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1.
World J Gastroenterol ; 27(37): 6345-6347, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34712037

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although, respiratory symptoms are typical the digestive system is also a susceptible target with gastrointestinal symptoms present even in the absence of respiratory symptoms. The gastrointestinal symptoms of COVID-19 include diarrhea, abdominal pain, anorexia, and nausea among other symptoms. Some questions that remain to be answered include: Do patients with gastrointestinal symptoms have a higher mortality? SARS-CoV-2 variants are already a global reality: Do these variants present with a greater prevalence of gastrointestinal symptoms? Do patients with these symptoms warrant more intensive care unit care?


Assuntos
COVID-19 , Gastroenteropatias , COVID-19/complicações , Diarreia/virologia , Gastroenteropatias/virologia , Humanos , SARS-CoV-2
2.
Curr Opin Infect Dis ; 34(5): 471-476, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34524198

RESUMO

PURPOSE OF REVIEW: The ubiquitous expression of angiotensin-converting enzyme-2 receptors and its significance as the origin of viral entry have assisted in comprehending the pathophysiology of extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, we focus on the clinical significance of gastrointestinal manifestations. RECENT FINDINGS: The global pandemic, a result of the widespread implications of SARS-CoV-2, remains a significant burden to current healthcare systems. Fever, dyspnea, and tussive symptoms have primarily been recognized as the most common presenting signs/symptoms. During the past one year our scope of practice has transcended beyond the management of the respiratory system to incorporate other varying systemic manifestations such as anorexia, nausea, vomiting, diarrhea, and abdominal pain. The outcomes reported by recent studies suggest an association between the presence of gastrointestinal symptoms and important clinical factors such as delay in presentation, disease severity, and mortality. SUMMARY: We provide a summarization of the most recent in-depth investigations of coronavirus disease 2019 with gastrointestinal manifestations and their conclusions. Although the pathophysiology remains an area of evolving interest, a better understanding of this disease process may allow for early recognition, efficient triage, and improved prognostication for those presenting with gastrointestinal manifestations of SARS-CoV-2.


Assuntos
COVID-19/complicações , COVID-19/patologia , Gastroenteropatias/etiologia , Gastroenteropatias/patologia , Trato Gastrointestinal/patologia , Gastroenteropatias/virologia , Trato Gastrointestinal/virologia , Humanos , Pandemias/prevenção & controle , SARS-CoV-2/patogenicidade
3.
Front Immunol ; 12: 711741, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34539642

RESUMO

COVID-19 is widespread worldwide and seriously affects the daily life and health of humans. Countries around the world are taking necessary measures to curb the spread. However, COVID-19 patients often have at least one organ complication and sequelae in addition to respiratory symptoms. Controlling the epidemic is only a phased victory, and the complication and sequelae of COVID-19 will need more attention in the post-epidemic era. We collected general information from over 1000 articles published in 2020 after the COVID-19 outbreak and systematically analyzed the complication and sequelae associated with eight major systems in COVID-19 patients caused by ACE2 intervention in the RAS regulatory axis. The autoimmune response induced by 2019-nCoV attacks and damages the normal tissues and organs of the body. Our research will help medical workers worldwide address COVID-19 complication and sequelae.


Assuntos
COVID-19/patologia , Doenças Cardiovasculares/patologia , Doenças do Sistema Endócrino/patologia , Gastroenteropatias/patologia , Doenças do Sistema Nervoso/patologia , Doenças Urológicas/patologia , COVID-19/complicações , Doenças Cardiovasculares/virologia , Surtos de Doenças , Progressão da Doença , Doenças do Sistema Endócrino/virologia , Gastroenteropatias/virologia , Humanos , Doenças do Sistema Nervoso/virologia , SARS-CoV-2 , Doenças Urológicas/virologia
4.
Gastroenterology ; 161(6): 2047-2050.e3, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34418440

RESUMO

One year into the coronavirus disease 2019 (COVID-19) pandemic, the African continent still seems to be spared from the devastating effects the disease had in other continents. Africa's COVID-19 seems to be of a milder nature both in adults and children. However, lack of data from Africa is significant, and more studies are needed to validate the disease status, clinical manifestations, and future implications for Africa. In this study, we report pediatric COVID-19 features in Africa represented by 8 countries.


