COVID-19-associated anorexia: Difference between revisions

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__NOTOC__
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'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
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'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
{{SI}}                                                                 
{{CMG}} {{AE}} [[User:Javaria Anwer|Javaria Anwer M.D.]][mailto:javaria.anwer@gmail.com]


'''COVID-19-associated anorexia Microchapters'''
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==Overview==
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According to a recent study by Pan et al, 48.5% presented with digestive symptoms as their chief complaint. [[Anorexia]] was the most common (83.8%) of digestive symptoms associated with SARS-Cov2 infection. With COVID-19 primarily being a respiratory disease, surprisingly around 3% cases had just the digestive symptoms but no respiratory symptoms.<ref name="pmid32287140">{{cite journal |vauthors=Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L |title=Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study |journal=Am. J. Gastroenterol. |volume=115 |issue=5 |pages=766–773 |date=May 2020 |pmid=32287140 |pmc=7172492 |doi=10.14309/ajg.0000000000000620 |url=}}</ref>


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====Historical Perspective==
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*On 30th December 2019, three [[bronchoalveolar lavage]] samples collected from a [[patient]] with [[pneumonia]] of unknown [[etiology]] – a surveillance definition established following the [[SARS]] [[outbreak ]]of 2002-2003 – in Wuhan Jinyintan Hospital. Real-time [[PCR]] (RT-PCR) assays on these samples were positive for [[pan-Betacoronavirus]].
[[COVID-19-associated anorexia|Home]]
*Nanopore sequencing and bioinformatic analyses indicated that the virus had features typical of the [[coronavirus]] family and belonged to the Beta[[coronavirus]] 2B lineage.<ref name="urlwww.who.int">{{cite web |url=https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf |title=www.who.int |format= |work= |accessdate=}}</ref>
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*Initially in reports till Feb 20, 2020, the patients known to have [[COVID-19|NCOV]] were reported to age between 30–69 years.
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*In the initial reports from [[WHO]], [[COVID-19]] was shown to be transmitted via [[droplets]] and [[fomites]] during close unprotected contact between an infector and infectee. Airborne was not reported for COVID-19. Fecal shedding was reported to be demonstrated from some [[patients]], with viable virus identified in a limited number of case reports. However, the [[fecal-oral]] route did not appear to be a driver of COVID-19 transmission.<ref name="urlwww.who.int">{{cite web |url=https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf |title=www.who.int |format= |work= |accessdate=}}</ref>
*On March 12, 2020, [[WHO]] declared the COVID-19 outbreak a [[pandemic]].
*Initially [[COVID-19]] was primarily known as a respiratory disease. In the initial phase of the [[pandemic]], the [[screening]] criteria for [[COVID‐19]] did not include [[symptoms]] of abdominal pain.
*On Feb 3rd, 2020, a study published by Wang D et al. first described abdominal pain as one of the less common symptoms of [[COVID-19]].<ref name="WangHu2020">{{cite journal|last1=Wang|first1=Dawei|last2=Hu|first2=Bo|last3=Hu|first3=Chang|last4=Zhu|first4=Fangfang|last5=Liu|first5=Xing|last6=Zhang|first6=Jing|last7=Wang|first7=Binbin|last8=Xiang|first8=Hui|last9=Cheng|first9=Zhenshun|last10=Xiong|first10=Yong|last11=Zhao|first11=Yan|last12=Li|first12=Yirong|last13=Wang|first13=Xinghuan|last14=Peng|first14=Zhiyong|title=Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China|journal=JAMA|volume=323|issue=11|year=2020|pages=1061|issn=0098-7484|doi=10.1001/jama.2020.1585}}</ref>
*With the increasing evidence and ongoing research, [[anorexia]] associated with [[COVID-19]] is now reported to be a common symptom in patients with [[COVID-19]], and the viral infection is suspected in a patient presenting with [[anorexia]] along with other [[gastrointestinal]] symptoms. Research is underway to develop a better understanding of the etiology, risk factors, and treatment of [[anorexia]] associated with [[COVID-19]].
*[[Anorexia]] was described as one of the common [[symptom]]s at the onset of illness and it was also reported to be more common in [[ICU]] [[patients]].<ref name="WangHu2020">{{cite journal|last1=Wang|first1=Dawei|last2=Hu|first2=Bo|last3=Hu|first3=Chang|last4=Zhu|first4=Fangfang|last5=Liu|first5=Xing|last6=Zhang|first6=Jing|last7=Wang|first7=Binbin|last8=Xiang|first8=Hui|last9=Cheng|first9=Zhenshun|last10=Xiong|first10=Yong|last11=Zhao|first11=Yan|last12=Li|first12=Yirong|last13=Wang|first13=Xinghuan|last14=Peng|first14=Zhiyong|title=Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China|journal=JAMA|volume=323|issue=11|year=2020|pages=1061|issn=0098-7484|doi=10.1001/jama.2020.1585}}</ref>


