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1.
Dig Dis ; 39(6): 622-625, 2021.
Article in English | MEDLINE | ID: covidwho-1574067

ABSTRACT

BACKGROUND/AIMS: The COVID-19 disease, which was declared epidemic by the WHO, is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of patients who should be considered for person-to-person transmission in the community. In our study, it was aimed to investigate the characteristics of patients with COVID-19-related diarrhea symptoms. MATERIALS AND METHODS: The study was conducted retrospectively in CO-VID-19 rtRT-PCR-positive patients in 5 medical centers. Three or more loose/liquid stools per day or increased number of defecations compared to normal defecation were defined as diarrhea. The patients were analyzed in 2 groups as those with and without diarrhea. RESULTS: One thousand eighty-six patients were included in the study. Seventy-eight (7.2%) of the patients had diarrhea. Diarrhea was watery in 54 (69.2%) patients while with blood and mucus in 18 (23.1%) patients. Diarrhea continued for an average of 5.2 ± 1.6 (2-11) days. The clinical and laboratory findings of patients with diarrhea were more serious than those without diarrhea. Diarrhea is more common in the elderly and people with comorbid disease, and patients with diarrhea had higher CMI score and CRP and higher complaints of fever, cough, shortness of breath, myalgia, and fatigue. CONCLUSIONS: The presence of diarrhea should indicate a suspected COVID-19 infection and suggest testing for early diagnosis of the disease. It should be kept in mind that the course of the disease may be more severe in these patients, and precautions should also be taken in terms of fecal transmission during discharge.


Subject(s)
COVID-19 , Diarrhea , Aged , Diarrhea/virology , Feces , Humans , Retrospective Studies , SARS-CoV-2
2.
J Korean Med Sci ; 36(44): e301, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1526760

ABSTRACT

We used serial rectal swabs to investigate the amount and duration of virus secretion through the gastrointestinal tract and assessed the association between fecal shedding and gastrointestinal symptoms and to clarify the clinical usefulness testing rectal swabs. We enrolled ten adult patients hospitalized with symptomatic coronavirus disease 2019 (COVID-19). Respiratory and stool specimens were collected by physicians. The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed using real-time reverse-transcription polymerase chain reaction. All ten patients had respiratory symptoms, six had diarrhea, and seven were positive for SARS-CoV-2 on rectal swabs. The viral loads in the respiratory specimens was higher than those in the rectal specimens, and no rectal specimens were positive after the respiratory specimens became negative. There was no association between gastrointestinal symptoms, pneumonia, severity, and rectal viral load. Rectal swabs may play a role in detecting SARS-CoV-2 in individuals with suspected COVID-19, regardless of gastrointestinal symptoms.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/virology , Rectum/virology , SARS-CoV-2/isolation & purification , Virus Shedding , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/transmission , Diarrhea/etiology , Diarrhea/virology , Feces/virology , Female , Humans , Male , Middle Aged , Nasopharynx/virology , Prospective Studies , Real-Time Polymerase Chain Reaction , Severity of Illness Index , Time Factors , Viral Load
3.
Medicine (Baltimore) ; 100(41): e27528, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1501205

ABSTRACT

ABSTRACT: Diarrhea is one of the manifestations of the novel coronavirus disease (COVID-19), but it also develops as a complication of massive antibiotic therapy in this disease. This study aimed to compare these types of diarrhea.We included patients with COVID-19 in a cohort study and excluded patients with chronic diarrhea, laxative use, and those who died during the first day of hospitalization.There were 89 (9.3%), 161 (16.7%), and 731 (75.7%) patients with early viral, late antibiotic-associated, and without diarrhea, respectively. Late diarrhea lasted longer (6 [4-10] vs 5 [3-7] days, P < .001) and was more severe. Clostridioides difficile was found in 70.5% of tested patients with late diarrhea and in none with early diarrhea. Presence of late diarrhea was associated with an increased risk of death after 20 days of disease (P = .009; hazard ratio = 4.7). Patients with late diarrhea had a longer hospital stay and total disease duration, and a higher proportion of these patients required intensive care unit admission. Oral amoxicillin/clavulanate (odds ratio [OR] = 2.23), oral clarithromycin (OR = 3.79), and glucocorticoids (OR = 4.41) use was a risk factor for the development of late diarrhea, while ceftriaxone use (OR = 0.35) had a protective effect. Before the development of late diarrhea, decrease in C-reactive protein levels and increase in lymphocyte count stopped but the white blood cell and neutrophil count increased. An increase in neutrophils by >0.6 × 109 cells/L predicted the development of late diarrhea in the coming days (sensitivity 82.0%, specificity 70.8%, area under the curve = 0.791 [0.710-0.872]).Diarrhea in COVID-19 is heterogeneous, and different types of diarrhea require different management.


