COVID-19-associated anorexia: Difference between revisions

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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>
*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]].
*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.
*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>
*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]].
*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>
*[[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>
==Classification==
==Classification==
There is no established system for the classification of annorexia in COVID-19.
There is no established system for the [[classification]] of annorexia in COVID-19.
==Pathophysiology==
==Pathophysiology==
*The exact mechanisms through which [[COVID-19]] causes [[anorexia]] is yet to be completely unveiled. The described possible mechanism of [[anorexia]], a general response to [[infection]] is as follows:
*The exact mechanisms through which [[COVID-19]] causes [[anorexia]] is yet to be completely unveiled. The described possible mechanism of [[anorexia]], a general response to [[infection]] is as follows:
**[[Gustatory system]] dysfunction partly explains [[anorexia]] in [[COVID-19]] due to its high [[incidence]] mild-moderate [[COVID-19]] patients. [[Olfactory]] dysfunction in addition contributes [[anorexia|to loss of appetite]].<ref name="pmid32253535">{{cite journal |vauthors=Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, Dequanter D, Blecic S, El Afia F, Distinguin L, Chekkoury-Idrissi Y, Hans S, Delgado IL, Calvo-Henriquez C, Lavigne P, Falanga C, Barillari MR, Cammaroto G, Khalife M, Leich P, Souchay C, Rossi C, Journe F, Hsieh J, Edjlali M, Carlier R, Ris L, Lovato A, De Filippis C, Coppee F, Fakhry N, Ayad T, Saussez S |title=Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study |journal=Eur Arch Otorhinolaryngol |volume= |issue= |pages= |date=April 2020 |pmid=32253535 |pmc=7134551 |doi=10.1007/s00405-020-05965-1 |url=}}</ref>
**[[Gustatory system]] dysfunction partly explains [[anorexia]] in [[COVID-19]] due to its high [[incidence]] mild-moderate [[COVID-19]] patients. [[Olfactory]] dysfunction in addition contributes [[anorexia|to loss of appetite]].<ref name="pmid32253535">{{cite journal |vauthors=Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, Dequanter D, Blecic S, El Afia F, Distinguin L, Chekkoury-Idrissi Y, Hans S, Delgado IL, Calvo-Henriquez C, Lavigne P, Falanga C, Barillari MR, Cammaroto G, Khalife M, Leich P, Souchay C, Rossi C, Journe F, Hsieh J, Edjlali M, Carlier R, Ris L, Lovato A, De Filippis C, Coppee F, Fakhry N, Ayad T, Saussez S |title=Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study |journal=Eur Arch Otorhinolaryngol |volume= |issue= |pages= |date=April 2020 |pmid=32253535 |pmc=7134551 |doi=10.1007/s00405-020-05965-1 |url=}}</ref>
** The [[microbial]] products during [[infection]] set off the development of [[acute phase protein]]s such as [[cytokines]] ([[Interleukin]] and [[Tumor necrosis factor-alpha|TNF alpha]]) which are known to cause [[anorexia]]. [[Cytokines]] locally released activate the [[peripheral]] [[sensory fibers]] causing loss of appetite. The direct effect of [[cytokines]] and [[microbial]] products on the [[CNS]] (the [[Hypothalamus|center of appetite]]) is involved in the anorexia during infection.<ref name="pmid17290560">{{cite journal |vauthors=Kanra GY, Ozen H, Kara A |title=Infection and anorexia |journal=Turk. J. Pediatr. |volume=48 |issue=4 |pages=279–87 |date=2006 |pmid=17290560 |doi= |url=}}</ref><ref name="pmid10657519">{{cite journal |vauthors=Langhans W, Hrupka B |title=Interleukins and tumor necrosis factor as inhibitors of food intake |journal=Neuropeptides |volume=33 |issue=5 |pages=415–24 |date=October 1999 |pmid=10657519 |doi=10.1054/npep.1999.0048 |url=}}</ref> Studies have reported several pro-inflammatory [[cytokines]] and [[chemokines]], particularly CXCL10, CXCL8, CCL2, [[Tumor necrosis factor-alpha|TNFα]] and IFNγ to be higher in the [[plasma]] of [[SARS-CoV-2]] patients.