Attaching clinical significance to COVID-19-associated diarrhea

Fantao Wang

Shiliang Zheng

Chengbin Zheng

Xiaodong Sun

^{Department of Stomatology, Affiliated Hospital of Weifang Medical University, Weifang, China}

^{Department of General medicine, Affiliated Hospital of Weifang Medical University, Weifang, China}

^{School of Information Science and Engineering, Qufu Normal University, Rizhao, China}

^{Department of Endocrinology, Affiliated Hospital of Weifang Medical University, Weifang, China}

^{Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, China}

Xiaodong Sun: nc.ude.cmfw@nus.gnodoaix

^{Corresponding author at: Department of Endocrinology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong 261031, China.}nc.ude.cmfw@nus.gnodoaix

^{These authors contribute equally to this article (co-first author).}

Received 2020 Jul 29; Revised 2020 Aug 14; Accepted 2020 Aug 19.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

The Corona Virus Disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), erupted in 2020 and created severe public health and socioeconomic challenges worldwide. A subset of patients, in addition to presenting with typical features such as fever, cough and dyspnea, was also afflicted with diarrhea. However, the clinical features and prognoses related to COVID-19-associated diarrhea have not attracted sufficient attention. This review of the medical literature examines the incidence, pathogenesis, clinical characteristics, fecal virus changes, prognoses and influencing factors of COVID-19-associated diarrhea. The reported incidence of diarrhea in patients with COVID-19 ranged from 2% to 49.5%. The main cause of diarrhea was found to be invasive by SARS-CoV-2 of ACE-2-expressing epithelial cells of the small intestine, causing local intestinal damage. This cellular invasion may be the key factor for the much longer duration of SARS-CoV-2 positivity observed for feces compared to pharyngeal swabs. The associated diarrhea in these patients upsets the balance of intestinal flora, resulting in more-severe disease intensity and worse prognosis. Clinicians should be vigilant to this kind of COVID-19-associated diarrhea, and design more effective prevention and treatment options for patients with positive fecal nucleic acid tests and intestinal microflora disorders.

Data on diarrhea in patients with COVID-19.

NA = no analysis.

Declaration of competing interest

No conflict of interest.

Declaration of competing interest

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