Subject(s)
Anti-Bacterial Agents/adverse effects , COVID-19/epidemiology , Diarrhea/chemically induced , Diarrhea/virology , Aged , Diarrhea/classification , Diarrhea/epidemiology , Humans , Length of Stay , Middle Aged , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2
4.
World J Gastroenterol ; 27(37): 6345-6347, 2021 Oct 07.
Article in English | MEDLINE | ID: covidwho-1468514

ABSTRACT

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although, respiratory symptoms are typical the digestive system is also a susceptible target with gastrointestinal symptoms present even in the absence of respiratory symptoms. The gastrointestinal symptoms of COVID-19 include diarrhea, abdominal pain, anorexia, and nausea among other symptoms. Some questions that remain to be answered include: Do patients with gastrointestinal symptoms have a higher mortality? SARS-CoV-2 variants are already a global reality: Do these variants present with a greater prevalence of gastrointestinal symptoms? Do patients with these symptoms warrant more intensive care unit care?


Subject(s)
COVID-19 , Gastrointestinal Diseases , COVID-19/complications , Diarrhea/virology , Gastrointestinal Diseases/virology , Humans , SARS-CoV-2
5.
Arch Virol ; 166(9): 2461-2468, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1292555

ABSTRACT

Bovine coronavirus (BCoV) can be spread by animal activity. Although cattle farming is widespread in Turkey, there are few studies of BCoV. The aim of this study was to evaluate the current situation regarding BCoV in Turkey. This is the first study reporting the full-length nucleotide sequences of BCoV spike (S) genes in Turkey. Samples were collected from 119 cattle with clinical signs of respiratory (n = 78) or digestive tract (n = 41) infection on different farms located across widely separated provinces in Turkey. The samples were screened for BCoV using RT-nested PCR targeting the N gene, which identified BCoV in 35 samples (9 faeces and 26 nasal discharge). RT-PCR analysis of the S gene produced partial/full-length S gene sequences from 11 samples (8 faeces and 3 nasal discharge samples). A phylogenetic tree of the S gene sequences was made to analyze the genetic relationships among BCoVs from Turkey and other countries. The results showed that the local strains present in faeces and nasal discharge samples had many different amino acid changes. Some of these changes were shown in previous studies to be critical for tropism. This study provides new data on BCoV in Turkey that will be valuable in designing effective vaccine approaches and control strategies.


Subject(s)
Cattle Diseases/epidemiology , Coronavirus Infections/veterinary , Coronavirus, Bovine/genetics , Diarrhea/veterinary , RNA, Viral/genetics , Respiratory Tract Infections/veterinary , Spike Glycoprotein, Coronavirus/genetics , Agriculture , Amino Acid Substitution , Animals , Cattle , Cattle Diseases/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Coronavirus, Bovine/classification , Diarrhea/epidemiology , Diarrhea/virology , Epidemiological Monitoring/veterinary , Evolution, Molecular , Feces/virology , Humans , Mutation , Nasal Cavity/virology , Phylogeny , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/virology , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, DNA , Turkey/epidemiology
6.
Pediatr Dev Pathol ; 24(5): 445-449, 2021.
Article in English | MEDLINE | ID: covidwho-1247536

ABSTRACT

Millions of patients seek medical attention for diarrhea, vomiting, nausea, and abdominal pain. In the current environment, it is important to recognize that these symptoms may be the only manifestation or may precede more serious systemic complications of COVID-19. Herein, we describe the first case of ischemic colitis (IC) in a young adult who presented with diarrhea and highlight the laboratory pitfalls for patients with COVID-19 presenting with gastrointestinal (GI) symptoms.


