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Shaffer A, Meyerowitz EA. Clinical Manifestations of SARS-CoV-2 Infection in Immunocompetent Adults in the Era of Widespread Population Immunity and Omicron Sublineage Viruses. Infect Dis Clin North Am 2025; 39:233-251. [PMID: 40068975 DOI: 10.1016/j.idc.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
While most SARS-CoV-2 infections and reinfections in the era of widespread population immunity with omicron subsub-lineage variants are mild for immunocompetent individuals, any manifestation previously seen during the pandemic phase is still possible. COVID-19 may affect any organ system. Previous infections and prior vaccines protect against symptomatic future SARS-CoV-2 infections, though this protection wanes over time.
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Affiliation(s)
- Alexander Shaffer
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric A Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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Marinova R, Marinova P. Gastrointestinal symptoms related to COVID-19 in ileoanal pouch and stoma patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S10-S16. [PMID: 39639693 DOI: 10.12968/bjon.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
COVID-19 symptoms are often perceived as respiratory only. However, recent findings have shown that gastrointestinal symptoms are being reported in a significant number of patients, ranging from 17% to more than 50%, with some studies speculating that the figure may be even higher, but that it is under-reported and overlooked. Therefore, a hypothesis was put forward that gastrointestinal symptoms related to COVID-19 may make pouch or stoma function deteriorate or even mimic pouchitis symptoms in ileoanal pouches and gastroenteritis in stoma patients; the intention was to investigate this further and to test the hypothesis. A retrospective analysis of patients with a stoma or ileoanal pouch was conducted, including those who reported having gastrointestinal symptoms following a positive COVID-19 test in the preceding 4 years (2020-2024). It was anticipated that gaining insight into this topic can help improve care for this patient group.
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Affiliation(s)
- Rali Marinova
- Nurse Practitioner, Pouch and Stoma Care, TWINS for iPouch & Stoma Patients Ltd
| | - Petya Marinova
- Nurse Practitioner, Pouch and Stoma Care, TWINS for iPouch & Stoma Patients Ltd
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Zhang X, Jiang Z, Ma J, Qi Y, Li Y, Zhang Y, Liu Y, Wei C, Chen Y, Liu P, Peng Y, Tan J, Han Y, Zeng S, Cai C, Shen H. Leveraging large-scale genetic data to assess the causal impact of COVID-19 on multisystemic diseases. JOURNAL OF BIG DATA 2024; 11:129. [DOI: 10.1186/s40537-024-00997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/02/2024] [Indexed: 01/02/2025]
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Antar SA, Ashour NA, Hamouda AO, Noreddin AM, Al-Karmalawy AA. Recent advances in COVID-19-induced liver injury: causes, diagnosis, and management. Inflammopharmacology 2024:10.1007/s10787-024-01535-7. [PMID: 39126569 DOI: 10.1007/s10787-024-01535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/29/2024] [Indexed: 08/12/2024]
Abstract
Since the start of the pandemic, considerable advancements have been made in our understanding of the effects of SARS-CoV-2 infection and the associated COVID-19 on the hepatic system. There is a broad range of clinical symptoms for COVID-19. It affects multiple systems and has a dominant lung illness depending on complications. The progression of COVID-19 in people with pre-existing chronic liver disease (CLD) has also been studied in large multinational groups. Notably, SARS-CoV-2 infection is associated with a higher risk of hepatic decompensation and death in patients with cirrhosis. In this review, the source, composition, mechanisms, transmission characteristics, clinical characteristics, therapy, and prevention of SARS-CoV-2 were clarified and discussed, as well as the evolution and variations of the virus. This review briefly discusses the causes and effects of SARS-CoV-2 infection in patients with CLD. As part of COVID-19, In addition, we assess the potential of liver biochemistry as a diagnostic tool examine the data on direct viral infection of liver cells, and investigate potential pathways driving SARS-CoV-2-related liver damage. Finally, we explore how the pandemic has had a significant impact on patient behaviors and hepatology services, which may increase the prevalence and severity of liver disease in the future. The topics encompassed in this review encompass the intricate relationships between SARS-CoV-2, liver health, and broader health management strategies, providing valuable insights for both current clinical practice and future research directions.
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Affiliation(s)
- Samar A Antar
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, 24016, USA
- Department of Pharmacology, Faculty of Pharmacy, Horus University-Egypt, New Damietta, 34518, Egypt
| | - Nada A Ashour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt
| | - Amir O Hamouda
- Department of Biochemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, 34518, Egypt
| | - Ayman M Noreddin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ahram Canadian University, 6Th of October City, Giza, 12566, Egypt
- Department of Internal Medicine, School of Medicine, University of California -Irvine, Irvine, USA
| | - Ahmed A Al-Karmalawy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, New Damietta, 34518, Egypt.
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6Th of October City, Giza, 12566, Egypt.
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Wang YN, Zhou LY, Huang YH, Jiang M, Dai C. The incidence and predisposing factors for irritable bowel syndrome following COVID-19: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2024; 36:168-176. [PMID: 38047738 DOI: 10.1097/meg.0000000000002688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder. Several studies have analyzed the long-term GI symptoms and IBS following coronavirus disease 2019 (COVID-19). The purpose of this study is to evaluate the incidence and predisposing factors for IBS following COVID-19 by a systematic review and meta-analysis. METHODS Electronic databases were searched to identify relevant studies. Primary outcomes were the pooled incidence rate of IBS following COVID-19 and the pooled relative risk (RR) for IBS in the COVID-19 group compared to the non-COVID-19 group. Secondary outcomes were the pooled RR and the standardized mean difference (SMD) for predisposing factors in the IBS group compared to the non-IBS group. Heterogeneity was evaluated using Cochran's Q test and I2 statistics. RESULTS Ten studies were included in this study. The pooled incidence rate of IBS in COVID-19 patients was 12%. The pooled incidence rate of IBS-D, IBS-C and IBS-M was 5%, 2% and 1%. The pooled incidence rate of IBS in 6 and 12 months was 10% and 3%. The pooled RR for IBS in COVID-19 patients was 1.23 [95% confidence interval (CI) = 0.50-3.01] compared to non-COVID-19 patients. The pooled RR or SMD for mild, moderate, and severe disease activity, procalcitonin (PCT), depression or anxiety in IBS patients following COVID-19 was 0.94 (95% CI = 0.74-1.21), 1.19 (95% CI = 0.65-2.21), 1.30 (95% CI = 0.63-2.66), 6.73 (95% CI = 6.08-7.38) and 3.21 (95% CI = 1.79-5.75). CONCLUSION The incidence of IBS following COVID-19 was 12%. But it was not higher than the general population. We also found some predisposing factors for IBS including depression or anxiety, PCT.
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Affiliation(s)
- Yi-Nuo Wang
- Department of Gastroenterology, First Hospital of China Medical University, Shenyang, China
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Gong L, Liu F, Liu J, Wang J. Dietary fiber (oligosaccharide and non-starch polysaccharide) in preventing and treating functional gastrointestinal disorders - Challenges and controversies: A review. Int J Biol Macromol 2024; 258:128835. [PMID: 38128805 DOI: 10.1016/j.ijbiomac.2023.128835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Functional gastrointestinal disorders (FGIDs) are a group of chronic or recurrent gastrointestinal functional diseases, including functional dyspepsia, irritable bowel syndrome, and functional constipation. A lack of safe and reliable treatments for abdominal pain-related FGIDs has prompted interest in new therapies. Evidence has shown that supplementation with dietary fiber may help treat FGIDs. Dietary fibers (DFs) have been demonstrated to have regulatory effects on the gut microbiota, microbiota metabolites, and gastrointestinal movement and have important implications for preventing and treating FGIDs. However, the adverse effects of some DFs, such as fermentable oligosaccharides, on FGIDs are unclear. This review provides an overview of the DFs physiological properties and functional characteristics that influence their use in management of FGIDs, with emphasis on structural modification technology to improve their therapeutic activities. The review highlights that the use of appropriate or novel fibers is a potential therapeutic approach for FGIDs.
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Affiliation(s)
- Lingxiao Gong
- Key Laboratory of Geriatric Nutrition and Health (Beijing Technology and Business University), Ministry of Education, Key Laboratory of Special Food Supervision Technology for State Market Regulation, School of Food and Health, Beijing Technology & Business University (BTBU), Beijing 100048, China
| | - Feiyue Liu
- Key Laboratory of Geriatric Nutrition and Health (Beijing Technology and Business University), Ministry of Education, Key Laboratory of Special Food Supervision Technology for State Market Regulation, School of Food and Health, Beijing Technology & Business University (BTBU), Beijing 100048, China
| | - Jie Liu
- Key Laboratory of Geriatric Nutrition and Health (Beijing Technology and Business University), Ministry of Education, Key Laboratory of Special Food Supervision Technology for State Market Regulation, School of Food and Health, Beijing Technology & Business University (BTBU), Beijing 100048, China
| | - Jing Wang
- Key Laboratory of Geriatric Nutrition and Health (Beijing Technology and Business University), Ministry of Education, Key Laboratory of Special Food Supervision Technology for State Market Regulation, School of Food and Health, Beijing Technology & Business University (BTBU), Beijing 100048, China.
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Marzoog BA. Gastrointestinal Tract and Kidney Injury Pathogenesis in Post-COVID-19 Syndrome. Curr Diabetes Rev 2024; 20:e051023221787. [PMID: 37815187 DOI: 10.2174/0115733998250889230919185305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/20/2023] [Accepted: 07/18/2023] [Indexed: 10/11/2023]
Abstract
COVID-19 is a global health emergency that requires worldwide collaboration to control its spread. The scientific community is working to understand the different aspects of the post-COVID-19 syndrome and potential treatment strategies. Interestingly, there have been reports of gastrointestinal tract (GIT) involvement in the post-COVID-19 syndrome, suggesting the presence of both severe and mild GIT disorders. The development of the post-COVID-19- GIT syndrome involves various factors, such as impaired GIT mucosa cells, disruptions in the feeling of satiety, reduced blood supply due to the formation of small blood clots, and increased prostaglandin secretion caused by an excessive immune response. GIT symptoms have been observed in around 16% of COVID-19 patients. Other complications include kidney damage and prolonged impairment in the filtration and excretion functions of the glomeruli and tubules. The pathogenesis of post-COVID-19 renal syndrome involves factors, like an overactive immune response, reduced lung perfusion and oxygenation, viral infection in kidney tissues, endothelial dysfunction, and decreased blood volume. Roughly 20% of hospitalized patients experience renal manifestations after recovering from COVID-19.
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Affiliation(s)
- Basheer Abdullah Marzoog
- World-Class Research Center, Digital Biodesign and Personalized Healthcare, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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Mijac D, Vucelj S, Todorovic K, Vojnovic M, Milicic B, Lukic S, Filipovic B, Marjanovic Haljilji M, Popovic D, Adzic Vukicevic T. Gastrointestinal and Hepatological Manifestations in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results from the Major COVID Hospital in Serbia. Microorganisms 2023; 12:27. [PMID: 38257854 PMCID: PMC10819747 DOI: 10.3390/microorganisms12010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
The coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), includes a clinical spectrum of diseases from mild to severe progressive pneumonia, which has affected and still affects the human population worldwide. Most commonly, it is presented by respiratory symptoms, but studies have shown that about 50% of patients with SARS-CoV-2 infection have at least one gastrointestinal symptom (GI), predominantly nausea, diarrhea, vomiting, or loss of appetite. In addition, abnormal liver functional tests are commonly present in the SARS-CoV-2 virus. The aim of our study was to examine the GI and hepatic manifestations of COVID-19 in patients hospitalized due to COVID-19 pneumonia in "COVID hospital Batajnica", University Clinical Center of Serbia in Belgrade. The study included 498 consecutive patients, and the data was obtained from the patient's electronic medical history. GI symptoms included nausea, vomiting, diarrhea, and anorexia. Collected laboratory values included baseline and peak values of blood count, inflammatory parameters, liver function tests, renal function tests, and cardiac enzyme tests. The results have shown that GI symptoms occurred in 26% of cases at diagnosis, which indicates the great susceptibility of the GI system to SARS-CoV-2. There was a high risk of liver injury in patients with COVID-19 pneumonia (>60%). The level of AST is more often increased compared to ALT, which is different from other virus-induced liver lesions and may be a useful indicator of SARS-CoV-2 infection. Further research should focus on the causes of liver damage in SARS-CoV-2 virus and the impact on treatment and outcome of COVID-19 disease.
