Clinical Course of a Covid-19 Patient with Gastrointestinal Symptoms- A Case Report

  • Sidra Agarwal
  • Hemanshi Mistry
Keywords: COVID-19, SARS-COV 2, Pandemic, gastrointestinal manifestations, PCR testing, rRT-PCR testing, Gastrointestinal symptoms, ACE2 receptor, Fecal-oral transmission, case report

Abstract

Background: COVID-19 most commonly presents with respiratory symptoms. However, it can involve the gastrointestinal tract causing symptoms like diarrhea and the resultant shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. This is due to the virus adhering to angiotensin-converting enzyme 2 receptors largely present in the gastrointestinal tract. This case report recommends routine stool Real-Time Reverse Polymerase Chain Reaction (rRT-PCR) testing for patients presenting with gastrointestinal symptoms.

The Case: A healthy 36-year-old male healthcare worker in New York who tested positive for SARS-CoV-2 infection through rRT-PCR of the nasopharyngeal swab. After 7 days of convalescence, he recovered from influenza like symptoms after which he predominantly developed diarrhea, nausea, vomiting and extreme fatigue. Cough was the only lower respiratory symptom during the 3rd week of the clinical course. Anosmia or ageusia preceding the onset of respiratory symptoms was also reported. Due to the outbreak of the pandemic and New York being the epicenter at the time, the patient was recommended to self-isolate with supportive management through antipyretics and electrolyte replacement.

Conclusion: This case highlights a SARS-CoV-2 PCR positive patient with predominant gastrointestinal symptoms. The reports regarding virus shedding in feces suggest that SARS-CoV-2 could be transmitted via fecal-oral route and thus routine stool rRT-PCR testing can aid in transmission-based precautions. Furthermore, reports of viral ribonucleic acid present in the stool, suggests direct infectivity of the virus on the intestinal tract. Therefore, screening in patients with only gastrointestinal symptoms can potentially help to contain the virus spread.

Author Biography

Sidra Agarwal

MBBS

References

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb;382(8):727‐733.

Parasa S, Desai M, Thoguluva Chandrasekar V, Patel H, Kennedy K, Roesch T, et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Jun 1;3(6):e2011335.

Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020 Apr;46(4):586-590.

Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020 May;51(9):843-851.

Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol. 2020 Jun;115(6):916-923.

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H, et al. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831‐1833.e3.

Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html.

Arslan M, Xu B, Gamal El-Din M. Transmission of SARS-CoV-2 via fecal-oral and aerosols-borne routes: Environmental dynamics and implications for wastewater management in underprivileged societies. Sci Total Environ. 2020 Jul 3;743:140709.

Zhang H, Kang Z, Gong H, Xu D, Wang J, Li Z, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. Preprint. Posted online January 31, 2020. bioRxiv 2020.01.30.927806.

Ma C, Cong Y, Zhang H. COVID-19 and the Digestive System. Am J Gastroenterol. 2020 May 22:10.14309/ajg.0000000000000691.

Ding S, Liang TJ. Is SARS-CoV-2 Also an Enteric Pathogen With Potential Fecal-Oral Transmission? A COVID-19 Virological and Clinical Review. Gastroenterology. 2020 Apr 27:S0016-5085(20)30571-0.

Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020 May;115(5):766-773.

Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al.; Washington State 2019-nCoV Case Investigation Team. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020 Mar 5;382(10):929-936.

Published
2020-08-31
How to Cite
Sidra Agarwal, & Hemanshi Mistry. (2020). Clinical Course of a Covid-19 Patient with Gastrointestinal Symptoms- A Case Report. International Journal of Medical Students, 8(2), 148-151. https://doi.org/10.5195/ijms.2020.617
Section
Case Report