COVID-19 extrapulmonary illness – special gastrointestinal and hepatic considerations

Abstract

Coronaviruses have caused three global outbreaks in the last 20 years, which include Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) by MERS-CoV and Coronavirus Disease-2019 (COVID-19) due to SARS-CoV-2. These outbreaks share many similarities, including clinical presentation, transmission, and management. Although respiratory manifestations are responsible for most of the morbidity and mortality in these conditions, extra-pulmonary manifestations such as gastrointestinal symptoms are also increasingly recognized as important symptoms. Important gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, and abdominal pain. Hepatic manifestations such as abnormal aminotransferases are also noted in these patients. Early identification of GI symptoms is crucial as some patients can present only with GI manifestations in the absence of pulmonary symptoms. Furthermore, patients with diarrhea have tested positive for viral RNA in the stool. This has been reported even after the resolution of respiratory symptoms and can extend up to many days from the onset of symptoms. Because of this phenomenon, there is a theoretical risk of fecal-oral transmission and the potential spread of the disease. Though GI symptoms are frequently observed, understanding the pathogenesis of these symptoms is crucial, as it can not only of public health importance but could also identify infected patients early in the spread. Understanding the different GI and hepatic manifestations with underlying mechanisms of symptoms can assist in the therapeutic management of these patients. In this article, we summarize various GI and hepatic manifestations with their prevalence, underlying pathophysiology with emphasis on stool positivity.

Successful Distancing: Telemedicine in Gastroenterology and Hepatology During the COVID-19 Pandemic

“…COVID-19 is rapidly changing and evolving with the emergence of extrapulmonary manifestations [ 20 ]. GI and liver symptoms have emerged as important manifestations of COVID-19, which can also precede respiratory symptoms, and in a few cases, can be the only symptoms [ 21 – 23 ]. Furthermore, taste changes among COVID-19 patients are observed in up to 50% of cases [ 24 ].…”

Coronavirus Disease (COVID-19) Caused by (SARS-CoV-2) Infections: A Real Challenge for Human Gut Microbiota

“…The molecular attachment between the viral entity and the human host cell is an important characteristic of SARS-like coronaviruses ( Ding and Liang, 2020 ). After invading the human body, SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) protein, which is found on the membranes of multiple types of cells (alveolar cells, myocardium, pancreas, enterocytes, spleen, thymus, bone marrow, liver, kidney, and brain) ( Hamming et al., 2004 ; Hoffmann et al., 2020 ; Jia et al., 2020 ; Muniyappa and Gubbi, 2020 ; Perisetti et al., 2020c ). Actually, SARS-CoV-2 presents an elevated binding affinity to the ACE2 receptors.…”

“…Up to September 4, 2020, the top three countries with the highest number of infected cases are represented by the US, Brazil, and India (Shah et al, 2020). A comprehensive list of pulmonary and extrapulmonary manifestations of the COVID-19 has been reported (Aziz et al, 2020;Gandhi et al, 2020;Johnson et al, 2020;Perisetti et al, 2020c). The pulmonary symptoms included fever, cough, chest tightness, fatigue, shortness of breath, hypoxemia, anosmia, nasal congestion, inflammatory storms, and viral pneumonia.…”

Management of Malaria in Children Younger Than 5 Years Old During Coronavirus Disease 2019 Pandemic in Sierra Leone: A Lesson Learned?

“…In particular, the first cases in Africa have been described around March 2020 ( 1 ). In this part of the world, the number of coronavirus disease 2019 (COVID-19) cases and deaths is rising day by day, although not significantly compared with Europe, Asia, and North and South America ( 2 ). The reasons for such a difference are still unexplained, but multiple factors can be involved, including race, sex, socioeconomic status, genetic differences ( 3 ), and lack of testing points in most areas, particularly in the peripheries.…”