Assuntos
COVID-19/epidemiologia , Saúde da Criança/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Gastroenteropatias/virologia , SARS-CoV-2 , Adolescente , África/epidemiologia , COVID-19/complicações , COVID-19/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Adulto Jovem
5.
Clin Otolaryngol ; 46(6): 1331-1338, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34358409

RESUMO

OBJECTIVES: This study investigated the relationship between viral load and the incidence of olfactory and gustatory dysfunction (OD and GD), the incidence of respiratory and gastrointestinal symptoms and the recovery of OD and GD in COVID-19 patients. DESIGN: A retrospective cohort study. SETTING AND PARTICIPANTS: This study was conducted on 599 outpatients' cases in Golestan province between February and June 2020. MAIN OUTCOME MEASURES: The incidence, severity (complete or partial) and recovery time of OD and GD and their associations with cycle threshold (CT) values of SARS-CoV-2 polymerase chain reaction were assessed. RESULTS: The mean age of patients was 38.27 ± 13.62 years. The incidence of general symptoms included myalgia 70.1%, headache 51.8%, fever 47.7% and dyspnoea 21.4%. 41.9% of patients had gastrointestinal symptoms, including abdominal pain 26.5%, diarrhoea 25.2%, nausea 20.5% and vomiting 12.9%. 12.2% of patients had comorbidity. The trimester recovery rates of OD and GD were 93.94% and 94.74% respectively. The mean recovery time of OD and GD was 14.56 ± 13.37 and 13.8 ± 3.77 days respectively. The mean CT value in all patients was 27.45 ± 4.55. There were significant associations between the mean of CT value with headache (p = 0.04), GD (p = 0.002) and OD (p = 0.001). CONCLUSIONS: The finding of this study indicates a possible association between viral load with incidence of OD and GD in COVID-19 patient's cases and assures the recovery of OD/GD in these patients.


Assuntos
COVID-19/complicações , Gastroenteropatias/epidemiologia , Transtornos do Olfato/epidemiologia , Doenças Respiratórias/epidemiologia , Distúrbios do Paladar/epidemiologia , Carga Viral , Adulto , Feminino , Gastroenteropatias/virologia , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Transtornos do Olfato/virologia , Doenças Respiratórias/virologia , Estudos Retrospectivos , SARS-CoV-2 , Distúrbios do Paladar/virologia
6.
World J Gastroenterol ; 27(26): 4143-4159, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34326615

RESUMO

Coronavirus disease 2019 (COVID-19) can be considered a systemic disease with a specific tropism for the vascular system, in which the alterations of the microcirculation have an important pathogenetic role. The lungs are the main organ involved in COVID-19, and severe progressive respiratory failure is the leading cause of death in the affected patients; however, many other organs can be involved with variable clinical manifestations. Concerning abdominal manifestations, the gastrointestinal tract and the hepatobiliary system are mainly affected, although the pancreas, urinary tract and spleen may also be involved. The most common gastrointestinal symptoms are loss of appetite, followed by nausea and vomiting, diarrhea and abdominal pain. Gastrointestinal imaging findings include bowel wall thickening, sometimes associated with hyperemia and mesenteric thickening, fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia. Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase, aspartate aminotransferase, serum bilirubin and γ-glutamyl transferase with clinical manifestations in most cases mild and transient. The most frequent radiological features are hepatic steatosis, biliary sludge and gallstones. Edematous acute pancreatitis, kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19. Lastly, splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge-shaped or even rounded morphology, with irregular or smooth profiles. In summary, the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature. Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs. Although radiological signs are not specific of abdominal and gastrointestinal involvement, the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management, evaluation of the severity and evolution of the COVID-19 patients.


