Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
New data from Chinese colleagues working at the forefront of the COVID-19 outbreak, and studies of earlier viral outbreaks, provide important insight into the hepatotoxic and gastrointestinal implications of this pandemic.
Respiratory symptoms are the most common presentation, but they're not the only early signs of COVID-19. Diarrhea, nausea, vomiting, and abdominal pain were well documented and often preceded respiratory symptoms in a subset of 138 consecutive hospitalized patients in Wuhan, China.
A recently published study also indicates that COVID-19 was detected in the stool of over 50% of infected hospitalized patients. Investigators found that the lamina propria of the stomach, duodenum, and rectum was edematous with infiltrating plasma cells and lymphocytes. Viral host receptor angiotensin-converting enzyme 2 (ACE2) and viral nucleocapsid protein stained positive in specimens, making gastrointestinal infection with COVID-19—and fecal-oral transmission—likely. Fecal shedding of viral RNA was also found in 20% of patients with COVID-19, despite real-time reverse transcriptase polymerase chain reaction testing from two sequential respiratory tract specimens collected at least 24 hours apart being negative. These results have a clear impact regarding transmission precautions, especially in hospitalized patients.
Liver impairment is another emerging concern with COVID-19, as it was with the similar novel coronavirus,
New Pandemic Peril? Pretending It's Over as Case Numbers Rise
COMMENTARY
COVID-19's Impact -- Don't Overlook the Liver
Nancy S. Reau, MD
DisclosuresMarch 20, 2020
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
New data from Chinese colleagues working at the forefront of the COVID-19 outbreak, and studies of earlier viral outbreaks, provide important insight into the hepatotoxic and gastrointestinal implications of this pandemic.
Respiratory symptoms are the most common presentation, but they're not the only early signs of COVID-19. Diarrhea, nausea, vomiting, and abdominal pain were well documented and often preceded respiratory symptoms in a subset of 138 consecutive hospitalized patients in Wuhan, China.
A recently published study also indicates that COVID-19 was detected in the stool of over 50% of infected hospitalized patients. Investigators found that the lamina propria of the stomach, duodenum, and rectum was edematous with infiltrating plasma cells and lymphocytes. Viral host receptor angiotensin-converting enzyme 2 (ACE2) and viral nucleocapsid protein stained positive in specimens, making gastrointestinal infection with COVID-19—and fecal-oral transmission—likely. Fecal shedding of viral RNA was also found in 20% of patients with COVID-19, despite real-time reverse transcriptase polymerase chain reaction testing from two sequential respiratory tract specimens collected at least 24 hours apart being negative. These results have a clear impact regarding transmission precautions, especially in hospitalized patients.
Liver impairment is another emerging concern with COVID-19, as it was with the similar novel coronavirus,
Medscape Gastroenterology © 2020 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: COVID-19's Impact -- Don't Overlook the Liver - Medscape - Mar 20, 2020.
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Authors and Disclosures
Authors and Disclosures
Author
Nancy S. Reau, MD
Professor, Department of Internal Medicine, Rush University; Section Chief, Hepatology; Associate Director of Organ Transplant, Rush University Medical Center, Chicago, Illinois
Disclosure: Nancy S. Reau, MD, has disclosed the following financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie Inc.; Gilead Sciences, Inc.; Bristol-Myers Squibb Company; Merck & Co., Inc.; Intercept Pharmaceuticals, Inc.
Received income in an amount equal to or greater than $250 from: American Board of Internal Medicine