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Meta-Analysis
. 2015 Dec 12:12:215.
doi: 10.1186/s12985-015-0448-4.

Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know?

Laetitia Minodier  1 , Remi N Charrel  2 , Pierre-Emmanuel Ceccaldi  3 , Sylvie van der Werf  4   5 , Thierry Blanchon  6   7 , Thomas Hanslik  8   9   10 , Alessandra Falchi  11
Affiliations
Meta-Analysis

Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know?

Laetitia Minodier et al. Virol J. .

Abstract

This review provides for the first time an assessment of the current understanding about the occurrence and the clinical significance of gastrointestinal (GI) symptoms in influenza patients, and their correlation with the presence of human influenza viruses in stools of patients with confirmed influenza virus infection. Studies exploring how human influenza viruses spread to the patient's GI tract after a primary respiratory infection have been summarized. We conducted a systematic search of published peer-reviewed literature up to June 2015 with regard to the above-mentioned aspects, focusing on human influenza viruses (A(H1N1), A(H1N1)pdm09, A(H3N2), and B). Forty-four studies were included in this systematic review and meta-analysis. The pooled prevalence of any digestive symptoms ranged from 30.9% (95% CI, 9.8 to 57.5; I(2) = 97.5%) for A(H1N1)pdm09 to 2.8% (95% CI, 0.6 to 6.5; I(2) = 75.4%) for A(H1N1). The pooled prevalence of influenza viruses in stool was 20.6% (95% CI, 8.9 to 35.5; I(2) = 96.8%), but their correlation with GI symptoms has rarely been explored. The presence of viral RNA in stools because of haematogenous dissemination to organs via infected lymphocytes is likely, but the potential to cause direct intestinal infection and faecal-oral transmission warrants further investigation. This review highlights the gaps in our knowledge, and the high degree of uncertainty about the prevalence and significance of GI symptoms in patients with influenza and their correlation with viral RNA positivity in stool because of the high level of heterogeneity among studies.

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Figures

Fig. 1
Fig. 1
Flow diagram describing literature search and selection of studies
Fig. 2
Fig. 2
Forestplot of the meta-analysis on prevalence of gastrointestinal symptoms and pooled proportion of all types of gastrointestinal symptoms by virus type and subtype
Fig. 3
Fig. 3
Forestplot of meta-analysis on prevalence of influenza virus detection on stool samples, pooled prevalence and Q test and I2 test
See this image and copyright information in PMC

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