusively present with GI symptoms. Special attention should be paid to these patients in order to avoid misdiagnosis or delayed treatment.
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Affiliation(s)
- Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Seyed Hamid Moosavy
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sadegh Yavarian
- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi HasaniAzad
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farid Khorrami
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoud Sharegi Brojeni
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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10
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Tcaciuc E, Olaru-Stavila C, Alexa Z, Tcaciuc A, Ardeleanu D. Gastrointestinal manifestations in hospitalized patients with chronic liver disease and COVID-19. Med Pharm Rep 2021; 94:S6-S11. [PMID: 38912406 PMCID: PMC11188023 DOI: 10.15386/mpr-2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background and aim Gastrointestinal manifestations in COVID-19 have been frequently acknowledged by clinicians and scientists. However, their clinical significance and potential influence on the disease outcome is not entirely elucidated. In this study we aim to evaluate gastrointestinal involvement, both digestive symptoms and liver-related changes in hospitalized COVID-19 patients in correlation to the presence or absence of underlying liver disease and rate of mortality. Methods We performed a retrospective cohort study of COVID-19 patients, consecutively admitted in a hospital from Chisinau, between September 3, 2020 and May 31, 2021. Data on clinical symptoms and laboratory findings were collected from electronic clinical records. The cohort was divided into two groups, with and without pre-existing liver disease. The Fisher exact, Pearson Chi-square tests were used to compare groups. Results A total of 1835 patients were included, 108 (5.9%) with pre-existing liver disease and 1727 (94.1%) without this comorbidity. Digestive symptoms were reported by 331(18%) of the patients, diarrhea being the most common symptom 11.8% (217) and being encountered more in patients with underlying chronic liver disease. No statistical difference was identified between the groups in regard to other symptoms, comorbidities and rate of mortality. But patients with chronic liver disease had significant (P < 0.001) lower ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in comparison with the other group. At admission, 341 (19.2%) had increased aspartate aminotransferase level (AST) and 317 (17.8%) alanine aminotransferase. The enzyme abnormalities were predominantly mild and transitory. Abnormal AST level at admission and during follow up, higher ESR, CRP, ferritin, lactate dehydrogenase (LDH) was found to correlate with higher rates of mortality. Conclusion Digestive implications, especially diarrhea in COVID-19 patients is frequent, but do not appear to be associated with mortality. Elevated liver enzymes during hospitalization, age, high ferritin, CRP, LDH might be interpreted as risk factors for mortality in COVID-19 but further studies are needed to address this topic.
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Affiliation(s)
- Eugen Tcaciuc
- Department of Gastroenterology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Catalina Olaru-Stavila
- Department of Internal Medicine, Timofei Mosneaga State Republican Hospital, Chisinau, Republic of Moldova
| | - Zinaida Alexa
- Department of Internal Medicine, Timofei Mosneaga State Republican Hospital, Chisinau, Republic of Moldova
| | - Angela Tcaciuc
- Department of Internal Medicine, Timofei Mosneaga State Republican Hospital, Chisinau, Republic of Moldova
| | - Denis Ardeleanu
- Department of Gastroenterology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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Ashktorab H, Folake A, Pizuorno A, Oskrochi G, Oppong-Twene P, Tamanna N, Mehdipour Dalivand M, Umeh LN, Moon ES, Kone AM, Banson A, Federman C, Ramos E, Awoyemi EO, Wonni BJ, Otto E, Maskalo G, Velez AO, Rankine S, Thrift C, Ekwunazu C, Scholes D, Chirumamilla LG, Ibrahim ME, Mitchell B, Ross J, Curtis J, Kim R, Gilliard C, Mathew J, Laiyemo A, Kibreab A, Lee E, Sherif Z, Shokrani B, Aduli F, Brim H. COVID-19 among African Americans and Hispanics: Does gastrointestinal symptoms impact the outcome? World J Clin Cases 2021; 9:8374-8387. [PMID: 34754847 PMCID: PMC8554449 DOI: 10.12998/wjcc.v9.i28.8374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) disproportionately affected African Americans (AA) and Hispanics (HSP). AIM To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal (GI) symptoms, laboratory values and comorbidities. METHODS We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020. We assessed the symptoms, including the GI manifestations, comorbidities, and mortality, using logistic regression analysis. RESULTS Of these 386 COVID-19 positive patients, 257 (63.7%) were AAs, 102 (25.3%) HSP, and 26 (6.45%) Whites. There were 257 (63.7%) AA, 102 (25.3%) HSP, 26 (6.45%) Whites. The mean age was 55.6 years (SD = 18.5). However, the mean age of HSP was the lowest (43.7 years vs 61.2 for Whites vs 60 for AAs). The mortality rate was highest among the AAs (20.6%) and lowest among HSP (6.9%). Patients with shortness of breath (SOB) (OR2 = 3.64, CI = 1.73-7.65) and elevated AST (OR2 = 8.01, CI = 3.79-16.9) elevated Procalcitonin (OR2 = 8.27, CI = 3.95-17.3), AST (OR2 = 8.01, CI = 3.79-16.9), ferritin (OR2 = 2.69, CI = 1.24-5.82), and Lymphopenia (OR2 = 2.77, CI = 1.41-5.45) had a high mortality rate. Cough and fever were common but unrelated to the outcome. Hypertension and diabetes mellitus were the most common comorbidities. Glucocorticoid treatment was associated with higher mortality (OR2 = 5.40, CI = 2.72-10.7). Diarrhea was prevalent (18.8%), and GI symptoms did not affect the outcome. CONCLUSION African Americans in our study had the highest mortality as they consisted of an older population and comorbidities. Age is the most important factor along with SOB in determining the mortality rate. Overall, elevated liver enzymes, ferritin, procalcitonin and C-reactive protein were associated with poor prognosis. GI symptoms did not affect the outcome. Glucocorticoids should be used judiciously, considering the poor outcomes associated with it. Attention should also be paid to monitor liver function during COVID-19, especially in AA and HSP patients with higher disease severity.