Clinical Insights into the Gastrointestinal Manifestations of COVID-19

Abstract

The month of December 2019 became a critical part of the time of humanity when the first case of coronavirus disease 2019 was reported in the Wuhan, Hubei Province in China. As of April 13th, 2020, there have been approximately 1.9 million cases and 199,000 deaths across the world, which were associated with COVID-19. The COVID-19 is the seventh coronavirus to be identified to infect humans. In the past, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome were the two coronaviruses that infected humans with a high fatality, particularly among the elderly. Fatalities due to COVID-19 are higher in patients older than 50 years of age or those with multimorbid conditions. The COVID-19 is mainly transmitted through respiratory droplets, with the most common symptoms being high fever, cough, myalgia, atypical symptoms included sputum production, headache, hemoptysis and diarrhea. However, the incubation period can range from 2 to 14 days without any symptoms. It is particularly true with gastrointestinal (GI) symptoms in which patients can still shed the virus even after pulmonary symptoms have resolved. Given the high percentage of COVID-19 patients that present with GI symptoms (e.g., nausea and diarrhea), screening patients for GI symptoms remain essential. Recently, cases of fecal-oral transmission of COVID-19 have been confirmed in the USA and China, indicating that the virus can replicate in both the respiratory and digestive tract. Moreover, the epidemiology, clinical characteristics, diagnostic procedures, treatments and prevention of the gastrointestinal manifestations of COVID-19 remain to be elucidated.

Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis

“…SARS-CoV-2, the causative organism of COVID-19, commonly enters the human body through inhalation of droplets ( 50 ). Once the virus comes in contact with respiratory mucosa, the spike (S) protein on the viral cell membrane fuses with the angiotensin-converting enzyme 2 (ACE2) receptors expressed on the mucosal cells, and the viral RNA enters the cell ( 51 , 52 ). These infected cells undergo apoptotic changes and phagocytosed by macrophages and presented to antigen-presenting T cells, which in turn leads to CD4 T cell-dependent immune response and results in increased antibody production from B lymphocytes.…”

Multi-omics data integration and network-based analysis drives a multiplex drug repurposing approach to a shortlist of candidate drugs against COVID-19

“…Mounting evidence indicate that the clinical manifestations of COVID-19 are systemic, affecting mainly the respiratory and digestive tract, the cardiovascular but also the Central Nervous System (CNS) [42][43][44][45][46] . Thus, we pursued an approach that integrates multi-omics data from different types of tissue (BALF, PBMC, alveolar, NHBE, Calu-2 cell lines and blood serum) aimed to build a comprehensive molecular profile of the disease to obtain a more informative basis for drug repurposing.…”

Gastrointestinal implications in COVID-19

“…33 34 Analysis of stool samples in patients with GI symptoms may be the best test for COVID-19; however, more studies are needed to establish specific protocols. 19 on October 30, 2020 by guest. Protected by copyright.…”