000			03114nam a22003977a 4500
008			210217s20202020 xxu||||| |||| 00| 0 eng d
022			_a2168-8184
024			_a10.7759/cureus.11698 [doi]
024			_aPMC7769789 [pmc]
040			_aOvid MEDLINE(R)
099			_a33391931
245			_aThe Pathophysiology of Gastrointestinal and Hepatic Manifestations of COVID-19.
251			_aCureus. 12(11):e11698, 2020 Nov 25.
252			_aCureus. 12(11):e11698, 2020 Nov 25.
253			_aCureus
260			_c2020
260			_fFY2021
265			_sepublish
266			_d2021-02-17
520			_aCoronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the sixth international public health emergency. While COVID-19 classically manifests as a respiratory illness, SARS-CoV-2 may infect multiple organ systems and cause a wide array of presentations. The gastrointestinal tract has become increasingly recognized as a site of SARS-CoV-2 infection with reports of diarrhea, nausea, and liver failure, with or without concomitant respiratory involvement. In this case series and literature review, we report three cases of SARS-CoV-2 infected patients that presented with predominantly gastrointestinal symptoms or laboratory abnormalities such as diarrhea, anorexia, and transaminitis. The receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), as well as the necessary protease to facilitate viral entry, transmembrane protease serine-2 (TMPRSS2), and to a lesser extent, cathepsins, have been demonstrated to be present throughout the gastrointestinal tract, thus facilitating viral entry and pathogenesis. Furthermore, multiple reports have demonstrated evidence of viral shedding outside the nasopharynx, including the stool, for prolonged time periods even in the absence of detection of viral RNA in the nasopharynx. As such, testing for SARS-CoV-2 in stool samples with reverse transcription polymerase chain reaction (RT-PCR) assays for detection of viral RNA could aid in identifying patients that lack classic respiratory symptoms, present with atypical symptoms, or in those with a high index of suspicion (e.g. elevated inflammatory markers), but test negative on the classic nasopharyngeal swab. Furthermore, this underscores the potential for atypical transmission, with a focus on fecal-oral transmission and the need for strict hand hygiene. Copyright (c) 2020, Yousaf et al.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Franklin Square Medical Center
651			_aMedStar Union Memorial Hospital
656			_aInternal Medicine
656			_aMedStar Health Baltimore Residents
657			_aCase Reports
700			_aChaudhary, Fizah
700			_aHaas, Christopher J
700			_aNaqvi, Haider A
700			_aRaddawi, Kenan
700			_aYousaf, Muhammad N
790			_aChaudhary F, Haas CJ, Naqvi HA, Raddawi K, Yousaf MN
856			_uhttps://dx.doi.org/10.7759/cureus.11698 _zhttps://dx.doi.org/10.7759/cureus.11698
942			_cART _dArticle
999			_c6122 _d6122