COVID-19-associated anorexia: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Study of Choice=== | ===Diagnostic Study of Choice=== | ||
*There are no established criteria | *There are no established criteria to identify the cause of [[COVID-19]] associated loss of appetite/ anorexia. [[COVID-19]] associated anorexia/ loss of appetite is a symptom, not a disease. [[Anorexia]] may be a symptom of direct injury of an involved abdominal organ or merely one of the symptoms of [[COVID-19]]. | ||
*COVID-19 [[anorexia]] can be diagnosed based on the history, timing of the | *COVID-19 [[anorexia]] can be diagnosed based on the history, timing of the symptoms, associated symptoms and signs such as [[abdominal pain]], [[nausea]] or [[vomiting]] (2nd and third most common symptoms) and most importantly, a positive [[Reverse transcription polymerase chain reaction|reverse transcriptase polymerase chain reaction]] (rRT-PCR) for [[COVID-19]]. | ||
===History === | === History and Symptoms === | ||
* History of contact with a person suspected or confirmed to have [[COVID-19]] infection is important to suspect [[COVID-19]] in a patient. | |||
* History of contact with person suspected or confirmed to have COVID-19 infection is important. | *Based on a retrospective observational study including 1141 cases of [[COVID-19]] from Wuhan, China [[anorexia]] was the most common [[gastrointestinal]] symptom of [[COVID-19]].<ref name="pmid32205220">{{cite journal |vauthors=Luo S, Zhang X, Xu H |title=Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19) |journal=Clin. Gastroenterol. Hepatol. |volume=18 |issue=7 |pages=1636–1637 |date=June 2020 |pmid=32205220 |pmc=7154217 |doi=10.1016/j.cgh.2020.03.043 |url=}}</ref> | ||
*The most common accompanying symptoms of [[COVID-19]] besides [[anorexia]] were [[nausea]], [[vomiting]], and [[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> | |||
===Symptoms=== | |||
*The most common symptoms of | |||
*The timing of symptoms and presence of co-morbid conditions helps differentiate the diseases with similar symptoms. | *The timing of symptoms and presence of co-morbid conditions helps differentiate the diseases with similar symptoms. | ||
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*Patients with [[COVID-19]] associated [[anorexia]] may appear [[lethargic]], [[fatigue]]d or [[irritable]]. | *Patients with [[COVID-19]] associated [[anorexia]] may appear [[lethargic]], [[fatigue]]d or [[irritable]]. | ||
*Signs of [[dehydration]] such as [[sunken eyes]] and dry [[mucosa]]. | *Signs of [[dehydration]] such as [[sunken eyes]] and dry [[mucosa]]. | ||
*[[Vital signs]]: | *[[Vital signs]]:<ref name="TeliasKatira2020">{{cite journal|last1=Telias|first1=Irene|last2=Katira|first2=Bhushan H.|last3=Brochard|first3=Laurent|title=Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?|journal=JAMA|volume=323|issue=22|year=2020|pages=2265|issn=0098-7484|doi=10.1001/jama.2020.8539}}</ref><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> | ||
**[[Heart rate]]/[[Pulse]]: [[Tachycardia]] may be due to [[fever]], [[pain]] or [[shock]]. A low volume [[pulse]] is seen in severe [[dehydration]]. | **[[Heart rate]]/[[Pulse]]: [[Tachycardia]] may be due to [[fever]], [[pain]] or [[shock]]. A low volume [[pulse]] is seen in severe [[dehydration]]. | ||
**[[Blood pressure]]: Depending upon the cause of [[anorexia]] a patient with mild disease may have a normal [[blood pressure]] and others may present with [[shock]] due to [[infection]] and resulting [[sepsis]]. | **[[Blood pressure]]: Depending upon the cause of [[anorexia]] a patient with mild disease may have a normal [[blood pressure]] and others may present with [[shock]] due to [[infection]] and resulting [[sepsis]]. | ||
**[[Respiratory rate]]: [[Tachypnea]] maybe due to high metabolic rate such as in [[fever]] and [[sepsis]] due to [[COVID-19]] along with inefficient [[ventilation]]. | **[[Respiratory rate]]: [[Tachypnea]] maybe due to high metabolic rate such as in [[fever]] and [[sepsis]] due to [[COVID-19]] along with inefficient [[ventilation]]. Inefficient ventilation can be due to [[COVID-19]] lung infection such as [[pneumonia]] or [[ARDS]]. Shallow breathing can be due to severe [[respiratory distress]] or associated severe [[abdominal pain]]. | ||
**[[Temperature]]: The patient can be [[fever|febrile]] due to [[COVID-19]] infection, hypothermic, or have a normal temperature. | **[[Temperature]]: The patient can be [[fever|febrile]] due to [[COVID-19]] infection, hypothermic, or have a normal temperature. | ||
*On [[Abdominal exam]]: | *On [[Abdominal exam]]:<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><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> | ||