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Affiliation(s)
- Dragana Mijac
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Samir Vucelj
- Department of Internal Medicine, General Hospital Novi Pazar, Generala Zivkovica 1, 36300 Novi Pazar, Serbia;
| | - Kristina Todorovic
- Department of Internal Medicine, General Hospital Jagodina, Karadjordjeva 4, 35000 Jagodina, Serbia;
| | - Marko Vojnovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Biljana Milicic
- Faculty of Dental Medicine, University of Belgrade, Rankeova 4, 11000 Belgrade, Serbia;
| | - Snezana Lukic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Marija Marjanovic Haljilji
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Tatjana Adzic Vukicevic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Pulmology, University Clinical Center of Serbia, Dr Koste Todorovica No 6, 11000 Belgrade, Serbia
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Banasik E, Dobrowolska A, Kołodziejczak B, Eder P. Inflammatory bowel diseases and the clinical course of coronavirus disease 2019 - a Polish single-centre experience from the pre-vaccine era. PRZEGLAD GASTROENTEROLOGICZNY 2023; 18:409-415. [PMID: 38572464 PMCID: PMC10985744 DOI: 10.5114/pg.2023.133479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/30/2022] [Indexed: 04/05/2024]
Abstract
Introduction The data on the relationship between inflammatory bowel diseases (IBD) and the course of COVID-19 from East-Central Europe are scarce. Aim To assess the frequency of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in IBD patients and the impact of IBD on the COVID-19 course from the perspective of a Polish tertiary centre. Material and methods Data on SARS-CoV-2 infection were retrospectively collected among IBD patients hospitalized in a Polish tertiary centre from March 2020 to May 2021. A questionnaire was used assessing the IBD characteristics, other comorbidities, and the course of COVID-19. Results Among 350 patients, SARS-CoV-2 infection was diagnosed in 32 (9%). Severe COVID-19, defined as the need for hospitalization, was reported in 6 (19%) and mild in 26 (81%) cases. Compared to the mild COVID-19 course, patients with a severe course more often showed a higher IBD activity (3 points [IQR 2.25-3] vs. 1 point [IQR 0-2] in a semi-quantitative scale, p = 0.002), more often received steroids (67% vs. 11%, p = 0.02), and were not treated with biologics (0% vs. 46%, p = 0.07). There was a correlation between the duration of symptomatic infection and the number of comorbidities (r = 0.4, p = 0.04). No death or short-term COVID-19 complications were reported. In 25% of cases, SARS-CoV-2 infection caused new gastrointestinal symptoms. Conclusions IBD is not a risk factor for SARS-CoV-2 infection. Steroids and higher IBD clinical activity may increase the risk of severe COVID-19. The prognosis for COVID-19 in our cohort was good. SARS-CoV-2 infection was a common cause of gastrointestinal symptoms.
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Affiliation(s)
- Estera Banasik
- Department of Gastroenterology, Dietetics, and Internal Medicine, Poznan University of Medical Sciences, University Clinical Hospital, Poznan, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics, and Internal Medicine, Poznan University of Medical Sciences, University Clinical Hospital, Poznan, Poland
| | - Barbara Kołodziejczak
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznan, Poland
| | - Piotr Eder
- Department of Gastroenterology, Dietetics, and Internal Medicine, Poznan University of Medical Sciences, University Clinical Hospital, Poznan, Poland
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Goyal H, Sureka B, Mangaraj N, Agarwal A, Kothari N, Garg MK, Banerjee M, Agarwal A, Garg P, Yadav T, Khera P. Comparison between abdominal CT findings in intensive care unit (ICU) and non-ICU patients with Covid-19: experience from a tertiary care hospital. Afr Health Sci 2023; 23:64-74. [PMID: 38974306 PMCID: PMC11225447 DOI: 10.4314/ahs.v23i4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background 16-66% of COVID-19 positive patients may have abdominal symptoms and findings in abdominal CT. The yield of abdominal CT scan in patients having abdominal complaints is not known. Objectives The aim of this study was to explore the various abdominal imaging manifestations of COVID-19 and COVID-19 associated Mucormycosis (CAM) and to identify the relevant clinical and laboratory features associated with severity of the symptoms. Methods A retrospective single centre observational study was performed at a tertiary care hospital in Northwest India. All consecutive patients who had COVID positive RT-PCR report and had undergone abdominal Computed Tomography scan from March 2020 to November 2021 for various abdominal complaints were included. Demographic data, CT images and reports and all relevant lab parameters were collected. Results Out of 75 patients, positive abdominal findings were seen in 65 patients. Hepatobiliary findings were seen in 41.3% (31 of 75; OR=1.9) and bowel abnormalities were found in 37.3% (28 of 75; OR=2.1) of COVID-19 patients. 7 patients who had renal infarcts or bowel ischemia were found to have COVID-19 associated Mucormycosis on histopathology. Conclusion Chest CT severity score was positively correlated with most of the abdominal manifestations in patients requiring ICU admission. Elevated D-dimer levels were significantly associated with abdominal symptoms.
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Affiliation(s)
- Himanshu Goyal
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Nachiketa Mangaraj
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Ashish Agarwal
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Nikhil Kothari
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - M K Garg
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Mithu Banerjee
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Ashwini Agarwal
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Pawan Garg
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Pushpinder Khera
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
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Jarvis NR, Mishra N. High-Grade Colonic Stricture After a Severe Case of COVID-19 Pneumonia. Am Surg 2023; 89:6197-6199. [PMID: 35728086 DOI: 10.1177/00031348221109811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extrapulmonary involvement of coronavirus-19 disease (COVID-19) is being documented and studied at an increasing frequency. Specifically, gastrointestinal involvement is hypothesized to occur due to cellular entry via the ACE2 receptor found in gastrointestinal epithelial cells, causing inflammation and symptoms such as abdominal pain, nausea/vomiting, and diarrhea. We present the case of a 45-year-old female with recent severe COVID-19 infection and early gastrointestinal symptoms who later presented with worsening abdominal pain, nausea, vomiting, and constipation after initial discharge. She was diagnosed with a large bowel obstruction and underwent urgent exploratory laparotomy, which revealed a stricture of the distal transverse colon. Following segmental resection, the patient experienced resolution of symptoms. We hypothesize that this patient's colonic stricture arose secondary to severe COVID-19-induced bowel inflammation.
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Affiliation(s)
| | - Nitin Mishra
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
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Guo BC, Wu KH, Chen CY, Lin WY, Chang YJ, Lee TA, Lin MJ, Wu HP. Mesenchymal Stem Cells in the Treatment of COVID-19. Int J Mol Sci 2023; 24:14800. [PMID: 37834246 PMCID: PMC10573267 DOI: 10.3390/ijms241914800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, many lives have been tragically lost to severe infections. The COVID-19 impact extends beyond the respiratory system, affecting various organs and functions. In severe cases, it can progress to acute respiratory distress syndrome (ARDS) and multi-organ failure, often fueled by an excessive immune response known as a cytokine storm. Mesenchymal stem cells (MSCs) have considerable potential because they can mitigate inflammation, modulate immune responses, and promote tissue regeneration. Accumulating evidence underscores the efficacy and safety of MSCs in treating severe COVID-19 and ARDS. Nonetheless, critical aspects, such as optimal routes of MSC administration, appropriate dosage, treatment intervals, management of extrapulmonary complications, and potential pediatric applications, warrant further exploration. These research avenues hold promise for enriching our understanding and refining the application of MSCs in confronting the multifaceted challenges posed by COVID-19.
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Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs’ Taichung Metro Harbor Hospital, Taichung 43503, Taiwan;
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 43503, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Tai-An Lee
- Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 50544, Taiwan;
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Maev IV, Osadchuk MA. [Diseases of the gastrointestinal tract in the context of COVID-19 infection: present and future challenges: A review]. TERAPEVT ARKH 2023; 95:586-590. [PMID: 38159010 DOI: 10.26442/00403660.2023.07.202282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024]
Abstract
A significant prevalence of gastrointestinal symptoms in SARS-CoV-2 infection is also associated with its fecal-oral transmission, which leads to a progressive increase in the number of patients with diseases of the esophagus, stomach and intestines. In addition, intestinal infections caused by SARS-CoV-2 may be one of the main causes of functional long-term stress-related gastrointestinal disorders, united in the concept of post-COVID syndrome.
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Affiliation(s)
- I V Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - M A Osadchuk
- Sechenov First Moscow State Medical University (Sechenov University)
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Azarbakhsh H, Moftakhar L, Valipour A, Mirahmadizadeh A, Moradi HA, Piraee E. Epidemiological features and consequences of COVID-19 in patients with and without gastrointestinal symptoms in southwestern Iran. A retrospective observational study. Health Sci Rep 2023; 6:e1499. [PMID: 37732104 PMCID: PMC10507146 DOI: 10.1002/hsr2.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/22/2023] Open
Abstract
Background and Aims Some studies have shown that in addition to respiratory symptoms, gastrointestinal (GI) manifestations reported in patients with coronavirus disease 2019 (COVID-19). The aim of this study was to compare the epidemiological features and consequences of COVID-19 in patients with and without GI symptoms. Methods This retrospective observational study concluded on 15,323 COVID-19 patients with GI symptoms and 95,724 patients without symptoms. All symptoms and comorbidities of the patients collected. To investigate the differences between qualitative variables in the two groups, χ 2 test was used. Logistic regression analysis also used to identify determinants of mortality in patients with COVID-19. Results During the course of the study, 111,047 cases of COVID-19 occurred. Of these, 13.8% of patients had GI symptoms, and 9.9% of deaths due to COVID-19 occurred in these patients. The most common reported GI symptoms among COVID-19 patients were nausea, vomiting, and diarrhea. In addition, comorbidities, such as diabetes, cardiovascular disease, and thyroid disease were significantly higher in patients with GI symptoms. The result of multiple logistic regression showed that the chance of mortality is higher in a patient with COVID-19 who have dyspnea, fever, cough, hypertension, cardiovascular disease, diabetes, immunodeficiency, chronic kidney disease, thyroid disease, chronic pulmonary disease, and male gender. The chance of death was lower in people with GI symptoms. Conclusion According to the findings of this study, nausea, vomiting, and diarrhea were the most common GI symptoms. Also, the chance of death is higher in people with co-morbidities such as cardiovascular diseases, diabetes, and high blood pressure. Therefore, it is necessary to follow these people closely.
