May GI Symptoms Be Overlooked in Coronavirus Cases?
Who is infected with 2019 novel Coronavirus (2019-nCoV)?

Gastrointestinal symptoms, which had not been considered primary clinical features of the novel coronavirus were observed within the first U.S. case of the illness, researchers found.

Coronavirus RNA was detected within the patient’s stool sample on day 7 after illness, and therefore the patient’s clinical symptoms included a 2-day history of nausea and vomiting before admission, consistent with Michelle Holshue, MPH, of the CDC in Atlanta, and colleagues.

The patient, age 35, presented with these gastrointestinal (GI) symptoms and dry cough, but no shortness of breath or pain. On the second day of hospitalization, the patient passed a loose movement and reported abdominal discomfort, they stated during a brief report within the New England Journal of Drugs.

Similarly, another NEJM report found that the adult son, age 27, of the family cluster of cases in Vietnam, also reported GI symptoms before admission, including fever, vomiting, and loose stools.

Susan Kline, MD, spokesperson for the Infectious Diseases Society of America, told MedPage Today that other coronaviruses might be shed in the stool, although there’s not much known about this virus at now.

But GI symptoms are often a clinical feature of coronaviruses and were “not unusual” during the SARS outbreak, she added.

Specifically, Kline noted prior research that SARS may are transmitted through the sewer system during a Hong Kong apartment house, where the index patient had diarrhea and used the restroom there, the virus spreading through both person-to-person contact and environmental contamination, researchers noted.

And it isn’t just coronaviruses. Kline said that while not thought of because of the predominant presentation, several illnesses have featured vomiting and diarrhea, like influenza and even Ebola.

“It wasn’t recognized early that [Ebola] patients had prominent diarrhea. Later, as [there were] reports of huge numbers of patients, it became more obvious that it might be a predominant a part of the illness,” she said.

Kline added that within the case of SARS, it had been helpful to possess information about nausea, vomiting, and diarrhea, because up until that time, those symptoms hadn’t been emphasized within the “patients under investigation” definition.

The same could be true for novel coronavirus.

“I think it might be helpful to possess some additional comments there that patients may have gastrointestinal symptoms,” she said. “That would be helpful for clinicians to possess, in order that they could a minimum of considering that a patient with novel coronavirus may need vomiting or diarrhea.”

However, in terms of a novel coronavirus, Kline said that it is vital to not assume that each one patient are having these symptoms, as illnesses never have uniform symptoms and there is often “quite a spectrum of disease.”

Holshue and colleagues wrote that detection of novel coronavirus RNA on days 4 and seven within the upper tract is “suggestive of high viral loads and potential for transmissibility.” They also found that while the patient’s serum tested negative for novel coronavirus, “viral RNA has been detected in severely ill patients in China,” but that the clinical significance of detecting viral RNA outside the tract is “unknown” at this point.

They detailed the progress of the patient’s illness, starting with mild symptoms, eventually ending up with pneumonia on day 9, with the onset of dyspnea, or shortness of breath, on day 8. Researchers noted the patient was treated with redelivering for compassionate use, though randomized trials are needed to work out its safety and effectiveness in patients with novel coronavirus, they added.

As of January 30, the patient is described as afebrile, with all symptoms resolving with the exception of his cough. He remains hospitalized.

“Some seem pretty mild, a minimum of some are been more severely ill [and] there are some ups and downs,” she said, adding that thus far, there are no deaths from novel coronavirus within the U.S.

Currently, there are 167 patients under investigation within the U.S., with test results pending on 82 patients.

Who are infected with the 2019 novel coronavirus (2019-nCoV)?

If you have traveled from China within the last 14 days, you should continue to be vigilant about monitoring yourself for fever and lower respiratory symptoms such as cough and shortness of breath. However, not all affected individuals will exhibit all symptoms, and if you have any symptoms at all.
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