**Inspection: A patient with [[COVID-19-associated hepatic injury]] causing [[anorexia]] may have [[jaundice]]. | **Inspection: A patient with [[COVID-19-associated hepatic injury]] causing [[anorexia]] may have [[jaundice]]. | ||
**Auscultation: Accompanying [[gastrointestinal]] infection may present as [[increased bowel sounds]] due to [[enteritis]]. | **Auscultation: Accompanying [[gastrointestinal]] infection may present as [[increased bowel sounds]] due to [[enteritis]]. | ||
**Palpation: Based of a few case reports generalized abdominal or [[epigastric]] [[tenderness]] or [[right iliac fossa]] [[tenderness]] may accompany the symptom mimicking [[acute appendicitis]]. | **Palpation: Based of a few case reports generalized abdominal or [[epigastric]] [[tenderness]] or [[right iliac fossa]] [[tenderness]] may accompany the symptom mimicking [[acute appendicitis]]. | ||
**Percussion: [[COVID-19-associated hepatic injury]] presenting as [[ascites]] may show a dull percussion note or [[shifting dullness]]. | **Percussion: [[COVID-19-associated hepatic injury]] presenting as [[ascites]] may show a dull percussion note or [[shifting dullness]]. | ||
*[[Respiratory examination|Respiratory exam]]: | *[[Respiratory examination|Respiratory exam]]: | ||
| Line 100: | Line 97: | ||
*In [[CBC]] increased [[hemoglobin|Hb]] due to [[hemoconcentration]] if [[dehydration]] accompanies. | *In [[CBC]] increased [[hemoglobin|Hb]] due to [[hemoconcentration]] if [[dehydration]] accompanies. | ||
*Value of [[CRP]] and [[procalcitonin]] provide information on the inflammation and superimposed bacterial source of infection.<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> | *Value of [[CRP]] and [[procalcitonin]] provide information on the inflammation and superimposed bacterial source of infection.<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> | ||
===Electrocardiogram=== | |||
*There are no ECG findings associated with [[COVID-19]] associated [[anorexia]. | |||
*The electrocardiogram findings in [[COVID-19]] can be viewed by [[COVID-19 electrocardiogram|clicking here]]. | |||
===X-ray=== | ===X-ray=== | ||
* | *In patients with [[COVID-19]] associated [[gastrointestinal|GI]] symptoms with [[anorexia]] as one of the symptoms, abdominal [[X-ray|Xrays]] have 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> | ||
*A [[Chest X-ray]] in a [[COVID-19]] patient may be normal or show patchy or diffuse reticular–nodular opacification and [[Pulmonary consolidation|consolidation]] with basal and peripheral predominance bilaterally. [[Bilateral]] [[perihilar]] and [[interstitial]] opacities with [[Chest X-ray#Limitations|air bronchograms]] have also been reported. These X-ray findings depict pulmonary disease [[COVID-19]].<ref name="pmid32519256">{{cite journal |vauthors=Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A, Luvarà S, Lucarini S, Busoni S, Mazzoni LN, Miele V |title=Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome |journal=Radiol Med |volume=125 |issue=8 |pages=730–737 |date=August 2020 |pmid=32519256 |pmc=7282464 |doi=10.1007/s11547-020-01232-9 |url=}}</ref> | |||
* The signs are not related to [[anorexia]] directly. [[COVID-19]] being primarily a pulmonary disease, the findings may serve as important tools to help strongly suspect [[COVID-19]] even in the absence of [[RT PCR]]. A retrospective non-peer reviewed study reports the sensitivity of [[CXR]] to be 68% in detecting lung manifestations of [[COVID-19]].<ref name="pmid32519256">{{cite journal |vauthors=Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A, Luvarà S, Lucarini S, Busoni S, Mazzoni LN, Miele V |title=Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome |journal=Radiol Med |volume=125 |issue=8 |pages=730–737 |date=August 2020 |pmid=32519256 |pmc=7282464 |doi=10.1007/s11547-020-01232-9 |url=}}</ref> | |||
*The x-ray findings in [[COVID-19]] can be viewed by [[COVID-19 x ray|clicking here]]. | |||
===Echocardiography or Ultrasound=== | |||
*There are no echocardiography/ultrasound findings associated with [[COVID-19]] associated [[anorexia]]. | |||
