Patients with new-onset digestive symptoms after a possible COVID-19 contact should be suspected for the illness, even in the absence of cough, shortness of breath, sore throat, or fever, according to the first analysis of gastrointestinal symptoms in mild disease COVID-19.
The research, published in pre-print by The American Journal of Gastroenterology, found digestive symptoms (particularly diarrhea), were these patients’ presentation of COVID-19, and some only later presented with respiratory symptoms or fever, and some never presented with either respiratory symptoms or fever.
Among 206 patients with low-severity COVID-19:
- (I) 48 presented with a digestive symptom alone;
- (II) 69 presented with both digestive and respiratory symptoms; and
- (III) 89 with respiratory symptoms alone.
- Of the 117 patients with digestive symptoms (group I and II), 67 presented with diarrhea, of whom about 20% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of over five days and a frequency around four bowel movements per day.
- Concurrent fever was found in 62% of patients with a digestive symptom (group I and II), meaning that nearly one-third did not have a fever.
Importantly, only two-thirds of the studied patients had a fever, meaning it is not even necessary to have a fever to suspect a COVID-19 diagnosis, according to the authors.
These patients are more likely to test positive in stool for COVID-19 RNA, to have a longer delay before viral clearance, and to experience delayed diagnosis (16 days) compared to patients with respiratory symptoms but no digestive symptoms (11 days), researchers reported.
These data emphasize that patients with new-onset digestive symptoms after a possible COVID-19 contact must be suspected for the illness, even in the absence of cough, shortness of breath, sore throat, or fever.
“This study is vital because it represents the 80% or more of patients who do not have severe or critical disease. This is about the more common scenario of people in the community struggling to figure out if they might have COVID-19 because of new-onset diarrhea, nausea, or vomiting,” said Brennan Spiegel, MD, MSHS, FACG, co-editor-in-chief of The American Journal of Gastroenterology.