Virus discharge and initial gastrointestinal involvement are negatively associated with circulating lymphocyte count in COVID-19

Abstract Background: It’s reported SARS-CoV-2 could transmit via gastrointestinal tract, with or without pulmonary symptoms. However, as far as we know, there is no convenient marker to predict the virus discharge in stool and initial gastrointestinal involvement of COVID-19.Aims: We aimed to investigate the biomarker predicting virus discharge in stool and initial gastrointestinal involvement of COVID-19, which may assist the clinicians to better combat and prevent COVID-19.Methods: The patients complained of initial gastrointestinal involvement, including vomiting, diarrhea, with or without respiratory symptoms, attending the Sixth People’s Hospital of Wenzhou, and the Second Affiliated Hospital of Wenzhou Medical University, were screened by qRT-PCR for SARS-CoV-2. The Confirmed COVID-19 patients without contaminated ingestion were all enrolled to investigate the association between circulating lymphocyte count and virus discharge, initial gastrointestinal involvement.Results: 76 COVID-19 patients were finally enrolled in this study (mean age 44.5, male 44.7%), with 24 (31.5%) complained of initial gastrointestinal symptoms. Significantly lower circulating lymphocyte count was found in the patients with positive results of qRT-PCR on stool (p = 0.012). Furthermore, when the circulating lymphocyte count increased from bottom tertile to the 2nd and 3rd tertiles, the risk of initial gastrointestinal involvement decreased by nearly 75% (OR = 0.25, 95% CI: 0.07, 0.98, p = 0.047), 83% (OR = 0.17, 95% CI: 0.05, 0.63, p = 0.008), adjusted for possible confounders.Conclusions: The circulating lymphocyte count is negatively associated with virus discharge in stool in COVID-19 patients, and the risk of initial gastrointestinal involvement also.

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Gastrointestinal Symptoms in Endometriosis

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v33i2.43568 ◽

2020 ◽

Vol 33 (2) ◽

pp. 140-142

Author(s):

Shakeela Ishrat ◽

Farzana Deeba ◽

Parveen Fatima

Keyword(s):

Gastrointestinal Tract ◽

Gastrointestinal Symptoms ◽

Stage Iv ◽

Cross Sectional Study ◽

Cross Sectional ◽

Comprehensive Management ◽

Severe Stage ◽

High Prevalence ◽

Tract Involvement ◽

Medical University

Background: Endometriosis is frequently associated with gastrointestinal symptoms, inaddition to dysmenorrhoea, dyspareunia and infertility. Gastrointestinal tract is not alwaysinvolved when gastrointestinal symptoms are present. Method: A cross sectional study was conducted in the department of Obstetrics &Gynaecology of Bangladesh Sheikh Mujib Medical University (BSMMU) on 55 infertile womenwith surgical diagnosis of endometriosis with the objective to determine the frequency ofgastrointestinal symptoms in our population of women with endometriosis and to find outwhether they were relevant to severity of endometriosis. Results: There was a high prevalence (37.5%) of gastrointestinal symptoms in women withendometriosis. Bloating was the most frequent gastrointestinal symptom. Among the womenwith severe stage IV endometriosis, 57.6% had gastrointestinal symptoms. Conclusion: A gynecologist must consider the gastrointestinal symptoms while dealing withthe women with endometriosis. Further evaluation of gastrointestinal tract involvement isnecessary for counseling and comprehensive management of the women with endometriosis. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 140-142

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Lupus Gastrointestinal Tract Vasculopathy: Lupus “Enteritis” Involving the Entire Gastrointestinal Tract from Esophagus to Rectum

Case Reports in Gastroenterology ◽

10.1159/000455826 ◽

2017 ◽

Vol 11 (1) ◽

pp. 48-53 ◽

Cited By ~ 1

Author(s):

Joseph Bert ◽

Elie Gertner

Keyword(s):