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Adeleye Folake
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Antonio Pizuorno
- Faculty of Medicine, La Universidad del Zulia, Maracaibo 4002, Zulia, Venezuela
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of Middle East Kuwait, Egaila 54200, Kuwait
| | - Philip Oppong-Twene
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Nuri Tamanna
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Maryam Mehdipour Dalivand
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Lisa N Umeh
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Esther S Moon
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Abdoul Madjid Kone
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Abigail Banson
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Cassandra Federman
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Edward Ramos
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Eyitope Ola Awoyemi
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Boubini Jones Wonni
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Eric Otto
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Guttu Maskalo
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Alexandra Ogando Velez
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Sheldon Rankine
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Camelita Thrift
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Chiamaka Ekwunazu
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Derek Scholes
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Lakshmi Gayathri Chirumamilla
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Mohd Elmugtaba Ibrahim
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Brianna Mitchell
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Jillian Ross
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Julencia Curtis
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Rachel Kim
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Chandler Gilliard
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Joseph Mathew
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Adeyinka Laiyemo
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Angesum Kibreab
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Edward Lee
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Zaki Sherif
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
- Department of Biochemistry and Molecular Biology, Howard University College of Medicine, Washington, DC 20060, United States
| | - Babak Shokrani
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Farshad Aduli
- Department of Medicine, Gastroenterology Division and Cancer Center, Howard University College of Medicine, Washington, DC 20060, United States
| | - Hassan Brim
- Pathology and Cancer Center, Department of Biochemistry and Molecular Biology, Howard University College of Medicine, Washington, DC 20060, United States
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12
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Chen F, Dai Z, Huang C, Chen H, Wang X, Li X. Gastrointestinal Disease and COVID-19: A Review of Current Evidence. Dig Dis 2021; 40:506-514. [PMID: 34510032 PMCID: PMC8678221 DOI: 10.1159/000519412] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented and catastrophic impact on humanity and continues to progress. In addition to typical respiratory symptoms such as fever, cough, and dyspnea, a large percentage of COVID-19 patients experience gastrointestinal (GI) complaints, with the most common symptoms being diarrhea, nausea, vomiting, and abdominal discomfort. SUMMARY We comprehensively summarize the latest knowledge of the adverse effects of COVID-19 and therapeutic drugs on the GI system, as well as related disease pathogenesis, and then provide a discussion focusing on the management and vaccination of patients who have inflammatory bowel disease (IBD) and GI cancer. The virus can affect the digestive system via binding to ACE2 receptors and subsequent gut microbiome dysbiosis. Through a variety of molecular pathways and mechanisms, numerous drugs for the treatment of COVID-19 could interfere with GI function and lead to multiple clinical manifestations, which may further intensify the risk and severity of GI symptoms of COVID-19 infection, such as nausea, vomiting, gastroparesis, and gastric ulcers. KEY MESSAGES We should monitor GI manifestations closely while managing COVID-19 patients and take timely measures to reduce the incidence of SARS-CoV-2 infections in GI cancer patients. IBD patients should receive vaccination timely, but corticosteroid use should be minimized when they are vaccinated. Simultaneously, for persons with IBD who have known or suspected COVID-19, immunosuppressive agents, especially thiopurines, should be avoided/minimized if possible.
