Clinical and virological factors associated with gastrointestinal symptoms in patients with acute respiratory infection: a two-year prospective study in general practice medicine

Laetitia Minodier,Thomas Hanslik,Alessandra Falchi,Pierre-Emmanuel Ceccaldi,Sylvie Van Der Werf,Thierry Blanchon,Lisandru Capai,Remi Charrel,Shirley Masse

doi:10.1186/s12879-017-2823-9

Abstract

BackgroundGastrointestinal (GI) symptoms, such as diarrhea, vomiting, abdominal pain and nausea are not an uncommon manifestation of an acute respiratory infection (ARI).We therefore evaluated clinical and microbiological factors associated with the presence of GI symptoms in patients consulting a general practitioner (GP) for ARI.MethodsNasopharyngeal swabs, stool specimens and clinical data from patients presenting to GPs with an ARI were prospectively collected during two winter seasons (2014-2016). Samples were tested by quantitative real-time PCR for 12 respiratory pathogen groups and for 12 enteric pathogens.ResultsTwo hundred and four of 331 included patients (61.6%) were positive for at least one respiratory pathogen. Sixty-nine stools (20.8%) were positive for at least one pathogen (respiratory and/or enteric). GI symptoms were more likely declared in case of laboratory confirmed-enteric infection (adjusted odds ratio (aOR) = 3.2; 95% confidence interval [CI] [1.2–9.9]; p = 0.02) or human coronavirus (HCoV) infection (aOR = 2.7; [1.2–6.8]; p = 0.02). Consumption of antipyretic medication before the consultation seemed to reduce the risk of developing GI symptoms for patients with laboratory-confirmed influenza (aOR = 0.3; [0.1–0.6]; p = 0.002).ConclusionsThe presence of GI symptoms in ARI patients could not be explained by the detection of respiratory pathogens in stools. However, the detection of enteric pathogens in stool samples could explained by the presence of GI symptoms in some of ARI cases. The biological mechanisms explaining the association between the presence of HCoVs in nasopharynx and GI symptoms need to be explored.

Highlights

Gastrointestinal (GI) symptoms, such as diarrhea, vomiting, abdominal pain and nausea are not an uncommon manifestation of an acute respiratory infection (ARI)
In this study, results showed that the presence of GI symptoms in ARI patients could not be explained by the detection of respiratory pathogens in stools
This result suggests that GI symptoms in patients with ARI could be related to enteric infections, and that the positive correlation between GI symptoms and fever or headache observed in this study increases the difficulty of clinical diagnosis

Summary

Introduction

Gastrointestinal (GI) symptoms, such as diarrhea, vomiting, abdominal pain and nausea are not an uncommon manifestation of an acute respiratory infection (ARI). Gastrointestinal (GI) symptoms, such as diarrhea, vomiting, abdominal pain and nausea are not an uncommon manifestation of an acute respiratory infection (ARI) [1,2,3,4,5,6,7,8] (Additional file 1) and have been reported as a hallmark of severe influenza in childhood [9]. Influenza viruses and other respiratory agents such as human rhinoviruses (HRV) [10], have been detected in stools of patients with ARIs (Additional file 2) [5, 10,11,12,13,14], but their correlation with GI symptoms and their viability in stool is still debated [10, 15]. GI symptoms could either be a manifestation of a direct viral effect, or an indirect viral effect of respiratory viruses, such as lung-derived CD4+ cell-induced dysbiosis resulting in intestinal injury [20]

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