Subject(s)
COVID-19/virology , Colitis, Ischemic/diagnosis , Down Syndrome/physiopathology , Gastrointestinal Diseases/diagnosis , SARS-CoV-2/pathogenicity , Adolescent , COVID-19/diagnosis , Colitis, Ischemic/complications , Colitis, Ischemic/physiopathology , Diarrhea/complications , Diarrhea/virology , Down Syndrome/diagnosis , Down Syndrome/virology , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/virology , Humans , Male
7.
Turk J Gastroenterol ; 32(2): 148-154, 2021 02.
Article in English | MEDLINE | ID: covidwho-1220242

ABSTRACT

BACKGROUND: Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), have fever, dry cough, dyspnea, and fatigue. The disease has now become a global pandemic. The purpose of this study was to explore the relationship between COVID-19 and gastrointestinal (GI) symptoms. METHODS: We collected and analyzed data on patients with laboratory-confirmed COVID-19 by high-throughput sequencing or reverse transcription-polymerase chain reaction. We reviewed electronic medical records of 405 hospitalized COVID-19 patients in the Third Hospital of Wuhan. RESULTS: Among the 405 confirmed patients, 210 had no GI symptoms, 195 had GI symptoms, and the first symptom of 155 patients was GI. The prevalence of vascular and digestive diseases in the group with GI symptoms was significantly higher than in the group without GI symptoms. In patients with GI symptoms, the proportion with fever, cough, dysphoria, chest tightness, poor appetite, chest pain, and pharyngeal pain was significantly higher than in those without GI symptoms. There was no significant difference in imaging between the 2 groups. In patients with GI symptoms, the proportion with increased procalcitonin (PCT) level and decreased lymphocyte count was significantly higher than in those without GI symptoms. CONCLUSION: COVID-19 patients with GI symptoms had significantly more vascular and digestive system diseases and were more likely to have clinical manifestations of fever, cough, poor appetite, chest tightness, chest pain, insomnia, and pharyngeal pain. There were more patients with diarrhea, nausea, and vomiting. Patients with GI symptoms were more likely to have increased PCT and decreased lymphocyte count.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/virology , SARS-CoV-2 , Adult , Aged , COVID-19/blood , COVID-19/virology , China/epidemiology , Diarrhea/blood , Diarrhea/epidemiology , Diarrhea/virology , Female , Humans , Lymphocyte Count , Male , Middle Aged , Nausea/blood , Nausea/epidemiology , Nausea/virology , Procalcitonin/blood , Vomiting/blood , Vomiting/epidemiology , Vomiting/virology
8.
Clin Transl Gastroenterol ; 12(4): e00343, 2021 04 09.
Article in English | MEDLINE | ID: covidwho-1175789