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13
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Amanollahi A, Sotoodeh Ghorbani S, Basir Ghafouri H, Afrashteh S, Hashemi Nazari SS. Which criteria were used to describe patients with COVID-19? A systematic review and meta analysis of clinical, laboratory, and imaging features. Med J Islam Repub Iran 2021; 35:112. [PMID: 34956958 PMCID: PMC8683786 DOI: 10.47176/mjiri.35.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The unknowingness of COVID-19 compared to other respiratory diseases and gaining an overview of its diagnostic criteria led to this study, which was designed to summarize the signs and symptoms along with the clinical tests that described these patients. Methods: PubMed\MEDLINE, Web of Science, Core Collection, Scopus, and Google Scholar were systematically searched on September 27, 2020. After screening, we selected 56 articles based on clinical characteristics and laboratory and imaging findings in confirmed COVID-19 patients as eligibility criteria. To evaluate risk of bias, the Newcastle Ottawa scale, for publication bias, Egger's test, and for heterogeneity, I2 and tau test were used; and finally, random-effects models were used for pooled estimation. Results: Pooled estimates for frequently clinical symptoms were as follows: fever (78% [95% CI, 74-82]), cough (60% [95% CI, 57-63]), and fatigue (31% [95% CI, 26-36]); and they were as follows for laboratory findings in lymphocyte (1.02 [95% CI, 0.92-1.12]), CRP (19.64 [95% CI, 13.96- 25.32]), and platelet count (175.2 [95% CI, 165.2-185.2]); they were as follows for imaging findings in bilateral pneumonia (64% [95% CI, 56-72]), and ground glass opacity (60% [95% CI, 48-7]). Also, in the subgroup analysis, bilateral pneumonia with 18% and fatigue with 15%, had the highest difference in values between the groups. Conclusion: According to Forest plots, the CI and dispersion among studies were smaller in laboratory findings than in symptom and imaging findings, which might indicate a high alignment in the laboratory findings among studies.
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Affiliation(s)
- Alireza Amanollahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Basir Ghafouri
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Afrashteh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Public Health, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Shafiee S, Cegolon L, Khafaei M, Gholami N, Zhao S, Khalesi N, Moosavian H, Fathi S, Izadi M, Ghadian A, Javanbakht M, Javanbakht A, Akhavan-Sigari R. Gastrointestinal cancers, ACE-2/TMPRSS2 expression and susceptibility to COVID-19. Cancer Cell Int 2021; 21:431. [PMID: 34399734 PMCID: PMC8365127 DOI: 10.1186/s12935-021-02129-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/30/2021] [Indexed: 12/22/2022] Open
Abstract
Recent studies on the pathophysiology of COVID-19 are indicating that the Angiotensin convertase enzyme 2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) can act as a major component in the fusion of SARS-Cov-2 with target cells. It has also been observed that the expression of ACE-2 and TMPRSS2 can be altered in malignancies. Shedding light on this matter could be crucial since the COVID-19 pandemic interfered with many gastrointestinal cancer screening programs. Herein we discuss the possibility of severe forms of COVID-19 in patients with gastrointestinal cancers due to the gastrointestinal entry route of SARS-CoV-2 into the human body. The disruption of cancer screening programs caused by the current COVID-19 pandemic could therefore have massive negative health impact on patients affected by gastrointestinal malignancies.
