Gastrointestinal symptoms in COVID-19 patients: a case series

Abstract

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents an ongoing global threat. Common clinical features reported in early confirmed infections included fever, cough, and myalgias or fatigue. But as testing capacity and case numbers have increased worldwide, gastrointestinal (GI) symptoms such as diarrhoea, nausea/vomiting, abdominal pain, and loss of appetite have been increasingly recognized. Authors present a case series of gastrointestinal symptoms in COVID-19 patients and how they were managed at the hospital. However, correlations between the presence of fecal virus RNA and severity of digestive symptoms, namely, diarrhoea severity could not be established due to unavailability of the test in the hospital setting. Although knowledge about the viability of SARS-CoV-2 is limited, the virus could remain viable in the environment for days, which could lead to faeco-oral transmission. Various studies conducted on COVID-19 patients recommended routine stool sample testing with real-time RT-PCR after the clearance of viral RNA in a patient’s respiratory samples. Strict precautions to prevent transmission should be taken for patients who are in hospital or self-quarantined if their faecal samples test positive. Optimally, testing for COVID-19 should be performed using both respiratory and stool samples, if available.

COVID-19 Crisis Creates Opportunity towards Global Monitoring & Surveillance

“…SARS-CoV-2, a respiratory virus, has also been shown to persist in the gastrointestinal tract as evident from its presence in the faecal samples of COVID-19 patients, who have tested positive for SARS-CoV-2 RNA [35]. Furthermore, its association with protein receptor or Angiotensin-converting enzyme 2 (ACE-2) [123,124] and release of infectious virions from the virus-infected gut through faecal discharge, in large numbers, is a worrying sign [125,126]. Studies further suggest that viral samples are extensively released into wastewater through faecal shedding and can last for longer even in those patients who have been declared PCR negative in oral & throat swabs and are not showing any COVID-19 respiratory symptoms even after a month [32,127].…”