Assuntos
COVID-19 , Gastroenteropatias , Pancreatite , Doença Aguda , COVID-19/complicações , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/virologia , Trato Gastrointestinal , Humanos , Pancreatite/diagnóstico por imagem , Pancreatite/virologia , Tomografia Computadorizada por Raios X
7.
World J Gastroenterol ; 27(26): 4160-4171, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34326616

RESUMO

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease-2019 (COVID-19) has provoked a global pandemic, mainly affecting the respiratory tract; however, a percentage of infected individuals can develop gastrointestinal (GI) symptoms. Some studies describe the development of GI symptoms and how they affect the progression of COVID-19. In this review, we summarize the main mechanisms associated with gut damage during infection by SARS-CoV-2 as well as other organs such as the liver and pancreas. Not only are host factors associated with severe COVID-19 but intestinal microbiota dysbiosis is also observed in patients with severe disease.


Assuntos
COVID-19 , Gastroenteropatias , Microbioma Gastrointestinal , COVID-19/complicações , Disbiose , Gastroenteropatias/virologia , Trato Gastrointestinal , Humanos , Inflamação/virologia
8.
Arab J Gastroenterol ; 22(2): 75-87, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34120849

RESUMO

In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable. GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions. Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development.


Assuntos
COVID-19 , Gastroenteropatias/virologia , Infecções por HIV , COVID-19/complicações , Infecções por HIV/complicações , Humanos , Pandemias , Sindemia
9.
BMC Infect Dis ; 21(1): 555, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116647

RESUMO

BACKGROUND: Covid-19 in Mexico is on the rise in different parts of the country. We aimed to study the symptoms and comorbidities that associate with this pandemic in 3 different regions of Mexico. METHODS: We analyzed data from SARS-CoV-2 positive patients evaluated at healthcare centers and hospitals of Mexico (n = 1607) including Northwest Mexico (Sinaloa state), Southeast Mexico (Veracruz state) and West Mexico (Jalisco state) between March 1 and July 30, 2020. Mexico consists of a total population that exceeds 128 million. Demographics, comorbidities and clinical symptoms were collected. Statistical descriptive analysis and correlation analyses of symptoms, comorbidities and mortality were performed. RESULTS: A total of 1607 hospitalized patients positive for COVID-19 across all 3 regions of Mexico were included. The average age was 54.6 years and 60.4% were male. A mortality rate of 33.1% was observed. The most common comorbidities were hypertension (43.2%), obesity (30.3%) and diabetes (31.4%). Hypertension was more frequent in West (45%), followed by Northwest (37%) and Southeast Mexico (29%). Obesity was around 30% in Northwest and West whereas an 18% was reported in Southeast. Diabetes was most common in West (34%) followed by Northwest (22%) and Southeast (13%). This might be related to the highest mortality rate in Northwest (31%) and West (37%) when compared to Southeast. Most common symptoms in our overall cohort were fever (80.8%), cough (79.8%), headache (66%), dyspnea (71.1%), myalgia (53.8%), joints pain (50.8%) and odynophagia (34.8%). Diarrhea was the main gastrointestinal (GI) symptom (21.3%), followed by abdominal pain (18%), and nausea/ vomiting (4.5%). Diarrhea and abdominal pain were more common in West (23.1 and 21%), followed by Southeast (17.8, and 9.8%) and Northwest (11.4 and 3.1%). CONCLUSION: Our study showed a high mortality rate likely related to high frequencies of comorbidities (hypertension, obesity and diabetes). Mortality was different across regions. These discrepancies might be related to the differences in the frequencies of comorbidities, and partially attributed to differences in socio-economic conditions and quality of care. Thus, our findings stress the need for improved strategies to get better outcomes in our population.


