Gastrointestinal tract and viral pathogens

Viral gastroenteritis is the most common viral illness that affects the gastrointestinal (GI) tract, causing inflammation and irritation of the lining of the stomach and intestines. Common signs and symptoms associated with this condition include abdominal pain, diarrhea, and dehydration. The infections commonly involved in viral gastroenteritis are rotavirus, norovirus, and adenovirus, which spread through the fecal-oral and contact routes and cause non-bloody diarrhea. These infections can affect both immunocompetent and immunocompromised individuals. Since the pandemic in 2019, coronavirus gastroenteritis has increased in incidence and prevalence. Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition, treatment with oral rehydration salts, and prompt vaccination. Improved sanitation measures have also played a key role in reducing the transmission of infection. In addition to viral hepatitis causing liver disease, herpes virus, and cytomegalovirus are responsible for ulcerative GI disease. They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals. Hepatitis viruses, Epstein-Barr virus, herpesvirus 8, and human papillomavirus have been involved in benign and malignant diseases. This mini review aims to list different viruses affecting the GI tract. It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management. This will help primary care physicians and hospitalists diagnose and treat patients more easily.

[1]  I. Ilic,et al.  Multi‐country outbreak of severe acute hepatitis of unknown origin in children, 2022 , 2023, Acta paediatrica.

[2]  Shuliang Zhao,et al.  Impact of Epstein–Barr virus infection in patients with inflammatory bowel disease , 2022, Frontiers in Immunology.

[3]  Vijay Shankar Balakrishnan Acute unexplained hepatitis in children , 2022, Bulletin of the World Health Organization.

[4]  G. Kang,et al.  The Epidemiology of Sapovirus in the Etiology, Risk Factors, and Interactions of Enteric Infection and Malnutrition and the Consequences for Child Health and Development Study: Evidence of Protection Following Natural Infection , 2022, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  M. Dobrzynski,et al.  The Involvement of Human Papilloma Virus in Gastrointestinal Cancers , 2022, Cancers.

[6]  Zeyar Thet,et al.  Septic Shock Secondary to Severe Gastroenteritis Resulting From Sapovirus Infection , 2022, Cureus.

[7]  Sheng‐Chieh Lin,et al.  Epidemiology, Clinical Features, and Unusual Complications of Norovirus Infection in Taiwan: What We Know after Rotavirus Vaccines , 2022, Pathogens.

[8]  J. Ferlay,et al.  Global, regional and national burden of primary liver cancer by subtype. , 2021, European journal of cancer.

[9]  J. Lynch,et al.  Adenovirus: Epidemiology, Global Spread of Novel Types, and Approach to Treatment , 2021, Seminars in Respiratory and Critical Care Medicine.

[10]  A. Lee,et al.  Hepatitis D Review: Challenges for the Resource-Poor Setting , 2021, Viruses.

[11]  Chao-chin Huang,et al.  Gastrointestinal Disease and COVID-19: A Review of Current Evidence , 2021, Digestive Diseases.

[12]  Ji Sun,et al.  Risk Factors and Prevention of Viral Hepatitis-Related Hepatocellular Carcinoma , 2021, Frontiers in Oncology.

[13]  W. Shieh Human adenovirus infections in pediatric population - An update on clinico–pathologic correlation , 2021, Biomedical journal.

[14]  J. Vinjé,et al.  Global distribution of sporadic sapovirus infections: A systematic review and meta-analysis , 2021, PloS one.

[15]  Shankun Zhao,et al.  Chronic Hepatitis Virus Infection Are Associated With High Risk of Gastric Cancer: A Systematic Review and Cumulative Analysis , 2021, Frontiers in Oncology.

[16]  P. Bruggmann,et al.  Trends of the Global Hepatitis C Disease Burden: Strategies to Achieve Elimination , 2021, Journal of preventive medicine and public health = Yebang Uihakhoe chi.

[17]  A. Gershon,et al.  Communicability of varicella before rash onset: a literature review , 2021, Epidemiology and Infection.

[18]  Kuangnan Fang,et al.  Global burden of acute viral hepatitis and its association with socioeconomic development status, 1990-2019. , 2021, Journal of hepatology.

[19]  T. Jin,et al.  Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation , 2021, Frontiers in Public Health.

[20]  Yiping Wei,et al.  Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis. , 2021, European journal of gastroenterology & hepatology.

[21]  J. Mascola,et al.  Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine , 2020, The New England journal of medicine.

[22]  P. Dormitzer,et al.  Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine , 2020, The New England journal of medicine.

[23]  T. Ayer,et al.  Assessment of Incidence of and Surveillance Burden for Hepatocellular Carcinoma Among Patients With Hepatitis C in the Era of Direct-Acting Antiviral Agents , 2020, JAMA network open.