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==Classification==
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There is no established system for the classification of [[anorexia]] in COVID-19.
[[COVID-19-associated anorexia (patient information)|Patient Information]]
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==Pathophysiology==
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[[COVID-19-associated anorexia overview|Overview]]
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*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
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*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
[[COVID-19-associated anorexia historical perspective|Historical Perspective]]
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
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*Hepatic manifestations can lead to anorexia.
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==Causes== 
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[[COVID-19-associated anorexia classification|Classification]]
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==Differentiating [[anorexia]] associated with [[COVID-19]] from other Diseases==
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*[[Anorexia]] associated with [[COVID-19]] must be differentiated from other diseases that cause [[anorexia]] such as:<ref name="pmid32314792">{{cite journal |vauthors=Occhipinti V, Pastorelli L |title=Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a "Red Zone" Area in Northern Italy |journal=Inflamm. Bowel Dis. |volume=26 |issue=6 |pages=793–796 |date=May 2020 |pmid=32314792 |pmc=7188155 |doi=10.1093/ibd/izaa084 |url=}}</ref><ref name="pmid22905065">{{cite journal |vauthors=Ponnurangam Nagarajan V, Palaniyadi A, Sathyamoorthi M, Sasitharan R, Shuba S, Padur Sivaraman R, Scott JX |title=Pleural effusion - An unusual cause |journal=Australas Med J |volume=5 |issue=7 |pages=369–72 |date=2012 |pmid=22905065 |pmc=3413004 |doi=10.4066/AMJ.2012.1024 |url=}}</ref><ref name="WangZhang2020">{{cite journal|last1=Wang|first1=Yeming|last2=Zhang|first2=Dingyu|last3=Du|first3=Guanhua|last4=Du|first4=Ronghui|last5=Zhao|first5=Jianping|last6=Jin|first6=Yang|last7=Fu|first7=Shouzhi|last8=Gao|first8=Ling|last9=Cheng|first9=Zhenshun|last10=Lu|first10=Qiaofa|last11=Hu|first11=Yi|last12=Luo|first12=Guangwei|last13=Wang|first13=Ke|last14=Lu|first14=Yang|last15=Li|first15=Huadong|last16=Wang|first16=Shuzhen|last17=Ruan|first17=Shunan|last18=Yang|first18=Chengqing|last19=Mei|first19=Chunlin|last20=Wang|first20=Yi|last21=Ding|first21=Dan|last22=Wu|first22=Feng|last23=Tang|first23=Xin|last24=Ye|first24=Xianzhi|last25=Ye|first25=Yingchun|last26=Liu|first26=Bing|last27=Yang|first27=Jie|last28=Yin|first28=Wen|last29=Wang|first29=Aili|last30=Fan|first30=Guohui|last31=Zhou|first31=Fei|last32=Liu|first32=Zhibo|last33=Gu|first33=Xiaoying|last34=Xu|first34=Jiuyang|last35=Shang|first35=Lianhan|last36=Zhang|first36=Yi|last37=Cao|first37=Lianjun|last38=Guo|first38=Tingting|last39=Wan|first39=Yan|last40=Qin|first40=Hong|last41=Jiang|first41=Yushen|last42=Jaki|first42=Thomas|last43=Hayden|first43=Frederick G|last44=Horby|first44=Peter W|last45=Cao|first45=Bin|last46=Wang|first46=Chen|title=Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial|journal=The Lancet|volume=395|issue=10236|year=2020|pages=1569–1578|issn=01406736|doi=10.1016/S0140-6736(20)31022-9}}</ref>