Systemic Lupus Erythematosus ◽

Gastrointestinal Tract ◽

Lupus Erythematosus ◽

Intestinal Tract ◽

Gastrointestinal Symptoms ◽

Gastrointestinal Involvement ◽

Systemic Lupus ◽

Lupus Enteritis ◽

Upper Gastrointestinal ◽

Entire Gastrointestinal Tract

Gastrointestinal symptoms are very common in systemic lupus erythematosus (SLE). Lupus “enteritis” is very responsive to treatment but can have devastating consequences if not detected. Most descriptions of enteritis involve the small and large bowel. This is the first report of lupus “enteritis” involving the entire gastrointestinal tract from the esophagus and stomach to the rectum. Lupus “enteritis” is another cause of upper gastrointestinal involvement in SLE (involving even the esophagus and stomach) in addition to involvement of the lower intestinal tract.

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Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19

Children ◽

10.3390/children9010041 ◽

2022 ◽

Vol 9 (1) ◽

pp. 41

Author(s):

Désirée Caselli ◽

Claudio Cafagno ◽

Daniela Loconsole ◽

Annamaria Giannini ◽

Francesco Tansella ◽

...

Keyword(s):

Respiratory Symptoms ◽

Gastrointestinal Symptoms ◽

Adult Patients ◽

Time Interval ◽

Gastrointestinal Involvement ◽

Diagnostic Impact ◽

Children's Hospital ◽

Optimal Separation ◽

Gi Symptoms ◽

Children’S Hospital

The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.

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

International Journal of Medical Students ◽

10.5195/ijms.2020.617 ◽

2020 ◽

Vol 8 (2) ◽

pp. 148-151

Author(s):

Sidra Agarwal ◽

Hemanshi Mistry

Keyword(s):

New York ◽

Case Report ◽

Gastrointestinal Tract ◽

Respiratory Symptoms ◽

Clinical Course ◽

Gastrointestinal Symptoms ◽

Oral Route ◽

Nasopharyngeal Swab ◽

Virus Shedding ◽

Angiotensin Converting Enzyme 2

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.

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Gastrointestinal involvement and multiple lymphomatous polyposis in mantle-zone lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.6.866 ◽

1986 ◽

Vol 4 (6) ◽

pp. 866-873 ◽

Cited By ~ 30

Author(s):

P L Triozzi ◽

M J Borowitz ◽

J P Gockerman

Keyword(s):

Gastrointestinal Tract ◽

Gastrointestinal Symptoms ◽

Lymphoid Cells ◽

Gastrointestinal Lymphoma ◽

Review Of The Literature ◽

Gastrointestinal Involvement ◽

Follicular Variant ◽

Mantle Zone ◽

Rare Presentation ◽

Multiple Lymphomatous Polyposis

The clinical, histologic, and immunologic features of three cases of lymphoma presenting with gastrointestinal symptoms and involving the gastrointestinal tract were studied. Two of the cases had involvement of long segments of the bowel with polypoid lesions, a rare presentation of gastrointestinal lymphoma referred to as multiple lymphomatous polyposis (MLP). All cases were classified as mantle-zone lymphoma (MZL), a follicular variant of intermediate lymphocytic lymphoma (ILL) characterized by the proliferation of small atypical lymphoid cells as wide mantles surrounding benign-appearing germinal centers. The patients were typical of other patients with MZL in that they were male, middle age or older, and their clinical courses were not aggressive despite the presence of disease at an advanced stage. Our review of the literature suggests that there is an inordinate number of cases of MZL with gastrointestinal involvement. We also note that most reports of cases of MLP have described histologic lesions remarkably similar to what we have observed. We conclude that MZL may have predilection for involvement of the gastrointestinal tract, that this involvement is often in the manner of MLP, and that most cases of MLP probably have MZL or ILL.