ABSTRACT

INTRODUCTION: The prevalence and shedding of fecal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA indicate coronavirus disease 2019 (COVID-19) infection in the gastrointestinal (GI) tract and likely infectivity. We performed a systemic review and meta-analysis to evaluate the prevalence and the duration of shedding of fecal RNA in patients with COVID-19 infection. METHODS: PubMed, Embase, Web of Science, and Chinese databases Chinese National Knowledge Infrastructure and Wanfang Data up to June 2020 were searched for studies evaluating fecal SARS-CoV-2 RNA, including anal and rectal samples, in patients with confirmed COVID-19 infection. The pooled prevalence of fecal RNA in patients with detectable respiratory RNA was estimated. The days of shedding and days to loss of fecal and respiratory RNA from presentation were compared. RESULTS: Thirty-five studies (N = 1,636) met criteria. The pooled prevalence of fecal RNA in COVID-19 patients was 43% (95% confidence interval [CI] 34%-52%). Higher proportion of patients with GI symptoms (52.4% vs 25.9%, odds ratio = 2.4, 95% CI 1.2-4.7) compared with no GI symptoms, specifically diarrhea (51.6% vs 24.0%, odds ratio = 3.0, 95% CI 1.9-4.8), had detectable fecal RNA. After loss of respiratory RNA, 27% (95% CI 15%-44%) of the patients had persistent shedding of fecal RNA. Days of RNA shedding in the feces were longer than respiratory samples (21.8 vs 14.7 days, mean difference = 7.1 days, 95% CI 1.2-13.0). Furthermore, days to loss of fecal RNA lagged respiratory RNA by a mean of 4.8 days (95% CI 2.2-7.5). DISCUSSION: Fecal SARS-CoV-2 RNA is commonly detected in COVID-19 patients with a 3-fold increased risk with diarrhea. Shedding of fecal RNA lasted more than 3 weeks after presentation and a week after last detectable respiratory RNA.


Subject(s)
COVID-19/virology , Feces/virology , Gastrointestinal Tract/virology , RNA, Viral/analysis , SARS-CoV-2/isolation & purification , Diarrhea/virology , Gastrointestinal Diseases/virology , Humans , Respiratory System/virology , Virus Shedding
9.
J Gastroenterol ; 56(5): 409-420, 2021 05.
Article in English | MEDLINE | ID: covidwho-1147593

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.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/epidemiology , Liver/enzymology , Abdominal Pain/etiology , COVID-19/physiopathology , Diarrhea/epidemiology , Diarrhea/virology , Gastrointestinal Diseases/virology , Humans , Liver/virology , Nausea/epidemiology , Nausea/virology , Severity of Illness Index , Vomiting/epidemiology , Vomiting/virology
10.
IUBMB Life ; 73(5): 739-760, 2021 05.
Article in English | MEDLINE | ID: covidwho-1135107

ABSTRACT

Gastrointestinal symptoms and liver injury are common in patients with coronavirus disease 2019 (COVID-19). However, profiles of different pharmaceutical interventions used are relatively underexplored. Chinese herbal medicine (CHM) has been increasingly used for patients with COVID-19, but the efficacy of CHM used in COVID-19 on gastrointestinal symptoms and liver functions has not been well studied with definitive results based on the updated studies. The present study aimed at testing the efficacy of CHM on digestive symptoms and liver function (primary outcomes), the aggravation of COVID-19, and the time to viral assay conversion (secondary outcomes), among patients with COVID-19, compared with standard pharmacotherapy. The literature search was undertaken in 11 electronic databases from December 1, 2019 up to November 8, 2020. Appraisal of the evidence was conducted with Cochrane risk of bias tool or Newcastle Ottawa Scale. A random-effects model or subgroup analysis was conducted when significant heterogeneity was identified in the meta-analysis. The certainty of the evidence was assessed with the grading of recommendations assessment, development, and evaluation approach. Forty-eight included trials involving 4,704 participants were included. Meta-analyses favored CHM plus standard pharmacotherapy for COVID-19 on reducing the aggravation of COVID-19 and the time to viral assay conversion compared with standard pharmacotherapy. However, the present CHM as a complementary therapy for treating COVID-19 may not be beneficial for improving most gastrointestinal symptoms and liver function based on the current evidence. More well-conducted trials are warranted to confirm the potential efficacy of CHM furtherly.