[[COVID-19-associated anorexia pathophysiology|Pathophysiology]]
*[[Hepatitis]]: [[Acute]] [[hepatitis]] especially [[autoimmune hepatitis]] shared common symptoms such as [[fatigue]], [[abdominal pain]], [[nausea]], [[vomiting]], [[diarrhea]], skin [[rash]]. Some hepatic infections may involve [[pleuritis]] and [[pleural effusion]] thus [[chest pain]].
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*''[[Crohn's disease]]'': The disease may have [[remission]]s and [[relapse]]s and present with symptoms shared by [[COVID-19]] infection as well specially during a [[relapse]]. Other [[symptoms]] of [[Crohn's disease]] include [[abdominal pain]], [[diarrhea]] that may or may not be bloody, [[fever]] and [[rash]]. A history of [[Crohn's disease]] can help the [[clinician]] decide on the [[differential diagnosis]] but it is equally important to access for possible [[COVID-19]] infection. Patient should be counselled about the similarities in two diseases.
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*''[[Ulcerative colitis]]'': A [[relapse]] can have [[symptoms]] similar to [[COVID-19]] such as: [[abdominal pain]],[[diarrhea]], [[rash]]. A history of [[ulcerative colitis]] is important it is equally important to access for possible [[COVID-19]] infection. Patient should be counselled about the similarities in two diseases.
*''Chronic underlying disease-associated [[anorexia]]'': [[Cancer]] patients have [[anorexia]] and are an increased risk of [[COVID-19]] infection itself. High suspicion is required and the [[patient]] should be tested for [[COVID-19]] infection if required.
*''Remdesivir'': The drug used itself in [[COVID-19]] patients has a side effect of [[anorexia]] associated with [[nausea]] and [[vomiting]].
==Epidemiology and Demographics==
*  Based upon the meta-analysis including 78 studies the weighted pooled prevalence of  loss of appetite associated with [[COVID-19]] is approximately 22.3% ( 11.2%-34.6%)<ref name="TariqSaha2020">{{cite journal|last1=Tariq|first1=Raseen|last2=Saha|first2=Srishti|last3=Furqan|first3=Fateeha|last4=Hassett|first4=Leslie|last5=Pardi|first5=Darrell|last6=Khanna|first6=Sahil|title=Prevalence and Mortality of COVID-19 patients with Gastrointestinal Symptoms: A Systematic Review and Meta-analysis|journal=Mayo Clinic Proceedings|year=2020|issn=00256196|doi=10.1016/j.mayocp.2020.06.003}}</ref>
===Race===
*China being the source of most of the demographic data on clinical features of [[COVID-19]] and fewer studies on the demographics in other races, enabled the scientists to compare the incidence of [[anorexia]] in Chinese population and rest of the world. Data showed that [[anorexia|loss of appetite]] was similar in both subgroups non-Chinese and Chinese. There is limited data to comment on the racial predilection of the symptom in other races.
==Risk Factors==
*The most important risk factor in the development of [[anorexia]] associated with [[COVID-19]] is the infection [[COVID-19]] itself.