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Affiliation(s)
| | - Leila Moftakhar
- Department of Public Health, Student Research Committee Shiraz University of Medical Sciences Shiraz Iran
| | - Aliasghar Valipour
- Department of Public Health Abadan Faculty of Medical Sciences Abadan Iran
| | - Alireza Mirahmadizadeh
- Department of Epidemiology, Non-communicable Diseases Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Hekmat Allah Moradi
- Department of Disaster and Emergency Health, Health Human Resources Research Center, School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz Iran
| | - Elahe Piraee
- Department of Public Health Social Determinants of Health Research Center, Yasuj University of Medical Sciences Yasuj Iran
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15
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Rezzoug I, Visseaux B, Bertine M, Parisey M, Bonnal C, Ruppe E, Descamps D, Timsit JF, Yazdanpanah Y, Armand-Lefevre L, Houze S, Argy N. Faecal Viral Excretion and Gastrointestinal Co-Infection Do Not Explain Digestive Presentation in COVID-19 Patients. Microorganisms 2023; 11:1780. [PMID: 37512952 PMCID: PMC10383301 DOI: 10.3390/microorganisms11071780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
The physiopathological mechanisms responsible for digestive symptoms in COVID-19 patients are still unclear. The aim of this study was to determine the influence of faecal viral shedding on digestive symptoms and propose differential diagnoses in order to understand the gastrointestinal clinical spectrum in acute cases of COVID-19. All patients managed between March and May 2020, from whom stool samples were collected for microbiological investigations, were included. Microbiological analysis consisted of syndromic PCR screening and microscopic parasitological examination supplemented with microsporidia and multiplex protozoa PCR. SARS-CoV-2 infection was diagnosed via viral detection in respiratory and frozen stool samples, completed via serological test when necessary. Epidemiological, clinical, radiological, and biological data and clinical courses were compared according to COVID-19 status and faecal SARS-CoV-2 shedding and enteric co-infection status. The sample included 50 COVID+ and 67 COVID- patients. Faecal viral shedding was detected in 50% of stool samples and was associated with a higher viral load in the upper respiratory tract. Detected enteric pathogens were not different between subjects with different COVID-19 statuses or faecal SARS-CoV-2 shedding and had no impact on the clinical course for COVID-19 patients. The connection between SARS-CoV-2 shedding and enteric pathogen co-infection involvement in gastrointestinal presentation and clinical course is still unclear, suggesting other processes are involved in digestive disorders in COVID-19 patients.
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Affiliation(s)
- Inès Rezzoug
- Laboratoire de Parasitologie-Mycologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Benoit Visseaux
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
- IAME Unit, INSERM, Faculté de Médecine, Université de Paris Cité, 75018 Paris, France
| | - Mélanie Bertine
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Marion Parisey
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Christine Bonnal
- Laboratoire de Parasitologie-Mycologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Etienne Ruppe
- IAME Unit, INSERM, Faculté de Médecine, Université de Paris Cité, 75018 Paris, France
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Diane Descamps
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
- IAME Unit, INSERM, Faculté de Médecine, Université de Paris Cité, 75018 Paris, France
| | - Jean François Timsit
- IAME Unit, INSERM, Faculté de Médecine, Université de Paris Cité, 75018 Paris, France
- Service de Réanimation Médicale et Infectieuses, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Yazdan Yazdanpanah
- IAME Unit, INSERM, Faculté de Médecine, Université de Paris Cité, 75018 Paris, France
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Laurence Armand-Lefevre
- IAME Unit, INSERM, Faculté de Médecine, Université de Paris Cité, 75018 Paris, France
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
| | - Sandrine Houze
- Laboratoire de Parasitologie-Mycologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
- MERIT UMR 261 Unit, IRD, Faculté de Pharmacie, Université de Paris Cité, 75006 Paris, France
| | - Nicolas Argy
- Laboratoire de Parasitologie-Mycologie, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, 75018 Paris, France
- MERIT UMR 261 Unit, IRD, Faculté de Pharmacie, Université de Paris Cité, 75006 Paris, France
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16
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Fazel P, Sedighian H, Behzadi E, Kachuei R, Imani Fooladi AA. Interaction Between SARS-CoV-2 and Pathogenic Bacteria. Curr Microbiol 2023; 80:223. [PMID: 37222840 DOI: 10.1007/s00284-023-03315-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023]
Abstract
The novel human coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which results in the coronavirus disease 2019 (COVID-19), has caused a serious threat to global public health. Therefore, many studies are performed on the causes and prevalence of this disease and the possible co-occurrence of the infection with other viral and bacterial pathogens is investigated. Respiratory infections predispose patients to co-infections and these lead to increased disease severity and mortality. Numerous types of antibiotics have been employed for the prevention and treatment of bacterial co-infection and secondary bacterial infections in patients with a SARS-CoV-2 infection. Although antibiotics do not directly affect SARS-CoV-2, viral respiratory infections often result in bacterial pneumonia. It is possible that some patients die from bacterial co-infection rather than virus itself. Therefore, bacterial co-infection and secondary bacterial infection are considered critical risk factors for the severity and mortality rates of COVID-19. In this review, we will summarize the bacterial co-infection and secondary bacterial infection in some featured respiratory viral infections, especially COVID-19.
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Affiliation(s)
- Parvindokht Fazel
- Department of Microbiology, Fars Science and Research Branch, Islamic Azad University, Eqlid, Fars, Iran
- Department of Microbiology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Hamid Sedighian
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Vanak Sq, Mollasadra St, P.O. Box 19395-5487, Tehran, Iran
| | - Elham Behzadi
- Academy of Medical Sciences of the I.R. of Iran, Tehran, Iran
| | - Reza Kachuei
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Vanak Sq, Mollasadra St, P.O. Box 19395-5487, Tehran, Iran.
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17
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Durairajan SSK, Singh AK, Saravanan UB, Namachivayam M, Radhakrishnan M, Huang JD, Dhodapkar R, Zhang H. Gastrointestinal Manifestations of SARS-CoV-2: Transmission, Pathogenesis, Immunomodulation, Microflora Dysbiosis, and Clinical Implications. Viruses 2023; 15:1231. [PMID: 37376531 PMCID: PMC10304713 DOI: 10.3390/v15061231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
The clinical manifestation of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the respiratory system of humans is widely recognized. There is increasing evidence suggesting that SARS-CoV-2 possesses the capability to invade the gastrointestinal (GI) system, leading to the manifestation of symptoms such as vomiting, diarrhea, abdominal pain, and GI lesions. These symptoms subsequently contribute to the development of gastroenteritis and inflammatory bowel disease (IBD). Nevertheless, the pathophysiological mechanisms linking these GI symptoms to SARS-CoV-2 infection remain unelucidated. During infection, SARS-CoV-2 binds to angiotensin-converting enzyme 2 and other host proteases in the GI tract during the infection, possibly causing GI symptoms by damaging the intestinal barrier and stimulating inflammatory factor production, respectively. The symptoms of COVID-19-induced GI infection and IBD include intestinal inflammation, mucosal hyperpermeability, bacterial overgrowth, dysbiosis, and changes in blood and fecal metabolomics. Deciphering the pathogenesis of COVID-19 and understanding its exacerbation may provide insights into disease prognosis and pave the way for the discovery of potential novel targets for disease prevention or treatment. Besides the usual transmission routes, SARS-CoV-2 can also be transmitted via the feces of an infected person. Hence, it is crucial to implement preventive and control measures in order to mitigate the fecal-to-oral transmission of SARS-CoV-2. Within this context, the identification and diagnosis of GI tract symptoms during these infections assume significance as they facilitate early detection of the disease and the development of targeted therapeutics. The present review discusses the receptors, pathogenesis, and transmission of SARS-CoV-2, with a particular focus on the induction of gut immune responses, the influence of gut microbes, and potential therapeutic targets against COVID-19-induced GI infection and IBD.
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Affiliation(s)
| | - Abhay Kumar Singh
- Department of Microbiology, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur 610005, India
| | - Udhaya Bharathy Saravanan
- Department of Microbiology, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur 610005, India
| | - Mayurikaa Namachivayam
- Department of Microbiology, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur 610005, India
| | - Moorthi Radhakrishnan
- Department of Microbiology, School of Life Sciences, Central University of Tamil Nadu, Tiruvarur 610005, India
| | - Jian-Dong Huang
- Department of Biochemistry, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong 999077, China
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Rahul Dhodapkar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Government of India, Puducherry 605006, India
| | - Hongjie Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong 999077, China
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18
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Parsa SM, Norozpour F, Elsheikh AH, Kabeel AE. Solar desalination/purification (solar stills, humidification-dehumidification, solar disinfection) in high altitude during COVID19: Insights of gastrointestinal manifestations and systems' mechanism. JOURNAL OF HAZARDOUS MATERIALS ADVANCES 2023; 10:100259. [PMID: 36816517 PMCID: PMC9927827 DOI: 10.1016/j.hazadv.2023.100259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
From the starting of the pandemic different transmission routes of the pathogen was brought into the spotlight by researchers from different disciplines. This matter in high-altitudes was more boosted as the main parameters were not exactly realized. In this review we are about to highlight the possibility of consuming contaminated water generated form solar water desalination/disinfection systems in highlands. Three systems including solar still, solar disinfection (which experimented by the authors in 2019 in high altitude) and humidification-dehumidification were consider in this context. Ascribe to the risks of pathogens transmission in solar desalination/disinfection systems where the water resources are heavily polluted in every corner of the world, highlighting the risk of consuming water in high-altitude where there are many other parameters associated with spread of pathogen is of great importance. As it was reported, reliability of solar desalination and solar water disinfections systems against contaminated water by the novel coronavirus remained on the question because the virus can be transmitted by vapor in solar stills due to tiny particle size (60-140 nm) and would not be killed by solar disinfections due to low-temperature of operation <40 °C while for HDH contamination of both water and air by sars-cov-2 could be a concern. Although the SARS-CoV-2 is not a waterborne pathogen, its capability to replicate in stomach and infection of gastrointestinal glandular suggested the potential of transmission via fecal-oral. Eventually, it was concluded that using solar-based water treatment as drinking water in high altitude regions should be cautiously consider and recommendations and considerations are presented. Importantly, this critical review not only about the ongoing pandemic, but it aims is to highlight the importance of produced drinking water by systems for future epidemic/pandemic to prevent spread and entering a pathogen particularly in high-altitude regions via a new routes.
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Affiliation(s)
- Seyed Masoud Parsa
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Fatemeh Norozpour
- Department of Environmental Engineering, Faculty of Marine Science and Technology, Islamic Azad University, North Tehran Branch, Tehran, Iran
| | - Ammar H Elsheikh
- Department of Production Engineering and Mechanical Design, Tanta University, Tanta, Egypt
| | - A E Kabeel
- Mechanical Power Engineering Department, Faculty of Engineering, Tanta University, Tanta, Egypt
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19
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Cohen BS, Lebwohl B. COVID-19 and celiac disease: a review. Therap Adv Gastroenterol 2023; 16:17562848231170944. [PMID: 37124373 PMCID: PMC10133858 DOI: 10.1177/17562848231170944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
The aim of this review is to broadly cover how the COVID-19 pandemic has affected individuals with celiac disease, including perceived risk, risk of contraction or severe infection, considerations regarding vaccination, access to gluten-free food during the pandemic, and possible long-term changes to the practice of celiac disease management spurred by the pandemic. While initially there was increased perceived risk about COVID-19 in the celiac disease population, studies have found that individuals with celiac disease are not at an increased risk of contracting or having a severe course compared to the general population. There is not yet evidence that COVID-19 infection will lead to an increase in celiac disease incidence, though more research on this topic with longer-term follow-up is necessary to make this determination. Limited access to in-person visits led to an increase in telemedicine, which was adopted swiftly by this patient population and may offer improved access in the long term. In summary, individuals with celiac disease do not appear to be at an increased risk of contracting COVID-19 or having a more severe disease course.