[24]  L. Zou,et al.  Coronaviruses and gastrointestinal diseases , 2020, Military Medical Research.

[25]  F. González,et al.  Sapovirus: an emerging cause of childhood diarrhea , 2020, Current opinion in infectious diseases.

[26]  M. Baldridge,et al.  Enteric Viral Co-Infections: Pathogenesis and Perspective , 2020, Viruses.

[27]  Minhu Chen,et al.  Epstein-Barr virus infection in ulcerative colitis: a clinicopathologic study from a Chinese area , 2020, Therapeutic advances in gastroenterology.

[28]  Xingwang Wu,et al.  Chronic Active Epstein-Barr Virus-Associated Enteritis: CT Findings and Clinical Manifestation , 2020, BioMed research international.

[29]  W. Kim,et al.  Prevalence of Chronic Hepatitis B Virus Infection in the United States. , 2020, The American journal of gastroenterology.

[30]  K. Mertz,et al.  Postmortem examination of COVID‐19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction , 2020, Histopathology.

[31]  Dr Glynn W Webb,et al.  Hepatitis E: an expanding epidemic with a range of complications. , 2020, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[32]  Robert D. Stedtfeld,et al.  Featured Gut Microbiomes Associated With the Progression of Chronic Hepatitis B Disease , 2020, Frontiers in Microbiology.

[33]  O. Quaye,et al.  Epstein Barr Virus Associated Lymphomas and Epithelia Cancers in Humans , 2020, Journal of Cancer.

[34]  D. Lau,et al.  An update on the management of chronic hepatitis D , 2019, Gastroenterology report.

[35]  Lindsey Westbrook,et al.  The Morphologic Features of Primary Epstein-Barr Virus Infection in the Gastrointestinal Tract , 2019, The American journal of surgical pathology.

[36]  C. Andersen,et al.  Epstein-Barr virus and its association with disease - a review of relevance to general practice , 2019, BMC Family Practice.

[37]  C. Coyne,et al.  Enteroviruses: A Gut-Wrenching Game of Entry, Detection, and Evasion , 2019, Viruses.

[38]  F. Negro,et al.  A review on hepatitis D: From virology to new therapies , 2019, Journal of advanced research.

[39]  Xueping Wang,et al.  Development and validation of a prognostic nomogram in gastric cancer with hepatitis B virus infection , 2019, Journal of Translational Medicine.

[40]  C. Bornet,et al.  Chickenpox: An update. , 2019, Medecine et maladies infectieuses.

[41]  R. Harpaz,et al.  The Epidemiology of Herpes Zoster in the United States During the Era of Varicella and Herpes Zoster Vaccines: Changing Patterns Among Older Adults. , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[42]  G. Vasquez,et al.  Successfully Treated Norovirus- and Sapovirus-Associated Diarrhea in Three Renal Transplant Patients , 2018, Case reports in infectious diseases.

[43]  Haniye Sadat Sajadi,et al.  Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 , 2018, The Lancet.

[44]  H. Goyal,et al.  Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis , 2018, Gut.

[45]  E. Shin,et al.  Natural History, Clinical Manifestations, and Pathogenesis of Hepatitis A. , 2018, Cold Spring Harbor perspectives in medicine.

[46]  C. Murray,et al.  Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years , 2018, JAMA pediatrics.

[47]  G. Dore,et al.  Management of acute HCV infection in the era of direct-acting antiviral therapy , 2018, Nature Reviews Gastroenterology & Hepatology.

[48]  J. Pagano,et al.  Antiviral Drugs for EBV , 2018, Cancers.

[49]  B. McMahon,et al.  Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance , 2018, Hepatology.

[50]  E. Flagg,et al.  Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015-2016. , 2018, NCHS data brief.

[51]  Rohit Loomba,et al.  Inflammation-induced IgA+ cells dismantle anti-liver cancer immunity , 2017, Nature.

[52]  S. Schultz-Cherry,et al.  Astrovirus Biology and Pathogenesis. , 2017, Annual review of virology.

[53]  Noele P. Nelson,et al.  Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct-Acting Antiviral Era , 2017, Current Epidemiology Reports.

[54]  C. Burnweit,et al.  Sapovirus Gastroenteritis in Young Children Presenting as Distal Small Bowel Obstruction: A Report of 2 Cases and Literature Review , 2016, Case reports in surgery.

[55]  K. Mekeel,et al.  Hepatitis B and Hepatocellular Carcinoma. , 2016, Clinics in liver disease.

[56]  E. Robertson,et al.  Epstein–Barr Virus: Diseases Linked to Infection and Transformation , 2016, Front. Microbiol..