<ref name="pmid32270184">{{cite journal |vauthors=Chu H, Chan JF, Wang Y, Yuen TT, Chai Y, Hou Y, Shuai H, Yang D, Hu B, Huang X, Zhang X, Cai JP, Zhou J, Yuan S, Kok KH, To KK, Chan IH, Zhang AJ, Sit KY, Au WK, Yuen KY |title=Comparative replication and immune activation profiles of SARS-CoV-2 and SARS-CoV in human lungs: an ex vivo study with implications for the pathogenesis of COVID-19 |journal=Clin. Infect. Dis. |volume= |issue= |pages= |date=April 2020 |pmid=32270184 |pmc=7184390 |doi=10.1093/cid/ciaa410 |url=}}</ref> A relationship of [[cytokines]] and [[COVID-19]] infection has been established.<ref name="pmid32446778">{{cite journal |vauthors=Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M |title=The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system |journal=Cytokine Growth Factor Rev. |volume=53 |issue= |pages=25–32 |date=June 2020 |pmid=32446778 |pmc=7211650 |doi=10.1016/j.cytogfr.2020.05.003 |url=}}</ref>
** The [[microbial]] products during [[infection]] set off the development of [[acute phase protein]]s such as [[cytokines]] ([[Interleukin]] and [[Tumor necrosis factor-alpha|TNF alpha]]) which are known to cause [[anorexia]]. [[Cytokines]] locally released activate the [[peripheral]] [[sensory fibers]] causing loss of appetite. The direct effect of [[cytokines]] and [[microbial]] products on the [[CNS]] (the [[Hypothalamus|center of appetite]]) is involved in the anorexia during infection.<ref name="pmid17290560">{{cite journal |vauthors=Kanra GY, Ozen H, Kara A |title=Infection and anorexia |journal=Turk. J. Pediatr. |volume=48 |issue=4 |pages=279–87 |date=2006 |pmid=17290560 |doi= |url=}}</ref><ref name="pmid10657519">{{cite journal |vauthors=Langhans W, Hrupka B |title=Interleukins and tumor necrosis factor as inhibitors of food intake |journal=Neuropeptides |volume=33 |issue=5 |pages=415–24 |date=October 1999 |pmid=10657519 |doi=10.1054/npep.1999.0048 |url=}}</ref> Studies have reported several pro-inflammatory [[cytokines]] and [[chemokines]], particularly [[CXCL10]], CXCL8, [[CCL2]], [[Tumor necrosis factor-alpha|TNFα]] and IFNγ to be higher in the [[plasma]] of [[SARS-CoV-2]] patients.<ref name="pmid32270184">{{cite journal |vauthors=Chu H, Chan JF, Wang Y, Yuen TT, Chai Y, Hou Y, Shuai H, Yang D, Hu B, Huang X, Zhang X, Cai JP, Zhou J, Yuan S, Kok KH, To KK, Chan IH, Zhang AJ, Sit KY, Au WK, Yuen KY |title=Comparative replication and immune activation profiles of SARS-CoV-2 and SARS-CoV in human lungs: an ex vivo study with implications for the pathogenesis of COVID-19 |journal=Clin. Infect. Dis. |volume= |issue= |pages= |date=April 2020 |pmid=32270184 |pmc=7184390 |doi=10.1093/cid/ciaa410 |url=}}</ref> A relationship of [[cytokines]] and [[COVID-19]] infection has been established.<ref name="pmid32446778">{{cite journal |vauthors=Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M |title=The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system |journal=Cytokine Growth Factor Rev. |volume=53 |issue= |pages=25–32 |date=June 2020 |pmid=32446778 |pmc=7211650 |doi=10.1016/j.cytogfr.2020.05.003 |url=}}</ref>
**The detection of viral [[nucleocapsid]] protein in gastrointestinal [[epithelial cells]] and viral RNA in [[fecal]] [[specimens]] reflects the infectivity and chance of direct [[cytokine]] or [[chemokine]] response.<ref name="ZouChen2020">{{cite journal|last1=Zou|first1=Xin|last2=Chen|first2=Ke|last3=Zou|first3=Jiawei|last4=Han|first4=Peiyi|last5=Hao|first5=Jie|last6=Han|first6=Zeguang|title=Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection|journal=Frontiers of Medicine|volume=14|issue=2|year=2020|pages=185–192|issn=2095-0217|doi=10.1007/s11684-020-0754-0}}</ref>
**The detection of viral [[nucleocapsid]] protein in gastrointestinal [[epithelial cells]] and viral RNA in [[fecal]] [[specimens]] reflects the infectivity and chance of direct [[cytokine]] or [[chemokine]] response.<ref name="ZouChen2020">{{cite journal|last1=Zou|first1=Xin|last2=Chen|first2=Ke|last3=Zou|first3=Jiawei|last4=Han|first4=Peiyi|last5=Hao|first5=Jie|last6=Han|first6=Zeguang|title=Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection|journal=Frontiers of Medicine|volume=14|issue=2|year=2020|pages=185–192|issn=2095-0217|doi=10.1007/s11684-020-0754-0}}</ref>
*[[COVID-19-associated hepatic injury]] can lead to anorexia.<ref name="pmid9062842">{{cite journal |vauthors=Laviano A, Cangiano C, Preziosa I, Riggio O, Conversano L, Cascino A, Ariemma S, Rossi Fanelli F |title=Plasma tryptophan levels and anorexia in liver cirrhosis |journal=Int J Eat Disord |volume=21 |issue=2 |pages=181–6 |date=March 1997 |pmid=9062842 |doi=10.1002/(sici)1098-108x(199703)21:2<181::aid-eat9>3.0.co;2-h |url=}}</ref>