* | *The echocardiographic findings in [[COVID-19]] can be viewed by [[COVID-19 echocardiography and ultrasound|clicking here]]. | ||
===CT scan=== | ===CT scan=== | ||
* Abdominal CT scan may be helpful in finding the cause of [[COVID-19]] associated [[anorexia]]. | |||
*Findings on CT scan suggestive of gastrointestinal symptoms (anorexia one of them) associated with [[COVID-19]] infection include peri-intestinal inflammatory reaction.<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> | |||
*The CT scan findings in [[COVID-19]] can be viewed by [[COVID-19 CT scan|clicking here]]. | |||
===MRI=== | |||
* | *There are no MRI findings associated with [[COVID-19]] associated [[anorexia]]. | ||
*The MRI findings in [[COVID-19]] can be viewed by [[COVID-19 MRI|clicking here]].<br /> | |||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
* Bedside lung [[ultrasound]] may be helpful in the diagnosis of [[COVID-19]] infection. | |||
* Bedside lung [[ultrasound]] may be helpful in the diagnosis of | * 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== | ||
Revision as of 13:40, 26 July 2020
For COVID-19 frequently asked outpatient questions, click here
For COVID-19 frequently asked inpatient questions, click here
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 digestive symptom in patients with COVID-19. 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 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. Hand hygiene and social distancing are important primary prevention tools. Contact tracing is an important tool of secondary prevention.
Historical Perspective
- COVID-19 was first discovered in Wuhan, China. 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.[1]
- Nanopore sequencing and bioinformatic analyses indicated that the virus had features typical of the coronavirus family and belonged to the Betacoronavirus 2B lineage.[1]
- COVID-19 was primarily known as a respiratory disease. In the initial reports from WHO, the mode of transmission of COVID-19 was droplets and fomites during close unprotected contact between an infector and the infectee. Airborne transmission was not reported initially.
- Fecal shedding was reported to be demonstrated from some patients, with viable virus identified in a limited number of case reports. However, fecal-oral route did not appear to drive COVID-19 transmission.[1][2]
- COVID-19 associated anorexia was first described as one of the less common symptoms of COVID-19 in a retrospective, single-center case series by Wang D et al. published on Feb 7th, 2020. The patient data was derived from January 1st-Jan 28th,2020 at Zhongnan Hospital in Wuhan, China.[3]
- COVID-19 associated anorexia was not only described as one of the common symptoms at the illness onset, it was reported to be more common in ICU patients.[3]
- On March 11th, 2020, WHO declared the COVID-19 outbreak a pandemic.[4]
- 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.
Classification
There is no established system for the classification of anorexia in COVID-19.
Pathophysiology
- The exact mechanisms through which COVID-19 causes anorexia is yet to be completely understood. The 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 in mild-moderate COVID-19 patients. In addition, Olfactory dysfunction contributes to loss of appetite.[5]
- The microbial products during infection set off the development of acute phase proteins such as cytokines (Interleukin and 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 center of appetite) is involved in the anorexia during infection.[6][7] Studies have reported several pro-inflammatory cytokines and chemokines, particularly CXCL10, CXCL8, CCL2, TNFα and IFNγ to be higher in the plasma of COVID-19 patients.[8] A relationship of cytokines and COVID-19 infection has been established.[9]
- 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.[10]
- COVID-19-associated hepatic injury can lead to anorexia.[11]
Causes
Anorexia in a patient hospitalized due to COVID-19 may be due to:
- COVID-19-associated hepatic injury
- Underlying conditions such as cancer
- Medication used to treat the COVID-19 infection such as Remdesivir[12]
- COVID-19 associated pancreatitis[13]
- Superimposed bacterial infections
- Anxiety associated with the infection itself
Differentiating COVID-19 associated anorexia from other Diseases
- For further information about the differential diagnosis, click here.
