Attaching clinical significance to COVID-19-associated diarrhea
Fantao Wang1, Shiliang Zheng2, Chengbin Zheng3
1Department of Stomatology, Affiliated Hospital of Weifang Medical University, Weifang, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China.
Insights
Diarrhea in COVID-19 patients, caused by SARS-CoV-2 intestinal invasion, is linked to worse outcomes. Early recognition and management of this gastrointestinal symptom are crucial for better patient prognoses.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Virology
Background:
- The COVID-19 pandemic caused widespread health and economic issues.
- Gastrointestinal symptoms, including diarrhea, occur in some COVID-19 patients.
- The clinical features and prognosis of COVID-19-associated diarrhea require further investigation.
Purpose of the Study:
- To review the incidence, pathogenesis, clinical characteristics, fecal virus shedding, prognosis, and influencing factors of COVID-19-associated diarrhea.
- To highlight the importance of recognizing and managing diarrhea in COVID-19 patients.
Main Methods:
- Literature review of medical studies on COVID-19 and diarrhea.
- Analysis of reported incidence, clinical data, and viral shedding patterns.
Main Results:
- Diarrhea incidence in COVID-19 patients ranges from 2% to 49.5%.
- SARS-CoV-2 invades small intestinal cells expressing ACE-2, causing damage and prolonged fecal viral shedding.
- Diarrhea disrupts gut flora, correlating with increased disease severity and poorer prognosis.
Conclusions:
- COVID-19-associated diarrhea stems from direct viral invasion of the gut.
- This symptom is linked to more severe illness and worse outcomes.
- Clinicians must be alert to COVID-19 diarrhea and develop targeted prevention and treatment strategies, especially for patients with positive fecal tests and gut dysbiosis.
Abstract:
The Corona Virus Disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), erupted in 2020 and created severe public health and socioeconomic challenges worldwide. A subset of patients, in addition to presenting with typical features such as fever, cough and dyspnea, was also afflicted with diarrhea. However, the clinical features and prognoses related to COVID-19-associated diarrhea have not attracted sufficient attention. This review of the medical literature examines the incidence, pathogenesis, clinical characteristics, fecal virus changes, prognoses and influencing factors of COVID-19-associated diarrhea. The reported incidence of diarrhea in patients with COVID-19 ranged from 2% to 49.5%. The main cause of diarrhea was found to be invasive by SARS-CoV-2 of ACE-2-expressing epithelial cells of the small intestine, causing local intestinal damage. This cellular invasion may be the key factor for the much longer duration of SARS-CoV-2 positivity observed for feces compared to pharyngeal swabs. The associated diarrhea in these patients upsets the balance of intestinal flora, resulting in more-severe disease intensity and worse prognosis. Clinicians should be vigilant to this kind of COVID-19-associated diarrhea, and design more effective prevention and treatment options for patients with positive fecal nucleic acid tests and intestinal microflora disorders.
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