Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms
Xi Jin, Jiang-Shan Lian, Jian-Hua Hu, Jianguo Gao, Lin Zheng, Yi-Min Zhang, Shao-Rui Hao, Hong-Yu Jia, Huan Cai, Xiao-Li Zhang, Guo-Dong Yu, Kai-Jin Xu, Xiao-Yan Wang, Jue-Qing Gu, Shan-Yan Zhang, Chan-Yuan Ye, Ci-Liang Jin, Ying-Feng Lu, Xia Yu, Xiao-Peng Yu, Jian-Rong Huang, Kang-Li Xu, Qin Ni, Cheng-Bo Yu, Biao Zhu, Yong-Tao Li, Jun Liu, Hong Zhao, Xuan Zhang, Liang Yu, Yong-Zheng Guo, Jun-Wei Su, Jing-Jing Tao, Guan-Jing Lang, Xiao-Xin Wu, Wen-Rui Wu, Ting-Ting Qv, Dai-Rong Xiang, Ping Yi, Ding Shi, Yanfei Chen, Yue Ren, Yun-Qing Qiu, Lan-Juan Li, Jifang Sheng, Yida Yang, Xi Jin, Jiang-Shan Lian, Jian-Hua Hu, Jianguo Gao, Lin Zheng, Yi-Min Zhang, Shao-Rui Hao, Hong-Yu Jia, Huan Cai, Xiao-Li Zhang, Guo-Dong Yu, Kai-Jin Xu, Xiao-Yan Wang, Jue-Qing Gu, Shan-Yan Zhang, Chan-Yuan Ye, Ci-Liang Jin, Ying-Feng Lu, Xia Yu, Xiao-Peng Yu, Jian-Rong Huang, Kang-Li Xu, Qin Ni, Cheng-Bo Yu, Biao Zhu, Yong-Tao Li, Jun Liu, Hong Zhao, Xuan Zhang, Liang Yu, Yong-Zheng Guo, Jun-Wei Su, Jing-Jing Tao, Guan-Jing Lang, Xiao-Xin Wu, Wen-Rui Wu, Ting-Ting Qv, Dai-Rong Xiang, Ping Yi, Ding Shi, Yanfei Chen, Yue Ren, Yun-Qing Qiu, Lan-Juan Li, Jifang Sheng, Yida Yang
Abstract
Objective: The SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics.
Design: COVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province.
Results: Among enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5°C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m6A methylation and changed binding capacity with ACE2.
Conclusion: We report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.
Keywords: diarrhoea; infectious disease.
Conflict of interest statement
Competing interests: None declared.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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References
- Lu H, Stratton CW, Tang Y-W. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol 2020;92:401–2. 10.1002/jmv.25678
- Zhao S, Lin Q, Ran J, et al. . Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: a data-driven analysis in the early phase of the outbreak. Int J Infect Dis 2020;92:214–7. 10.1016/j.ijid.2020.01.050
- Bogoch II, Watts A, Thomas-Bachli A, et al. . Potential for global spread of a novel coronavirus from China. J Travel Med 2020;27 10.1093/jtm/taaa011
- Chen N, Zhou M, Dong X, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. 10.1016/S0140-6736(20)30211-7
- Huang C, Wang Y, Li X, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. 10.1016/S0140-6736(20)30183-5
- Li Q, Guan X, Wu P, et al. . Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020. 10.1056/NEJMoa2001316. [Epub ahead of print: 29 Jan 2020].
- Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet 2020;395:689–97. 10.1016/S0140-6736(20)30260-9
- Lu R, Zhao X, Li J, et al. . Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–74. 10.1016/S0140-6736(20)30251-8
- Wan Y, Shang J, Graham R, et al. . Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol 2020;94. 10.1128/JVI.00127-20. [Epub ahead of print: 17 Mar 2020].
- Zhao S, Zhuang Z, Ran J, et al. . The association between domestic train transportation and novel coronavirus (2019-nCoV) outbreak in China from 2019 to 2020: a data-driven correlational report. Travel Med Infect Dis 2020;33:101568. 10.1016/j.tmaid.2020.101568
- Holshue ML, DeBolt C, Lindquist S, et al. . First case of 2019 novel coronavirus in the United States. N Engl J Med 2020;382:929–36. 10.1056/NEJMoa2001191
- Zhang H, Kang Z, Gong H, et al. . The digestive system is a potentila route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. bioRxiv 2020:927806.
- WHO Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Available: [Accessed 30 Jan2020].
- Guan WJ, Ni ZY, Hu Y, et al. . Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. 10.1056/NEJMoa2002032
- Li G, Fan Y, Lai Y, et al. . Coronavirus infections and immune responses. J Med Virol 2020;92:424–32. 10.1002/jmv.25685
- Xia J, Tong J, Liu M, et al. . Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020. 10.1002/jmv.25725. [Epub ahead of print: 26 Feb 2020].
- Wang D, Hu B, Hu C, et al. . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020. 10.1001/jama.2020.1585. [Epub ahead of print: 07 Feb 2020].
- Fang Dan MJ, Guan J, Wang M, et al. . Manifestations of digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Chin J Dig 2020.
- Roundtree IA, Evans ME, Pan T, et al. . Dynamic RNA modifications in gene expression regulation. Cell 2017;169:1187–200. 10.1016/j.cell.2017.05.045
- Wang X, Lu Z, Gomez A, et al. . N6-methyladenosine-dependent regulation of messenger RNA stability. Nature 2014;505:117–20. 10.1038/nature12730
- Kennedy EM, Bogerd HP, Kornepati AVR, et al. . Posttranscriptional m(6)A Editing of HIV-1 mRNAs Enhances Viral Gene Expression. Cell Host Microbe 2016;19:675–85. 10.1016/j.chom.2016.04.002
- Gokhale NS, McIntyre ABR, McFadden MJ, et al. . N6-Methyladenosine in Flaviviridae viral RNA genomes regulates infection. Cell Host Microbe 2016;20:654–65. 10.1016/j.chom.2016.09.015
- Karikó K, Buckstein M, Ni H, et al. . Suppression of RNA recognition by Toll-like receptors: the impact of nucleoside modification and the evolutionary origin of RNA. Immunity 2005;23:165–75. 10.1016/j.immuni.2005.06.008
- Courtney DG, Kennedy EM, Dumm RE, et al. . Epitranscriptomic enhancement of influenza A virus gene expression and replication. Cell Host Microbe 2017;22:377–86. 10.1016/j.chom.2017.08.004
- Schäfer A, Baric RS. Epigenetic landscape during coronavirus infection. Pathogens 2017;6. 10.3390/pathogens6010008. [Epub ahead of print: 15 Feb 2017].
- Chen Y, Guo D. Molecular mechanisms of coronavirus RNA capping and methylation. Virol Sin 2016;31:3–11. 10.1007/s12250-016-3726-4
- Menachery VD, Yount BL, Debbink K, et al. . A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. Nat Med 2015;21:1508–13. 10.1038/nm.3985
- Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017;39:529–39. 10.1007/s00281-017-0629-x
- Pan Y, Zhang D, Yang P, et al. . Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis 2020. 10.1016/S1473-3099(20)30113-4. [Epub ahead of print: 24 Feb 2020].
Source: PubMed