COVID-19 and the gastrointestinal tract: emerging clinical data

Prevalence and Severity of Gastrointestinal Symptoms in COVID-19 Patients in Casablanca: A Retrospective Cohort Study

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.

Trends in non-pharmaceutical intervention (NPI) related community practice for the prevention of COVID-19 in Addis Ababa, Ethiopia

BACKGROUND

The COVID-19 pandemic has affected Ethiopia since March 13, 2020, when the first case was detected in Addis Ababa. Since then, the incidence of cases has continued to increase day by day. As a result, the health sector has recommended universal preventive measures to be practiced by the public. However, studies on adherence to these preventive measures are limited.

OBJECTIVE

To monitor the status of preventive practices of the population related to hand washing, physical distancing, and respiratory hygiene practices at selected sites within the city of Addis Ababa.

METHODS

Weekly cross-sectional non-participatory observations were done during the period of April-June, 2020. Data was collected using the Open Data Kit (ODK) tool in ten public sites involving eight public facilities targeted for individual observations. Ten individuals were randomly observed at each facility over two days a week at peak hours of public services. WHO operational definitions of the preventive behaviors were adopted for this study. Observations were conducted anonymously at gates or entrances of public facilities and places.

RESULTS

A total of 12,056 individual observations with 53% males and 82% in an estimated age range of 18-50 years age group were involved in this study. There was an increase in the practice of respiratory hygiene from 14% in week one to 77% in week 10, while those of hand hygiene and physical distancing changed little over the weeks from their baseline of 24% and 34%, respectively. Overall, respiratory hygiene demonstrated an increased rate of 6% per week, while hand hygiene and physical distancing had less than a 1% change per week, Females and the estimated age group of 18-50 years had practice changes in respiratory hygiene with no difference in hand hygiene and physical distancing practices. Respiratory hygiene took about six weeks to reach a level of 77% from its baseline of 24%, making an increment of about 9% per week.

CONCLUSION

The public practice of respiratory hygiene improved threefold whereas hand hygiene and physical distancing revealed no change. Regularly sustained public mobilization and mass education are required to sustain the achievements gained in respiratory hygiene and further hand hygiene and physical distancing.

Alimentary system is directly attacked by SARS-COV-2 and further prevents immune dysregulation caused by COVID-19

BACKGROUND

SARS-COV-2 causes digestive system symptom, the effect of which remains equivocal.

METHODS

Patients with COVID-19 were classified into four groups according to symptom. The study traced the onset and duration of symptoms, compared laboratory examinations and conducted bioinformatic analysis. Immune indices were further analysed.

RESULTS

By March 16, 25 patients with COVID-19 and 13 with suspect COVID-19 were admitted to West China Hospital, Sichuan University. Digestive system symptom group had the highest level of ESR (mm/h, P < .0001), serum ferritin (ng/ml, P < .0001), hepatic enzymes (P < .05) and retentive lymphocyte count/percentage (P < .05) and its subsets (P < .05). Combined group (respiratory combined with subsequent digestive system symptom) had the highest level of IL-6 (pg/ml, P = .0046), CRP (mg/L, P = .0004) and moderate lymphocyte depletion. Respiratory system symptom and asymptomatic groups suffered the most from lymphocyte depletion (P < .05). Bioinformatic analysis indicated co-expression of binding related proteins of SARS-COV-2 (ACE2, TMPRSS2 and Furin) in small intestine. CD147 was extensively expressed in alimentary tract. CTSL, PIKfyve, TPC2 and CTSB could be detected with ≥moderate expressions in a variety of organs including alimentary system.

CONCLUSIONS

Alimentary system is possibly attacked by SARS-COV-2 other than hyperinflammation or immune dysregulation caused by it. Involvement of alimentary system might further protect mild and moderate cases from lymphocyte depletion caused by COVID-19.

Cytomegalovirus-Induced Gastrointestinal Bleeding and Pancreatitis Complicating Severe Covid-19 Pneumonia: A Paradigmatic Case

COVID-19 is a new pandemic disease whose pathophysiology and clinical description are still not completely defined.

Besides respiratory symptoms and fever, gastrointestinal (GI) symptoms (including especially anorexia, diarrhea, and abdominal pain) represent the most frequent clinical manifestations.

Emerging data point out that severe SARS-CoV-2 infection causes an immune dysregulation, which in turn may favor other infections.

Here we describe a patient with severe COVID-19 pneumonia who developed in the resolving phase abdominal pain associated with cytomegalovirus (CMV)-induced duodenitis with bleeding and pancreatitis.

A high level of suspicion toward multiple infections, including CMV, should be maintained in COVID-19 patients with heterogeneous clinical manifestations.