- To view the differential diagnosis of COVID-19, click here
Epidemiology and Demographics
- 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 COVID-19.[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 understood.
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.
- Most COVID-19 patients develop anorexia associated with COVID-19 during hospitalization.
- Anorexia as an initial presentation is observed in a minority of patients.[17]
- Prognosis the odds ratio for severe disease in patients with anorexia as one of the gastrointestinal symptoms were 2.83.[18]
- Prolonged anorexia with no supplementation may lead to hypotension, and electrolyte imbalances.
Diagnosis
Diagnostic Study of Choice
- There are no established criteria to identify the cause of COVID-19 associated loss of appetite/ anorexia. COVID-19 associated anorexia/ loss of appetite is a symptom, not a disease. Anorexia may be a symptom of direct injury of an involved abdominal organ or merely one of the symptoms of COVID-19.
- COVID-19 anorexia can be diagnosed based on the history, timing of the symptoms, associated symptoms and signs such as abdominal pain, nausea or vomiting (2nd and third most common symptoms) and most importantly, a positive reverse transcriptase polymerase chain reaction (rRT-PCR) for COVID-19.
History and Symptoms
- History of contact with a person suspected or confirmed to have COVID-19 infection is important to suspect COVID-19 in a patient.
- Based on a retrospective observational study including 1141 cases of COVID-19 from Wuhan, China anorexia was the most common gastrointestinal symptom of COVID-19.[19]
- The most common accompanying symptoms of COVID-19 besides anorexia were nausea, vomiting, and diarrhea.[18]
- The timing of symptoms and presence of co-morbid conditions helps differentiate the diseases with similar symptoms.
Physical Examination
- Patients with COVID-19 associated anorexia may appear lethargic, fatigued or irritable.
- Signs of dehydration such as sunken eyes and dry mucosa.
- Vital signs:[20][21]
- Heart rate/Pulse: Tachycardia may be due to fever, pain or shock. A low volume pulse is seen in severe dehydration.
- Blood pressure: Depending upon the cause of anorexia a patient with mild disease may have a normal blood pressure and others may present with shock due to infection and resulting sepsis.
- Respiratory rate: Tachypnea maybe due to high metabolic rate such as in fever and sepsis due to COVID-19 along with inefficient ventilation. Inefficient ventilation can be due to COVID-19 lung infection such as pneumonia or ARDS. Shallow breathing can be due to severe respiratory distress or associated severe abdominal pain.
- Temperature: The patient can be febrile due to COVID-19 infection, hypothermic, or have a normal temperature.
- On Abdominal exam:[22][13]
- Inspection: A patient with COVID-19-associated hepatic injury causing anorexia may have jaundice.
- Auscultation: Accompanying gastrointestinal infection may present as increased bowel sounds due to enteritis.
- Palpation: Based of a few case reports generalized abdominal or epigastric tenderness or right iliac fossa tenderness may accompany the symptom mimicking acute appendicitis.
- Percussion: COVID-19-associated hepatic injury presenting as ascites may show a dull percussion note or shifting dullness.
- Respiratory exam:
- The physical exam findings associated with COVID-19 can be viewed by clicking here.
Laboratory Findings
- Infectious virions in the GI or respiratory tract can be detected via reverse transcriptase polymerase chain reaction (rRT-PCR).
- Electrolyte disturbances such as hypokalemia especially if diarrhea or vomiting accompanies. Hypovolemic Hyponatremia may occur in severe cases.
- In CBC increased Hb due to hemoconcentration if dehydration accompanies.
- Value of CRP and procalcitonin provide information on the inflammation and superimposed bacterial source of infection.[21]
Electrocardiogram
- There are no ECG findings associated with COVID-19 associated [[anorexia].
- The electrocardiogram findings in COVID-19 can be viewed by clicking here.