Assuntos
COVID-19 , Gastroenteropatias , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/mortalidade , Comorbidade , Diabetes Mellitus , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/virologia , Humanos , Hipertensão , Masculino , México , Pessoa de Meia-Idade , Obesidade , SARS-CoV-2
10.
Am J Clin Oncol ; 44(8): 402-408, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34107499

RESUMO

BACKGROUND AND OBJECTIVE: Immune-mediated diarrhea and colitis (IMDC) is a common adverse event in cancer patients receiving immune checkpoint inhibitors (ICIs). Gastrointestinal (GI) infections can co-occur with IMDC, and its impact on the course and outcome of IMDC remains unclear. PATIENTS AND METHODS: We retrospectively reviewed cancer patients who received ICIs and developed IMDC between January 2015 and September 2019. GI multiplex panel is used to assess GI infection. The study group included patients with positive infection except those who are only positive for Clostridioides difficile or cytomegalovirus. The control group is IMDC patients with negative infection using frequency matching. Patients' disease course and outcome were compared between groups. RESULTS: A total of 72 patients with IMDC were included: 22 in the study group and 50 as control. Escherichia coli of different pathotypes was observed in 17 patients. Five patients had viral infections, for example, adenovirus, norovirus, and sapovirus. Patients with GI infections more frequently had grade 3 or 4 colitis (43% vs. 18%, P=0.041). Overall, GI infections were not associated with different risks of IMDC recurrence or overall survival. Antibiotics treatment did not affect the requirement for infliximab or vedolizumab but relate to a higher risk of IMDC recurrence (50.0% vs. 0.0%, P=0.015). CONCLUSIONS: In our study, concomitant GI infections are associated with more severe symptoms in IMDC patients. Antimicrobial treatment did not circumvent the need for immunosuppressive therapy for IMDC or improve the clinical outcome. Concomitant GI infection was not associated with a higher risk of IMDC recurrence or poor overall survival.


Assuntos
Colite/induzido quimicamente , Diarreia/induzido quimicamente , Gastroenteropatias/microbiologia , Gastroenteropatias/virologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Infecções por Clostridium/induzido quimicamente , Colite/mortalidade , Colite/terapia , Diarreia/mortalidade , Diarreia/terapia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/etiologia , Feminino , Gastroenteropatias/tratamento farmacológico , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Viroses/etiologia , Viroses/virologia
11.
Sci Rep ; 11(1): 12592, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34131245

RESUMO

Gastrointestinal symptoms (GIS) are common in kidney transplant candidates and recipients and may be worsened by HIV. Objective: To determine the frequency and severity of GIS in HIV-positive kidney transplant recipients from HIV-positive donors, and those waiting to receive one. A GIS rating scale (GSRS) was completed by 76 participants at baseline and at 6 months. GIS frequency was defined as having at least one symptom (GSRS > 1). Severity was indicated by the GSRS score. Transplant candidates: GIS frequency was 88.9% and 86.3% at baseline and 6 months respectively. Indigestion was the most frequent (79.6% and 66.7% at baseline and 6 months), and severe GIS (GSRS 2.3). Women reported global mean (p = 0.030) severity significantly more than men. Transplant recipients: GIS frequency was 95.2% and 76.2% at baseline and 6 months respectively. At both assessment points, indigestion occurred most frequently (85.7% and 61.9% respectively). Highest GSRS was reported for indigestion at baseline (2.33) and at 6 months (1.33). Waist circumference (WC) was positively associated with the severity of constipation GSRS. GIS are common in both groups, especially indigestions. WC in transplant recipients should be monitored.


Assuntos
Gastroenteropatias/terapia , Infecções por HIV/terapia , Nefropatias/terapia , Transplante de Rim/efeitos adversos , Adulto , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/patologia , Gastroenteropatias/virologia , Trato Gastrointestinal/patologia , Trato Gastrointestinal/virologia , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Imunossupressores , Nefropatias/complicações , Nefropatias/virologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários , Doadores de Tecidos , Transplantados
12.
Artigo em Inglês | MEDLINE | ID: mdl-34011623