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== Natural History, Complications and Prognosis==
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*The appearance of [[anorexia]] has no fixed pattern of appearance in the [[COVID-19]] clinical course. But the [[symptom]] is usually associated with [[nausea]] and [[vomiting]].
[[COVID-19-associated anorexia causes|Causes]]
* [[Anorexia]] at illness onset was reported in 4 studies WPP 28.9% (11.5%-48.1%).<ref name="TariqSaha2020">{{cite journal|last1=Tariq|first1=Raseen|last2=Saha|first2=Srishti|last3=Furqan|first3=Fateeha|last4=Hassett|first4=Leslie|last5=Pardi|first5=Darrell|last6=Khanna|first6=Sahil|title=Prevalence and Mortality of COVID-19 patients with Gastrointestinal Symptoms: A Systematic Review and Meta-analysis|journal=Mayo Clinic Proceedings|year=2020|issn=00256196|doi=10.1016/j.mayocp.2020.06.003}}</ref>
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*Data from 3 studies reported [[anorexia]] in [[OVID-19]] patients at admission with a weighted pooled prevalence of 16.3%.
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*''Prognosis'': In a meta-analysis by Mao R. et al. the odds ratio for severe disease in patients with [[anorexia]] as one of the [[gastrointestinal]] symptoms were 2.83.<ref name="MaoQiu2020">{{cite journal|last1=Mao|first1=Ren|last2=Qiu|first2=Yun|last3=He|first3=Jin-Shen|last4=Tan|first4=Jin-Yu|last5=Li|first5=Xue-Hua|last6=Liang|first6=Jie|last7=Shen|first7=Jun|last8=Zhu|first8=Liang-Ru|last9=Chen|first9=Yan|last10=Iacucci|first10=Marietta|last11=Ng|first11=Siew C|last12=Ghosh|first12=Subrata|last13=Chen|first13=Min-Hu|title=Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis|journal=The Lancet Gastroenterology & Hepatology|volume=5|issue=7|year=2020|pages=667–678|issn=24681253|doi=10.1016/S2468-1253(20)30126-6}}</ref>


