Respiratory Viruses Associated with Gastrointestinal Symptoms

Primary Respiratory Viruses with GI Tropism

• Adenovirus serotypes 40 and 41 are the most prominent respiratory viruses causing GI symptoms, contributing to 5-20% of hospitalizations for childhood diarrhea in developed countries, according to the Centers for Disease Control and Prevention (CDC) 1, 2.
• These serotypes primarily affect the gut rather than respiratory tract, with diarrhea being more prominent than vomiting or fever, as reported by the CDC 1.
• Respiratory symptoms are often present alongside GI manifestations, as noted by the CDC 1.
• The incubation period is 3-10 days, with illness lasting ≥1 week—longer than other enteric viral pathogens, according to the CDC 1.
• Peak incidence occurs in children <2 years of age, though older children and adults may be infected, as reported by the CDC 1.
• GI symptoms occur in approximately 15-20% of hospitalized COVID-19 patients, including nausea, vomiting, abdominal pain, and diarrhea, according to the American Gastroenterological Association 3, 4.
• Diarrhea is the most common GI symptom, reported in 1-36% of patients depending on the study population, as noted by the American Gastroenterological Association 4.
• The prevalence of diarrhea as the sole presenting symptom is very low; most patients have accompanying respiratory symptoms, according to the American Gastroenterological Association 3.
• In long COVID, GI symptoms including nausea, abdominal pain, loss of appetite, heartburn, and constipation can persist for months, as reported by the National Institute of Allergy and Infectious Diseases 5.
• SARS-CoV-2 RNA persists in stool samples of 12.7% of patients at 4 months and 3.8% at 7 months after diagnosis, according to the National Institute of Allergy and Infectious Diseases 5.
• Adenovirus GI disease predominantly affects children <2 years of age, as reported by the CDC and the American Academy of Pediatrics 1, 7.
• Adult outbreaks of adenovirus gastroenteritis have never been reported, according to the CDC 1.
• COVID-19 GI manifestations occur across all age groups but are primarily documented in hospitalized patients, as noted by the American Gastroenterological Association and the Infectious Diseases Society of America 3, 4.