Review article: gastrointestinal features in COVID‐19 and the possibility of faecal transmission
Identifieur interne : 000301 ( 2020/Analysis ); précédent : 000300; suivant : 000302Review article: gastrointestinal features in COVID‐19 and the possibility of faecal transmission
Auteurs : Yuan Tian ; Long Rong ; Weidong Nian ; Yan HeSource :
- Alimentary Pharmacology & Therapeutics [ 0269-2813 ] ; 2020.
Descripteurs français
- KwdFr :
- Adulte, Chine (épidémiologie), Diarrhée (virologie), Diarrhée (épidémiologie), Enfant, Flambées de maladies, Fèces (virologie), Humains, Incidence, Infections à coronavirus (), Infections à coronavirus (transmission), Infections à coronavirus (épidémiologie), Maladies gastro-intestinales (virologie), Maladies gastro-intestinales (épidémiologie), Pandémies, Pneumopathie virale (), Pneumopathie virale (transmission), Pneumopathie virale (épidémiologie), Vomissement (virologie), Vomissement (épidémiologie).
- MESH :
- virologie : Diarrhée, Fèces, Maladies gastro-intestinales, Vomissement.
- épidémiologie : Chine, Diarrhée, Infections à coronavirus, Maladies gastro-intestinales, Pneumopathie virale, Vomissement.
- Adulte, Enfant, Flambées de maladies, Humains, Incidence, Infections à coronavirus, Pandémies, Pneumopathie virale.
- Wicri :
- geographic : République populaire de Chine.
English descriptors
- KwdEn :
- Adult, Betacoronavirus, Child, China (epidemiology), Coronavirus Infections (complications), Coronavirus Infections (epidemiology), Coronavirus Infections (transmission), Diarrhea (epidemiology), Diarrhea (virology), Disease Outbreaks, Feces (virology), Gastrointestinal Diseases (epidemiology), Gastrointestinal Diseases (virology), Humans, Incidence, Pandemics, Pneumonia, Viral (complications), Pneumonia, Viral (epidemiology), Pneumonia, Viral (transmission), Vomiting (epidemiology), Vomiting (virology).
- MESH :
- geographic , epidemiology : China.
- complications : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Coronavirus Infections, Diarrhea, Gastrointestinal Diseases, Pneumonia, Viral, Vomiting.
- transmission : Coronavirus Infections, Pneumonia, Viral.
- virology : Diarrhea, Feces, Gastrointestinal Diseases, Vomiting.
- Adult, Betacoronavirus, Child, Disease Outbreaks, Humans, Incidence, Pandemics.
Abstract
There is little published evidence on the gastrointestinal features of COVID‐19.
To report on the gastrointestinal manifestations and pathological findings of patients with COVID‐19, and to discuss the possibility of faecal transmission.
We have reviewed gastrointestinal features of, and faecal test results in, COVID‐19 from case reports and retrospective clinical studies relating to the digestive system published since the outbreak.
With an incidence of 3% (1/41)‐79% (159/201), gastrointestinal symptoms of COVID‐19 included anorexia 39.9% (55/138)‐50.2% (101/201), diarrhoea 2% (2/99)‐49.5% (146/295), vomiting 3.6% (5/138)‐66.7% (4/6), nausea 1% (1/99)‐29.4% (59/201), abdominal pain 2.2% (3/138)‐6.0% (12/201) and gastrointestinal bleeding 4% (2/52)‐13.7% (10/73). Diarrhoea was the most common gastrointestinal symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, and was observed before and after diagnosis. Vomiting was more prominent in children. About 3.6% (5/138)‐15.9% (32/201) of adult and 6.5% (2/31)‐66.7% (4/6) of children patients presented vomiting. Adult and children patients can present with digestive symptoms in the absence of respiratory symptoms. The incidence of digestive manifestations was higher in the later than in the early stage of the epidemic, but no differences in digestive symptoms among different regions were found. Among the group of patients with a higher proportion of severe cases, the proportion of gastrointestinal symptoms in severe patients was higher than that in nonsevere patients (anorexia 66.7% vs 30.4%; abdominal pain 8.3% vs 0%); while in the group of patients with a lower severe rate, the proportion with gastrointestinal symptoms was similar in severe and nonsevere cases (nausea and vomiting 6.9% vs 4.6%; diarrhoea 5.8% vs 3.5%). Angiotensin converting enzyme 2 and virus nucleocapsid protein were detected in gastrointestinal epithelial cells, and infectious virus particles were isolated from faeces. Faecal PCR testing was as accurate as respiratory specimen PCR detection. In 36% (5/14)‐53% (39/73) faecal PCR became positive, 2‐5 days later than sputum PCR positive. Faecal excretion persisted after sputum excretion in 23% (17/73)‐82% (54/66) patients for 1‐11 days.
Gastrointestinal symptoms are common in patients with COVID‐19, and had an increased prevalence in the later stage of the recent epidemic in China. SARS‐CoV‐2 enters gastrointestinal epithelial cells, and the faeces of COVID‐19 patients are potentially infectious.