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Affiliation(s)
- Brandon S. Cohen
- Department of Medicine, Celiac Disease Center,
Columbia University Irving Medical Center, New York, NY, USA
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center,
Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite
936, New York, NY 10032, USA
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20
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Yang C, Cai L, Xiao SY. Pathologic Characteristics of Digestive Tract and Liver in Patients with Coronavirus Disease 2019. Gastroenterol Clin North Am 2023; 52:201-214. [PMID: 36813426 PMCID: PMC9531645 DOI: 10.1016/j.gtc.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
With the high prevalence of coronavirus disease-2019 (COVID-19), there has been increasing understanding of the pathologic changes associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes the pathologic changes in the digestive system and liver associated with COVID-19, including the injuries induced by SARS-CoV2 infection of GI epithelial cells and the systemic immune responses. The common digestive manifestations associated with COVID-19 include anorexia, nausea, vomiting, and diarrhea; the clearance of the viruses in COVID-19 patients with digestive symptoms is usually delayed. COVID-19-associated gastrointestinal histopathology is characterized by mucosal damage and lymphocytic infiltration. The most common hepatic changes are steatosis, mild lobular and portal inflammation, congestion/sinusoidal dilatation, lobular necrosis, and cholestasis.
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Affiliation(s)
- Chunxiu Yang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lijun Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shu-Yuan Xiao
- Department of Pathology, University of Chicago Medicine, University of Chicago Medicine, MC6101, Anatomic Pathology, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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21
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Dhakal S, Charoen P, Pan-ngum W, Luvira V, Sivakorn C, Hanboonkunupakarn B, Chirapongsathorn S, Poovorawan K. Severity of COVID-19 in Patients with Diarrhoea: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2023; 8:84. [PMID: 36828500 PMCID: PMC9966065 DOI: 10.3390/tropicalmed8020084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
COVID-19 patients occasionally present with diarrhoea. Our objective was to estimate the risk of developing the severe disease in COVID-19 patients with and without diarrhoea and to provide a more precise estimate of the prevalence of COVID-19-associated digestive symptoms. A total of 88 studies (n = 67,794) on patients with a COVID-19 infection published between 1 January 2020 and 20 October 2022 were included in this meta-analysis. The overall prevalence of digestive symptoms was 27% (95% confidence interval (CI): 21-34%; I2 = 99%). According to our data, the pooled prevalence of diarrhoea symptoms in the 88 studies analysed was 17% (95% CI: 14-20%; I2 = 98%). The pooled estimate of nausea or vomiting in a total of 60 studies was 12% (95% CI: 8-15%; I2 = 98%). We also analysed 23 studies with eligible individuals (n = 3800) to assess the association between the disease severity and diarrhoea. Individuals who had diarrhoea were more likely to have experienced severe COVID-19 (odds ratio: 1.71; 95% CI: 1.31-2.24; p < 0.0001; I2 = 10%). Gastrointestinal symptoms and diarrhoea are frequently presenting COVID-19 manifestations that physicians should be aware of.
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Affiliation(s)
- Sunita Dhakal
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Pimphen Charoen
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wirichada Pan-ngum
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Viravarn Luvira
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Chaisith Sivakorn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Sakkarin Chirapongsathorn
- Department of Gastroenterology and Hepatology, Phramongkutklao Hospital, College of Medicine, Bangkok 10400, Thailand
| | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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22
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Dolu S, Bengi G, Avkan-Oğuz V, Tertemiz KC, Sinem Gezer N, Çavuş SA, Alpaydın AÖ, Kuruüzüm Z, Ergan B, Sevinç C, Ömeroğlu Şimsek G, Kılınç O, Örmen M, Sayıner A, Somalı I, Çavdar C, Can G, Demir T, Akarsu M, Savran Y, Soytürk M. Prevalence of Gastrointestinal Symptoms and Clinical Outcomes in Hospitalized Coronavirus Disease 2019 Patients: A Single-Center Study from Turkey. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2022; 33:955-963. [PMID: 35946895 PMCID: PMC9797795 DOI: 10.5152/tjg.2022.21484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND In patients with coronavirus disease 2019, the gastrointestinal symptoms have been reported increasingly in addition to the respiratory system symptoms. The studies show that the prevalence of gastrointestinal system symptoms and how the gastrointestinal system contributes to the severity and prognosis of the disease is still not clear. This study aims to find the prevalence of gastrointestinal symptoms and the correlation between the gastrointestinal symptoms and the clinical results in hospitalized patients diagnosed with coronavirus disease 2019. METHODS This study retrospectively analyzes patients diagnosed with coronavirus disease 2019 and hospitalized in the pandemic unit between March 2020 and August 2020 and compares their demographic and clinical characteristics, laboratory and radiologic findings, coronavirus disease 2019 treatments received, the clinical course of the disease, and the gastrointestinal symptoms. RESULTS In our study, we included 322 patients diagnosed with coronavirus disease 2019 and hospitalized; 39 patients (12.1%) were admitted to the hospital with at least one gastrointestinal symptom (nausea and vomiting, diarrhea, abdominal pain, and the loss of taste). Nausea and vomiting are the most common gastrointestinal symptoms with a prevalence of 7.1%, followed by diarrhea with 2.8%, the loss of taste with 2.2%, and abdominal pain with 1.5%. The mean age and D-dimer levels of the patients showing gastrointestinal symptoms were lower than those who did not have any gastrointestinal symptoms. We did not find a significant correlation between the presence of the gastrointestinal symptoms and the severity of the disease, treatment received, risk of acute respiratory distress syndrome and septic shock, admission to the intensive care unit, the need for mechanical ventilation, the mortality rate or the length of hospitalization in the medical floor or the intensive care unit. CONCLUSION In this study, we observed that 12.1% of coronavirus disease 2019 patients apply to the hospital due to gastrointestinal symptoms. Furthermore, the gastrointestinal symptoms do not seem to affect the severity and the course of the disease, it is important to identify coronavirus disease 2019 patients showing unusual symptoms such as the gastrointestinal symptoms at an early stage to protect healthcare professionals from infection risk.
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Affiliation(s)
- Süleyman Dolu
- Department of Gastroenterology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Göksel Bengi
- Department of Gastroenterology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Vildan Avkan-Oğuz
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Kemal Can Tertemiz
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Naciye Sinem Gezer
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sema Alp Çavuş
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ziya Kuruüzüm
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Can Sevinç
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Gökçen Ömeroğlu Şimsek
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Oğuz Kılınç
- Department of Pulmonary Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Murat Örmen
- Department of Biochemistry, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Arzu Sayıner
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Işıl Somalı
- Department of Medical Oncology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Caner Çavdar
- Department of Nephrology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Gerçek Can
- Department of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Tevfik Demir
- Department of Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Yusuf Savran
- Department of Internal Medicine and Medical Intensive Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Müjde Soytürk
- Department of Gastroenterology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Leung JSM. Interaction between gut microbiota and COVID-19 and its vaccines. World J Gastroenterol 2022; 28:5801-5806. [PMID: 36353201 PMCID: PMC9639653 DOI: 10.3748/wjg.v28.i40.5801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 02/06/2023] Open
Abstract
The whole world has been continuously afflicted by the coronavirus disease 2019 (COVID-19) pandemic for the past 3 years. Many countries have tried many methods to control this virus infection with varying successes and failures. The gut microbiota is a biosystem spanning the entire length of the digestive tract and playing important roles in health and disease. It is much affected by COVID-19. In return it also substantially impacts infection. In particular, the gut microbiota has established a bidirectional interaction with the COVID-19 vaccines, enhancing or reducing vaccine efficacy by virtue of its varying components. Conversely, COVID-19 vaccines also make a substantial impact on the gut microbiota, re-ducing its overall population and biodiversity. It is hoped that by exploring and harnessing this bidirectional interaction we may break new ground and develop new methods to prevent and treat this formidable virus infection.
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Affiliation(s)
- John S M Leung
- Cardiothoracic Unit, St. Paul’s Hospital, Hong Kong, China
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24
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Belabbes FZ, Maizi M, Belghyti N, Hmamouchi I, Khalis M, El Aidaoui K, Kantri A, El Kettani C, Naitlhou A, Rouibaa F. Prevalence and Severity of Gastrointestinal Symptoms in COVID-19 Patients in Casablanca: A Retrospective Cohort Study. Cureus 2022; 14:e27815. [PMID: 36106205 PMCID: PMC9454376 DOI: 10.7759/cureus.27815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/08/2023] Open
Abstract
Background The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19), is behind the current pandemic. At the start of the pandemic, gastrointestinal symptoms initially described as rare were reported, but their spread to other countries increased rapidly. This study aimed to determine the prevalence of digestive symptoms among COVID-19 patients and to assess the correlation between these symptoms and disease severity. Methods This retrospective observational study was conducted in the Cheikh Khalifa University Hospital of Casablanca, Morocco. Patients were divided into two groups based on the presence or absence of gastrointestinal symptoms upon initial assessment and hospital admission. Results A total of 154 patients were included in this study from March 21 to April 26, 2020. The mean age of patients was about 48.5 (± 20.0) years, and 85 (55.2%) of them were men. In our population, 8.17% of patients had toxic habits. Digestive symptoms were present at admission in 30% of our patients. The most frequent digestive symptoms were diarrhea (15%), abdominal pain (5.6%), vomiting (5%), and anorexia (3.1%). We found a significant difference in COVID-19 patients with digestive symptoms and toxic habits contrary to all other comorbidities. Neurologic symptoms were significantly associated (p=0,004) with digestive symptoms in 50%. Conclusion In this study, we found that digestive symptoms were present in 22.64% of patients diagnosed with COVID-9. The clinician must know the different digestive symptoms to evoke the diagnosis and take charge of the patient early.
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Shah SC, Canakis A, Halvorson AE, Dorn C, Wilson O, Denton J, Hauger R, Hunt C, Suzuki A, Matheny ME, Siew E, Hung A, Greevy RA, Roumie CL. Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score-Weighted Analysis of a Nationwide Cohort. GASTRO HEP ADVANCES 2022; 1:977-984. [PMID: 35966642 PMCID: PMC9357443 DOI: 10.1016/j.gastha.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) symptoms are well-recognized manifestations of coronavirus disease 2019 (COVID-19). Our primary objective was to evaluate the association between GI symptoms and COVID-19 severity. METHODS In this nationwide cohort of US veterans, we evaluated GI symptoms (nausea/vomiting/diarrhea) reported 30 days before and including the date of positive SARS-CoV-2 testing (March 1, 2020, to February 20, 2021). All patients had ≥1 year of prior baseline data and ≥60 days follow-up relative to the test date. We used propensity score (PS)-weighting to balance covariates in patients with vs without GI symptoms. The primary composite outcome was severe COVID-19, defined as hospital admission, intensive care unit admission, mechanical ventilation, or death within 60 days of positive testing. RESULTS Of 218,045 SARS-CoV-2 positive patients, 29,257 (13.4%) had GI symptoms. After PS weighting, all covariates were balanced. In the PS-weighted cohort, patients with vs without GI symptoms had severe COVID-19 more often (29.0% vs 17.1%; P < .001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of intensive care unit admission and mechanical ventilation compared with patients without symptoms. There was a significant age interaction; among hospitalized patients aged ≥70 years, lower COVID-19-associated mortality was observed in patients with vs without GI symptoms, even after accounting for COVID-19-specific medical treatments. CONCLUSION In the largest integrated US health care system, SARS-CoV-2-positive patients with GI symptoms experienced severe COVID-19 outcomes more often than those without symptoms. Additional research on COVID-19-associated GI symptoms may inform preventive efforts and interventions to reduce severe COVID-19.