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Affiliation(s)
- Sepehr Shafiee
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Luca Cegolon
- Public Health Department, Local Health Unit N.2 "Marca Trevigiana", 31100, Treviso, Italy
| | - Mostafa Khafaei
- Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nasrin Gholami
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Nasrin Khalesi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moosavian
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Saeid Fathi
- Department of Parasite Vaccine Research and Production, Razi Vaccine and Serum Research Institute, Agriculture Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Ghadian
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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15
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Oikonomou KG, Papamichalis P, Zafeiridis T, Xanthoudaki M, Papapostolou E, Valsamaki A, Bouliaris K, Papamichalis M, Karvouniaris M, Vlachostergios PJ, Skoura AL, Komnos A. Gastroenterology and liver disease during COVID-19 and in anticipation of post-COVID-19 era: Current practice and future directions. World J Clin Cases 2021; 9:4918-4938. [PMID: 34307544 PMCID: PMC8283616 DOI: 10.12998/wjcc.v9.i19.4918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a major threat to global public health. The virus causes the clinical syndrome known as coronavirus disease 2019 (COVID-19), in which multiple organs can get affected. Apart from manifestations of the respiratory system, which predominate, its clinical presentation is frequently accompanied by symptoms of the gastro-intestinal (GI) tract and liver abnormalities. The correlation of symptoms and abnormalities with disease severity is discussed, leading to ambiguous results from international literature. Moreover, the disease infects patients with co-existing liver and GI disorders affecting both their health status and the availability of healthcare services provided to them. The risk of transmission of the disease during aerosol-generating procedures has changed the diagnostic approach and follow-up algorithms for liver and GI diseases. For the safety of both doctors and patients, telemedicine and distant evaluation have become everyday practice, whereas several routines and emergency visits at outpatient and emergency departments have been postponed or delayed. Vaccination against SARS-CoV-2 is underway, providing hope to humanity and the expectation that the post-COVID-19 era is near. This review aims to update knowledge about the manifestations of COVID-19 related to liver and GI diseases and the effect of the pandemic on the diagnostic and therapeutic procedures for these diseases with a special focus on how current practices have changed and what changes will possibly remain in the future.
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Affiliation(s)
- Katerina G Oikonomou
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | | | - Maria Xanthoudaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | - Asimina Valsamaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | - Michail Papamichalis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Marios Karvouniaris
- Intensive Care Unit, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Panagiotis J Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Apostolia-Lemonia Skoura
- Intensive Care Unit, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
- Transfusion Medicine Department, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Apostolos Komnos
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
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16
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Elshazli RM, Kline A, Elgaml A, Aboutaleb MH, Salim MM, Omar M, Munshi R, Mankowski N, Hussein MH, Attia AS, Toraih EA, Settin A, Killackey M, Fawzy MS, Kandil E. Gastroenterology manifestations and COVID-19 outcomes: A meta-analysis of 25,252 cohorts among the first and second waves. J Med Virol 2021; 93:2740-2768. [PMID: 33527440 PMCID: PMC8014082 DOI: 10.1002/jmv.26836] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/09/2021] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
A meta-analysis was performed to identify patients with coronavirus disease 2019 (COVID-19) presenting with gastrointestinal (GI) symptoms during the first and second pandemic waves and investigate their association with the disease outcomes. A systematic search in PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE was performed up to July 25, 2020. The pooled prevalence of the GI presentations was estimated using the random-effects model. Pairwise comparison for the outcomes was performed according to the GI manifestations' presentation and the pandemic wave of infection. Data were reported as relative risk (RR), or odds ratio and 95% confidence interval. Of 125 articles with 25,252 patients, 20.3% presented with GI manifestations. Anorexia (19.9%), dysgeusia/ageusia (15.4%), diarrhea (13.2%), nausea (10.3%), and hematemesis (9.1%) were the most common. About 26.7% had confirmed positive fecal RNA, with persistent viral shedding for an average time of 19.2 days before being negative. Patients presenting with GI symptoms on admission showed a higher risk of complications, including acute respiratory distress syndrome (RR = 8.16), acute cardiac injury (RR = 5.36), and acute kidney injury (RR = 5.52), intensive care unit (ICU) admission (RR = 2.56), and mortality (RR = 2.01). Although not reach significant levels, subgroup-analysis revealed that affected cohorts in the first wave had a higher risk of being hospitalized, ventilated, ICU admitted, and expired. This meta-analysis suggests an association between GI symptoms in COVID-19 patients and unfavorable outcomes. The analysis also showed improved overall outcomes for COVID-19 patients during the second wave compared to the first wave of the outbreak.