RESUMO

OBJECTIVE: This study will test the performance of the anal swab PCR test when compared with the nasopharyngeal swab PCR test as a diagnostic tool for COVID-19. DESIGN: An observational descriptive study which included hospitalised suspected, or probable cases of hopitalised COVID-19 patients, conducted in Dr. Cipto Mangunkusumo National Hospital, Ciputra Hospital, Mitra Keluarga Depok Hospital and Mitra Keluarga Kelapa Gading Hospital, Indonesia. Epidemiological, clinical, laboratory and radiology data were obtained. Nasopharyngeal and anal swabs specimens were collected for SARS-CoV-2 RNA detection. RESULTS: We analysed 136 subjects as part of this study. The clinical spectrum of COVID-19 manifesation in this study was typical of hospitalised patients, with 25% classified as mild cases, 14.7% in severe condition and 12.5% of subjects classified as having acute respiratory distress syndrome. When compared with nasopharyngeal swab as the standard specimen for reverse transcription polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 antigen, the sensitivity and specificity of the anal swab was 36.7% and 93.8%, respectively. The positive and negative predictive value were 97.8% and 16.5 %, respectively. The performance of the anal swab remained similar when only the subgroup of patients with gastrointestinal symptoms (n=92, 67.6%) was analysed (sensitivity 40% and specificity 91.7%). Out of all the subjects included in analysis, 67.6% had gastrointestinal symptoms. Similarly, 73.3% of patients in the anal swab-positive group had gastrointestinal symptoms. The two most common gastrointestinal symptoms in the subjects' population were nausea and anorexia. CONCLUSION: Anal swab specimen has low sensitivity (36.7%) but high specificity (93.8%) for detecting SARS-CoV-2 antigen by RT-PCR. Only one additional positive result was found by anal swab among the nasopharyngeal swab-negative group. Anal swab may not be needed as an additional test at the beginning of a patient's diagnostic investigation and nasopharyngeal swab RT-PCR remains as the standard diagnostic test for COVID-19.


Assuntos
Canal Anal/virologia , COVID-19/diagnóstico , Gastroenteropatias/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , SARS-CoV-2/genética , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Teste para COVID-19/métodos , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Gastroenteropatias/diagnóstico , Hospitalização , Humanos , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Valor Preditivo dos Testes , Reação em Cadeia da Polimerase Via Transcriptase Reversa/estatística & dados numéricos , Sensibilidade e Especificidade
14.
Turk J Gastroenterol ; 32(2): 148-154, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33960938

RESUMO

BACKGROUND: Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), have fever, dry cough, dyspnea, and fatigue. The disease has now become a global pandemic. The purpose of this study was to explore the relationship between COVID-19 and gastrointestinal (GI) symptoms. METHODS: We collected and analyzed data on patients with laboratory-confirmed COVID-19 by high-throughput sequencing or reverse transcription-polymerase chain reaction. We reviewed electronic medical records of 405 hospitalized COVID-19 patients in the Third Hospital of Wuhan. RESULTS: Among the 405 confirmed patients, 210 had no GI symptoms, 195 had GI symptoms, and the first symptom of 155 patients was GI. The prevalence of vascular and digestive diseases in the group with GI symptoms was significantly higher than in the group without GI symptoms. In patients with GI symptoms, the proportion with fever, cough, dysphoria, chest tightness, poor appetite, chest pain, and pharyngeal pain was significantly higher than in those without GI symptoms. There was no significant difference in imaging between the 2 groups. In patients with GI symptoms, the proportion with increased procalcitonin (PCT) level and decreased lymphocyte count was significantly higher than in those without GI symptoms. CONCLUSION: COVID-19 patients with GI symptoms had significantly more vascular and digestive system diseases and were more likely to have clinical manifestations of fever, cough, poor appetite, chest tightness, chest pain, insomnia, and pharyngeal pain. There were more patients with diarrhea, nausea, and vomiting. Patients with GI symptoms were more likely to have increased PCT and decreased lymphocyte count.