[57]  S. Dhillon,et al.  The Epstein Barr Virus: An Unusual Source of Gastritis: 2342 , 2016 .

[58]  F. Stracci,et al.  Human papillomavirus and gastrointestinal cancer: A review , 2016, World journal of gastroenterology.

[59]  R. Arsenescu,et al.  Cytomegalovirus-Related Hospitalization Is Associated With Adverse Outcomes and Increased Health-Care Resource Utilization in Inflammatory Bowel Disease , 2016, Clinical and Translational Gastroenterology.

[60]  Springer-Verlag,et al.  Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections , 2016, European Journal of Clinical Microbiology & Infectious Diseases.

[61]  P. Krogstad,et al.  Enteroviruses in the early 21st century: new manifestations and challenges , 2016, Current opinion in pediatrics.

[62]  P. Cintas,et al.  Hepatitis E virus and neurological injury , 2016, Nature Reviews Neurology.

[63]  M. Khuroo,et al.  Hepatitis E: an emerging global disease – from discovery towards control and cure , 2016, Journal of viral hepatitis.

[64]  K. Vega,et al.  Gastrointestinal Kaposi's sarcoma: Case report and review of the literature. , 2015, World journal of gastrointestinal pharmacology and therapeutics.

[65]  Malik Peiris,et al.  Middle East respiratory syndrome , 2015, The Lancet.

[66]  K. Ohtsuka,et al.  Tacrolimus for the Treatment of Ulcerative Colitis , 2015, Intestinal research.

[67]  Jason P. Womack,et al.  Common questions about infectious mononucleosis. , 2015, American family physician.

[68]  M. Poles,et al.  Human Immunodeficiency Virus-Associated Diarrhea: Still an Issue in the Era of Antiretroviral Therapy , 2015, Digestive Diseases and Sciences.

[69]  A. Thompson,et al.  Viral hepatitis B: clinical and epidemiological characteristics. , 2014, Cold Spring Harbor perspectives in medicine.

[70]  A. Bosch,et al.  Human Astroviruses , 2014, Clinical Microbiology Reviews.

[71]  C. C. Hsu,et al.  Gastrointestinal Manifestations of Disseminated Varicella. , 2014, Gastroenterology & hepatology.

[72]  C. Midgley,et al.  Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014 , 2014, MMWR. Morbidity and mortality weekly report.

[73]  J. Arbiza,et al.  Transmission, diagnosis, and management of hepatitis E: an update , 2014, Hepatic medicine : evidence and research.

[74]  M. Zwahlen,et al.  HHV-8 seroprevalence: a global view , 2014, Systematic Reviews.

[75]  E. Kim,et al.  Abdominal distention and constipation followed by herpes zoster infection , 2013, Korean journal of anesthesiology.

[76]  C. Whitlow,et al.  Sexually transmitted and anorectal infectious diseases. , 2013, Gastroenterology clinics of North America.

[77]  C. Bradshaw,et al.  The etiology of infectious proctitis in men who have sex with men differs according to HIV status. , 2013, Sexually transmitted diseases.

[78]  S. Mishiro,et al.  Epidemiological and molecular analyses of a non‐seasonal outbreak of acute icteric hepatitis E in Bangladesh , 2013, Journal of medical virology.

[79]  Z. Memish,et al.  Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study , 2013, The Lancet Infectious Diseases.

[80]  D. Gilden,et al.  Complications of Varicella Zoster Virus Reactivation , 2013, Current Treatment Options in Neurology.

[81]  R. Sterling,et al.  Extrahepatic manifestations of acute hepatitis B virus infection. , 2013, Gastroenterology & hepatology.

[82]  J. Mansfield,et al.  Sexually transmitted infections manifesting as proctitis , 2012, Frontline Gastroenterology.

[83]  S. H. van der Burg,et al.  Therapy of human papillomavirus-related disease. , 2012, Vaccine.

[84]  P. Farci,et al.  Clinical Features of Hepatitis D , 2012, Seminars in Liver Disease.

[85]  M. Manns,et al.  Pathogenesis and treatment of hepatitis e virus infection. , 2012, Gastroenterology.

[86]  M. Iturriza-Gómara,et al.  Norovirus diagnostics: options, applications and interpretations , 2012, Expert review of anti-infective therapy.

[87]  M. Buti,et al.  Clinical outcome of acute and chronic hepatitis delta over time: a long‐term follow‐up study , 2011, Journal of viral hepatitis.

[88]  P. Selwyn,et al.  Complications of HIV infection: a systems-based approach. , 2011, American family physician.

[89]  N. Crum‐Cianflone HIV and the Gastrointestinal Tract. , 2010, Infectious diseases in clinical practice.

[90]  M. Cannon,et al.  Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection , 2010, Reviews in medical virology.