*[[COVID-19-associated hepatic injury]] can lead to anorexia.<ref name="pmid9062842">{{cite journal |vauthors=Laviano A, Cangiano C, Preziosa I, Riggio O, Conversano L, Cascino A, Ariemma S, Rossi Fanelli F |title=Plasma tryptophan levels and anorexia in liver cirrhosis |journal=Int J Eat Disord |volume=21 |issue=2 |pages=181–6 |date=March 1997 |pmid=9062842 |doi=10.1002/(sici)1098-108x(199703)21:2<181::aid-eat9>3.0.co;2-h |url=}}</ref>
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|[[Crohn's disease]]
|[[Crohn's disease]]
|
|
* Crohn's disease may have a history of [[remission]]s and [[relapse]]s  
*[[Crohn's disease]] may have a history of [[remission]]s and [[relapse]]s
* Present with symptoms shared by [[COVID-19]] infection as well especially during a [[relapse]].  
* Present with symptoms shared by COVID-19 infection as well especially during a [[relapse]].
* Other [[symptoms]] of [[Crohn's disease]] include [[abdominal pain]], [[diarrhea]] that may or may not be bloody, [[fever]] and [[rash]].
* Other [[symptoms]] of [[Crohn's disease]] include [[abdominal pain]], [[diarrhea]] that may or may not be bloody, [[fever]] and [[rash]].
* History of [[Crohn's disease]] can help on deciding on the [[differential diagnosis]] but it is equally important to access possible [[COVID-19]] infection.  
* History of [[Crohn's disease]] can help on deciding on the [[differential diagnosis]] but it is equally important to access possible COVID-19 infection.
* Patients should be counseled about the similarities in two diseases.
* Patients should be counseled about the similarities in two diseases.
|-
|-
|[[Ulcerative colitis]]
|[[Ulcerative colitis]]
|
|
* A [[relapse]] can have [[symptoms]] similar to [[COVID-19]] such as: [[abdominal pain]] ,[[diarrhea]], [[rash]].
* 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.
* A history of [[ulcerative colitis]] is important it is equally important to access for possible [[COVID-19]] infection.
* Patients should be counseled about the similarities in two diseases.
* Patients should be counseled about the similarities in two diseases.
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|Chronic underlying disease-associated [[anorexia]]
|Chronic underlying disease-associated [[anorexia]]
|
|
* [[Cancer]] patients have [[anorexia]] and are an increased risk of [[COVID-19]] infection itself.  
* [[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.
* High suspicion is required and the [[patient]] should be tested for COVID-19 infection if required.
|}
|}
<br />
<br />
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== Natural History, Complications and Prognosis==
== 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]].
*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]].
*Most SARS-CoV-2 patients develop [[anorexia]] associated with [[COVID-19]] during [[hospitalization]].  
*Most SARS-CoV-2 patients develop [[anorexia]] associated with [[COVID-19]] during [[hospitalization]].  
*[[Anorexia]] as an initial presentation is observed in a minority of patients.<ref name="pmid32241899">{{cite journal |vauthors=Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, Gu Z, Gao L, Shi H, Mai L, Liu Y, Lin X, Lai R, Yan Z, Li X, Shan H |title=Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection |journal=Gut |volume=69 |issue=6 |pages=997–1001 |date=June 2020 |pmid=32241899 |pmc=7316116 |doi=10.1136/gutjnl-2020-321013 |url=}}</ref>
*[[Anorexia]] as an initial presentation is observed in a minority of patients.<ref name="pmid32241899">{{cite journal |vauthors=Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, Gu Z, Gao L, Shi H, Mai L, Liu Y, Lin X, Lai R, Yan Z, Li X, Shan H |title=Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection |journal=Gut |volume=69 |issue=6 |pages=997–1001 |date=June 2020 |pmid=32241899 |pmc=7316116 |doi=10.1136/gutjnl-2020-321013 |url=}}</ref>
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===History ===
===History ===