Subject(s)
COVID-19/drug therapy , Drugs, Chinese Herbal/therapeutic use , Gastrointestinal Diseases/drug therapy , Liver Diseases/drug therapy , Adolescent , Adult , Aged , Anorexia/virology , COVID-19/etiology , Diarrhea/drug therapy , Diarrhea/virology , Drugs, Chinese Herbal/pharmacology , Female , Gastrointestinal Diseases/virology , Humans , Liver Diseases/etiology , Liver Diseases/virology , Liver Function Tests , Male , Middle Aged , Nausea/drug therapy , Nausea/virology , Young Adult
11.
Sci Rep ; 11(1): 3040, 2021 02 04.
Article in English | MEDLINE | ID: covidwho-1107304

ABSTRACT

Porcine epidemic diarrhea virus (PEDV) and porcine deltacoronavirus (PDCoV) cause an enteric disease characterized by diarrhea clinically indistinguishable. Both viruses are simultaneously detected in clinical cases, but a study involving the co-infection has not been reported. The study was therefore conducted to investigate the disease severity following a co-infection with PEDV and PDCoV. In the study, 4-day-old pigs were orally inoculated with PEDV and PDCoV, either alone or in combination. Following challenge, fecal score was monitored on a daily basis. Fecal swabs were collected and assayed for the presence of viruses. Three pigs per group were necropsied at 3 and 5 days post inoculation (dpi). Microscopic lesions and villous height to crypt depth (VH:CD) ratio, together with the presence of PEDV and PDCoV antigens, were evaluated in small intestinal tissues. Expressions of interferon alpha (IFN-α) and interleukin 12 (IL12) were investigated in small intestinal mucosa. The findings indicated that coinoculation increased the disease severity, demonstrated by significantly prolonged fecal score and virus shedding and decreasing VH:CD ratio in the jejunum compared with pigs inoculated with either PEDV or PDCoV alone. Notably, in single-inoculated groups, PEDV and PDCoV antigens were detected only in villous enterocytes wile in the coinoculated group, PDCoV antigen was detected in both villous enterocytes and crypts. IFN-α and IL12 were significantly up-regulated in coinoculated groups in comparison with single-inoculated groups. In conclusion, co-infection with PEDV and PDCoV exacerbate clinical signs and have a synergetic on the regulatory effect inflammatory cytokines compared to a single infection with either virus.


Subject(s)
Deltacoronavirus/pathogenicity , Diarrhea/genetics , Interferon-alpha/genetics , Interleukin-12/genetics , Porcine epidemic diarrhea virus/pathogenicity , Animals , Coinfection/genetics , Coinfection/veterinary , Coinfection/virology , Coronavirus Infections/genetics , Coronavirus Infections/veterinary , Coronavirus Infections/virology , Deltacoronavirus/genetics , Deltacoronavirus/isolation & purification , Diarrhea/veterinary , Diarrhea/virology , Feces/virology , Porcine epidemic diarrhea virus/genetics , Porcine epidemic diarrhea virus/isolation & purification , Severity of Illness Index , Swine , Swine Diseases/genetics , Swine Diseases/virology
12.
Neurogastroenterol Motil ; 33(3): e14104, 2021 03.
Article in English | MEDLINE | ID: covidwho-1085279

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, infects gastrointestinal epithelial cells expressing angiotensin-converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS-CoV-2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID-19. Liver and pancreas dysfunctions have also been described as non-respiratory complications of COVID-19 and add further emphasis to the common view of SARS-CoV-2 infection as a systemic disease with multiorgan involvement. PURPOSE: The aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS-CoV-2 infection, including the crosstalk with the gut microbiota, the fecal-oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID-19.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/physiopathology , Gastrointestinal Microbiome/physiology , Gastrointestinal Tract/physiopathology , Animals , Diarrhea/etiology , Diarrhea/physiopathology , Diarrhea/virology , Dysbiosis/etiology , Dysbiosis/physiopathology , Dysbiosis/virology , Enteric Nervous System/physiopathology , Enteric Nervous System/virology , Gastrointestinal Diseases/virology , Gastrointestinal Tract/virology , Humans , Liver Diseases/etiology , Liver Diseases/physiopathology , Liver Diseases/virology , Pancreatic Diseases/etiology , Pancreatic Diseases/physiopathology , Pancreatic Diseases/virology
13.
Twin Res Hum Genet ; 23(6): 316-321, 2020 12.
Article in English | MEDLINE | ID: covidwho-1072088

