Atypical presentation of SARS-CoV-2 infection: A case report

Li, Ruilin; Sh, Chu; Luo, Yu; Huang, Zhen-Hao; Hao, Ying; Fan, Chenghui

doi:10.12998/wjcc.v8.i7.1265

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…Furthermore, our review identifies and includes several studies with zero prevalence of isolated GI symptoms that were not included in the Mao review. Even if the overall prevalence of isolated GI symptoms is relatively low, 1% represents hundreds of cases daily in the US alone, with both clinical and public health implications 43,44 …”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal and hepatic manifestations of COVID‐19: A systematic review and meta‐analysis

Dorrell¹,

Dougherty

Barash

et al. 2020

JGH Open

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal and hepatic manifestations of COVID‐19: A systematic review and meta‐analysis

Dorrell¹,

Dougherty

Barash

et al. 2020

JGH Open

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“…A viral infection causes an alteration of intestinal permeability, resulting in enterocyte dysfunction. 16 , 17 , 18 , 19 , 20 , 21 , 22 When we investigate what happened with another coronavirus, we found that diarrhea was a frequent symptom in severe acute respiratory syndrome (SARS) patients, occurring in 40%. 23 Intestinal problems were also associated with the severity of the infection.…”

Section: Clinical Characteristics Of Covid-19 Patients With Digestivementioning

confidence: 99%

Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome

Villapol

2020

Translational Research

300

302

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the greatest worldwide pandemic since the 1918 flu. The consequences of the coronavirus disease 2019 (COVID-19) are devastating and represent the current major public health issue across the globe. At the onset, SARS-CoV-2 primarily attacks the respiratory system as it represents the main point of entry in the host, but it also can affect multiple organs. Although most of the patients do not present symptoms or are mildly symptomatic, some people infected with SARS-CoV-2 that experience more severe multiorgan dysfunction. The severity of COVID-19 is typically combined with a set of comorbidities such as hypertension, diabetes, obesity, and/or advanced age that seriously exacerbates the consequences of the infection. Also, SARS-CoV-2 can cause gastrointestinal symptoms, such as vomiting, diarrhea, or abdominal pain during the early phases of the disease. Intestinal dysfunction induces changes in intestinal microbes, and an increase in inflammatory cytokines. Thus, diagnosing gastrointestinal symptoms that precede respiratory problems during COVID-19 may be necessary for improved early detection and treatment. Uncovering the composition of the microbiota and its metabolic products in the context of COVID-19 can help determine novel biomarkers of the disease and help identify new therapeutic targets. Elucidating changes to the microbiome as reliable biomarkers in the context of COVID-19 represent an overlooked piece of the disease puzzle and requires further investigation. (Translational Research 2020; 226:57À69) Abbreviations: ARDS = acute respiratory distress syndrome; ACE2 = Angiotensin-Converting Enzyme II; CNS = central nervous system; COVID-19 = coronavirus disease 2019; CPR = C-reactive protein; H1N1 = influenza A virus; IL = Interleukin; MERS = Middle East respiratory syndrome; PRS = proteomic risk score; SARS = severe acute respiratory syndrome; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; SCFA = short-chain fatty acids; RAS = renin-angiotensin system; ROS = Reactive oxygen species; RT-PCR = reverse transcription-polymerase chain reaction; TMPRSS2 = transmembrane serine protease 2; TNFa = tumor necrosis factor alpha;

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“…It is unknown from the reported data to what extent these symptoms co-occur. In a rare number of cases, diarrhea has been shown to be the only COVID-19 symptom, making these cases very difficult to diagnose ( Li et al, 2020a ; Taxonera et al, 2020 ). Although there are reports of renal organ failure from SARS-CoV-2 in severe infections ( Martinez-Rojas et al, 2020 ), there are fewer reports of urinary dysfunction as a result of infection ( Prabhu et al, 2020 ).…”

Section: Proportion Of Covid-19 Cases Showing Gastrointestinal Symptomentioning

confidence: 99%

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

Jones

Quintela-Baluja

Graham

et al. 2020

Science of The Total Environment

341

264

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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. 10 2 –10 5 gc/ml) and feces (ca. 10 2 –10 7 gc/ml) is much lower than in nasopharyngeal fluids (ca. 10 5 –10 11 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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Atypical presentation of SARS-CoV-2 infection: A case report

Cited by 8 publications

References 13 publications

Gastrointestinal and hepatic manifestations of COVID‐19: A systematic review and meta‐analysis

Gastrointestinal and hepatic manifestations of COVID‐19: A systematic review and meta‐analysis

Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome

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

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