* History of contact with person suspected or confirmed to have [[COVID-19]] infection is important.
* History of contact with person suspected or confirmed to have COVID-19 infection is important.


===Symptoms===
===Symptoms===
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===X-ray===
===X-ray===
*A [[Chest X-ray]] may be normal or show [[consolidation]], [[bilateral]]  [[perihilar]] and [[interstitial]] opacities opacities with [[air bronchograms]].
*A [[Chest X-ray]] may be normal or show [[consolidation]], [[bilateral]]  [[perihilar]] and [[interstitial]] opacities opacities with [[air bronchograms]].
*Abdominal [[Xray]] has been reported to be normal in a few studies available.<ref name="pmid32387082">{{cite journal |vauthors=Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL |title=Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members |journal=Pancreatology |volume=20 |issue=4 |pages=665–667 |date=June 2020 |pmid=32387082 |pmc=7199002 |doi=10.1016/j.pan.2020.04.021 |url=}}</ref><ref name="pmid32523872">{{cite journal |vauthors=Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L |title=Can COVID 19 present like appendicitis? |journal=IDCases |volume=21 |issue= |pages=e00860 |date=2020 |pmid=32523872 |pmc=7265835 |doi=10.1016/j.idcr.2020.e00860 |url=}}</ref>
*Abdominal [[X-ray]] has been reported to be normal in a few studies available.<ref name="pmid32387082">{{cite journal |vauthors=Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL |title=Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members |journal=Pancreatology |volume=20 |issue=4 |pages=665–667 |date=June 2020 |pmid=32387082 |pmc=7199002 |doi=10.1016/j.pan.2020.04.021 |url=}}</ref><ref name="pmid32523872">{{cite journal |vauthors=Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L |title=Can COVID 19 present like appendicitis? |journal=IDCases |volume=21 |issue= |pages=e00860 |date=2020 |pmid=32523872 |pmc=7265835 |doi=10.1016/j.idcr.2020.e00860 |url=}}</ref>


===Ultrasound===
===Ultrasound===
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* Bedside lung [[ultrasound]]  may be helpful in the diagnosis of covid-19 infection.
* Bedside lung [[ultrasound]]  may be helpful in the diagnosis of covid-19 infection.
* Other Imaging findings in bedside lung [[ultrasound]] to detect the signs of respiratory [[COVID-19]] infection even when there are no respiratory symptoms.<ref name="pmid32309266">{{cite journal |vauthors=Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A |title=Abdominal Pain: A Real Challenge in Novel COVID-19 Infection |journal=Eur J Case Rep Intern Med |volume=7 |issue=4 |pages=001632 |date=2020 |pmid=32309266 |pmc=7162568 |doi=10.12890/2020_001632 |url=}}</ref>
* Other Imaging findings in bedside lung [[ultrasound]] to detect the signs of respiratory COVID-19 infection even when there are no respiratory symptoms.<ref name="pmid32309266">{{cite journal |vauthors=Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A |title=Abdominal Pain: A Real Challenge in Novel COVID-19 Infection |journal=Eur J Case Rep Intern Med |volume=7 |issue=4 |pages=001632 |date=2020 |pmid=32309266 |pmc=7162568 |doi=10.12890/2020_001632 |url=}}</ref>