ABSTRACT

Susceptibility to infection such as SARS-CoV-2 may be influenced by host genotype. TwinsUK volunteers (n = 3261) completing the C-19 COVID-19 symptom tracker app allowed classical twin studies of COVID-19 symptoms, including predicted COVID-19, a symptom-based algorithm to predict true infection, derived from app users tested for SARS-CoV-2. We found heritability of 49% (32-64%) for delirium; 34% (20-47%) for diarrhea; 31% (8-52%) for fatigue; 19% (0-38%) for anosmia; 46% (31-60%) for skipped meals and 31% (11-48%) for predicted COVID-19. Heritability estimates were not affected by cohabiting or by social deprivation. The results suggest the importance of host genetics in the risk of clinical manifestations of COVID-19 and provide grounds for planning genome-wide association studies to establish specific genes involved in viral infectivity and the host immune response.


Subject(s)
COVID-19/etiology , COVID-19/epidemiology , COVID-19/genetics , Diarrhea/etiology , Diarrhea/genetics , Diarrhea/virology , Diseases in Twins , Fatigue/etiology , Fatigue/genetics , Fatigue/virology , Humans , Mobile Applications , Prevalence , Self Report , Twins, Dizygotic , Twins, Monozygotic
14.
J Pediatr Gastroenterol Nutr ; 72(3): 384-387, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1072474

ABSTRACT

ABSTRACT: Multisystem inflammatory syndrome in children (MIS-C) is a recently identified syndrome that appears to be temporally associated with novel coronavirus 2019 infection. MIS-C presents with fever and evidence of systemic inflammation, which can manifest as cardiovascular, pulmonary, neurologic, and gastrointestinal (GI) system dysfunction. Presenting GI symptoms are seen in the majority, including abdominal pain, diarrhea, and vomiting. Any segment of the GI tract may be affected; however, inflammation in the ileum and colon predominates. Progressive bowel wall thickening can lead to luminal narrowing and obstruction. Most will have resolution of intestinal inflammation with medical therapies; however, in rare instances, surgical resection may be required.


Subject(s)
COVID-19/complications , Intestinal Diseases/virology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/complications , Abdominal Pain/virology , Child , Diarrhea/virology , Female , Gastrointestinal Tract/virology , Humans , Male , Vomiting/virology
15.
Korean J Intern Med ; 35(6): 1261-1269, 2020 11.
Article in English | MEDLINE | ID: covidwho-1067812

ABSTRACT

BACKGROUND/AIMS: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. METHODS: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. RESULTS: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. CONCLUSION: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.


Subject(s)
Coronavirus Infections/complications , Diarrhea/virology , Pneumonia, Viral/complications , Adult , Aged , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Diarrhea/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prevalence , Radiography, Thoracic , Republic of Korea/epidemiology , Retrospective Studies , Shock, Septic/virology
16.
BMJ Open Gastroenterol ; 8(1)2021 01.
Article in English | MEDLINE | ID: covidwho-1066881

ABSTRACT

We present a case of haemorrhagic enterocolitis in a patient with SARS-CoV-2 who recovered from respiratory failure after support with venovenous extracorporeal membrane oxygenation. We describe clinicopathological features consistent with the systemic coinfection/reactivation of cytomegalovirus (CMV) concurrent with COVID-19 infection and the protracted clinical course of resolution of gastrointestinal inflammation after the treatment of CMV infection. Stool PCR, abdominal CT perfusion scan and histological examination of ileal and colonic tissues excluded enterocolitis secondary to other causes of infection (common viral, bacterial and protozoal gastrointestinal pathogens), macrovascularand microvascular ischaemia and classic inflammatory bowel disease, respectively. We propose possible synergistic pathophysiologic mechanisms for enterocolitis complicating severe COVID-19 infection: (1) T lymphocyte depletion and immune response dysregulation, (2) use of immunomodulators in the management of severe COVID-19 infection and (3) high concentration of ACE-2 receptors for COVID-19 virus in the gastrointestinal tract.