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Affiliation(s)
- Rami M. Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical TherapyHorus University ‐ EgyptNew DamiettaEgypt
| | - Adam Kline
- School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Abdelaziz Elgaml
- Department of Microbiology and Immunology, Faculty of PharmacyMansoura UniversityMansouraEgypt
- Department of Microbiology and Immunology, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
| | - Mohamed H. Aboutaleb
- Department of Pharmaceutical Chemistry, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
| | - Mohamed M. Salim
- Department of Pharmaceutical Chemistry, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
- Department of Pharmaceutical Analytical Chemistry, Faculty of PharmacyMansoura UniversityMansouraEgypt
| | - Mahmoud Omar
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Ruhul Munshi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | | | - Mohammad H. Hussein
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Abdallah S. Attia
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Eman A. Toraih
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
- Genetics Unit, Histology and Cell Biology Department, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Ahmad Settin
- Pediatrics and Genetics Department, Faculty of MedicineMansoura UniversityMansouraEgypt
| | - Mary Killackey
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Department of Biochemistry, College of MedicineNorthern Border UniversityArarSaudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
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17
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Troisi J, Venutolo G, Pujolassos Tanyà M, Delli Carri M, Landolfi A, Fasano A. COVID-19 and the gastrointestinal tract: Source of infection or merely a target of the inflammatory process following SARS-CoV-2 infection? World J Gastroenterol 2021; 27:1406-1418. [PMID: 33911464 PMCID: PMC8047540 DOI: 10.3748/wjg.v27.i14.1406] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/13/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) symptoms have been described in a conspicuous percentage of coronavirus disease 2019 (COVID-19) patients. This clinical evidence is supported by the detection of viral RNA in stool, which also supports the hypothesis of a possible fecal-oral transmission route. The involvement of GI tract in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is corroborated by the theoretical assumption that angiotensin converting enzyme 2, which is a SARS-CoV-2 target receptor, is present along the GI tract. Studies have pointed out that gut dysbiosis may occur in COVID-19 patients, with a possible correlation with disease severity and with complications such as multisystem inflammatory syndrome in children. However, the question to be addressed is whether dysbiosis is a consequence or a contributing cause of SARS-CoV-2 infection. In such a scenario, pharmacological therapies aimed at decreasing GI permeability may be beneficial for COVID-19 patients. Considering the possibility of a fecal-oral transmission route, water and environmental sanitation play a crucial role for COVID-19 containment, especially in developing countries.