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
*The mainstay of treatment in [[COVID-19]] infection is [[antiviral therapy]] such as lopinavir and ritonavir tablets and supportive therapy.
*The mainstay of treatment in COVID-19 infection is [[antiviral therapy]] such as lopinavir and ritonavir tablets and supportive therapy.
*[[Rehydration]], [[Intravenous therapy#IV fluids|IV fluid therapy]], are essential if [[vomiting]] accompanies [[anorexia]].
*[[Rehydration]], [[Intravenous therapy#IV fluids|IV fluid therapy]], are essential if [[vomiting]] accompanies [[anorexia]].
*Associated [[vomiting]] is treated with [[antiemetic]] drugs and [[diarrhea]] is treated with [[antidiarrheal]] drugs such as [[loperamide]].  
*Associated [[vomiting]] is treated with [[antiemetic]] drugs and [[diarrhea]] is treated with [[antidiarrheal]] drugs such as [[loperamide]].  
*[[Loperamide]] is not given if the patient has [[C. difficile]] infection or signs of infection such as [[fever]], [[Hematochezia|bloody stools]].
*[[Loperamide]] is not given if the patient has [[C. difficile]] infection or signs of infection such as [[fever]], [[Hematochezia|bloody stools]].
*Although the [[COVID-19]] infection and [[inflammatory bowel disease|IBDs]] mimic in some parameters, [[glucocorticoids]] such as [[prednisone]] treatment should not be abruptly discontinued but tapered to a possible minimum dose.
*Although the [[COVID-19]] infection and [[inflammatory bowel disease|IBDs]] mimic in some parameters, [[glucocorticoids]] such as [[prednisone]] treatment should not be abruptly discontinued but tapered to a possible minimum dose.
*A dose above ⩾20 mg/day for prednisone should be tapered to stop if patient becomes[[COVID-19]] positive or prevent infection.<ref name="pmid32321117">{{cite journal |vauthors=Queiroz NSF, Barros LL, Azevedo MFC, Oba J, Sobrado CW, Carlos AS, Milani LR, Sipahi AM, Damião AOMC |title=Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance |journal=Clinics (Sao Paulo) |volume=75 |issue= |pages=e1909 |date=2020 |pmid=32321117 |pmc=7153358 |doi=10.6061/clinics/2020/e1909 |url=}}</ref><ref name="SuShen2020">{{cite journal|last1=Su|first1=Song|last2=Shen|first2=Jun|last3=Zhu|first3=Liangru|last4=Qiu|first4=Yun|last5=He|first5=Jin-Shen|last6=Tan|first6=Jin-Yu|last7=Iacucci|first7=Marietta|last8=Ng|first8=Siew C|last9=Ghosh|first9=Subrata|last10=Mao|first10=Ren|last11=Liang|first11=Jie|title=Involvement of digestive system in COVID-19: manifestations, pathology, management and challenges|journal=Therapeutic Advances in Gastroenterology|volume=13|year=2020|pages=175628482093462|issn=1756-2848|doi=10.1177/1756284820934626}}</ref>
*A dose above ⩾20 mg/day for prednisone should be tapered to stop if patient becomesCOVID-19 positive or prevent infection.<ref name="pmid32321117">{{cite journal |vauthors=Queiroz NSF, Barros LL, Azevedo MFC, Oba J, Sobrado CW, Carlos AS, Milani LR, Sipahi AM, Damião AOMC |title=Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance |journal=Clinics (Sao Paulo) |volume=75 |issue= |pages=e1909 |date=2020 |pmid=32321117 |pmc=7153358 |doi=10.6061/clinics/2020/e1909 |url=}}</ref><ref name="SuShen2020">{{cite journal|last1=Su|first1=Song|last2=Shen|first2=Jun|last3=Zhu|first3=Liangru|last4=Qiu|first4=Yun|last5=He|first5=Jin-Shen|last6=Tan|first6=Jin-Yu|last7=Iacucci|first7=Marietta|last8=Ng|first8=Siew C|last9=Ghosh|first9=Subrata|last10=Mao|first10=Ren|last11=Liang|first11=Jie|title=Involvement of digestive system in COVID-19: manifestations, pathology, management and challenges|journal=Therapeutic Advances in Gastroenterology|volume=13|year=2020|pages=175628482093462|issn=1756-2848|doi=10.1177/1756284820934626}}</ref>