Url:
DOI: 10.1111/apt.15731
PubMed: 32222988
PubMed Central: 7161803
Affiliations:
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<term>Betacoronavirus</term>
<term>Child</term>
<term>China (epidemiology)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Coronavirus Infections (transmission)</term>
<term>Diarrhea (epidemiology)</term>
<term>Diarrhea (virology)</term>
<term>Disease Outbreaks</term>
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<term>Gastrointestinal Diseases (epidemiology)</term>
<term>Gastrointestinal Diseases (virology)</term>
<term>Humans</term>
<term>Incidence</term>
<term>Pandemics</term>
<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (epidemiology)</term>
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<term>Chine (épidémiologie)</term>
<term>Diarrhée (virologie)</term>
<term>Diarrhée (épidémiologie)</term>
<term>Enfant</term>
<term>Flambées de maladies</term>
<term>Fèces (virologie)</term>
<term>Humains</term>
<term>Incidence</term>
<term>Infections à coronavirus ()</term>
<term>Infections à coronavirus (transmission)</term>
<term>Infections à coronavirus (épidémiologie)</term>
<term>Maladies gastro-intestinales (virologie)</term>
<term>Maladies gastro-intestinales (épidémiologie)</term>
<term>Pandémies</term>
<term>Pneumopathie virale ()</term>
<term>Pneumopathie virale (transmission)</term>
<term>Pneumopathie virale (épidémiologie)</term>
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</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Diarrhea</term>
<term>Gastrointestinal Diseases</term>
<term>Pneumonia, Viral</term>
<term>Vomiting</term>
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<keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
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<keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Diarrhée</term>
<term>Fèces</term>
<term>Maladies gastro-intestinales</term>
<term>Vomissement</term>
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<term>Feces</term>
<term>Gastrointestinal Diseases</term>
<term>Vomiting</term>
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<term>Diarrhée</term>
<term>Infections à coronavirus</term>
<term>Maladies gastro-intestinales</term>
<term>Pneumopathie virale</term>
<term>Vomissement</term>
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<term>Betacoronavirus</term>
<term>Child</term>
<term>Disease Outbreaks</term>
<term>Humans</term>
<term>Incidence</term>
<term>Pandemics</term>
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<term>Enfant</term>
<term>Flambées de maladies</term>
<term>Humains</term>
<term>Incidence</term>
<term>Infections à coronavirus</term>
<term>Pandémies</term>
<term>Pneumopathie virale</term>
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<front><div type="abstract" xml:lang="en"><title>Summary</title>
<sec id="apt15731-sec-0001"><title>Background</title>
<p>There is little published evidence on the gastrointestinal features of COVID‐19.</p>
</sec>
<sec id="apt15731-sec-0002"><title>Aims</title>
<p>To report on the gastrointestinal manifestations and pathological findings of patients with COVID‐19, and to discuss the possibility of faecal transmission.</p>
</sec>
<sec id="apt15731-sec-0003"><title>Methods</title>
<p>We have reviewed gastrointestinal features of, and faecal test results in, COVID‐19 from case reports and retrospective clinical studies relating to the digestive system published since the outbreak.</p>
</sec>
<sec id="apt15731-sec-0004"><title>Results</title>
<p>With an incidence of 3% (1/41)‐79% (159/201), gastrointestinal symptoms of COVID‐19 included anorexia 39.9% (55/138)‐50.2% (101/201), diarrhoea 2% (2/99)‐49.5% (146/295), vomiting 3.6% (5/138)‐66.7% (4/6), nausea 1% (1/99)‐29.4% (59/201), abdominal pain 2.2% (3/138)‐6.0% (12/201) and gastrointestinal bleeding 4% (2/52)‐13.7% (10/73). Diarrhoea was the most common gastrointestinal symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, and was observed before and after diagnosis. Vomiting was more prominent in children. About 3.6% (5/138)‐15.9% (32/201) of adult and 6.5% (2/31)‐66.7% (4/6) of children patients presented vomiting. Adult and children patients can present with digestive symptoms in the absence of respiratory symptoms. The incidence of digestive manifestations was higher in the later than in the early stage of the epidemic, but no differences in digestive symptoms among different regions were found. Among the group of patients with a higher proportion of severe cases, the proportion of gastrointestinal symptoms in severe patients was higher than that in nonsevere patients (anorexia 66.7% vs 30.4%; abdominal pain 8.3% vs 0%); while in the group of patients with a lower severe rate, the proportion with gastrointestinal symptoms was similar in severe and nonsevere cases (nausea and vomiting 6.9% vs 4.6%; diarrhoea 5.8% vs 3.5%). Angiotensin converting enzyme 2 and virus nucleocapsid protein were detected in gastrointestinal epithelial cells, and infectious virus particles were isolated from faeces. Faecal PCR testing was as accurate as respiratory specimen PCR detection. In 36% (5/14)‐53% (39/73) faecal PCR became positive, 2‐5 days later than sputum PCR positive. Faecal excretion persisted after sputum excretion in 23% (17/73)‐82% (54/66) patients for 1‐11 days.</p>
</sec>
<sec id="apt15731-sec-0005"><title>Conclusions</title>
<p>Gastrointestinal symptoms are common in patients with COVID‐19, and had an increased prevalence in the later stage of the recent epidemic in China. SARS‐CoV‐2 enters gastrointestinal epithelial cells, and the faeces of COVID‐19 patients are potentially infectious.</p>
</sec>
</div>
</front>
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