X-ray
- In patients with COVID-19 associated GI symptoms with anorexia as one of the symptoms, abdominal Xrays have been reported to be normal in a few studies available.[13][22]
- A Chest X-ray in a COVID-19 patient may be normal or show patchy or diffuse reticular–nodular opacification and consolidation with basal and peripheral predominance bilaterally. Bilateral perihilar and interstitial opacities with air bronchograms have also been reported. These X-ray findings depict pulmonary disease COVID-19.[23]
- The signs are not related to anorexia directly. COVID-19 being primarily a pulmonary disease, the findings may serve as important tools to help strongly suspect COVID-19 even in the absence of RT PCR. A retrospective non-peer reviewed study reports the sensitivity of CXR to be 68% in detecting lung manifestations of COVID-19.[23]
- The x-ray findings in COVID-19 can be viewed by clicking here.
Echocardiography or Ultrasound
- There are no echocardiography/ultrasound findings associated with COVID-19 associated anorexia.
- The echocardiographic findings in COVID-19 can be viewed by clicking here.
CT scan
- Abdominal CT scan may be helpful in finding the cause of COVID-19 associated anorexia.
- Findings on CT scan suggestive of gastrointestinal symptoms (anorexia one of them) associated with COVID-19 infection include peri-intestinal inflammatory reaction.[21]
- The CT scan findings in COVID-19 can be viewed by clicking here.
MRI
- There are no MRI findings associated with COVID-19 associated anorexia.
- The MRI findings in COVID-19 can be viewed by clicking here.
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.[21]
Treatment
Medical Therapy
- The mainstay of treatment in COVID-19 infection is antiviral therapy such as lopinavir and ritonavir tablets and supportive therapy.
- Rehydration, 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.
- Loperamide is not given if the patient has C. difficile infection or signs of infection such as fever, bloody stools.
- Although the COVID-19 infection and 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 becomesCOVID-19 positive or prevent infection.[24][25]
Primary Prevention
- Effective measures for the primary prevention of COVID-19 include::[26]
- Frequent hand-washing with soap and water for at least 20 seconds or using a alcohol based hand sanitizer with at least 60% alcohol. Alcohol means ethanol here not methanol/ wood alcohol, as FDA warns against the use of methanol containing hand-wash.[27]
- 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.[28]
Secondary prevention
- Effective measures for the secondary prevention of COVID-19 include:
- Use of personal protective equipment (PPE) by the personnel handling the fecal matter or visiting the patient. Protective eyewear (such as goggles or a face shield) used by healthcare personnel should cover the front and sides of the face with no gaps between glasses and the face.[29].
- Screening of fecal microbiota transplant donors for COVID-19 is also recommended.[30]
- Contact tracing helps reduce the spread of the disease.[31]
References
- ↑ 1.0 1.1 1.2 "www.who.int" (PDF).
- ↑ 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.
- ↑ "WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020".
- ↑ 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
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|pmc=value (help). PMID 32387082 Check|pmid=value (help). - ↑ 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). - ↑ "Management of Patients with Confirmed 2019-nCoV | CDC".
- ↑ 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). - ↑ 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). - ↑ 18.0 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.
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|pmc=value (help). PMID 32205220 Check|pmid=value (help). - ↑ Telias, Irene; Katira, Bhushan H.; Brochard, Laurent (2020). "Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?". JAMA. 323 (22): 2265. doi:10.1001/jama.2020.8539. ISSN 0098-7484.
- ↑ 21.0 21.1 21.2 21.3 Poggiali E, Ramos PM, Bastoni D, Vercelli A, Magnacavallo A (2020). "Abdominal Pain: A Real Challenge in Novel COVID-19 Infection". Eur J Case Rep Intern Med. 7 (4): 001632. doi:10.12890/2020_001632. PMC 7162568 Check
|pmc=value (help). PMID 32309266 Check|pmid=value (help). - ↑ 22.0 22.1 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). - ↑ 23.0 23.1 Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A, Luvarà S, Lucarini S, Busoni S, Mazzoni LN, Miele V (August 2020). "Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome". Radiol Med. 125 (8): 730–737. doi:10.1007/s11547-020-01232-9. PMC 7282464 Check
|pmc=value (help). PMID 32519256 Check|pmid=value (help). - ↑ 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) - ↑ 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.
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- ↑ "NIH clinical trial of investigational vaccine for COVID-19 begins | National Institutes of Health (NIH)".
- ↑ 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). - ↑ "Contact Tracing for COVID-19 | CDC".