Journal Article

Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes

Wang, Weijun, Ding, Zhen, Lin, Rong, Han, Chaoqun, Duan, Caihan, Hou, Xiaohua, Zhang, Shengyan, Spiegel, Brennan, Shi, Huiying, Zhang, Lei, Liu, Jun

2020

Overview

Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms.

• Publisher: Wolters Kluwer,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Betacoronavirus - isolation & purification / China - epidemiology / Clinical Laboratory Techniques - methods / Coronavirus Infections - complications / Coronavirus Infections - diagnosis / Coronavirus Infections - epidemiology / Coronaviruses / COVID-19 / COVID-19 diagnostic tests / COVID-19 Testing / Diarrhea / Diarrhea - diagnosis / Diarrhea - etiology / Digestive System Diseases - diagnosis / Digestive System Diseases - physiopathology / Digestive System Diseases - virology / Disease transmission / Feces - virology / Female / Fever / Gastroenterology / Hospitals / Humans / Illnesses / Male / Middle Aged / Nausea / Outcome Assessment, Health Care / Pandemics / Patients / Pneumonia, Viral - complications / Pneumonia, Viral - diagnosis / Pneumonia, Viral - epidemiology / Quarantine / RNA, Viral - analysis / SARS-CoV-2 / Severity of Illness Index / Statistical analysis / Symptom Assessment - methods / Variables