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Crohn’s Disease of the Vulva: a Case Report

Folia Medica ◽

10.3897/folmed.63.e58002 ◽

2021 ◽

Vol 63 (6) ◽

pp. 990-993

Author(s):

Kalliopi Kokkali ◽

Christos Iavazzo ◽

Efthimia Souka ◽

Sofia Lekka ◽

Alexandros Fotiou ◽

...

Keyword(s):

Case Report ◽

Gastrointestinal Tract ◽

Inflammatory Disease ◽

Gastrointestinal Symptoms ◽

Granulomatous Inflammation ◽

Chronic Inflammatory Disease ◽

Rare Entity ◽

Gastrointestinal Involvement ◽

History Of ◽

Granulomatous Diseases

Crohn’s disease is a multi-systemic chronic inflammatory disease that can affect various organs besides the gastrointestinal tract such as joints, uvea, and the skin. Vulvar Crohn’s disease is a rare entity occurring with vulvar lesions that show typical Crohn’s disease granulomatous inflammation but are not contiguous with the gastrointestinal involvement. Vulvar Crohn’s disease can be easily confused with other granulomatous diseases and awareness that such involvement may precede gastrointestinal symptoms must be raised. Few cases of vulvar Crohn’s disease have been reported in the literature to date. Here, we report a case of a 43-year-old woman with a 6-month history of a vulvar lesion; the patient was diagnosed with Crohn’s disease of the large bowel just over a year ago.

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Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand

SAGE Open Medicine ◽

10.1177/2050312121989631 ◽

2021 ◽

Vol 9 ◽

pp. 205031212198963

Author(s):

Artit Sangkakam ◽

Pasin Hemachudha ◽

Abhinbhen W Saraya ◽

Benjamard Thaweethee-Sukjai ◽

Thaniwan Cheun-Arom ◽

...

Keyword(s):

Influenza Virus ◽

Gastrointestinal Tract ◽

Hospital Stay ◽

Rectal Swab ◽

Average Length ◽

Gastrointestinal Symptoms ◽

Virus Detection ◽

Length Of Hospital Stay ◽

Nasopharyngeal Swab ◽

Influenza Virus Detection

Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and replication, and it is transmitted mainly via respiratory secretions. Nasopharyngeal swab is the gold standard specimen type for influenza detection, but several studies have also suggested that the virus replicates in the human gastrointestinal tract. Methods: A retrospective study was conducted on all patients positive for influenza virus and initially recruited as part of the PREDICT project from 2017 to 2018. The objectives of the study were to investigate whether rectal swab could aid in improving influenza detection, and if there was any correlation between gastrointestinal disturbances and severity of infection, using length of hospital stay as an indicator of severity. Results: Of the 51 influenza-positive patients, 12 had detectable influenza virus in their rectal swab. Among these 12 rectal swab positive patients, influenza virus was not detected in the nasopharyngeal swab of three of them. Gastrointestinal symptoms were observed for 28.2% patients with a negative rectal swab negative and 25.0% patients with a positive rectal swab. Average length of hospital stay was 4.2 days for rectal swab positive group and 3.7 days for rectal swab negative group. This difference was not statistically significant (p = 0.288). Conclusions: There is no correlation between influenza virus detection in rectal swab and gastrointestinal disturbances or disease severity, and there is currently insufficient evidence to support replicative ability in the gastrointestinal tract.

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Eosinophilic Gastrointestinal Diseases: Review and Update

ISRN Gastroenterology ◽

10.5402/2012/463689 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Mahreema Jawairia ◽

Ghulamullah Shahzad ◽

Paul Mustacchia

Keyword(s):

Gastrointestinal Tract ◽

Clinical Features ◽

Gastrointestinal Symptoms ◽

Gastrointestinal Diseases ◽

Gastrointestinal Disorders ◽

Diverse Group ◽

Intestinal Diseases ◽

Gastrointestinal Inflammation ◽

Eosinophilic Gastrointestinal Disorders

Eosinophilic gastrointestinal disorders (EGIDs) are a progressively more frequent diverse group of intestinal diseases. The intention of this paper is to present the newest developments in the care of patients with EGIDs and to sum up a rising literature defining the clinical features and mechanistic elements of eosinophils and their intricate associations with the gastrointestinal tract. Clinicians ought to stay sensitive to EGIDs as a diagnostic likelihood for patients with general gastrointestinal symptoms. Further research is warranted to establish various methods leading to dysfunction coupled with eosinophilic gastrointestinal inflammation.