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Affiliation(s)
- Jacopo Troisi
- Metabolomics Section, Theoreo srl - Spin-off Company of the University of Salerno, Montecorvino Pugliano 84090, SA, Italy
- Department of Chemistry and Biology “A. Zambelli”, University of Salerno, Fisciano 84084, SA, Italy
- European Biomedical Research Institute of Salerno, Salerno 84125, SA, Italy
| | - Giorgia Venutolo
- European Biomedical Research Institute of Salerno, Salerno 84125, SA, Italy
| | - Meritxell Pujolassos Tanyà
- Metabolomics Section, Theoreo srl - Spin-off Company of the University of Salerno, Montecorvino Pugliano 84090, SA, Italy
| | - Matteo Delli Carri
- Metabolomics Section, Theoreo srl - Spin-off Company of the University of Salerno, Montecorvino Pugliano 84090, SA, Italy
- Department of Chemistry and Biology “A. Zambelli”, University of Salerno, Fisciano 84084, SA, Italy
| | - Annamaria Landolfi
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi 84081, SA, Italy
| | - Alessio Fasano
- European Biomedical Research Institute of Salerno, Salerno 84125, SA, Italy
- Mucosal Immunology and Biology Research Center and Center for Celiac Research, Harvard Medical School, Massachusetts Gen Hosp Children, Mucosal Immunology and Biology Research Center, Boston, MA 02114, United States
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18
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Abdulateef DS, Rahman HS, Salih JM, Osman SM, Mahmood TA, Omer SHS, Ahmed RA. COVID-19 severity in relation to sociodemographics and vitamin D use. Open Med (Wars) 2021; 16:591-609. [PMID: 33869781 PMCID: PMC8034240 DOI: 10.1515/med-2021-0273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023] Open
Abstract
Most COVID-19 cases are treated as outpatients, while the majority of studies on COVID-19 focus on inpatients. Little is known about the self-reporting and self-rating of the disease's symptoms, and the associations of prophylactic use of dietary supplements with COVID-19 severity have not been addressed. The aims of this study are to evaluate COVID-19 severity and to relate them to sociodemographic characteristics and prophylactic dietary supplements. An observational patient-based study conducted through an online questionnaire on recovered COVID-19 patients. The patients were assessed for several severity parameters, sociodemographic parameters, and prophylactic dietary supplement use. A total of 428 patients were evaluated. Age and presence of comorbidities had positive associations with the severity parameters. The severe infection group had the highest proportion of patients stressed about COVID-19 (P < 0.05). Cigarette, but not hookah, smoking was significantly associated with less severe symptoms. Vitamin D negatively predicted disease severity (P < 0.05). In conclusion, stress, age, and presence of comorbidities were the most important positive predictors of COVID-19 severity, while prophylactic vitamin D use and smoking were significant negative predictors. The use of protective measures and other prophylactic dietary supplements was not significantly associated with symptom severity.
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Affiliation(s)
- Darya Saeed Abdulateef
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
| | - Heshu Sulaiman Rahman
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
| | - Jamal Mahmood Salih
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
| | - Sangar Mahmoud Osman
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
| | - Trifa Abdalla Mahmood
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
| | - Shirwan Hama Salih Omer
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
| | - Rana Adnan Ahmed
- Department of Physiology, College of Medicine, University of Sulaimani, New–Street-27, Zone 209, P. O. Box: 334, Kurdistan Region, Sulaymaniyah, Iraq
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19
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Hayashi Y, Wagatsuma K, Nojima M, Yamakawa T, Ichimiya T, Yokoyama Y, Kazama T, Hirayama D, Nakase H. The characteristics of gastrointestinal symptoms in patients with severe COVID-19: a systematic review and meta-analysis. J Gastroenterol 2021; 56:409-420. [PMID: 33759041 PMCID: PMC7987120 DOI: 10.1007/s00535-021-01778-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
Although primarily a respiratory illness, several studies have shown that COVID-19 causes elevation of liver enzymes and various gastrointestinal (GI) symptoms. The aim of this study was to undertake a systematic review and meta-analysis to determine whether the presence of gastrointestinal (GI) symptoms contributed toward COVID-19 severity, and identify the GI symptoms characteristic of severe COVID-19. We conducted a literature search of PubMed from December 1, 2019, to June 30, 2020, and identified all reports with GI symptoms reported. A meta-analysis comparing the severity of COVID-19 with the presence of liver enzyme elevation and GI symptoms was performed using RevMan version 5.4. Pooled data from 15,305 unique reverse transcriptase-polymerase chain reaction positive COVID-19 patients from 44 studies were analyzed. We found that the severe COVID-19 patients significantly had abdominal pain compared to the non-severe COVID-19 patients (OR = 2.70, 95% CI 1.17-6.27, Z = 2.32, p = 0.02, I2 = 0%) by analyzed 609 patients of 4 studies who reported both abdominal pain and COVID-19 severity. However, there was no significant difference in the incidence of diarrhea, nausea, or vomiting between the two groups. Thus, this systematic review and meta-analysis demonstrated that abdominal pain could be characteristic of severe COVID-19 infections. Compared with other viral infections that primarily infect the respiratory system, patients with COVID-19 have a slightly lower frequency of diarrheal symptoms with abdominal pain. However, to confirm this, further studies with COVID-19 patients across various countries and ethnicities are required.