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==Diagnosis==
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===Diagnostic Study of Choice===
[[COVID-19-associated anorexia differential diagnosis|Differentiating Xyz from other Diseases]]
* COVID-19 nausea and vomiting can be diagnosed based on the history of the same and other gastrointestinal symptoms like anorexia, diarrhea and a positive [[Human feces|stool]] test for SARS-CoV-2
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* There are no established criteria for the diagnosis of nausea and vomiting in COVID-19.
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[[COVID-19-associated anorexia epidemiology and demographics|Epidemiology and Demographics]]
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===History and Symptoms===
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*Important associated [[gastrointestinal]] symptoms with [[anorexia]] are [[nausea]] or [[vomiting]], [[diarrhea]].<ref name="MaoQiu2020">{{cite journal|last1=Mao|first1=Ren|last2=Qiu|first2=Yun|last3=He|first3=Jin-Shen|last4=Tan|first4=Jin-Yu|last5=Li|first5=Xue-Hua|last6=Liang|first6=Jie|last7=Shen|first7=Jun|last8=Zhu|first8=Liang-Ru|last9=Chen|first9=Yan|last10=Iacucci|first10=Marietta|last11=Ng|first11=Siew C|last12=Ghosh|first12=Subrata|last13=Chen|first13=Min-Hu|title=Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis|journal=The Lancet Gastroenterology & Hepatology|volume=5|issue=7|year=2020|pages=667–678|issn=24681253|doi=10.1016/S2468-1253(20)30126-6}}</ref>
[[COVID-19-associated anorexia risk factors|Risk Factors]]
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===Physical Examination===
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Patients with [disease name] usually appear Physical examination of patients with [disease name]
[[COVID-19-associated anorexia screening|Screening]]
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[[COVID-19-associated anorexia natural history, complications and prognosis|Natural History, Complications and Prognosis]]
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Diagnosis
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===Laboratory Findings===
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[[COVID-19-associated anorexia diagnostic study of choice|Diagnostic Study of Choice]]
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[[COVID-19-associated anorexia history and symptoms|History and Symptoms]]
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[[COVID-19-associated anorexia physical examination|Physical Examination]]
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[[COVID-19-associated anorexia laboratory findings|Laboratory Findings]]
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==Treatment==
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===Medical Therapy===
[[COVID-19-associated anorexia electrocardiogram|Electrocardiogram]]
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* The mainstay of treatment is [[COVID-19]] infection treatment.
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* Rehydration, fluid repletion,  are essential.
[[COVID-19-associated anorexia x ray|X-ray]]
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===Primary Prevention===
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*There have been rigorous efforts in order to develop a [[vaccine]] for [[COVID-10|novel coronavirus]] and several vaccines are in the later phases of trials.
[[COVID-19-associated anorexia echocardiography and ultrasound|Echocardiography and Ultrasound]]
*Measure to prevent [[COVID-19]] infection itself include:<ref name="urlHow to Protect Yourself & Others | CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html |title=How to Protect Yourself & Others &#124; CDC |format= |work= |accessdate=}}</ref>
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**Frequent handwashing with soap and water for at least 20 seconds or using a [[alcohol rub|alcohol based hand sanitizer]] with at least 60% alcohol.
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**Staying at least 6 feet (about 2 arms’ length) from other people who do not live with you.
**Covering your mouth and nose with a cloth face cover when around others and covering sneezes and coughs.
**Cleaning and [[disinfect]]ing.
* For the prevention of transmission through [[gastrointestinal]] tract (presence of viral RNA in the stool raise suspicion for [[fecal-oral route|fecal-oral transmission]])
**Use of [[personal protective equipment]] (PPE) by the personnel handling the fecal matter.
**Screening of fecal [[Microbiome|microbiota]] [[transplant]] donors for [[COVID-19]] is also recommended.<ref name="pmid32240618">{{cite journal |vauthors=Green CA, Quraishi MN, Shabir S, Sharma N, Hansen R, Gaya DR, Hart AL, Loman NJ, Iqbal TH |title=Screening faecal microbiota transplant donors for SARS-CoV-2 by molecular testing of stool is the safest way forward |journal=Lancet Gastroenterol Hepatol |volume=5 |issue=6 |pages=531 |date=June 2020 |pmid=32240618 |pmc=7225406 |doi=10.1016/S2468-1253(20)30089-3 |url=}}</ref>
==References==
{{Reflist|2}}
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[[COVID-19-associated anorexia CT scan|CT scan]]
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[[COVID-19-associated anorexia MRI|MRI]]
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[[COVID-19-associated anorexia other imaging findings|Other Imaging Findings]]
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Treatment
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[[COVID-19-associated anorexia medical therapy|Medical Therapy]]
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[[COVID-19-associated anorexia interventions|Interventions]]
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[[COVID-19-associated anorexia surgery|Surgery]]
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[[COVID-19-associated anorexia primary prevention|Primary Prevention]]
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[[COVID-19-associated anorexia secondary prevention|Secondary Prevention]]
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[[COVID-19-associated anorexia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]
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[[COVID-19-associated anorexia future or investigational therapies|Future or Investigational Therapies]]
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Case Studies
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[[COVID-19-associated anorexia case study one|Case #1]]
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Revision as of 09:05, 29 June 2020

