The atypical presentation of COVID-19 as gastrointestinal disease: key points for primary care

INTRODUCTION

Since the SARS-CoV2 outbreak in Wuhan, China, in late 2019, the world has been ravaged by a roaring pandemic. Unlike coronavirus SARS-CoV that caused the severe acute respiratory syndrome (SARS) outbreak in 2002, SARS-CoV2 has proven to be more contagious and difficult to control. A key challenge is that the disease presentation can be very variable: patients in the early phase of infection may be asymptomatic, have subclinical symptoms, or atypical symptoms of COVID-19. This, compounded with the lack of easily accessible diagnostic tests, makes it challenging to diagnose COVID-19 in the community.

The most common symptoms of patients with COVID-19 are fever (72–88%) and cough (68–83%).^1,2 A sore throat may be present in 14–61% of patients, and dyspnoea is usually seen in severe cases and is less frequent (11–19%).^1,2 Other non-specific symptoms such as myalgia, headaches, rhinorrhoea, anosmia, ageusia, nasal congestion, conjunctivitis, and haemoptysis have been reported but are comparatively infrequent. However, of significant concern is the atypical presentation of gastrointestinal (GI) symptoms.

Early experience in Wuhan illustrated how a cluster outbreak occurred from a single index patient being mistakenly admitted to surgical services for abdominal pain. This resulted in nosocomial spread to 10 healthcare workers and four other patients, all presenting with abdominal symptoms of diarrhoea, nausea, and loss of appetite.³