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Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus
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  1. Weicheng Liang1,2,
  2. Zhijie Feng3,
  3. Shitao Rao4,
  4. Cuicui Xiao1,2,
  5. Xingyang Xue5,
  6. Zexiao Lin2,6,
  7. Qi Zhang1,2,
  8. Wei Qi3
  1. 1 Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  2. 2 Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, China
  3. 3 Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Shijiazhuang, China
  4. 4 School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
  5. 5 Department of Thoracic Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
  6. 6 Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  1. Correspondence to Wei Qi, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Shijiazhuang, China; chinaqiwei{at}yahoo.com; Qi Zhang, Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; keekee77{at}126.com

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A series of pneumonia cases caused by 2019 novel coronavirus (2019-nCoV, also named COVID-19) are being reported globally. Based on recent publications,1–3 the most common symptoms in patients infected by 2019-nCoV were fever and cough. However, the incidence of other clinical features differs in different reports. To address this issue, we collected the data from three reports1–3 and compared the incidence accordingly. We found that the incidence of leucopenia, fever and diarrhoea in the three studies showed a statistically significant difference (table 1). Among these symptoms, diarrhoea displayed the smallest p-value (p=0.016), suggesting that the criteria for diagnosing diarrhoea may differ in different hospitals. Due to the different criteria, clinicians may underestimate the value of this symptom in clinical practice, and it may affect the preliminary diagnostic accuracy.

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Table 1

Intergroup comparison between three recent publications

Recent studies showed that the spike protein of 2019-nCoV shared the same cell entry receptor ACE2 as SARS-CoV.4 5 In terms of the pathological importance of ACE2 in modulating intestinal inflammation and diarrhoea,6 we examined the expression profiles of ACE2 in various human tissues and found that ACE2 was highly expressed in the human small intestine (online supplementary file 1). Intriguingly, the RNA level of ACE2 was quite low in lung tissues from healthy donors.

Supplemental material

[gutjnl-2020-320832supp001.pdf]

Given that the distribution of ACE2 may determine the route of 2019-nCoV infection, we next evaluated the expression of ACE2 in different cell populations of the small intestine by analysing the single-cell RNA sequencing (scRNA-Seq) …

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