Subject(s)
COVID-19/complications , Coinfection/virology , Cytomegalovirus Infections/complications , Enterocolitis/complications , Gastrointestinal Hemorrhage/virology , COVID-19/therapy , Diarrhea/virology , Enterocolitis/virology , Extracorporeal Membrane Oxygenation , Female , Humans , Middle Aged , SARS-CoV-2
17.
mBio ; 12(1)2021 01 19.
Article in English | MEDLINE | ID: covidwho-1066819

ABSTRACT

Bats host many viruses pathogenic to humans, and increasing evidence suggests that rotavirus A (RVA) also belongs to this list. Rotaviruses cause diarrheal disease in many mammals and birds, and their segmented genomes allow them to reassort and increase their genetic diversity. Eighteen out of 2,142 bat fecal samples (0.8%) collected from Europe, Central America, and Africa were PCR-positive for RVA, and 11 of those were fully characterized using viral metagenomics. Upon contrasting their genomes with publicly available data, at least 7 distinct bat RVA genotype constellations (GCs) were identified, which included evidence of reassortments and 6 novel genotypes. Some of these constellations are spread across the world, whereas others appear to be geographically restricted. Our analyses also suggest that several unusual human and equine RVA strains might be of bat RVA origin, based on their phylogenetic clustering, despite various levels of nucleotide sequence identities between them. Although SA11 is one of the most widely used reference strains for RVA research and forms the backbone of a reverse genetics system, its origin remained enigmatic. Remarkably, the majority of the genotypes of SA11-like strains were shared with Gabonese bat RVAs, suggesting a potential common origin. Overall, our findings suggest an underexplored genetic diversity of RVAs in bats, which is likely only the tip of the iceberg. Increasing contact between humans and bat wildlife will further increase the zoonosis risk, which warrants closer attention to these viruses.IMPORTANCE The increased research on bat coronaviruses after severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) allowed the very rapid identification of SARS-CoV-2. This is an excellent example of the importance of knowing viruses harbored by wildlife in general, and bats in particular, for global preparedness against emerging viral pathogens. The current effort to characterize bat rotavirus strains from 3 continents sheds light on the vast genetic diversity of rotaviruses and also hints at a bat origin for several atypical rotaviruses in humans and animals, implying that zoonoses of bat rotaviruses might occur more frequently than currently realized.


Subject(s)
Chiroptera/virology , Rotavirus Infections/transmission , Rotavirus Infections/virology , Rotavirus/genetics , Zoonoses/transmission , Zoonoses/virology , Animals , COVID-19/transmission , COVID-19/virology , Diarrhea/virology , Genetic Variation , Genome, Viral , Genotype , Horses , Humans , Metagenomics , Middle East Respiratory Syndrome Coronavirus/isolation & purification , Phylogeny , SARS-CoV-2/isolation & purification
18.
Emerg Infect Dis ; 27(4): 1196-1200, 2021 04.
Article in English | MEDLINE | ID: covidwho-1067635
19.
Arch Virol ; 166(1): 35-42, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1064511

ABSTRACT

Canine coronavirus (CCoV) generally causes an infection with high morbidity and low mortality in dogs. In recent years, studies on coronaviruses have gained a momentum due to coronavirus outbreaks. Mutations in coronaviruses can result in deadly diseases in new hosts (such as SARS-CoV-2) or cause changes in organ-tissue affinity, as occurred with feline infectious peritonitis virus, exacerbating their pathogenesis. In recent studies on different types of CCoV, the pantropic strains characterized by hypervirulent and multi-systemic infections are believed to be emerging, in contrast to classical enteric coronavirus infections. In this study, we investigated emerging hypervirulent and multi-systemic CCoV strains using molecular and bioinformatic analysis, and examined differences between enteric and pantropic CCoV strains at the phylogenetic level. RT-PCR was performed with specific primers to identify the coronavirus M (membrane) and S (spike) genes, and samples were then subjected to DNA sequencing. In phylogenetic analysis, four out of 26 samples were classified as CCoV-1. The remaining 22 samples were all classified as CCoV-2a. In the CCoV-2a group, six samples were in branches close to enteric strains, and 16 samples were in the branches close to pantropic strains. Enteric and pantropic strains were compared by molecular genotyping of CCoV in dogs. Phylogenetic analysis of hypervirulent pantropic strains was carried out at the amino acid and nucleotide sequence levels. CCoV was found to be divergent from the original strain. This implies that some CCoV strains have become pantropic strains that cause multisystemic infections, and they should not be ruled out as the cause of severe diarrhea and multisystemic infections.


