Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis.
2019 冠状病毒病患者胃肠道症状和粪便病毒脱落的患病率: 系统综述和荟萃分析。
- 作者列表："Parasa S","Desai M","Thoguluva Chandrasekar V","Patel HK","Kennedy KF","Roesch T","Spadaccini M","Colombo M","Gabbiadini R","Artifon ELA","Repici A","Sharma P
Importance:Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. Objective:To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19. Data Sources:An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included "COVID-19," "SARS-Cov-2," and/or "novel coronavirus." Study Selection:Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms. Data Extraction and Synthesis:Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2). Main Outcomes and Measures:Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed. Results:Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted. Conclusions and Relevance:These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen.
重要性: 冠状病毒病 2019 (新型冠状病毒肺炎) 是一种全球性流行病，可累及胃肠道 (GI)，包括腹泻和粪便中新型冠状病毒冠状病毒 2 (SARS-CoV-2) 脱落等症状。 目的: 在SARS-CoV-2 患者中提供GI症状、参考范围外的肝酶水平和粪便试验阳性的新型冠状病毒肺炎的汇总估计。 数据来源: 对 2019 年 11 月 1 日进行的已发表 (使用MEDLINE/PubMed和Embase) 和预印本 (使用bioRxiv和medRxiv) 感兴趣的研究进行了电子文献检索，至 2020 年 3 月 30 日。检索词包括 “新型冠状病毒肺炎” 、 “SARS-Cov-2” 和/或 “新型冠状病毒”。 研究选择: 符合条件的研究包括那些报告胃肠道症状的SARS-CoV-2 感染患者。 数据提取与综合: 提取胃肠道症状 (即腹泻、恶心或呕吐) 、肝酶水平变化和粪便病毒脱落患者的数据。使用非随机研究的方法学指标检查研究质量。合并估计 (%) 报告了 95% 个ci的异质性水平 (I2)。 主要结局和措施: 分析了腹泻、恶心或呕吐、肝酶水平超出参考范围和粪便试验SARS-CoV-2 阳性的合并检出率的研究和患者特征。 结果: 在回顾的 1484 项记录中，23 项已发表和 6 项预印本研究被纳入分析，共有 4805 例患者 (平均 [SD] 年龄，52.2 [14.8] 岁; 1598 [33.2%] 女性) 新型冠状病毒肺炎。报告腹泻的患者的汇总率为 7.4% (95% CI，4.3%-12.2%)，报告恶心或呕吐的患者为 4.6% (95% CI，2.6%-8.0%)。参考范围外天冬氨酸氨基转移酶水平的合并率为 20% (95% CI，15.3%-25.6%) 的患者，参考范围外丙氨酸氨基转移酶水平的合并率为 14.6% (95% CI，12.8%-16.6%) 的患者。8 项研究报告了SARS-CoV-2 阳性的粪便检测，40.5% (95% CI，27.4%-55.1%) 的患者粪便中检测到病毒RNA脱落。存在高水平的异质性 (I2 = 94%)，但未注意到统计学显著的发表偏倚。 结论和相关性: 这些研究结果表明，12% 的新型冠状病毒肺炎患者会表现出GI症状; 然而，在 40.5% 的确诊SAR-CoV-2 感染患者中观察到SARS-CoV-2 脱落。这突出表明需要更好地了解需要采取哪些措施来防止这种高传染性病原体的进一步传播。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.