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Key Words
- BMI, body mass index
- CDW, Corporate Data Warehouse
- COVID-19
- COVID-19, coronavirus disease 2019
- Epidemiology
- GI, gastrointestinal
- ICD, International Classification of Diseases
- ICU, intensive care unit
- Infectious diseases
- OMOP, Observational Medical Outcomes Partnership
- OR, odds ratios
- Outcomes
- PCR, polymerase chain reaction
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitors
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SD, standard deviation
- SDR, Shared Data Resource
- SMD, standardized mean differences
- VHA, Veterans Health Administration
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Affiliation(s)
- Shailja C. Shah
- Gastroenterology Section, VA San Diego, San Diego, California
- Division of Gastroenterology, University of California, San Diego, San Diego, California
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alese E. Halvorson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Otis Wilson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason Denton
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard Hauger
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Center of Excellence for Stress and Mental Health, San Diego, California
| | - Christine Hunt
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- Gastroenterology Section, Durham VA Health Care System, Durham, North Carolina
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- Gastroenterology Section, Durham VA Health Care System, Durham, North Carolina
| | - Michael E. Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Siew
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adriana Hung
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee
| | - Christianne L. Roumie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee
- VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, Tennessee
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Singh S, Samanta J, Suri V, Bhalla A, Puri GD, Sehgal R, Kochhar R. Presence of diarrhea associated with better outcomes in patients with COVID-19 - A prospective evaluation. Indian J Med Microbiol 2022; 40:404-408. [PMID: 35483999 PMCID: PMC9271117 DOI: 10.1016/j.ijmmb.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Gastrointestinal (GI) manifestations have been well documented in patients with coronavirus disease 2019 (COVID-19), but its clinical impact on the course of the disease is debatable. Majority of the available data is retrospective, and hence this prospective study was planned to study the impact of GI symptoms on COVID-19 outcome. METHODS All COVID-19 patients admitted in a tertiary care centre from August-October 2020 were screened and patients without pre-existing GI diseases were included. A detailed history of the various symptoms including duration was documented. Various baseline laboratory investigations and inflammatory markers were conducted as per the protocol. Patients with and without diarrhea were compared for the various disease outcome parameters. RESULTS Of the 244 patients screened, 203 patients (128 males; 63.1%) were included. Respiratory symptoms alone were present in 49 (24.1%), GI symptoms alone in 20 (9.9%) and 117 (57.6%) had both. Overall GI symptoms was noted in 137 (67.5%) cases with the commonest being diarrhea (61; 30.0%). Patients with both respiratory and any GI symptoms showed a lower trend towards need for mechanical ventilation (12.2% vs 7.7%; p = 0.35) and mortality (10.2% vs 4.3%; p = 0.14) compared to respiratory symptoms alone, although not statistically significant. Patients with diarrhea (n = 61) had no mortality (0% vs 7.7%; p = 0.036) or need for mechanical ventilation and shorter hospital stay compared to those who did not have diarrhea. CONCLUSION GI symptoms are frequent in patients with SARS-CoV-2 infection and the commonest is diarrhea. Diarrhea is a harbinger of better outcome with lower mortality among COVID-19 positive patients.
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Affiliation(s)
- Seerat Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Targoński R, Gąsecka A, Prowancki A, Targoński R. An alternative to airborne droplet transmission route of SARS-CoV-2, the feco-oral route, as a factor shaping COVID-19 pandemic. Med Hypotheses 2022; 166:110903. [PMID: 35791352 PMCID: PMC9247218 DOI: 10.1016/j.mehy.2022.110903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 01/08/2023]
Abstract
The Chinese scenario, a rapid increase in the frequency of SARS-CoV-2 infections and sudden decline, is uncommon worldwide. Enormous differences in COVID-19 severity among individual countries are the striking findings of the pandemics. It has been demonstrated that a mild course of COVID-19 is associated with gastrointestinal symptoms, less inflammatory response, and better prognosis. The presence of SARS-CoV-2 was observed longer in the gastrointestinal tract than in respiratory swabs, promoting feco-oral transmissions and mild virus attenuation. The spread of the pandemic and its severity might, consequently, depends on the dominant environmental route of infection and emerging immunity. We hypothesize that the feco-oral SARS-CoV-2 transmission may help to achieve the long-term immunity against COVID-19, since it enables the continuous contact with viral antigens in the gastrointestinal tract, resulting in lower mortality rate. To conclude, countries producing rice through traditional methods developed rapidly emerging long-lasting population immunity, possibly through increased SARS-CoV-2 antigen exposure in the gastrointestinal tract. Our hypothesis brings attention to this potential route of herd immunity against SARS-CoV-2 which warrants further investigation in the future.
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Affiliation(s)
- Ryszard Targoński
- Cardiology and Internal Medicine Clinic, Metropolitan Hospital in Olsztyn, University of University of Warmia and Mazury, Olsztyn, Poland
| | - Aleksandra Gąsecka
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Adrian Prowancki
- Cardiology and Internal Medicine Clinic, Metropolitan Hospital in Olsztyn, University of University of Warmia and Mazury, Olsztyn, Poland
- Department of Human Physiology and Pathophysiology, University of University of Warmia and Mazury, Olsztyn, Poland
| | - Radosław Targoński
- 1 Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
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Kahi CJ. CGH Rising. Clin Gastroenterol Hepatol 2022; 20:1427-1428. [PMID: 35364314 DOI: 10.1016/j.cgh.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/07/2023]
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Milano A, Efthymakis K, D’Ardes D, Tana M, Mazzotta E, De Febis G, Laterza F, Tarquini P, Marini E, Porreca E, Cipollone F, Neri M. Gastrointestinal manifestations of SARS-CoV-2 infection in an Italian population of hospitalized patients. Therap Adv Gastroenterol 2022; 15:17562848221104610. [PMID: 35757382 PMCID: PMC9218448 DOI: 10.1177/17562848221104610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters the cells via angiotensin-converting enzyme 2 receptor; therefore, tissues expressing this receptor are potential targets for infection. Although many studies have observed gastrointestinal (GI) symptoms in coronavirus disease 2019 (COVID-19) patients, prevalence and clinical impact are still uncertain due to the heterogeneity of reports and obstacles to generalization. METHODS In this cross-sectional study, we included symptomatic patients requiring hospital admission, with a confirmed diagnosis of COVID-19 by nasopharyngeal polymerase chain reaction test, between 18 March and 30 May 2020. Demographic data, symptoms at onset, vital signs, and laboratory tests at admission were recorded. RESULTS In all, 300 patients were included (57%M, 43%F). GI symptoms were mainly diarrhea (13%), anorexia (4.3%), vomiting (3%), and abdominal pain (2.3%). Overall, males were younger (68 years versus 76 years; p = 0.01); patients with GI manifestations at disease onset required significantly faster hospital admission and showed larger GI complication rates. GI symptoms were associated with abnormal high aspartate aminotransferase and alanine aminotransferase serum titers, especially in male patients. CONCLUSION Our study on an Italian population during the outbreak of the COVID-19 pandemic shows that GI symptoms are part of the spectrum of the SARS-CoV-2 infection and could be the only manifestations at disease onset. Although patients with GI symptoms were associated with faster hospital admission and liver involvement, prognosis was not affected.
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Affiliation(s)
- Angelo Milano
- UOSD Endoscopia Digestiva e Gastroenterologia, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Konstantinos Efthymakis
- UOSD Endoscopia Digestiva e Gastroenterologia, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Damiano D’Ardes
- Medicina Generale 1, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Marco Tana
- Medicina Generale 2, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Elena Mazzotta
- Malattie Infettive, Ospedale Civile ‘Giuseppe Mazzini’, ASL Teramo, Teramo, Italy
| | - Giulia De Febis
- Medicina Interna, Ospedale ‘San Liberatore’, ASL Teramo, Atri, Italy
| | - Francesco Laterza
- UOSD Endoscopia Digestiva e Gastroenterologia, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy
| | - Pierluigi Tarquini
- Malattie Infettive, Ospedale Civile ‘Giuseppe Mazzini’, ASL Teramo, Teramo, Italy
| | - Enrico Marini
- Medicina Interna, Ospedale ‘San Liberatore’, ASL Teramo, Atri, Italy
| | - Ettore Porreca
- Medicina Generale 2, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy,Department of Innovative Technologies in Medicine and Dentistry, University ‘G. D’Annunzio’, Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Medicina Generale 1, Ospedale Clinicizzato ‘SS Annunziata’, ASL2 Abruzzo, Chieti, Italy,Department of Medicine and Ageing Sciences, University ‘G. D’Annunzio’, Chieti-Pescara, Chieti, Italy
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Sahin T, Simsek C, Balaban HY. Practical points that gastrointestinal fellows should know in management of COVID-19. World J Clin Cases 2022; 10:5133-5145. [PMID: 35812670 PMCID: PMC9210885 DOI: 10.12998/wjcc.v10.i16.5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/31/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Pandemics obligate providers to transform their clinical practice. An extensive effort has been put to find out feasible approaches for gastrointestinal diseases and also to manage coronavirus disease 2019 (COVID-19) related gastrointestinal conditions. Diarrhea, hepatitis, and pancreatitis can be seen in the COVID-19 course. Endoscopic procedures increase the risk of contamination for medical staff and patients despite precautions, therefore indications should be tailored to balance risks vs benefits. Furthermore, whether the immunosupression in inflammatory bowel diseases, liver transplantation, and autoimmune liver diseases increases COVID-19 related risks and how to modify immunosupression are topics of ongoing debate. This review aims to provide most up to date practical approaches that a gastrointestinal fellow should be aware on the problems and management of gastrointestinal and hepatobiliary diseases during the COVID-19 pandemic.
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Affiliation(s)
- Tevhide Sahin
- Department of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey
| | - Cem Simsek
- Department of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey
| | - Hatice Yasemin Balaban
- Department of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey
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Gastrointestinal Involvement in SARS-CoV-2 Infection. Viruses 2022; 14:v14061188. [PMID: 35746659 PMCID: PMC9228950 DOI: 10.3390/v14061188] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2 has evolved into a virus that primarily results in mild or asymptomatic disease, making its transmission more challenging to control. In addition to the respiratory tract, SARS-CoV-2 also infects the digestive tract. Some gastrointestinal symptoms occur with or before respiratory symptoms in patients with COVID-19. Respiratory infections are known to cause intestinal immune impairment and gastrointestinal symptoms. When the intestine is inflamed, cytokines affect the lung immune response and inflammation through blood circulation. The gastrointestinal microbiome may be a modifiable factor in determining the risk of SARS-CoV-2 infection and disease severity. The development of oral SARS-CoV-2 vaccine candidates and the maintenance of gut microbiota profiles may contribute to the early control of COVID-19 outbreaks. To this end, this review summarizes information on the gastrointestinal complications caused by SARS-CoV-2, SARS-CoV-2 infection, the gastrointestinal–lung axis immune response, potential control strategies for oral vaccine candidates and maintaining intestinal microbiota homeostasis.
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Hashem WM, Abdelaziz H, Sallam DE, Ismail MA, Ahmed AE. Impact of COVID-19 on digestive system: prevalence, clinical characteristics, outcome, and relation to the severity of COVID-19. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:45. [PMID: 35615724 PMCID: PMC9123607 DOI: 10.1186/s43162-022-00132-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is commonly associated with respiratory symptoms. However, gastrointestinal (GI) symptoms are increasingly recognized in COVID-19 patients. The aim is to study the prevalence and features of gastrointestinal manifestations in severe acute respiratory coronavirus 2 (SARS-CoV-2) infected patients and evaluate the outcome among the studied population. Results We enrolled adult patients with laboratory-confirmed COVID-19 admitted to Ain Shams University designated hospitals, Cairo, Egypt, from March 2021 to June 2021. The patients were assigned to a GI group and a non-GI group based on the presence or absence of one or more digestive symptoms. A total of 300 hospitalized COVID-19 patients were included, of which 104 (34.7%) had one or more digestive symptoms. They were compared with 196 COVID-19 patients without GI symptoms. The most common reported GI symptom was diarrhea (82.7%). GI symptoms' presence was higher in moderate cases. Patients with digestive symptoms presented for care later than those without (7.9±3.8 vs 7.4±7.2 days, P=0.5). Moreover, they have lower mortality, though non-significant (7.7 vs 12.8%, P=0.18). Patients with digestive symptoms had lower total leucocytic count (TLC), neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet count, and higher serum sodium than those without digestive symptoms. Conclusion GI symptoms are prevalent among COVID-19 patients, and the most common was diarrhea. The presence of GI manifestations was not associated with increased mortality.