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Affiliation(s)
- Yuki Hayashi
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Kohei Wagatsuma
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Masanori Nojima
- grid.26999.3d0000 0001 2151 536XCenter for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639 Japan
| | - Tsukasa Yamakawa
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Tadashi Ichimiya
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Yoshihiro Yokoyama
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Tomoe Kazama
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Daisuke Hirayama
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Hiroshi Nakase
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
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20
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Jones DL, Baluja MQ, Graham DW, Corbishley A, McDonald JE, Malham SK, Hillary LS, Connor TR, Gaze WH, Moura IB, Wilcox MH, Farkas K. Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141364. [PMID: 32836117 PMCID: PMC7836549 DOI: 10.1016/j.scitotenv.2020.141364] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 04/14/2023]
Abstract
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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Affiliation(s)
- David L Jones
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UWA School of Agriculture and Environment, The University of Western Australia, Perth, WA 6009, Australia.
| | | | - David W Graham
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Alexander Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Easter Bush Campus Midlothian, EH25 9RG, UK
| | - James E McDonald
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Luke S Hillary
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Thomas R Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK; Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, ESI, Penryn Campus, TR10 9FE, UK
| | - Ines B Moura
- Leeds Institute for Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 3EX, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
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21
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Jones DL, Baluja MQ, Graham DW, Corbishley A, McDonald JE, Malham SK, Hillary LS, Connor TR, Gaze WH, Moura IB, Wilcox MH, Farkas K. Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141364. [PMID: 32836117 DOI: 10.20944/preprints202007.0471.v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 05/18/2023]
Abstract
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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Affiliation(s)
- David L Jones
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UWA School of Agriculture and Environment, The University of Western Australia, Perth, WA 6009, Australia.
| | | | - David W Graham
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Alexander Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Easter Bush Campus Midlothian, EH25 9RG, UK
| | - James E McDonald
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Luke S Hillary
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Thomas R Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK; Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, ESI, Penryn Campus, TR10 9FE, UK
| | - Ines B Moura
- Leeds Institute for Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 3EX, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
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22
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Jones DL, Baluja MQ, Graham DW, Corbishley A, McDonald JE, Malham SK, Hillary LS, Connor TR, Gaze WH, Moura IB, Wilcox MH, Farkas K. Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020. [PMID: 32836117 DOI: 10.1016/j.scitotenv.2020.141364pmid-32836117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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Affiliation(s)
- David L Jones
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UWA School of Agriculture and Environment, The University of Western Australia, Perth, WA 6009, Australia.
