Characteristics of COVID-19 Patients With SARS-CoV-2 Positivity in Feces

Abstract

BackgroundSARS-CoV-2 is highly contagious and poses a great threat to epidemic control and prevention. The possibility of fecal-oral transmission has attracted increasing concern. However, viral shedding in feces has not been completely investigated.MethodsThis study retrospectively reviewed 97 confirmed coronavirus disease 2019 (COVID-19) patients hospitalized at the First Affiliated Hospital, School of Medicine, Zhejiang University, from January 19 to February 17, 2020. SARS-CoV-2 RNA in samples of sputum, nasopharyngeal or throat swabs, bronchoalveolar lavage and feces was detected by real-time reverse transcription polymerase chain reaction (RT–PCR). Clinical characteristics and parameters were compared between groups to determine whether fecal RNA was positive.ResultsThirty-four (35.1%) of the patients showed detectable SARS-CoV-2 RNA in feces, and 63 (64.9%) had negative detection results. The median time of viral shedding in feces was approximately 25 days, with the maximum time reaching 33 days. Prolonged fecal-shedding patients showed longer hospital stays. Those patients for whom fecal viral positivity persisted longer than 3 weeks also had lower plasma B-cell counts than those patients in the non-prolonged group [70.5 (47.3-121.5) per μL vs. 186.5 (129.3-376.0) per μL, P = 0.023]. Correlation analysis found that the duration of fecal shedding was positively related to the duration of respiratory viral shedding (R = 0.70, P < 0.001) and negatively related to peripheral B-cell counts (R = -0.44, P < 0.05).ConclusionsCOVID-19 patients who shed SARS-CoV-2 RNA in feces presented similar clinical characteristics and outcomes as those who did not shed SARS-CoV-2 RNA in feces. The prolonged presence of SARS-CoV-2 nucleic acids in feces was highly correlated with the prolonged shedding of SARS-CoV-2 RNA in the respiratory tract and with lower plasma B-cell counts.

The clinical and immunological characteristics of COVID‐19 patients with delayed SARS‐CoV‐2 virus clearance

“…A recent report revealed that 22 of the 133 patients admitted with COVID‐19 had an initial or follow‐up positive sputum or fecal sample after the conversion of their pharyngeal samples from positive to negative. 39 We are uncertain as to whether or not the 52 cases in the recovered group in our study had SARS‐CoV‐2 in additional body sites and its influences on immunological response. Systematic and simultaneous collection of specimens from multiple body sites during future evaluations may be necessary to clarify this potentially confounding factor.…”

“…We lack information on the current form of the pandemics, such as changes in treatment or the emergence of new varieties. A recent report revealed that 22 of the 133 patients admitted with COVID‐19 had an initial or follow‐up positive sputum or fecal sample after the conversion of their pharyngeal samples from positive to negative 39 . We are uncertain as to whether or not the 52 cases in the recovered group in our study had SARS‐CoV‐2 in additional body sites and its influences on immunological response.…”

SARS-CoV-2: Reinfection after 18 Months of a Previous Case with Multiple Negative Nasopharyngeal Swab Tests and Positive Fecal Molecular Test

“…However, some studies demonstrated that the clearance time of COVID-19 in the digestive tract was later than that in the respiratory tract [ 44 , 45 ]. Recently, Wu et al [ 15 ] found that fecal positivity for SARS-CoV-2 was independent from the manifestation of gastrointestinal symptoms or disease severity.…”

“…Several researches pointed out how the fecal-oral transmission could be considered on par with airborne transmission [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Achalasia Following SARS-CoV-2 Infection: A Case Report and Review of Literature

“…However, as our comprehension of the virus and its pathophysiology has deepened, it has become evident that the impact of SARS-CoV-2 extends beyond the respiratory system, with the gastrointestinal (GI) tract being a notable site of involvement [4,5]. A significant subset of COVID-19 patients exhibits gastrointestinal symptoms, including diarrhea, nausea, and vomiting, and viral shedding in feces has been documented [5,6,7,8]. The propensity of SARS-CoV-2 to infect the GI tract is attributed to its utilization of the angiotensin-converting enzyme 2 (ACE2) receptor for cellular entry, a receptor abundantly expressed in various tissues, including the epithelial cells of the GI tract [9].…”