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Profile and outcomes of critically ill children in a lower middle-income country

Emergency Medicine Journal ◽

10.1136/emermed-2016-205720 ◽

2017 ◽

Vol 35 (1) ◽

pp. 52-55 ◽

Cited By ~ 3

Author(s):

Muhammad Irfan Habib ◽

Khalid Mehmood A Khan

Keyword(s):

Critically Ill ◽

Respiratory Symptoms ◽

Gastrointestinal Symptoms ◽

Middle Income Country ◽

Income Country ◽

Critically Ill Children ◽

Age Group ◽

Middle Income ◽

Lower Middle Income Country ◽

Level 1

ObjectiveTo determine the clinical profile and outcome of critically ill children presenting to a paediatric ED in a lower middle-income country.MethodsWe performed a retrospective analysis of children (<14 years) presenting to the ED of the National Institute of Child Health, Karachi, between January and December 2014 who were assigned to acuity 1 (requiring immediate life-saving interventions) according to the Emergency Severity Index. Data included demographic variables, presenting complaints, interventions and outcomes in the ED.ResultsThere were 172 162 visits during the year. Of these, 13 551 (8%) were level 1. 64% of level 1 patients were transported to the ED without ambulance service. Neonates (0–28 days) constituted 48% of level 1 children; their most frequent presenting complaints were respiratory symptoms, followed by fever and reluctance to feed. Above the neonatal age group, the most common presenting complaints were gastrointestinal symptoms (with signs of hypoperfusion), followed by seizures, reluctance to feed and respiratory symptoms. 64% of children of >28 days presenting were malnourished. Interventions included cardiopulmonary resuscitation, application of bubble continuous positive airway pressure and endotracheal intubation. Overall mortality was 13%; 63% of all deaths were in the neonatal age group.ConclusionChildren with the highest triage acuity represent 8% of all visits to a paediatric ED. In this group, neonates account for nearly half of all the children, and more than half of all the deaths among critically ill children came in ED. A large proportion of high-acuity children are malnourished.

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Metastatic Melanoma Presenting as Intussusception in an 80-Year-Old Man: A Case Report

Case Reports in Pathology ◽

10.1155/2013/672816 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sarah Alghamdi ◽

Yumna Omarzai

Keyword(s):

Differential Diagnosis ◽

Small Intestine ◽

Gastrointestinal Tract ◽

Metastatic Melanoma ◽

Clinical Presentation ◽

Gastrointestinal Symptoms ◽

Common Site ◽

Neoplastic Process ◽

History Of ◽

Uncommon Neoplasm

Malignant melanoma of the gastrointestinal tract is an uncommon neoplasm that could be primary or metastatic. Small intestine represents the most common site for the metastatic melanoma; however, it could be found anywhere in the gastrointestinal tract. Intussusception is a rare cause of intestinal obstruction in adults compared to children. In 90% of the cases, the underlying cause can be found, and in 65% of the cases, intussusception is caused by the neoplastic process. The majority of the neoplasms are benign, and about 15% are malignant. Metastatic melanoma is one of the most common metastatic malignancies to the gastrointestinal tract; however, the premortem diagnosis is rarely made. Here, we report an uncommon clinical presentation of metastatic melanoma causing intussusception in an 80-year-old man. This diagnosis should be considered in a differential diagnosis in any patient who presents with gastrointestinal symptoms and a history of melanoma.

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