| | | | - David W Graham
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Alexander Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Easter Bush Campus Midlothian, EH25 9RG, UK
| | - James E McDonald
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Luke S Hillary
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Thomas R Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK; Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, ESI, Penryn Campus, TR10 9FE, UK
| | - Ines B Moura
- Leeds Institute for Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 3EX, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
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23
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de Moura DTH, Proença IM, McCarty TR, Sagae VMT, Ribeiro IB, de Oliveira GHP, de Souza GMV, Hirsch BS, Scatimburgo MVCV, Thompson CC, Carrilho FJ, Cecconello I, de Moura EGH. Gastrointestinal Manifestations and Associated Health Outcomes of COVID-19: A Brazilian Experience From the Largest South American Public Hospital. Clinics (Sao Paulo) 2020; 75:e2271. [PMID: 33146362 PMCID: PMC7561063 DOI: 10.6061/clinics/2020/e2271] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Brazil has rapidly developed the second-highest number of COVID-19 cases in the world. As such, proper symptom identification, including gastrointestinal manifestations, and relationship to health outcomes remains key. We aimed to assess the prevalence and impact of gastrointestinal symptoms associated with COVID-19 in a large quaternary referral center in South America. METHODS This was a single-center cohort study in a COVID-19 specific hospital in São Paulo, Brazil. Consecutive adult patients with laboratory confirmed SARS-CoV-2 were included. Baseline patient history, presenting symptoms, laboratory results, and clinically relevant outcomes were recorded. Regression analyses were performed to determine significant predictors of the gastrointestinal manifestations of COVID-19 and hospitalization outcomes. RESULTS Four-hundred patients with COVID-19 were included. Of these, 33.25% of patients reported ≥1 gastrointestinal symptom. Diarrhea was the most common gastrointestinal symptom (17.25%). Patients with gastrointestinal symptoms had higher rates of concomitant constitutional symptoms, notably fatigue and myalgia (p<0.05). Gastrointestinal symptoms were also more prevalent among patients on chronic immunosuppressants, ACE/ARB medications, and patient with chronic kidney disease (p<0.05). Laboratory results, length of hospitalization, ICU admission, ICU length of stay, need for mechanical ventilation, vasopressor support, and in-hospital mortality did not differ based upon gastrointestinal symptoms (p>0.05). Regression analyses showed older age [OR 1.04 (95% CI, 1.02-1.06)], male gender [OR 1.94 (95% CI, 1.12-3.36)], and immunosuppression [OR 2.60 (95% CI, 1.20-5.63)], were associated with increased mortality. CONCLUSION Based upon this Brazilian study, gastrointestinal manifestations of COVID-19 are common but do not appear to impact clinically relevant hospitalization outcomes including the need for ICU admission, mechanical ventilation, or mortality.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
- Brigham and Women’s Hospital - Harvard Medical School, Boston 02115, MA, United States
| | - Igor Mendonça Proença
- Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Thomas R. McCarty
- Brigham and Women’s Hospital - Harvard Medical School, Boston 02115, MA, United States
| | | | - Igor Braga Ribeiro
- Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | | | | | - Bruno Salomão Hirsch
- Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | | | | | - Flair José Carrilho
- Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Ivan Cecconello
- Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
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24
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Ahlawat S, Asha, Sharma KK. Immunological co-ordination between gut and lungs in SARS-CoV-2 infection. Virus Res 2020; 286:198103. [PMID: 32717345 PMCID: PMC7380259 DOI: 10.1016/j.virusres.2020.198103] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a major pandemic called coronavirus disease 2019 (COVID-19) that has created unprecedented global health emergencies, and emerged as a serious threat due to its strong ability for human-to-human transmission. The reports indicate the ability of SARS-CoV-2 to affect almost any organ due to the presence of a receptor known as angiotensin converting enzyme 2 (ACE2) across the body. ACE2 receptor is majorly expressed in the brush border of gut enterocytes along with the ciliated cells and alveolar epithelial type II cells in the lungs. The amino acid transport function of ACE2 has been linked to gut microbial ecology in gastrointestinal (GI) tract, thereby suggesting that COVID-19 may, to some level, be linked to the enteric microbiota. The significant number of COVID-19 patients shows extra-pulmonary symptoms in the GI tract. Many subsequent studies revealed viral RNA of SARS-CoV-2 in fecal samples of COVID-19 patients. This presents a new challenge in the diagnosis and control of COVID-19 infection with a caution for proper sanitation and hygiene. Here, we aim to discuss the immunological co-ordination between gut and lungs that facilitates SARS-CoV-2 to infect and multiply in the inflammatory bowel disease (IBD) and non-IBD patients.
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Affiliation(s)
- Shruti Ahlawat
- Laboratory of Enzymology and Recombinant DNA Technology, Department of Microbiology, Maharshi Dayanand University, Rohtak, 124001, Haryana, India
| | - Asha
- Laboratory of Enzymology and Recombinant DNA Technology, Department of Microbiology, Maharshi Dayanand University, Rohtak, 124001, Haryana, India
| | - Krishna Kant Sharma
- Laboratory of Enzymology and Recombinant DNA Technology, Department of Microbiology, Maharshi Dayanand University, Rohtak, 124001, Haryana, India.
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