Assuntos
COVID-19/complicações , Gastroenteropatias/epidemiologia , Gastroenteropatias/virologia , SARS-CoV-2 , Adulto , Idoso , COVID-19/sangue , COVID-19/virologia , China/epidemiologia , Diarreia/sangue , Diarreia/epidemiologia , Diarreia/virologia , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Náusea/sangue , Náusea/epidemiologia , Náusea/virologia , Pró-Calcitonina/sangue , Vômito/sangue , Vômito/epidemiologia , Vômito/virologia
15.
Front Immunol ; 12: 665300, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981312

RESUMO

The irruption of SARS-CoV-2 during 2020 has been of pandemic proportions due to its rapid spread and virulence. COVID-19 patients experience respiratory, digestive and neurological symptoms. Distinctive symptom as anosmia, suggests a potential neurotropism of this virus. Amongst the several pathways of entry to the nervous system, we propose an alternative pathway from the infection of the gut, involving Toll-like receptor 4 (TLR4), zonulin, protease-activated receptor 2 (PAR2) and zonulin brain receptor. Possible use of zonulin antagonists could be investigated to attenuate neurological manifestations caused by SARS-CoV-19 infection.


Assuntos
COVID-19/complicações , Haptoglobinas/metabolismo , Doenças do Sistema Nervoso/complicações , Precursores de Proteínas/metabolismo , Barreira Hematoencefálica/metabolismo , Barreira Hematoencefálica/virologia , Encéfalo/metabolismo , Encéfalo/virologia , COVID-19/metabolismo , COVID-19/virologia , Proteínas do Sistema Complemento/metabolismo , Gastroenteropatias/complicações , Gastroenteropatias/metabolismo , Gastroenteropatias/virologia , Humanos , Doenças do Sistema Nervoso/metabolismo , Doenças do Sistema Nervoso/virologia , SARS-CoV-2/metabolismo , SARS-CoV-2/patogenicidade , Receptor 4 Toll-Like/metabolismo
16.
Pediatr Dev Pathol ; 24(5): 445-449, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34048305

RESUMO

Millions of patients seek medical attention for diarrhea, vomiting, nausea, and abdominal pain. In the current environment, it is important to recognize that these symptoms may be the only manifestation or may precede more serious systemic complications of COVID-19. Herein, we describe the first case of ischemic colitis (IC) in a young adult who presented with diarrhea and highlight the laboratory pitfalls for patients with COVID-19 presenting with gastrointestinal (GI) symptoms.


Assuntos
COVID-19/virologia , Colite Isquêmica/diagnóstico , Síndrome de Down/fisiopatologia , Gastroenteropatias/diagnóstico , SARS-CoV-2/patogenicidade , Adolescente , COVID-19/diagnóstico , Colite Isquêmica/complicações , Colite Isquêmica/fisiopatologia , Diarreia/complicações , Diarreia/virologia , Síndrome de Down/diagnóstico , Síndrome de Down/virologia , Gastroenteropatias/complicações , Gastroenteropatias/virologia , Humanos , Masculino
17.
PLoS One ; 16(4): e0250446, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886672

RESUMO

Interventional studies targeting environment enteropathy (EE) are impeded by the lack of appropriate, validated, non-invasive biomarkers of EE. Thus, we aimed to validate the association of potential biomarkers for EE with enteric infections and nutritional status in a longitudinal birth cohort study. We measured endotoxin core antibody (EndoCab) and soluble CD14 (sCD14) in serum, and myeloperoxidase (MPO) in feces using commercially available enzyme-linked immunosorbent assay (ELISA) kits. We found that levels of serum EndoCab and sCD14 increase with the cumulative incidence of enteric infections. We observed a significant correlation between the fecal MPO level in the children at 24 months of age with the total number of bacterial and viral infections, the total number of parasitic infections, and the total number of diarrheal episodes and diarrheal duration. We observed that the levels of serum EndoCab, sCD14, and fecal MPO at 3 months of age were significantly associated with whether children were malnourished at 18 months of age or not. Biomarkers such as fecal MPO, serum EndoCab and sCD14 in children at an early age may be useful as a measure of cumulative burden of preceding enteric infections, which are predictive of subsequent malnutrition status and may be useful non-invasive biomarkers for EE.