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Affiliation(s)
- Walaa M. Hashem
- Gastroenterology, Hepatology and Internal Medicine Department, Ain Shams University, Cairo, Egypt
| | - Heba Abdelaziz
- Public Health Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Dina E. Sallam
- Department of Pediatrics and Pediatric nephrology, Ain Shams University, Cairo, Egypt
| | | | - Ahmed Elmetwally Ahmed
- Gastroenterology, Hepatology and Internal Medicine Department, Ain Shams University, Cairo, Egypt
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Systemic Emergencies in COVID-19 Patient: A Pictorial Review. Tomography 2022; 8:1041-1051. [PMID: 35448718 PMCID: PMC9031887 DOI: 10.3390/tomography8020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Since the first report of the outbreak in Wuhan, China in December 2019, as of 1 September 2021, the World Health Organization has confirmed more than 239 million cases of the novel coronavirus (SARS-CoV-2) infectious disease named coronavirus disease 2019 (COVID-19), with more than 4.5 million deaths. Although SARS-CoV-2 mainly involves the respiratory tract, it is considered to be a systemic disease. Imaging plays a pivotal role in the diagnosis of all manifestations of COVID-19 disease, as well as its related complications. The figure of the radiologist is fundamental in the management and treatment of the patient. The authors try to provide a systematic approach based on an imaging review of major multi-organ manifestations of this infection.
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Potential Pathophysiological Mechanisms Underlying Multiple Organ Dysfunction in Cytokine Release Syndrome. Mediators Inflamm 2022; 2022:7137900. [PMID: 35431655 PMCID: PMC9007670 DOI: 10.1155/2022/7137900] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
In recent decades, many serious respiratory infections have broken out all over the world, including SARS-CoV, MERS, and COVID-19. They are characterized by strong infectivity, rapid disease progression, high mortality, and poor prognosis. Excessive immune system activation results in cytokine hypersecretion, which is an important reason for the aggravation of symptoms, and can spread throughout the body leading to systemic multiple organ dysfunction, namely, cytokine release syndrome (CRS). Although many diseases related to CRS have been identified, the mechanism of CRS is rarely mentioned clearly. This review is intended to clarify the pathogenetic mechanism of CRS in the deterioration of related diseases, describe the important signaling pathways and clinical pathophysiological characteristics of CRS, and provide ideas for further research and development of specific drugs for corresponding targets to treat CRS.
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Kariyawasam JC, Jayarajah U, Abeysuriya V, Riza R, Seneviratne SL. Involvement of the Liver in COVID-19: A Systematic Review. Am J Trop Med Hyg 2022; 106:1026-1041. [PMID: 35203056 PMCID: PMC8991364 DOI: 10.4269/ajtmh.21-1240] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/16/2022] [Indexed: 01/11/2023] Open
Abstract
COVID-19, a respiratory viral infection, has affected 388 million individuals worldwide as of the February 4, 2022. In this review, we have outlined the important liver manifestations of COVID-19 and discussed the possible underlying pathophysiological mechanisms and their diagnosis and management. Factors that may contribute to hepatic involvement in COVID-19 include direct viral cytopathic effects, exaggerated immune responses/systemic inflammatory response syndrome, hypoxia-induced changes, vascular changes due to coagulopathy, endothelitis, cardiac congestion from right heart failure, and drug-induced liver injury. The majority of COVID-19-associated liver symptoms are mild and self-limiting. Thus management is generally supportive. Liver function tests and abdominal imaging are the primary investigations done in relation to liver involvement in COVID-19 patients. However, imaging findings are nonspecific. Severe acute respiratory syndrome coronavirus 2 RNA has been found in liver biopsies. However, there is limited place for liver biopsy in the clinical context, as it does not influence management. Although, the management is supportive in the majority of patients without previous liver disease, special emphasis is needed in those with nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, hepatitis B and C infections, and alcoholic liver disease, and in liver transplant recipients.
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Affiliation(s)
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
| | - Rishdha Riza
- Colombo South Teaching Hospital, Colombo, Sri Lanka
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Pandey R, Rai D, Tahir MW, Wahab A, Bandyopadhyay D, Lesho E, Laguio-Vila M, Fentanes E, Tariq R, Naidu SS, Aronow WS. Prevalence of comorbidities and symptoms stratified by severity of illness amongst adult patients with COVID-19: a systematic review. Arch Med Sci Atheroscler Dis 2022; 7:e5-e23. [PMID: 35582712 PMCID: PMC9081912 DOI: 10.5114/amsad.2022.115008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction We performed a systematic review of comorbidities and symptoms of adult patients with coronavirus disease 2019 (COVID-19) to evaluate comorbidities, symptoms, and severity. Material and methods We searched databases and extracted comorbidities and symptoms from the included studies. We stratified the similar signs and symptoms in groups and on the basis of severity and compared them with stratified analysis. Individual case reports and case series with < 5 patients were excluded. Results A total of 163 studies with 43,187 patients were included. Mean age was 54.6 years. There were significantly fewer women in the study (43.9% vs. 56.1%, p < 0.0001). Prevalent cardiovascular comorbidities were hypertension (31.9%), obesity (27.9%), hyperlipidemia (26.4%), smoking (18.9%), diabetes mellitus (17.2%), atherosclerotic disease (9.2%) and arrhythmia (5.0%). The most frequently reported constitutional symptoms of COVID-19 were fever (73.9%), fatigue (33.4%), malaise (29.9%), myalgia and/or arthralgia (19.2%), generalized weakness (19.0%), and chills (11.3%). For the cardiovascular system, chest pain and/or tightness were most often reported (19.6%), followed by palpitations (5.2%). Hypertension and diabetes were common in severe disease. Obesity and congestive heart failure were not observed in any non-severe cases. Severe cases compared to non-severe cases more frequently had fever (87.8% vs. 58.5%, p < 0.001), shortness of breath (47.4% vs. 20.6%, p < 0.001), cough (66.8% vs. 62.9%, p < 0.001), sputum production (35.4% vs. 26.5%, p < 0.001) and rhinorrhea (32.2% vs. 7.3%, p < 0.001). Conclusions Hypertension, diabetes, and atherosclerotic diseases are common comorbidities across the world, with obesity as the second most common in the US and more common in men.
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Affiliation(s)
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, USA
| | | | - Abdul Wahab
- Department of Internal Medicine, University of Iowa, IA, USA
| | | | - Emil Lesho
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Maryrose Laguio-Vila
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Emilio Fentanes
- Department of Cardiology, Brigham and Women’s Hospital, MA, USA
| | - Raseen Tariq
- Department of Internal Medicine, Rochester General Hospital, USA
| | - Srihari S. Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
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Assessment of Gastrointestinal Symptoms and Dyspnea in Patients Hospitalized due to COVID-19: Contribution to Clinical Course and Mortality. J Clin Med 2022; 11:jcm11071821. [PMID: 35407430 PMCID: PMC8999487 DOI: 10.3390/jcm11071821] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Gastrointestinal manifestations may accompany the respiratory symptoms of COVID-19. Abdominal pain (AP) without nausea and vomiting is one of the most common. To date, its role and prognostic value in patients with COVID-19 is still debated. Therefore, we performed a retrospective analysis of 2184 individuals admitted to hospital due to COVID-19. We divided the patients into four groups according to presented symptoms: dyspnea, n = 871 (39.9%); AP, n = 97 (4.4%); AP with dyspnea together, n = 50 (2.3%); and patients without dyspnea and AP, n = 1166 (53.4%). The patients with AP showed tendency to be younger than these with dyspnea, but without AP (63.0 [38.0−70.0] vs. 65.0 [52.0−74.0] years, p = 0.061), and they were more often females as compared to patients with dyspnea (57.7% vs. 44.6%, p = 0.013, for females). Patients with AP as a separate sign of COVID-19 significantly less often developed pneumonia as compared to individuals with dyspnea or with dyspnea and AP together (p < 0.0001). Patients with AP or AP with dyspnea were significantly less frequently intubated or transferred to the intensive care unit (p = 0.003 and p = 0.031, respectively). Individuals with AP alone or with dyspnea had significantly lower rate of mortality as compared to patients with dyspnea (p = 0.003). AP as a separate symptom and also as a coexisting sign with dyspnea does not predispose the patients with COVID-19 to the worse clinical course and higher mortality.
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Twigg C, Wenk J. Review and Meta‐Analysis: SARS‐CoV‐2 and Enveloped Virus Detection in Feces and Wastewater. CHEMBIOENG REVIEWS 2022. [PMCID: PMC9083821 DOI: 10.1002/cben.202100039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Detection and quantification of viruses supplies key information on their spread and allows risk assessment for public health. In wastewater, existing detection methods have been focusing on non‐enveloped enteric viruses due to enveloped virus transmission, such as coronaviruses, by the fecal‐oral route being less likely. Since the beginning of the SARS‐CoV‐2 pandemic, interest and importance of enveloped virus detection in wastewater has increased. Here, quantitative studies on SARS‐CoV‐2 occurrence in feces and raw wastewater and other enveloped viruses via quantitative real‐time reverse transcription polymerase chain reaction (RT‐qPCR) during the early stage of the pandemic until April 2021 are reviewed, including statistical evaluation of the positive detection rate and efficiency throughout the detection process involving concentration, extraction, and amplification stages. Optimized and aligned sampling protocols and concentration methods for enveloped viruses, along with SARS‐CoV‐2 surrogates, in wastewater environments may improve low and variable recovery rates providing increased detection efficiency and comparable data on viral load measured across different studies.
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Affiliation(s)
- Charlotte Twigg
- University of Bath Department of Chemical Engineering and Water Innovation and Research Centre (WIRC@Bath) Claverton Down BA2 7AY Bath Somerset United Kingdom
| | - Jannis Wenk
- University of Bath Department of Chemical Engineering and Water Innovation and Research Centre (WIRC@Bath) Claverton Down BA2 7AY Bath Somerset United Kingdom
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Ambrose PA, Goodman WA. Impact of COVID-19 on Patients with Inflammatory Bowel Disease. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2022; 7:37-44. [PMID: 35966234 PMCID: PMC9373928 DOI: 10.14218/jerp.2021.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, in late 2019. Responsible for the ongoing coronavirus disease 2019 (COVID-19) pandemic, SARS-CoV-2 is one of three structurally similar beta-coronaviruses that can cause a strong upregulation of cytokines referred to as cytokine release syndrome (CRS). Unresolved CRS leads to respiratory symptoms, including pneumonia, and in more severe cases, acute respiratory distress syndrome (ARDS). Although COVID-19 is widely known for these hallmark respiratory symptoms, it also impacts the gut, causing gastrointestinal (GI) tract inflammation and diarrhea. COVID-19's GI symptoms may be due to the high intestinal expression of angiotensin converting enzyme-2 receptors, which are for the binding of SARS-CoV-2 viral particles. Reports have shown that SARS-CoV-2 can be passed through fecal matter, with one study finding that 48.1% of COVID-19 patients expressed viral SARS-CoV-2 mRNA in their stool. Given that the GI tract is a target tissue affected by COVID-19, this causes concern for those with underlying GI pathologies, such as inflammatory bowel disease (IBD). Regrettably, there have been only limited studies on the impact of COVID-19 on gut health, and the impact of COVID-19 on intestinal inflammation among IBD patients remains unclear. In particular, questions regarding susceptibility to SARS-CoV-2 infection, clinical impact of COVID-19 on IBD, and the potential influence of age, sex, and immunosuppressant medications are still poorly understood. An improved understanding of these issues is needed to address the unique risks of COVID-19 among IBD patients, as well as the potential impact of SARS-CoV-2 on the host intestinal microbiota.
