Is nausea a symptom of covid

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Nausea as a Symptom of COVID-19

Introduction to COVID-19 Symptoms

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily manifests with respiratory symptoms such as fever, cough, and shortness of breath. However, gastrointestinal (GI) symptoms, including nausea, have also been reported in a subset of patients 134.

Prevalence of Nausea in COVID-19 Patients

Incidence and Early Presentation

Nausea can be an early presenting symptom of COVID-19. Studies have shown that the incidence of nausea in COVID-19 patients is comparable to that of diarrhea, with a median incidence of around 10.5% . This symptom is often underreported due to poor definition and confusion with appetite loss .

Global Prevalence and Prolonged Symptoms

A systematic review and meta-analysis revealed that the global prevalence of prolonged nausea among COVID-19 survivors is approximately 3.23% . This indicates that while nausea is not the most common symptom, it persists in a notable fraction of patients even after recovery.

Mechanisms Behind Nausea in COVID-19

Viral Interaction with the Gastrointestinal Tract

The angiotensin-converting enzyme 2 (ACE2) receptor, which SARS-CoV-2 uses to enter cells, is highly expressed in the gastrointestinal epithelium. This interaction can lead to the development of nausea and vomiting . The virus-induced release of epithelial mediators due to exocytosis, inflammation, and apoptosis provides both peripheral and central emetic drives .

Central Nervous System Involvement

Nausea in COVID-19 patients may also be linked to the central nervous system (CNS). The virus can potentially invade the dorsal brainstem, which could contribute to delayed onset symptoms . Additionally, increased plasma angiotensin II, a centrally acting emetic, has been observed in COVID-19 patients, providing another potential mechanism for nausea .

Clinical Implications and Management

Importance of Recognizing GI Symptoms

Recognizing nausea as a symptom of COVID-19 is crucial for early diagnosis and management. It is important for healthcare providers to be aware of these symptoms and consider them when diagnosing and treating COVID-19 patients 34.

Long-term Impact on Quality of Life

Persistent GI symptoms, including nausea, can significantly impact the quality of life of COVID-19 survivors. This highlights the need for ongoing monitoring and management of these symptoms even after the acute phase of the infection has resolved .

Conclusion

Nausea is a recognized symptom of COVID-19, with a notable incidence both during the acute phase and as a prolonged symptom in survivors. Understanding the mechanisms behind this symptom and its prevalence can aid in better management and improve the quality of life for those affected by COVID-19. Increased awareness and timely intervention are essential in combating the pandemic effectively.

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Most relevant research papers on this topic

COVID‐19, nausea, and vomiting

Nausea is an early symptom of COVID-19, comparable to diarrhea, and may be influenced by GI effects of SARS-CoV-2.

Observational StudyRigorous Journal

2020·

55citations

·P. Andrews et al.

Journal of Gastroenterology and Hepatology·

DOI

Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis

Prolonged gastrointestinal symptoms are prevalent in COVID-19 survivors, highlighting the long-term impact of the infection on their quality of life.

Meta-AnalysisRigorous Journal

2021·

51citations

·Fauzi Yusuf et al.

F1000Research·

DOI

The roles of nausea and vomiting in COVID-19: did we miss something?

COVID-19 can cause gastrointestinal symptoms, including nausea and vomiting, and recognizing these symptoms is crucial for effective management and prevention.

2020·

27citations

·Tongyue Zhang et al.

Journal of Microbiology, Immunology, and Infection·

DOI

AGA 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 Cited

2020·

377citations

·S. Sultan et al.

Gastroenterology·

DOI

Gastrointestinal symptoms associated with severity of coronavirus disease 2019 (COVID-19): a pooled analysis

Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting, may increase the odds of severe COVID-19.

Meta-AnalysisRigorous JournalHighly Cited

2020·

80citations

·B. Henry et al.

Internal and Emergency Medicine·

DOI

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

The prevalence of gastrointestinal symptoms in COVID-19 patients is higher than previously reported, with nausea persisting after infection resolution.

Observational Study

2021·

54citations

·G. Marasco et al.

The American Journal of Gastroenterology·

DOI

Neurological Manifestations in COVID-19 Patients: A Meta-Analysis

COVID-19 patients experience various neurological manifestations related to the central and peripheral nervous systems, with high heterogeneity among studies.

Meta-Analysis

2021·

58citations

·V. D et al.

ACS Chemical Neuroscience·

DOI

Manifestations 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-AnalysisRigorous JournalHighly Cited

2020·

885citations

·R. Mao et al.

The Lancet. Gastroenterology & Hepatology·

DOI

COVID‐19 patients' clinical characteristics, discharge rate, and fatality rate of meta‐analysis

COVID-19 patients have a higher discharge rate (52%), with a fatality rate of 5%, and the main clinical symptoms are fever, cough, myalgia, fatigue, expectoration, and dyspnea.

Meta-AnalysisHighly Cited

2020·

1209citations

·Long-Quan Li et al.

Journal of Medical Virology·

DOI

Gastrointestinal 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 Cited

2020·

1496citations

·K. Cheung et al.

Gastroenterology·

DOI

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