COVID-19 Diarrhea

Hugh James Freeman^1,

¹Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada

Cite this paper:
Hugh James Freeman. COVID-19 Diarrhea. International Journal of Celiac Disease. 2020; 8(2):60-63. doi: 10.12691/ijcd-8-2-6

Abstract

In 2019, a novel virus emerged in Wuhan, China that caused a febrile respiratory illness, sometimes rapidly fatal and thought to be transmitted by droplet contact. It likely originated from another species (possibly the bat), but later, spread occurred from human-to-human. Over a period of months, this disease disseminated to more than 100 nations as a highly infectious pandemic, reminiscent of disease associated with other coronavirus agents in 2002 (SARS) and 2012 (MERS). This COVID-19 virus also caused other forms of clinical illness, albeit in the minority, and most infected patients (over 50%) had few symptoms or remained completely asymptomatic. Prominent in some patients was watery diarrhea, often lasting less than a week, but sometimes without any respiratory features, such as fever, cough or shortness of breath. It is believed that fecal-oral transmission may result. The virus attaches to the surface of human respiratory and intestinal cells, gains entry into these cells, ultimately leading to production of new virions intraluminally. Fecal shedding may occur for extended periods, even after respiratory secretions become negative. Apart from preventive measures, vaccine development remains the most important strategy.

Keywords:
Covid-19 coronavirus ACE-2 Receptors fecal shedding

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References:

[1]	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
[2]	World Health Organization. Coronavirus disease (COVID-19) outbreak (https://www.who.int).
[3]	Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel corona virus: implications for virus origins and receptor binding. Lancet 2020; 395: 565-574.
[4]	Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733.
[5]	Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158: 1518-1519.
[6]	Zhong NS, Zheng BJ, Li YM, et al. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People’s Republic of China, in February 2003. Lancet 2003; 363: 1353-1358.
[7]	Ksiazek TG, Erdman D, Goldsmith CD, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003; 348: 1953-1966.
[8]	Drosten C, Gunther S, Preiser W, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 2003; 348: 1967-1976.
[9]	Zaki AM, van Boheemen S, Bestebroer TM, et al. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367:1814-1820.
[10]	World Health Organization. Coronavirus disease (COVID-19) technical guidance: laboratory testing for 2019-nCoV in humans (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance//laboratory-guidance).
[11]	Guan W, Ni Z, Hu Y, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med 2010; 382:1708-1720.
[12]	Wang X, Fang J, Zhu Y, et al. Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID-19) in a Fangcang Hospital. Clin Microbiol Infect 2020; In press.
[13]	Giacomelli A, Pezzati L, Conti F, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis 2020; ciaa330.
[14]	Eliezer M, Hautefort C, Hamel AL, et al. Sudden and complete olfactory loss function as a possible symptom of covid-19. JAMA Otolaryngol Head Neck Surg 2020.
[15]	Biadsee A, Biadsee A, Kassem F, et al. Olfactory and oral manifestations of COVID-19: sex-related symptoms—a potential pathway to early diagnosis. Otolaryngol Head Neck Surg 2020; 1-7
[16]	Netland J, Meyerholz DK, Moore S, et al. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol 2008; 82: 7264-7275.
[17]	Poyiadji N, Shahin G, Noujaim D, et al. Covid-19-associated acute hemorrhagic necrotizing encepathopathy: CT and MRI features. Radiology 2020; 201187.
[18]	Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (covid-19). JAMA Cardiol 2020; In press.
[19]	Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062.
[20]	Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (covid-19) in Hubei Province, China. JAMA Ophthalmol 2020; In press.
[21]	Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382: 929-936.
[22]	Xiao F, Tang M, Zheng X, et al. Evidence fo gastrointestinal infection of SARS-Cov-2. Gastroenterology 2020; 158: 1831-1833.
[23]	Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579: 270-273.
[24]	Harmer D, Gilbert M, Borman R, et al. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett 2002; 532:107-110.
[25]	Yan R, Zhang Y, Li Y, et al. Structural basis for the recognition of SARS-CoV-2 by full length human ACE2. Science 2020; 367: 1444-1448.
[26]	Mancia G, Rea F, Ludergnani M, et al. Renin-angiotensin-aldosterone blockers and the risk of Covid-19. N Engl J Med 2020; 382: 2431-2440.
[27]	Reynolds HR, Adhikari S, Pulgarin C, et al. Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19. N Engl J Med 2020; 382: 2441-2448.
[28]	D’Amico F, Baumgart DC, Danese S, et al. Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention, and management. Clin Gastroenterol Hepatol 2020; 18: 1663-1672.
[29]	Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; In press.
[30]	Hashimoto T, Perlot T, Rehman A, et al. ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation. Nature 2012; 487: 477-481.
[31]	Chan JF-W, Yuan S, Kok K-H, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395: 514-523.
[32]	Mo P, Xing Y, Xiao Y, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis 2020; In press.
[33]	Aroniadis OC, DiMaio CJ, Dixon RE, et al. Current knowledge and research priorities in the digestive manifestations of COVID-19. Clin Gastroenterol Hepatol 2020; 18: 1682-1684.