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Affiliation(s)
- Paula A. Ambrose
- Department of Pathology, Case Western Reserve University School of Medicine, OH, USA
| | - Wendy A. Goodman
- Department of Pathology, Case Western Reserve University School of Medicine, OH, USA
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Bozada-Gutiérrez K, Trejo-Avila M, Chávez-Hernández F, Parraguirre-Martínez S, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature. World J Clin Cases 2022; 10:1296-1310. [PMID: 35211563 PMCID: PMC8855198 DOI: 10.12998/wjcc.v10.i4.1296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/16/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research concerning postoperative outcomes of confirmed coronavirus disease 2019 (COVID-19) patients revealed unfavorable postoperative results with increased morbidity, pulmonary complications and mortality. Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis. The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with concomitant acute cholecystitis who underwent cholecystectomy.
CASE SUMMARY We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy. Six patients were males, the mean age was 47.1 years. Nine patients had moderate acute cholecystitis, and one patient had severe acute cholecystitis. All patients were treated with urgent/early laparoscopic cholecystectomy. Regarding the Parkland grading scale, two patients received a Parkland grade of 3, two patients received a Parkland grade of 4, and six patients received a Parkland grade of 5. Eight patients required a bail-out procedure. Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy. After surgery, five patients developed acute respiratory distress syndrome (ARDS) and required intensive care unit (ICU) admission. One patient died after cholecystectomy due to ARDS complications. The mean total length of stay (LOS) was 18.2 d. The histopathology demonstrated transmural necrosis (n = 5), vessel obliteration with ischemia (n = 3), perforation (n = 3), and acute peritonitis (n = 10).
CONCLUSION COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.
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Affiliation(s)
- Katya Bozada-Gutiérrez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Mario Trejo-Avila
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Fátima Chávez-Hernández
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | | | - Carlos Valenzuela-Salazar
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Jesús Herrera-Esquivel
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Mucio Moreno-Portillo
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
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Abstract
Objective COVID-19 may cause an anorexic situation. This in turn leads to underfeeding, puts the patient in an energy protein malnutrition state, develops the hyperinflammation, weakens the immunity, and makes COVID-19 conditions more dangerous. Meanwhile, the more severe inflammation conditions in the body, the more severe the anorexia, which in turn affect the disease severity. Studies evaluating appetite in COVID-19 patients are very rare; therefore, we evaluated anorexia and analyzed the related factors in patients with COVID-19. Material and methods In this cross sectional study, adult patients’ ≥18 years old with the positive real-time fluorescence polymerase chain reaction for COVID-19 were included. The patients were classified as mild, moderate, and severe based on the WHO classification. We measured the appetite score, weight, height, body mass index (BMI), depression and anxiety score, at admission for every patient. Results A total of 301 patients participated in the study. The prevalence of admission anorexia was 58%, and this rate was significantly more in the severe group compared to the mild and moderate groups (P < 0.001). Comorbidities, depression and anxiety were independently correlated with anorexia risk [(OR = 3.6, 95% CI 1.68–7.70, P = 0.001), (OR = 1.23, 95% CI 1.16–1.30, P < 0001), and (OR = 1.24, 95% CI 1.17–1.31, P < 0001)], respectively. This correlation was adherence to a U-shape association for BMI, which means BMI < 18.5 (OR = 3.35, 95% CI 1.8–10.42, P < 0001) and BMI ≥30 (OR = 2.45, 95% CI 1.02–6.53, P = 0.048) were related to higher risk of anorexia. Conclusion We reported a high prevalence of anorexia (58%) in COVID-19 patients, which was positively correlated with disease severity. Furthermore, any factor worsening inflammatory state, including underweight, obesity, comorbidities, depression and anxiety can exacerbate anorexia in these patients.
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Noviello D, Costantino A, Muscatello A, Bandera A, Consonni D, Vecchi M, Basilisco G. Functional gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection: A controlled cohort study. Neurogastroenterol Motil 2022; 34:e14187. [PMID: 34060710 PMCID: PMC8209890 DOI: 10.1111/nmo.14187] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gastrointestinal infections represent a risk factor for functional gastrointestinal and somatoform extraintestinal disorders. We investigated the prevalence and relative risk (RR) of gastrointestinal and somatoform symptoms 5 months after SARS-CoV-2 infection compared with a control cohort. METHODS One hundred and sixty-four SARS-CoV-2 infected patients and 183 controls responded to an online questionnaire about symptoms and signs during the acute phase of the infection and after 4.8 ± 0.3 months. Presence and severity of gastrointestinal symptoms, somatization, anxiety, and depression were recorded with standardized questionnaires. Stool form and presence of irritable bowel syndrome (IBS) were also recorded. Any association between exposure to infection and symptoms was evaluated by calculating crude and adjusted RR values and score differences with 95% confidence intervals (CI). KEY RESULTS Fever, dyspnea, loss of smell/taste/weight, diarrhea, myalgia, arthralgia, and asthenia were reported by more than 40% of patients during the acute phase. Compared with controls, adjusted RRs for loose stools, chronic fatigue, and somatization were increased after infection: 1.88 (95% CI 0.99-3.54), 2.24 (95% CI 1.48-3.37), and 3.62 (95% CI 1.01-6.23), respectively. Gastrointestinal sequelae were greater in patients with diarrhea during the acute phase. CONCLUSIONS & INFERENCES Mild gastroenterological symptoms persist 5 months after SARS-CoV-2 infection, in particular in patients reporting diarrhea in the acute phase. Infected patients are at increased risk of chronic fatigue and somatoform disorders, thus supporting the hypothesis that both functional gastrointestinal and somatoform disorders may have a common biological origin.
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Affiliation(s)
- Daniele Noviello
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Andrea Costantino
- Gastroenterology and Endoscopy UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Antonio Muscatello
- Infectious Disease UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Alessandra Bandera
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
- Infectious Disease UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Dario Consonni
- Epidemiology UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Maurizio Vecchi
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
- Gastroenterology and Endoscopy UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Guido Basilisco
- Gastroenterology and Endoscopy UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
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Zeng W, Qi K, Ye M, Zheng L, Liu X, Hu S, Zhang W, Tang W, Xu J, Yu D, Wei Y. Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2022; 34:168-176. [PMID: 33470700 DOI: 10.1097/meg.0000000000002072] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19. METHODS We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I2 statistic. RESULTS A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0-51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05-1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3-76.4%) and 2.76 (95% CI: 1.59-4.81), respectively; for nausea, 41.4% (95% CI: 23.2-60.7%) and 0.92 (95% CI: 0.59-1.43), respectively; for vomiting, 51.3% (95% CI: 36.8-65.8%) and 1.68 (95% CI: 0.97-2.92), respectively. CONCLUSION The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.
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Affiliation(s)
- Weibiao Zeng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Kai Qi
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Miao Ye
- Medical College of Nanchang University
| | - Li Zheng
- Department of Gastroenterology Medicine, The Third Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinliang Liu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Sheng Hu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Wenxiong Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Wenjing Tang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Jianjun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Dongliang Yu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Yiping Wei
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
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Hasel K, Salim A, Verma S, D'Adamo C, Arrup D, Vinayek R, Dutta SK. Prevalence of Gastrointestinal Symptoms, Hepatic Dysfunction, and Outcomes in Hospitalized Patients With COVID-19 Infection: An Early Experience. Cureus 2022; 14:e22152. [PMID: 35308711 PMCID: PMC8919765 DOI: 10.7759/cureus.22152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background and objective Coronavirus disease 2019 (COVID-19) was first reported in China two years ago as primarily a lung infection associated with cough and fever. It spread rapidly across the world and was declared a pandemic in early 2020, with 131 million people infected and 2.85 million deaths worldwide. To date, approximately 550,000 deaths have occurred due to COVID-19 in the United States and the numbers continue to rise. The extrapulmonary manifestations of this disease such as acute kidney injury (AKI), cardiovascular events, and gastrointestinal (GI) indications were not emphasized initially. However, subsequent studies from the United States and Canada have noted GI involvement in this disease in a large number of cases. Our group, taking care of these patients during the early phase of the pandemic in 2020, observed the frequent presentations of GI symptoms such as diarrhea and hepatic dysfunction and this study examines the same. Methods We undertook a retrospective study of 184 consecutive adult patients who were hospitalized at our center with confirmed COVID-19 infection, with a view to further elucidate the GI and hepatic involvement during the early breakout (March 17-May 17, 2020) of this illness. Results Major comorbidities associated with this illness in our cohort of patients included hypertension (HTN, 66%), diabetes mellitus (DM, 44%), obesity (41%), and chronic kidney disease (CKD, 17%). The most common GI manifestation was diarrhea (25%) and, interestingly, more than two-thirds of the patients had at least one liver function abnormality. The most common liver function abnormality was elevated serum aspartate aminotransferase (AST). Elevated AST was significantly correlated (p<0.05) with inflammatory markers such as D-dimer, lactate dehydrogenase (LDH), and ferritin, as well as AKI by bi-variate analysis. Salient observations from our study include higher mortality, frequent AKI, and cardiovascular events in male patients (p<0.05). The liver injury in our cohort was suspected to be multifactorial, involving excessive cytokine release, viral infiltration of the hepatocytes, and cholangiocytes playing a role in transaminitis. The mean (±SD) duration of hospital stay was 13.5 ±15 days with 33% admissions to the ICU. The overall mortality was around 27%, with no significant difference between African Americans and Caucasians. However, patients admitted to the ICU had a very high mortality rate (54%) compared to those admitted to intermediate care (IMC)/acute care who had less severity of illness and associated pulmonary complications. Conclusions This study evaluates the presence of comorbidities such as DM, HTN, and obesity in patients hospitalized with COVID-19 at a community hospital in the Mid-Atlantic region of the United States. Statistical analysis of the data obtained for this cohort revealed a high frequency of GI symptoms, with diarrhea as the predominant common initial manifestation of the disease. Serum AST elevations were common and correlated with inflammatory markers and AKI. Male gender was also significantly associated with the development of AKI, higher frequency of cardiovascular events, and increased mortality. Overall mortality was noted to be 27%, with higher mortality in patients admitted to the ICU (54%) as compared to the IMC/floor (13%). These observations should spur future investigations into the role of these comorbidities, development of diarrhea, and hepatic dysfunction in COVID-19.
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Affiliation(s)
- Krystal Hasel
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Ahlaa Salim
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Sandeep Verma
- Medicine/Gastroenterology, Sinai Hospital of Baltimore, Baltimore, USA
| | - Christopher D'Adamo
- Family and Community Medicine, University of Maryland Medical Center, Baltimore, USA
| | - Denise Arrup
- Nursing, Sinai Hospital of Baltimore, Baltimore, USA
| | - Rakesh Vinayek
- Gastroenterology and Hepatology, Sinai Hospital of Baltimore, Baltimore, USA
| | - Sudhir K Dutta
- Gastroenterology and Hepatology, Sinai Hospital of Baltimore/University of Maryland School of Medicine, Baltimore, USA
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Al Argan RJ, Ismail MH, Alkhafaji DM, Alsulaiman RM, Ismaeel FE, AlSulaiman RS, Almajid AN, Alsheekh L, Alsaif TS, Alzaki AA, Alqatari SG, Alwaheed AJ, Al Said AH, Al Wazzeh MJ, AlQurain AA. Gastrointestinal manifestations of COVID-19 in a single center in the Eastern Province of Saudi Arabia. Saudi J Gastroenterol 2022; 28:218-224. [PMID: 35042321 PMCID: PMC9212119 DOI: 10.4103/sjg.sjg_547_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several gastrointestinal (GI) symptoms have been associated with novel coronavirus disease-2019 (COVID-19). Their prevalence and relation to the severity and hospital outcome of COVID-19 have not been well reported in the Middle East and Saudi Arabia. We aimed to examine the GI manifestations of COVID-19 and their association with the severity and hospital outcome of COVID-19 infection. METHODS We conducted a retrospective observational study of hospitalized COVID-19 patients who had a positive SARS-COV2 PCR test and were admitted at a university hospital in Saudi Arabia, from March to September 2020. The primary objective of the study was to describe the GI manifestations of COVID-19. The secondary objective was to investigate the association of GI manifestations with severity and outcome of COVID-19 infection. RESULTS We included 390 patients, of which 111 (28.5%) presented with GI manifestations. The most common presentation was diarrhea followed by nausea, vomiting, and abdominal pain. Patients without GI manifestations had a higher risk of severe-critical COVID-19 infection evident by the development of lung infiltration in more than 50% of lung fields within 24-48 h, acute respiratory distress syndrome, altered mental status, multiorgan failure, and cytokine storm syndrome (P < 0.05). These patients had a higher mortality rate compared to patients with GI manifestations (P = 0.01). A lower odds of death was seen among patients with GI symptoms (AOR 0.36; 95% CI, 0.158-0.82; P = 0.01). CONCLUSION COVID-19 infection presents commonly with GI manifestations. Patients with GI manifestations have less severe COVID-19 disease and lower mortality rates.