===Primary Prevention===
===Primary Prevention===

Revision as of 14:39, 16 July 2020

For COVID-19 frequently asked outpatient questions, click here
For COVID-19 frequently asked inpatient questions, click here

COVID-19 Microchapters

Home

Long COVID

Frequently Asked Outpatient Questions

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating COVID-19 from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Vaccines

Secondary Prevention

Future or Investigational Therapies

Ongoing Clinical Trials

Case Studies

Case #1

COVID-19-associated anorexia On the Web

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Ongoing Trials at Clinical Trials.gov

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Risk calculators and risk factors for 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:COVID-19 associated loss of appetite, COVID-19 and hunger, appetite and COVID-19, loss of appetite in COVID, COVID and hunger, SARS-Cov-2 associated anorexia, SARS-Cov-2 associated loss of appetite, SARS CoV2 and hunger, Coronavirus and hunger, appetite and COVID-19.

Overview

COVID-19 is primarily known to be a respiratory disease. Anorexia associated with COVID-19 is the most common of the digestive systems in patients with SARS-CoV-2. The exact mechanism of loss of appetite associated with the infection is unknown but the symptom may be due to various causes. Several diseases share loss of appetite symptom and it is important to suspect COVID-19 to catch COVI-19 and perform RT-PCR to detect the infection or CXR to detect possible lung manifestations. Patients with loss of appetite may present with associated symptoms such as nausea or vomiting and diarrhea. The mainstay of treatment in COVID-19 infection is supportive therapy and antiviral therapy. Hygiene practice and social distancing are important primary and contact tracing is an important tool of secondary prevention.

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.[1]
  • Initially in reports till Feb 20, 2020, the patients are 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.[1]
  • 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.[2]
  • 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.[2]

Classification

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

Pathophysiology

Causes

Anorexia in a patient hospitalized due to COVID-19 may be due to:

Differentiating anorexia associated with COVID-19 from other Diseases

Anorexia associated with COVID-19 must be differentiated from other diseases that cause anorexia such as:[12][13]

Disease Differentiating features
Hepatitis
Crohn's disease
Ulcerative colitis
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.


  • To view the differential diagnosis of COVID-19, click here
  • To view the differential diagnosis of Anorexia click here

Epidemiology and Demographics

  • Nearly around 48.5% of covid-19 patients presented with digestive symptoms as their chief complaint.
  • With COVID-19 primarily being a respiratory disease, surprisingly around 3% of cases had just the digestive symptoms but no respiratory symptoms.[14]
  • According to recent studies anorexia is the most common (40-84%) digestive symptoms associated with SARS-Cov2 infection.[15][16]

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 potent risk factor for the development of anorexia associated with COVID-19 is the infection COVID-19 itself.
  • Other risk factors involved in the process COVID-19 infected people presenting with anorexia have yet to be unveiled.

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History

  • History of contact with person suspected or confirmed to have COVID-19 infection is important.

Symptoms

Physical Examination

Laboratory Findings

X-ray

Ultrasound

  • Ultrasound of the abdomen may or may not show any abnormal findings.

CT scan

  • Abdominal CT scan may be helpful in the diagnosis of covid related anorexia.
  • Findings on CT scan suggestive of anorexia associated with covid-19 infection include peri-intestinal inflammatory reaction.[20]

Other Imaging Findings

  • Bedside lung ultrasound may be helpful in the diagnosis of covid-19 infection.
  • Other Imaging findings in bedside lung ultrasound to detect the signs of respiratory COVID-19 infection even when there are no respiratory symptoms.[20]

Treatment

Medical Therapy

Primary Prevention

  • Effective measures for the primary prevention of COVID-19 include::[23]
    • Frequent handwashing with soap and water for at least 20 seconds or using a alcohol based hand sanitizer with at least 60% alcohol
    • 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 disinfecting
  • There have been rigorous efforts in order to develop a vaccine for novel coronavirus and several vaccines are in the later phases of trials.[24]