Assuntos
Biomarcadores/sangue , Diarreia/sangue , Gastroenteropatias/sangue , Doenças Parasitárias/sangue , Peroxidase/sangue , Anticorpos/sangue , Pré-Escolar , Estudos de Coortes , Diarreia/microbiologia , Diarreia/parasitologia , Diarreia/virologia , Endotoxinas/sangue , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Gastroenteropatias/microbiologia , Gastroenteropatias/parasitologia , Gastroenteropatias/virologia , Trato Gastrointestinal/microbiologia , Trato Gastrointestinal/patologia , Humanos , Lactente , Recém-Nascido , Receptores de Lipopolissacarídeos/sangue , Masculino , Estado Nutricional , Doenças Parasitárias/microbiologia , Doenças Parasitárias/parasitologia , Doenças Parasitárias/virologia , Viroses/sangue , Viroses/virologia
18.
J Trauma Acute Care Surg ; 90(5): 880-890, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33891572

RESUMO

BACKGROUND: We sought to describe characteristics, multisystem outcomes, and predictors of mortality of the critically ill COVID-19 patients in the largest hospital in Massachusetts. METHODS: This is a prospective cohort study. All patients admitted to the intensive care unit (ICU) with reverse-transcriptase-polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection between March 14, 2020, and April 28, 2020, were included; hospital and multisystem outcomes were evaluated. Data were collected from electronic records. Acute respiratory distress syndrome (ARDS) was defined as PaO2/FiO2 ratio of ≤300 during admission and bilateral radiographic pulmonary opacities. Multivariable logistic regression analyses adjusting for available confounders were performed to identify predictors of mortality. RESULTS: A total of 235 patients were included. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 5 (3-8), and the median (IQR) PaO2/FiO2 was 208 (146-300) with 86.4% of patients meeting criteria for ARDS. The median (IQR) follow-up was 92 (86-99) days, and the median ICU length of stay was 16 (8-25) days; 62.1% of patients were proned, 49.8% required neuromuscular blockade, and 3.4% required extracorporeal membrane oxygenation. The most common complications were shock (88.9%), acute kidney injury (AKI) (69.8%), secondary bacterial pneumonia (70.6%), and pressure ulcers (51.1%). As of July 8, 2020, 175 patients (74.5%) were discharged alive (61.7% to skilled nursing or rehabilitation facility), 58 (24.7%) died in the hospital, and only 2 patients were still hospitalized, but out of the ICU. Age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12), higher median Sequential Organ Failure Assessment score at ICU admission (OR, 1.24; 95% CI, 1.06-1.43), elevated creatine kinase of ≥1,000 U/L at hospital admission (OR, 6.64; 95% CI, 1.51-29.17), and severe ARDS (OR, 5.24; 95% CI, 1.18-23.29) independently predicted hospital mortality.Comorbidities, steroids, and hydroxychloroquine treatment did not predict mortality. CONCLUSION: We present here the outcomes of critically ill patients with COVID-19. Age, acuity of disease, and severe ARDS predicted mortality rather than comorbidities. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
COVID-19/complicações , COVID-19/mortalidade , Mortalidade Hospitalar , Gravidade do Paciente , Injúria Renal Aguda/virologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antimaláricos/uso terapêutico , Boston/epidemiologia , COVID-19/fisiopatologia , COVID-19/terapia , Comorbidade , Creatina Quinase/sangue , Cuidados Críticos , Estado Terminal , Oxigenação por Membrana Extracorpórea , Feminino , Gastroenteropatias/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Bloqueio Neuromuscular , Escores de Disfunção Orgânica , Pneumonia Bacteriana/virologia , Lesão por Pressão/etiologia , Decúbito Ventral , Estudos Prospectivos , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/virologia , Fatores de Risco , SARS-CoV-2 , Choque/virologia , Esteroides/uso terapêutico , Taxa de Sobrevida , Tromboembolia/virologia , Resultado do Tratamento
19.
Clin Transl Gastroenterol ; 12(4): e00343, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33835096

