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Anyone seeing diarrhea as first symptom COVID-19


Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

I am curious if any other nurses are seeing patients who describe diarrhea/n/v as first presenting symptoms of confirmed COVID-19?

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

I saw this Medscape video/article about evidence of possible COVID-19 fecal transmission.

Fecal Evidence of COVID-19 Raises Transmission Concerns


In a recently published single-center case series of 138 consecutive hospitalized patients with confirmed COVID-19, investigators reported that approximately 10% of patients initially presented with GI symptoms, prior to the subsequent development of respiratory symptoms. Common and often very subtle symptoms included diarrhea, nausea, and abdominal pain, with a less common symptom being nonspecific GI illness.

...Virus in the stool may be evident on presentation and last throughout the course of illness resolution for up to 12 days after the respiratory virus evidence is gone.

The Centers for Disease Control and Prevention recommends that after two negative respiratory tests separated by ≥ 24 hours, patients can be dismissed from having transmissibility infection risk for COVID-19. But we now know that these stools may lag up to 12 days after. In fact, in one of the most recent studies looking at 73 patients, approximately 24% remained positive in their stool for evidence of virus, though not necessarily infection, after showing negative in respiratory samples.

Yes this seems to be a preliminary sign before real issues


Has 43 years experience.

It may be evidence of primary exposure or infection through the GI tract rather than respiratory exposure. The initial symptoms may reflect the initial area of viral inflammation and growth.