COVID-19-associated anorexia

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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 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

  • 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.[12]
  • According to recent studies anorexia is the most common (40-84%) digestive symptoms associated with SARS-Cov2 infection.[13][14]

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.[18]

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.[18]

Treatment

Medical Therapy

Primary Prevention

  • Effective measures for the primary prevention of COVID-19 include::[22]
    • 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.[23]

Secondary prevention

References

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