Secondary prevention

References

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  3. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, Dequanter D, Blecic S, El Afia F, Distinguin L, Chekkoury-Idrissi Y, Hans S, Delgado IL, Calvo-Henriquez C, Lavigne P, Falanga C, Barillari MR, Cammaroto G, Khalife M, Leich P, Souchay C, Rossi C, Journe F, Hsieh J, Edjlali M, Carlier R, Ris L, Lovato A, De Filippis C, Coppee F, Fakhry N, Ayad T, Saussez S (April 2020). "Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study". Eur Arch Otorhinolaryngol. doi:10.1007/s00405-020-05965-1. PMC 7134551 Check |pmc= value (help). PMID 32253535 Check |pmid= value (help).
  4. Kanra GY, Ozen H, Kara A (2006). "Infection and anorexia". Turk. J. Pediatr. 48 (4): 279–87. PMID 17290560.
  5. Langhans W, Hrupka B (October 1999). "Interleukins and tumor necrosis factor as inhibitors of food intake". Neuropeptides. 33 (5): 415–24. doi:10.1054/npep.1999.0048. PMID 10657519.
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  7. Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M (June 2020). "The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system". Cytokine Growth Factor Rev. 53: 25–32. doi:10.1016/j.cytogfr.2020.05.003. PMC 7211650 Check |pmc= value (help). PMID 32446778 Check |pmid= value (help).
  8. Zou, Xin; Chen, Ke; Zou, Jiawei; Han, Peiyi; Hao, Jie; Han, Zeguang (2020). "Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection". Frontiers of Medicine. 14 (2): 185–192. doi:10.1007/s11684-020-0754-0. ISSN 2095-0217.
  9. Laviano A, Cangiano C, Preziosa I, Riggio O, Conversano L, Cascino A, Ariemma S, Rossi Fanelli F (March 1997). "Plasma tryptophan levels and anorexia in liver cirrhosis". Int J Eat Disord. 21 (2): 181–6. doi:10.1002/(sici)1098-108x(199703)21:2<181::aid-eat9>3.0.co;2-h. PMID 9062842.
  10. 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.
  11. 11.0 11.1 11.2 Hadi A, Werge M, Kristiansen KT, Pedersen UG, Karstensen JG, Novovic S, Gluud LL (June 2020). "Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members". Pancreatology. 20 (4): 665–667. doi:10.1016/j.pan.2020.04.021. PMC 7199002 Check |pmc= value (help). PMID 32387082 Check |pmid= value (help).
  12. 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).
  13. 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.
  14. 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).
  15. "Management of Patients with Confirmed 2019-nCoV | CDC".
  16. Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J, Shen J, Zhu LR, Chen Y, Iacucci M, Ng SC, Ghosh S, Chen MH (July 2020). "Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis". Lancet Gastroenterol Hepatol. 5 (7): 667–678. doi:10.1016/S2468-1253(20)30126-6. PMC 7217643 Check |pmc= value (help). PMID 32405603 Check |pmid= value (help).
  17. Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, Gu Z, Gao L, Shi H, Mai L, Liu Y, Lin X, Lai R, Yan Z, Li X, Shan H (June 2020). "Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection". Gut. 69 (6): 997–1001. doi:10.1136/gutjnl-2020-321013. PMC 7316116 Check |pmc= value (help). PMID 32241899 Check |pmid= value (help).
  18. 18.0 18.1 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.
  19. 19.0 19.1 Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L (2020). "Can COVID 19 present like appendicitis?". IDCases. 21: e00860. doi:10.1016/j.idcr.2020.e00860. PMC 7265835 Check |pmc= value (help). PMID 32523872 Check |pmid= value (help).
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  21. Queiroz N, Barros LL, Azevedo M, Oba J, Sobrado CW, Carlos AS, Milani LR, Sipahi AM, Damião A (2020). "Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance". Clinics (Sao Paulo). 75: e1909. doi:10.6061/clinics/2020/e1909. PMC 7153358 Check |pmc= value (help). PMID 32321117 Check |pmid= value (help). Vancouver style error: initials (help)
  22. Su, Song; Shen, Jun; Zhu, Liangru; Qiu, Yun; He, Jin-Shen; Tan, Jin-Yu; Iacucci, Marietta; Ng, Siew C; Ghosh, Subrata; Mao, Ren; Liang, Jie (2020). "Involvement of digestive system in COVID-19: manifestations, pathology, management and challenges". Therapeutic Advances in Gastroenterology. 13: 175628482093462. doi:10.1177/1756284820934626. ISSN 1756-2848.
  23. "How to Protect Yourself & Others | CDC".
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  25. 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).
  26. "Contact Tracing for COVID-19 | CDC".

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