[91]  T. Oka,et al.  Detection and Genetic Analysis of Human Sapoviruses in River Water in Japan , 2010, Applied and Environmental Microbiology.

[92]  D. Moradpour,et al.  [An update on the management of chronic hepatitis C]. , 2010, Revue medicale suisse.

[93]  A. Limaye,et al.  Varicella Zoster Virus (VZV) in Solid Organ Transplant Recipients , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[94]  H. Tilg,et al.  Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. , 2009, Journal of Crohn's & colitis.

[95]  D. Bernstein Rotavirus Overview , 2009, The Pediatric infectious disease journal.

[96]  W. Coyle,et al.  Herpes simplex virus and the alimentary tract , 2008, Current gastroenterology reports.

[97]  L. Pantanowitz Kaposi sarcoma , 2008, Cancer.

[98]  P. Colson,et al.  Chronic hepatitis E with cirrhosis in a kidney-transplant recipient. , 2008, The New England journal of medicine.

[99]  T. Liang,et al.  Hepatitis C: a clinical review. , 2007, Oral diseases.

[100]  E. Schiff,et al.  Clinical Features of Hepatitis , 2007 .

[101]  K. Hatakeyama,et al.  Clinicopathologic characteristics of clinically relevant cytomegalovirus infection in inflammatory bowel disease , 2007, Journal of Gastroenterology.

[102]  Mark A Pallansch,et al.  Morbidity and Mortality Weekly Report Editorial and Production Staff Vol. 55 / Ss-8 Surveillance Summaries 1 Enterovirus Surveillance — United States, 1970–2005 , 2022 .

[103]  H. Schultheiss,et al.  Viral Persistence in the Myocardium Is Associated With Progressive Cardiac Dysfunction , 2005, Circulation.

[104]  C. Fraser,et al.  Epidemiological and genetic analysis of severe acute respiratory syndrome , 2004, The Lancet Infectious Diseases.

[105]  D. Prais,et al.  Presence of viremia in patients with primary herpetic gingivostomatitis. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[106]  R. D. Hess Routine Epstein-Barr Virus Diagnostics from the Laboratory Perspective: Still Challenging after 35 Years , 2004, Journal of Clinical Microbiology.

[107]  G. Burstein,et al.  Sexually transmitted diseases treatment guidelines , 2003, Current opinion in pediatrics.

[108]  Arul Earnest,et al.  Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. , 2003, JAMA.

[109]  E. Cesarman,et al.  Spectrum of Kaposi's Sarcoma-Associated Herpesvirus, or Human Herpesvirus 8, Diseases , 2002, Clinical Microbiology Reviews.

[110]  K. Vaiphei,et al.  Exacerbation of ulcerative colitis by cytomegalovirus infection in an immunocompetent Indian patient. , 2002, Tropical gastroenterology : official journal of the Digestive Diseases Foundation.

[111]  R. Goodgame Viral infections of the gastrointestinal tract , 1999, Current gastroenterology reports.

[112]  B. Paz,et al.  Visceral Varicella-Zoster after bone marrow transplantation: report of a case series and review of the literature , 1998, American Journal of Gastroenterology.

[113]  Edoardo Cervoni,et al.  Hepatitis C , 1998, The Lancet.

[114]  G. Pugliese,et al.  Severe Streptococcus pyogenes Infections, United Kingdom, 2003–2004 , 2008, Emerging infectious diseases.

[115]  P. Schwarczmann [THE VISCERAL MANIFESTATIONS OF HERPES ZOSTER]. , 1964, Munchener medizinische Wochenschrift.

[116]  J. Vinjé,et al.  Rotaviruses, astroviruses, and sapoviruses as foodborne infections , 2021, Foodborne Infections and Intoxications.

[117]  Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV , 2020 .

[118]  G. Kang,et al.  Rotavirus infection , 2017, Nature Reviews Disease Primers.

[119]  A. Azman,et al.  Long-term efficacy of a hepatitis E vaccine. , 2015, The New England journal of medicine.

[120]  E. Gupta,et al.  Hepatitis C virus: Screening, diagnosis, and interpretation of laboratory assays , 2014, Asian journal of transfusion science.

[121]  R. Aggarwal Diagnosis of hepatitis E , 2013, Nature Reviews Gastroenterology &Hepatology.

[122]  Y. Marfatia,et al.  Laboratory diagnosis of human papillomavirus virus infection in female genital tract , 2011, Indian journal of sexually transmitted diseases and AIDS.

[123]  D. Douek,et al.  HIV infection and the gastrointestinal immune system , 2008, Mucosal Immunology.

[124]  R. Webster,et al.  Encyclopedia of virology , 1999 .

[125]  T. Tucker,et al.  Hepatitis E. , 1994, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.