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Affiliation(s)
- Reem J. Al Argan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia,Address for correspondence: Dr. Reem J. Al Argan, King Fahad University Hospital, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia. E-mail:
| | - Mona H. Ismail
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Dania M. Alkhafaji
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Raed M. Alsulaiman
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Fatimah E. Ismaeel
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Reem S. AlSulaiman
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Ali N. Almajid
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Lameyaa Alsheekh
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Tariq S. Alsaif
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Alaa A. Alzaki
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Safi G. Alqatari
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abrar J. Alwaheed
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abir H. Al Said
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Marwan J. Al Wazzeh
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abdulaziz A. AlQurain
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University - King Fahad Hospital of the University, Khobar, Eastern Province, Saudi Arabia
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Zhang K, Qin W, Zheng Y, Pang J, Zhong N, Fei J, Li Y, Jian X, Hou X, Hu Z, Li C, Wang H, Chen Y. Malnutrition Contributes to Low Lymphocyte Count in Early-Stage Coronavirus Disease-2019. Front Nutr 2022; 8:739216. [PMID: 35071291 PMCID: PMC8770860 DOI: 10.3389/fnut.2021.739216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background and Aim: Lymphocytes play an important role in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). The current explanation for the cause of low TLC is that it is directly related to the invasiveness of SARS-CoV-2, which attacks lymphocytes. We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19. Methods: We prospectively enrolled 101 patients with confirmed COVID-19. On their first day of hospitalization, we collected baseline and laboratory data, including clinical symptoms; the Sequential Organ Failure Assessment, Nutrition Risk Screening 2002 and Subjective Global Assessment were used to assess the malnutrition status of the patients. Multivariable logistic regression was used to identify independent risk factors for low TLC and severe COVID-19. Results: Malnutrition was associated with lower TLC in COVID-19. Fifty-nine (58.4%) of the patients showed low TLC, 41 (40.6%) were at risk for malnutrition, and 18 of them were malnourished. Low TLC was an independent risk factor for severe COVID-19. Compared to patients with normal TLC, those with low TLC more often presented with anorexia, malnutrition, higher SOFA scores (P < 0.05) and comorbidities (diabetes and malignancies). Malnutrition (OR: 3.05, 95% CI: 1.5-6.19, P = 0.006) and SOFA scores (OR: 1.51, 95% CI: 1.04-2.43, P = 0.042) were identified as independent risk factors for low TLC. Conclusions: Malnutrition was common among our patients with early-stage COVID-19, and it contributed to the occurrence of low TLC.
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Affiliation(s)
- Kai Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weidong Qin
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yue Zheng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jiaojiao Pang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Ning Zhong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Jianchun Fei
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Li
- Department of Respiratory and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, China
| | - Xinguo Hou
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Li
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Wang
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
- Department of Pharmacology, School of Basic Medical Science, Shandong University, Jinan, China
| | - Yuguo Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
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Bajpai D, Deb S, Bose S, Gandhi CP, Modi T, Katyal A, Saxena N, Patil A, Patil S, Thakare S, Pajai A, Haridas A, Keskar VS, Jawale SY, Sultan AG, Nataraj G, Ingole N, Jamale TE. Clinical Course and Outcomes of COVID-19 in Kidney Transplant Recipients. Indian J Nephrol 2022; 32:467-475. [PMID: 36568606 PMCID: PMC9775604 DOI: 10.4103/ijn.ijn_509_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Kidney transplant recipients (KTR) are at increased risk of morbidity and mortality due to coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics and outcomes of COVID-19 in KTR. Methods We reviewed the clinical profile, outcomes, and immunological responses of recipients admitted with COVID-19. We determined the risk factors for mortality and severe COVID-19. Results Out of 452 recipients on follow-up, 60 were admitted with COVID-19. Prevalent comorbidities were hypertension (71%), diabetes (40%), lung disease (17%). About 27% had tuberculosis. The median Sequential Organ Failure Assessment score at presentation was 3 (interquartile range [IQR] 1-5). There was a high incidence of diarrhea (52%) and anemia (82%). Treatment strategies included antimetabolite withdrawal (85%), calcineurin inhibitor decrease or withdrawal (64%), increased steroids (53%), hydroxychloroquine (21%), remdesivir (28.3%), and tocilizumab (3.3%). Severe COVID-19 occurred in 34 (56.4%) patients. During a median follow-up of 42.5 days (IQR 21-81 days), 83% developed acute kidney injury (AKI) and eight (13%) died. Mortality was associated with the baseline graft dysfunction, hypoxia at admission, lower hemoglobin and platelets, higher transaminases, higher C reactive protein, diffuse radiological lung involvement, hypotension requiring inotropes, and Kidney Diseases Improving Global Outcomes (KDIGO) stage 3 AKI (univariate analysis). Around 57% of patients remained RT-PCR positive at the time of discharge. By the last follow-up, 66.6% of patients developed IgM (immunoglobulin M) antibodies and 82.3% of patients developed IgG antibodies. Conclusion COVID-19 in kidney transplant recipients is associated with a high risk of AKI and significant mortality.
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Affiliation(s)
- Divya Bajpai
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Divya Bajpai, Department of Nephrology, Ward no. 34a, Third Floor, Seth G. S. M. C. and K. E. M. Hospital, Parel, Mumbai – 400012, Maharashtra, India. E-mail:
| | - Satarupa Deb
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Sreyashi Bose
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Chintan P. Gandhi
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Tulsi Modi
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Abhinav Katyal
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Nikhil Saxena
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Ankita Patil
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Sunil Patil
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Sayali Thakare
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Atim Pajai
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Ashwathy Haridas
- Department of Nephrology, Apollo Hospital, Navi Mumbai, Maharashtra, India
| | | | | | | | - Gita Nataraj
- Department of Microbiology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Nayana Ingole
- Department of Microbiology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
| | - Tukaram E. Jamale
- Department of Nephrology, Seth G. S. M. C. and K. E. M. Hospital, Mumbai, Maharashtra, India
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Sharma R, Bajwa S, Kurdi M, Katikar M, Bajwa S, Choudhary R. Anesthesia management in a post Covid-19 obstetric patient-What we need to know. J Anaesthesiol Clin Pharmacol 2022; 38:S13-S21. [PMID: 36060195 PMCID: PMC9438824 DOI: 10.4103/joacp.joacp_550_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 01/08/2023] Open
Abstract
The outbreak of the coronavirus disease (COVID)-19 pandemic has led to unprecedented challenges globally. At the outset of the receding second wave and third wave of COVID-19, many patients who have recovered from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are coming for elective/emergency surgery. This demands a noteworthy emphasis on the post-COVID-19 obstetric patients. The administration of quality and safe obstetric anesthesia are quite challenging in this mentioned subset due to the overlap of signs and symptoms of COVID-19 with the constitutional signs and symptoms of pregnancy. The physiological changes in normal pregnancy and vascular, metabolic alterations in high-risk pregnancy may affect or exacerbate the pathogenesis or clinical presentation of COVID-19, respectively. This article highlights the specific concerns in recovered COVID-19 pregnant patients with associated comorbidity posted for surgery and their repercussions on anesthesia management.
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49
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Singh AK, Jena A, Kumar-M P, Jha DK, Sharma V. Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis. Intest Res 2022; 20:134-143. [PMID: 33440918 PMCID: PMC8831773 DOI: 10.5217/ir.2020.00108] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. METHODS We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. RESULTS Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38-83.88), cough: 59.58% (95% CI, 45.01-72.63), diarrhea: 27.26% (95% CI, 19.51-36.69), running nose: 27% (95% CI, 15.26-43.19) and dyspnea: 25.29% (95% CI, 18.52-33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24-18.19), 10.08% (95% CI, 5.84-16.85) and 8.80% (95% CI, 4.43-16.70) per 100 population, respectively. CONCLUSIONS The clinical presentation of COVID-19 in IBD patients is similar to the general population.
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Affiliation(s)
- Anupam K. Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daya Krishna Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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50
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Aimrane A, Laaradia MA, Sereno D, Perrin P, Draoui A, Bougadir B, Hadach M, Zahir M, Fdil N, El Hiba O, El Hidan MA, Kahime K. Insight into COVID-19's epidemiology, pathology, and treatment. Heliyon 2022; 8:e08799. [PMID: 35071819 PMCID: PMC8767941 DOI: 10.1016/j.heliyon.2022.e08799] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/08/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
The newly emerged 2019 coronavirus disease (COVID-19) has urged scientific and medical communities to focus on epidemiology, pathophysiology, and treatment of SARS-CoV-2. Indeed, little is known about the virus causing this severe acute respiratory syndrome pandemic, coronavirus (SARS-CoV-2). Data already collected on viruses belonging to the coronaviridae family are of interest to improve our knowledge rapidly on this pandemic. The current review aims at delivering insight into the fundamental advances inSARS-CoV-2 epidemiology, pathophysiology, life cycle, and treatment.
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Affiliation(s)
- Abdelmohcine Aimrane
- Metabolics Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
- Nutritional Physiopathology Team, Faculty of Sciences, ChouaibDoukkali University, El Jadida, 24000, Morocco
| | - Mehdi Ait Laaradia
- Laboratory of Pharmacology, Neurobiology and Behavior, Semlalia Faculty of Sciences, Cadi Ayyad University, Marrakech, Morocco
| | - Denis Sereno
- IRD, University of Montpellier, InterTryp, Parasite Infectiology Research Group, 34000, Montpellier, France
| | - Pascale Perrin
- IRD, University of Montpellier, MiVeGec, Parasite Infectiology Research Group, 34000, Montpellier, France
| | - Ahmed Draoui
- Laboratory of Clinical and Experimental Neurosciences and Environment, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Morocco
| | - Blaid Bougadir
- SAEDD Laboratory, School of Technology Essaouira, Cadi Ayyad University of Marrakesh, Morocco
| | - Mohamed Hadach
- SAEDD Laboratory, School of Technology Essaouira, Cadi Ayyad University of Marrakesh, Morocco
| | - Mustapha Zahir
- SAEDD Laboratory, School of Technology Essaouira, Cadi Ayyad University of Marrakesh, Morocco
| | - Naima Fdil
- Metabolics Platform, Biochemistry Laboratory, Faculty of Medicine, Cadi Ayad University, Marrakech, Morocco
| | - Omar El Hiba
- Nutritional Physiopathology Team, Faculty of Sciences, ChouaibDoukkali University, El Jadida, 24000, Morocco
| | | | - Kholoud Kahime
- SAEDD Laboratory, School of Technology Essaouira, Cadi Ayyad University of Marrakesh, Morocco
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