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List of terms related to COVID-19-associated anorexia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Synonyms and keywords:

Overview

According to a recent study by Pan et al, 48.5% presented with digestive symptoms as their chief complaint. Anorexia was the most common (83.8%) of digestive symptoms associated with SARS-Cov2 infection. With COVID-19 primarily being a respiratory disease, surprisingly around 3% cases had just the digestive symptoms but no respiratory symptoms.[1]

==Historical Perspective

  • On 30th December 2019, three bronchoalveolar lavage samples collected from a patient with pneumonia of unknown etiology – a surveillance definition established following the SARS outbreak of 2002-2003 – in Wuhan Jinyintan Hospital. Real-time PCR (RT-PCR) assays on these samples were positive for pan-Betacoronavirus.
  • Nanopore sequencing and bioinformatic analyses indicated that the virus had features typical of the coronavirus family and belonged to the Betacoronavirus 2B lineage.[2]
  • Initially in reports till Feb 20, 2020, the patients known to have NCOV were reported to age between 30–69 years.
  • In the initial reports from WHO, COVID-19 was shown to be transmitted via droplets and fomites during close unprotected contact between an infector and infectee. Airborne was not reported for COVID-19. Fecal shedding was reported to be demonstrated from some patients, with viable virus identified in a limited number of case reports. However, the fecal-oral route did not appear to be a driver of COVID-19 transmission.[2]
  • On March 12, 2020, WHO declared the COVID-19 outbreak a pandemic.
  • Initially COVID-19 was primarily known as a respiratory disease. In the initial phase of the pandemic, the screening criteria for COVID‐19 did not include symptoms of abdominal pain.
  • On Feb 3rd, 2020, a study published by Wang D et al. first described abdominal pain as one of the less common symptoms of COVID-19.[3]
  • With the increasing evidence and ongoing research, anorexia associated with COVID-19 is now reported to be a common symptom in patients with COVID-19, and the viral infection is suspected in a patient presenting with anorexia along with other gastrointestinal symptoms. Research is underway to develop a better understanding of the etiology, risk factors, and treatment of anorexia associated with COVID-19.
  • Anorexia was described as one of the common symptoms at the onset of illness and it was also reported to be more common in ICU patients.[3]

Classification

There is no established system for the classification of anorexia in COVID-19.

Pathophysiology

  • The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
  • On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
  • Hepatic manifestations can lead to anorexia.

Causes

Differentiating anorexia associated with COVID-19 from other Diseases

Epidemiology and Demographics

  • Based upon the meta-analysis including 78 studies the weighted pooled prevalence of loss of appetite associated with COVID-19 is approximately 22.3% ( 11.2%-34.6%)[7]

Race

  • China being the source of most of the demographic data on clinical features of COVID-19 and fewer studies on the demographics in other races, enabled the scientists to compare the incidence of anorexia in Chinese population and rest of the world. Data showed that loss of appetite was similar in both subgroups non-Chinese and Chinese. There is limited data to comment on the racial predilection of the symptom in other races.

Risk Factors

  • The most important risk factor in the development of anorexia associated with COVID-19 is the infection COVID-19 itself.

Natural History, Complications and Prognosis

  • The appearance of anorexia has no fixed pattern of appearance in the COVID-19 clinical course. But the symptom is usually associated with nausea and vomiting.
  • Anorexia at illness onset was reported in 4 studies WPP 28.9% (11.5%-48.1%).[7]
  • Data from 3 studies reported anorexia in OVID-19 patients at admission with a weighted pooled prevalence of 16.3%.
  • Prognosis: In a meta-analysis by Mao R. et al. the odds ratio for severe disease in patients with anorexia as one of the gastrointestinal symptoms were 2.83.[8]

Diagnosis

Diagnostic Study of Choice

  • COVID-19 nausea and vomiting can be diagnosed based on the history of the same and other gastrointestinal symptoms like anorexia, diarrhea and a positive stool test for SARS-CoV-2
  • There are no established criteria for the diagnosis of nausea and vomiting in COVID-19.

History and Symptoms

Physical Examination

Patients with [disease name] usually appear Physical examination of patients with [disease name]


Laboratory Findings



Treatment

Medical Therapy

  • The mainstay of treatment is COVID-19 infection treatment.
  • Rehydration, fluid repletion, are essential.

