Article ; Online: Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes.
The American journal of gastroenterology
2020 Volume 115, Issue 6, Page(s) 916–923
Abstract: ... to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease ... severity.: Methods: We identified COVID-19 patients with mild disease and one or more digestive symptoms ... than those with respiratory symptoms.: Discussion: We describe a unique subgroup of COVID-19 patients with mild disease ...
| Abstract | Objectives: Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. Methods: We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. Results: There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. Discussion: We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms. |
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| MeSH term(s) | Betacoronavirus/isolation & purification ; COVID-19 ; COVID-19 Testing ; China/epidemiology ; Clinical Laboratory Techniques/methods ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Diarrhea/diagnosis ; Diarrhea/etiology ; Digestive System Diseases/diagnosis ; Digestive System Diseases/physiopathology ; Digestive System Diseases/virology ; Feces/virology ; Female ; Humans ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; RNA, Viral/analysis ; SARS-CoV-2 ; Severity of Illness Index ; Symptom Assessment/methods |
| Chemical Substances | RNA, Viral |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-04-06 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 390122-1 |
| ISSN | 1572-0241 ; 0002-9270 |
| ISSN (online) | 1572-0241 |
| ISSN | 0002-9270 |
| DOI | 10.14309/ajg.0000000000000664 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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