RESUMO

INTRODUCTION: The prevalence and shedding of fecal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA indicate coronavirus disease 2019 (COVID-19) infection in the gastrointestinal (GI) tract and likely infectivity. We performed a systemic review and meta-analysis to evaluate the prevalence and the duration of shedding of fecal RNA in patients with COVID-19 infection. METHODS: PubMed, Embase, Web of Science, and Chinese databases Chinese National Knowledge Infrastructure and Wanfang Data up to June 2020 were searched for studies evaluating fecal SARS-CoV-2 RNA, including anal and rectal samples, in patients with confirmed COVID-19 infection. The pooled prevalence of fecal RNA in patients with detectable respiratory RNA was estimated. The days of shedding and days to loss of fecal and respiratory RNA from presentation were compared. RESULTS: Thirty-five studies (N = 1,636) met criteria. The pooled prevalence of fecal RNA in COVID-19 patients was 43% (95% confidence interval [CI] 34%-52%). Higher proportion of patients with GI symptoms (52.4% vs 25.9%, odds ratio = 2.4, 95% CI 1.2-4.7) compared with no GI symptoms, specifically diarrhea (51.6% vs 24.0%, odds ratio = 3.0, 95% CI 1.9-4.8), had detectable fecal RNA. After loss of respiratory RNA, 27% (95% CI 15%-44%) of the patients had persistent shedding of fecal RNA. Days of RNA shedding in the feces were longer than respiratory samples (21.8 vs 14.7 days, mean difference = 7.1 days, 95% CI 1.2-13.0). Furthermore, days to loss of fecal RNA lagged respiratory RNA by a mean of 4.8 days (95% CI 2.2-7.5). DISCUSSION: Fecal SARS-CoV-2 RNA is commonly detected in COVID-19 patients with a 3-fold increased risk with diarrhea. Shedding of fecal RNA lasted more than 3 weeks after presentation and a week after last detectable respiratory RNA.


Assuntos
COVID-19/virologia , Fezes/virologia , Trato Gastrointestinal/virologia , RNA Viral/análise , SARS-CoV-2/isolamento & purificação , Diarreia/virologia , Gastroenteropatias/virologia , Humanos , Sistema Respiratório/virologia , Eliminação de Partículas Virais
20.
Viruses ; 13(3)2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33804173

RESUMO

Three human protoparvoviruses, bufavirus (BuV), tusavirus (TuV) and cutavirus (CuV), have recently been discovered in diarrheal stool. BuV has been associated with diarrhea and CuV with cutaneous T-cell lymphoma, but there are hardly any data for TuV or CuV in stool or respiratory samples. Hence, using qPCR and IgG enzyme immunoassays, we analyzed 1072 stool, 316 respiratory and 445 serum or plasma samples from 1098 patients with and without gastroenteritis (GE) or respiratory-tract infections (RTI) from Finland, Latvia and Malawi. The overall CuV-DNA prevalences in stool samples ranged between 0-6.1% among our six patient cohorts. In Finland, CuV DNA was significantly more prevalent in GE patients above rather than below 60 years of age (5.1% vs 0.2%). CuV DNA was more prevalent in stools among Latvian and Malawian children compared with Finnish children. In 10/11 CuV DNA-positive adults and 4/6 CuV DNA-positive children with GE, no known causal pathogens were detected. Interestingly, for the first time, CuV DNA was observed in two nasopharyngeal aspirates from children with RTI and the rare TuV in diarrheal stools of two adults. Our results provide new insights on the occurrence of human protoparvoviruses in GE and RTI in different countries.


Assuntos
DNA Viral/genética , Gastroenteropatias/virologia , Infecções por Parvoviridae/epidemiologia , Infecções por Parvoviridae/virologia , Parvovirus/genética , Doenças Respiratórias/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , DNA Viral/análise , Fezes/virologia , Feminino , Finlândia/epidemiologia , Gastroenteropatias/epidemiologia , Humanos , Lactente , Letônia/epidemiologia , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Infecções por Parvoviridae/sangue , Parvovirus/classificação , Filogenia , Doenças Respiratórias/sangue , Doenças Respiratórias/epidemiologia , Adulto Jovem
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