Subject(s)
Coronavirus Infections/pathology , Coronavirus Infections/veterinary , Coronavirus, Canine/genetics , Dog Diseases/pathology , Spike Glycoprotein, Coronavirus/genetics , Viral Matrix Proteins/genetics , Amino Acid Sequence , Animals , Base Sequence , Coronavirus, Canine/pathogenicity , Diarrhea/veterinary , Diarrhea/virology , Dog Diseases/virology , Dogs , Feces/virology , Intestine, Small/virology , Mutation/genetics , Sequence Analysis, DNA , Turkey
20.
Rev Recent Clin Trials ; 16(3): 294-302, 2021.
Article in English | MEDLINE | ID: covidwho-1034907

ABSTRACT

BACKGROUND: At the time of writing this paper, no data was available for the clinical and epidemiological characteristics of African patients with COVID-19. Herein, we profiled retrospectively the epidemiological characteristics (clinical, laboratory, radiological, treatment, and clinical outcomes) of 64 confirmed cases of COVID-19 in the Regional Hospital Center (RHC) of Errachidia in Morocco. The aim of this study was to analyze the epidemiological characteristics and laboratory Findings of Covid-19 patients in Errachidia Province, Morocco. METHODS: This is a retrospective single-center study that included all COVID-19 confirmed patients (died or discharged) hospitalized in the Regional Center of Errachidia, Morocco, between March 20, 2020 and May 23, 2020. Patients were confirmed by real-time RT-PCR and epidemiological, demographic, clinical, laboratory, treatment, and outcomes of patients were extracted manually from patient's medical records. RESULTS: In a total of 64 patients with COVID-19, 60.9% of patients were men, with a mean age of 41.5 years (SD 18.62). At the admission, 38 patients were asymptomatic (59.4%), and 58 (90.6%) were clinically classified as being in a benign state. Chronic illnesses were the most comorbidities observed, including diabetes with 8 cases (12.5%), hypertension 3 cases (4.7%), and hyperlipidemia 1 patient (1.6%). The main symptoms were cough 15 (23.4%), fever 10 (15.6), diarrhea 8 (12.5%), headache 5 (7.8%), and sore throat 5 (7.8%). Only 7 patients (10.9%) had lung lesions, and lymphopenia was present in only 7 patients (11.1%). The median duration of viral shedding was 14.5 days (9-22). Concerning deceased cases, they were elderly subjects aged 69.75 years, and they have presented dyspnea, breathing problems, and respiratory distress as specific symptoms. In addition, an increase of the medians of serum AST, CRP, and glucose levels was noticed in this group. During hospitalization, they presented acute respiratory distress syndrome (ARDS), and they were transferred to intensive care before they died. CONCLUSION: This study revealed that covid-19 infection often appeared in a benign form in the studied population (90.6% in this study). This finding may incriminate the implication of some protective parameters such as genetic, nutritional or other factors in the Moroccan population.


Subject(s)
COVID-19/epidemiology , Adult , Aged , Asymptomatic Diseases/epidemiology , Comorbidity , Cough/epidemiology , Cough/virology , Diarrhea/epidemiology , Diarrhea/virology , Female , Fever/epidemiology , Fever/virology , Headache/epidemiology , Headache/virology , Humans , Male , Middle Aged , Morocco/epidemiology , Pandemics , Pharyngitis/epidemiology , Pharyngitis/virology , Retrospective Studies , Virus Shedding
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