Primary Prevention

References

  1. ↑ Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L (May 2020). "Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study". Am. J. Gastroenterol. 115 (5): 766–773. doi:10.14309/ajg.0000000000000620. PMC 7172492 Check |pmc= value (help). PMID 32287140 Check |pmid= value (help).
  2. ↑ 2.0 2.1 "www.who.int" (PDF).
  3. ↑ 3.0 3.1 Wang, Dawei; Hu, Bo; Hu, Chang; Zhu, Fangfang; Liu, Xing; Zhang, Jing; Wang, Binbin; Xiang, Hui; Cheng, Zhenshun; Xiong, Yong; Zhao, Yan; Li, Yirong; Wang, Xinghuan; Peng, Zhiyong (2020). "Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China". JAMA. 323 (11): 1061. doi:10.1001/jama.2020.1585. ISSN 0098-7484.
  4. ↑ Occhipinti V, Pastorelli L (May 2020). "Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a "Red Zone" Area in Northern Italy". Inflamm. Bowel Dis. 26 (6): 793–796. doi:10.1093/ibd/izaa084. PMC 7188155 Check |pmc= value (help). PMID 32314792 Check |pmid= value (help).
  5. ↑ Ponnurangam Nagarajan V, Palaniyadi A, Sathyamoorthi M, Sasitharan R, Shuba S, Padur Sivaraman R, Scott JX (2012). "Pleural effusion - An unusual cause". Australas Med J. 5 (7): 369–72. doi:10.4066/AMJ.2012.1024. PMC 3413004. PMID 22905065.
  6. ↑ Wang, Yeming; Zhang, Dingyu; Du, Guanhua; Du, Ronghui; Zhao, Jianping; Jin, Yang; Fu, Shouzhi; Gao, Ling; Cheng, Zhenshun; Lu, Qiaofa; Hu, Yi; Luo, Guangwei; Wang, Ke; Lu, Yang; Li, Huadong; Wang, Shuzhen; Ruan, Shunan; Yang, Chengqing; Mei, Chunlin; Wang, Yi; Ding, Dan; Wu, Feng; Tang, Xin; Ye, Xianzhi; Ye, Yingchun; Liu, Bing; Yang, Jie; Yin, Wen; Wang, Aili; Fan, Guohui; Zhou, Fei; Liu, Zhibo; Gu, Xiaoying; Xu, Jiuyang; Shang, Lianhan; Zhang, Yi; Cao, Lianjun; Guo, Tingting; Wan, Yan; Qin, Hong; Jiang, Yushen; Jaki, Thomas; Hayden, Frederick G; Horby, Peter W; Cao, Bin; Wang, Chen (2020). "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial". The Lancet. 395 (10236): 1569–1578. doi:10.1016/S0140-6736(20)31022-9. ISSN 0140-6736.
  7. ↑ 7.0 7.1 Tariq, Raseen; Saha, Srishti; Furqan, Fateeha; Hassett, Leslie; Pardi, Darrell; Khanna, Sahil (2020). "Prevalence and Mortality of COVID-19 patients with Gastrointestinal Symptoms: A Systematic Review and Meta-analysis". Mayo Clinic Proceedings. doi:10.1016/j.mayocp.2020.06.003. ISSN 0025-6196.
  8. ↑ 8.0 8.1 Mao, Ren; Qiu, Yun; He, Jin-Shen; Tan, Jin-Yu; Li, Xue-Hua; Liang, Jie; Shen, Jun; Zhu, Liang-Ru; Chen, Yan; Iacucci, Marietta; Ng, Siew C; Ghosh, Subrata; Chen, Min-Hu (2020). "Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis". The Lancet Gastroenterology & Hepatology. 5 (7): 667–678. doi:10.1016/S2468-1253(20)30126-6. ISSN 2468-1253.
  9. ↑ "How to Protect Yourself & Others | CDC".
  10. ↑ Green CA, Quraishi MN, Shabir S, Sharma N, Hansen R, Gaya DR, Hart AL, Loman NJ, Iqbal TH (June 2020). "Screening faecal microbiota transplant donors for SARS-CoV-2 by molecular testing of stool is the safest way forward". Lancet Gastroenterol Hepatol. 5 (6): 531. doi:10.1016/S2468-1253(20)30089-3. PMC 7225406 Check |pmc= value (help). PMID 32240618 Check |pmid= value (help).

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