Is diarrhea a symptom of covid
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Diarrhea as a Symptom of COVID-19
Introduction to COVID-19 and Gastrointestinal Symptoms
COVID-19, caused by the SARS-CoV-2 virus, is primarily known for its respiratory symptoms. However, gastrointestinal (GI) symptoms, including diarrhea, have also been frequently reported among patients. Understanding the prevalence and implications of these symptoms is crucial for effective diagnosis and management.
Prevalence of Diarrhea in COVID-19 Patients
Several studies have documented the occurrence of diarrhea in COVID-19 patients, with varying prevalence rates. A comprehensive review found that diarrhea was reported in 7.7% of patients globally, with higher rates observed outside of China, reaching up to 18.3%2. Another meta-analysis reported a pooled prevalence of 8.4% for diarrhea among COVID-19 patients5. Additionally, a study from Hubei, China, noted that 34% of patients experienced diarrhea3.
Clinical Presentation and Pathogenesis
Diarrhea can be an early symptom of COVID-19, sometimes preceding respiratory symptoms1. The virus infects the gastrointestinal tract by binding to the angiotensin-converting enzyme 2 (ACE2) receptors, which are abundantly present in the small intestine1 9. This binding can lead to direct damage to the intestinal epithelium, contributing to symptoms like diarrhea9. Moreover, the presence of viral RNA in stool samples suggests that the virus can replicate in the gastrointestinal tract, potentially leading to fecal-oral transmission1 8.
Impact on Disease Severity and Management
Patients with gastrointestinal symptoms, including diarrhea, often present later for medical care and have a longer duration of illness compared to those with only respiratory symptoms7. These patients are also more likely to have prolonged viral shedding in stool, which can complicate the management and containment of the virus7 8. Furthermore, severe cases of COVID-19 are associated with higher rates of gastrointestinal symptoms and liver injury4.
Implications for Healthcare and Prevention
The detection of SARS-CoV-2 in fecal samples underscores the importance of considering fecal-oral transmission in infection control practices8 9. Healthcare workers should exercise caution when handling fecal samples and performing procedures involving the gastrointestinal tract. Additionally, recognizing diarrhea as a potential early symptom of COVID-19 can aid in timely diagnosis and isolation of infected individuals, thereby reducing the spread of the virus1 10.
Conclusion
Diarrhea is a notable symptom of COVID-19, affecting a significant proportion of patients. Its presence can complicate the clinical course and management of the disease. Understanding the gastrointestinal manifestations of COVID-19 is essential for improving patient outcomes and preventing further transmission. Continued research and awareness are necessary to address these challenges effectively.
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Most relevant research papers on this topic
Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management
Diarrhea is a common symptom in COVID-19 patients, with potential fecal oral transmission, highlighting the need for rapid modification of screening and diagnostic algorithms.
Highly CitedAGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19
Gastrointestinal symptoms are associated with COVID-19 in less than 10% of patients, with higher prevalence estimates outside of China.
Meta-AnalysisHighly CitedClinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study
COVID-19 patients with digestive symptoms, such as diarrhea, have a longer time from onset to admission, longer coagulation, and higher liver enzyme levels.
Observational StudyHighly CitedManifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis
Summary Background The prevalence and prognosis of digestive system involvement, including gastrointestinal symptoms and liver injury, in patients with COVID-19 remains largely unknown. We aimed to quantify the effects of COVID-19 on the digestive system. Methods In this systematic review and meta-analysis, we systematically searched PubMed, Embase, and Web of Science for studies published between Jan 1, 2020, and April 4, 2020. The websites of WHO, CDC, and major journals were also searched. We included studies that reported the epidemiological and clinical features of COVID-19 and the prevalence of gastrointestinal findings in infected patients, and excluded preprints, duplicate publications, reviews, editorials, single case reports, studies pertaining to other coronavirus-related illnesses, and small case series (<10 cases). Extracted data included author; date; study design; country; patient demographics; number of participants in severe and non-severe disease groups; prevalence of clinical gastrointestinal symptoms such as vomiting, nausea, diarrhoea, loss of appetite, abdominal pain, and belching; and digestive system comorbidities including liver disease and gastrointestinal diseases. Raw data from studies were pooled to determine effect estimates. Findings We analysed findings from 35 studies, including 6686 patients with COVID-19, that met inclusion criteria. 29 studies (n=6064) reported gastrointestinal symptoms in patients with COVID-19 at diagnosis, and the pooled prevalence of digestive system comorbidities was 4% (95% CI 2–5; range 0–15; I 2=74%). The pooled prevalence of digestive symptoms was 15% (10–21; range: 2–57; I 2=96%) with nausea or vomiting, diarrhoea, and loss of appetite being the three most common symptoms. The pooled prevalence of abnormal liver functions (12 studies, n=1267) was 19% (9–32; range 1–53; I 2=96%). Subgroup analysis showed patients with severe COVID-19 had higher rates of gastrointestinal symptoms (odds ratio [OR] 1·60 [95% CI 1·09–2·36]; p=0·0020; I 2=44%) and liver injury (2·20 [1·60–3·02]; p<0·00001; I 2=36%) compared with those with non-severe disease. Patients in Hubei province, where the initial COVID-19 outbreak occurred, were more likely to present with abnormal liver functions (p<0·0001) compared with those outside of Hubei. Paediatric patients with COVID-19 had a similar prevalence of gastrointestinal symptoms to those of adult patients. 10% (95% CI 4–19; range 3–23; I 2=97%) of patients presented with gastrointestinal symptoms alone without respiratory features. Patients who presented with gastrointestinal system involvement had delayed diagnosis (standardised mean difference 2·85 [95% CI 0·22–5·48]; p=0·030; I 2=73%). Patients with gastrointestinal involvement had a higher prevalence of complication (OR 2·51 [95% CI 1·62–3·89]; p<0·0001; I 2=0%). Interpretation Our study showed that digestive symptoms and liver injury are not uncommon in patients with COVID-19. Increased attention should be paid to the care of this unique group of patients. Funding None.
Meta-Analysis
Rigorous JournalHighly CitedGastrointestinal and hepatic abnormalities in patients with confirmed COVID‐19: A systematic review and meta‐analysis
Gastrointestinal and liver manifestations are not rare in COVID-19 patients, with diarrhea and mild liver abnormalities being relatively common regardless of comorbidities.
Meta-AnalysisSARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19
COVID-19 patients with gastrointestinal symptoms should be evaluated for virus infectivity, especially during the outbreak period.
Case ReportRigorous JournalHighly CitedDigestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes
COVID-19 patients with digestive symptoms and mild disease severity are more likely to have delayed diagnosis, longer viral clearance, and higher stool viral RNA positivity compared to those with only respiratory symptoms.
Observational StudyHighly CitedGastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis
17.6% of COVID-19 patients in Hong Kong had gastrointestinal symptoms, and 48.1% had virus RNA detected in their stool samples, highlighting the need for caution in fecal sample collection and endoscopic procedures.
Meta-AnalysisHighly CitedCOVID-19-associated diarrhea
COVID-19-associated diarrhea is caused by direct damage to the intestinal epithelium, gut dysbiosis, and immune response, leading to increased intestinal permeability and requiring new therapeutic and preventive options.
Rigorous JournalThe mechanism and treatment of gastrointestinal symptoms in patients with COVID-19
COVID-19 patients with gastrointestinal symptoms should receive prompt treatment adjustments, considering intestinal immune damage and drug-induced diarrhea, to prevent secondary bacterial infections and maintain intestinal balance.
Highly Cited