Advertisement

Diarrhea Is Associated With Prolonged Symptoms and Viral Carriage in Corona Virus Disease 2019

  • Xiao-Shan Wei
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Xu Wang
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Yi-Ran Niu
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Lin-Lin Ye
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Wen-Bei Peng
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Zi-Hao Wang
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Wei-Bing Yang
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Bo-Han Yang
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Jian-Chu Zhang
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Wan-Li Ma
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Xiao-Rong Wang
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
  • Qiong Zhou
    Correspondence
    Reprint requests Address requests for reprints to: Qiong Zhou, PhD, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China. fax: (86) 27-85726527.
    Affiliations
    Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    Search for articles by this author
Published:April 17, 2020DOI:https://doi.org/10.1016/j.cgh.2020.04.030

      Background & Aims

      We compared clinical, laboratory, radiological, and outcome features of patients with SARS-CoV-2 infection (COVID-19) with pneumonia, with vs without diarrhea.

      Methods

      We performed a retrospective, single-center analysis of 84 patients with SARS-CoV-2 pneumonia in Wuhan Union Hospital, China, from January 19 through February 7, 2020. Cases were confirmed by real-time reverse-transcriptase PCR of nasal and pharyngeal swab specimens for SARS-CoV-2 RNA. Blood samples were analyzed for white blood cell count, lymphocyte count, alanine aminotransferase, creatine kinase, lactate dehydrogenase, D-dimer, C-reactive protein, and in some cases, immunoglobulins, complement, lymphocyte subsets, and cytokines. Virus RNA was detected in stool samples by real-time PCR.

      Results

      Of the 84 patients with SARS-CoV-2 pneumonia, 26 (31%) had diarrhea. The duration of fever and dyspnea in patients with diarrhea was significantly longer than those without diarrhea (all P < .05). Stool samples from a higher proportion of patients with diarrhea tested positive for virus RNA (69%) than from patients without diarrhea (17%) (P < .001). As of February 19, a lower proportion of patients with diarrhea had a negative result from the latest throat swab for SARS-CoV-2 (77%) than patients without diarrhea (97%) (P = .010), during these patients’ hospitalization. Of 76 patients with a negative result from their latest throat swab test during hospitalization, a significantly higher proportion of patients with diarrhea had a positive result from the retest for SARS-CoV-2 in stool (45%) than patients without diarrhea (20%) (P = .039).

      Conclusions

      At a single center in Wuhan, China, 31% of patients with SARS-CoV-2 pneumonia had diarrhea. A significantly higher proportion of patients with diarrhea have virus RNA in stool than patients without diarrhea. Elimination of SARS-CoV-2 from stool takes longer than elimination from the nose and throat.

      Keywords

      Abbreviations used in this paper:

      ACE2 (angiotensin-converting enzyme 2), COVID-19 (corona virus disease 2019), CT (computed tomography), RT-PCR (reverse transcriptase polymerase chain reaction), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), WHO (World Health Organization)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Guan W.-j.
        • Ni Z.-y.
        • Hu Y.
        • et al.
        Clinical characteristics of 2019 novel coronavirus infection in China.
        medRxiv. 2020; (2020.02.06.20020974)
        • Rothe C.
        • Schunk M.
        • Sothmann P.
        • et al.
        Transmission of 2019-nCoV infection from an asymptomatic contact in Germany.
        N Engl J Med. 2020; 382: 970-971
        • Holshue M.L.
        • DeBolt C.
        • Lindquist S.
        • et al.
        First case of 2019 novel coronavirus in the United States.
        N Engl J Med. 2020; 382: 929-936
      1. nCo VNIRST. 2019-nCoV acute respiratory disease, Australia: epidemiology report 1 (reporting week 26 January - 1 February 2020).
        Commun Dis Intell (2018). 2020; : 44
      2. WHO main website.
        (Available at:)
        https://www.who.int
        Date accessed: April 10, 2020
        • 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
        • Chen N.
        • Zhou M.
        • Dong X.
        • et al.
        Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.
        Lancet. 2020; 395: 507-513
        • Wang D.
        • Hu B.
        • Hu C.
        • et al.
        Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China.
        JAMA. 2020; 323: 1061-1069
        • Yang Y.
        • Lu Q.
        • Liu M.
        • et al.
        Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China.
        medRxiv. 2020; (2020.02.10.20021675)
      3. Coronavirus disease (COVID-19) technical guidance: laboratory testing for 2019-nCoV in humans.
        (Available at:)
        • Zhou P.
        • Yang X.-L.
        • Wang X.-G.
        • et al.
        A pneumonia outbreak associated with a new coronavirus of probable bat origin.
        Nature. 2020; 579: 270-273
        • Wu F.
        • Zhao S.
        • Yu B.
        • et al.
        A new coronavirus associated with human respiratory disease in China.
        Nature. 2020; 579: 265-269
        • Gu J.
        • Gong E.
        • Zhang B.
        • et al.
        Multiple organ infection and the pathogenesis of SARS.
        J Exp Med. 2005; 202: 415-424
        • Hoffmann M.
        • Kleine-Weber H.
        • Krüger N.
        • et al.
        The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells.
        bioRxiv. 2020; (2020.01.31.929042)
        • Zhao Y.
        • Zhao Z.
        • Wang Y.
        • et al.
        Single-cell RNA expression profiling of ACE2, the putative receptor of Wuhan 2019-nCov.
        bioRxiv. 2020; (2020.01.26.919985)
        • Zhang H.
        • Kang Z.
        • Gong H.
        • et al.
        The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes.
        bioRxiv. 2020; (2020.01.30.927806)
        • Ettayebi K.
        • Crawford S.E.
        • Murakami K.
        • et al.
        Replication of human noroviruses in stem cell–derived human enteroids.
        Science. 2016; 353: 1387-1393
        • Desmarets L.M.D.
        • Theuns T.
        • Roukaerts I.D.
        • et al.
        Role of sialic acids in feline enteric coronavirus infections.
        J Gen Virol. 2014; 95: 1911-1918
        • Evans M.
        • Salewski R.P.
        • Christman M.C.
        • et al.
        Effectiveness of Lactobacillus helveticus and Lactobacillus rhamnosus for the management of antibiotic-associated diarrhoea in healthy adults: a randomised, double-blind, placebo-controlled trial.
        Br J Nutr. 2016; 116: 94-103
        • de Gunzburg J.
        • Ghozlane A.
        • Ducher A.
        • et al.
        Protection of the human gut microbiome from antibiotics.
        J Infect Dis. 2018; 217: 628-636
        • Gonzalez-Perez G.
        • Hicks A.L.
        • Tekieli T.M.
        • et al.
        Maternal antibiotic treatment impacts development of the neonatal intestinal microbiome and antiviral immunity.
        J Immunol. 2016; 196: 3768-3779
        • McAleer J.P.
        • Kolls J.K.
        Contributions of the intestinal microbiome in lung immunity.
        Eur J Immunol. 2018; 48: 39-49