Excretion and viability of SARS-CoV-2 in feces and its association with the clinical outcome of COVID-19

Abstract

The main objective was to evaluate the viability of the SARS-CoV-2 viral particles excreted in stools. In addition, we aimed to identify clinical factors associated with the detection of SARS-CoV-2 RNA in feces, and to determine if its presence is associated with an unfavorable clinical outcome, defined as intensive care unit (ICU) admission and/or death. A prospective multicenter cohort study of COVID-19 adult patients, with confirmed SARS-CoV-2 infection by RT-PCR assay in nasopharyngeal (NP) swabs admitted to four hospitals in Spain, from March 2020 to February 2021. Sixty-two adult COVID-19 patients had stool samples collected at admission and/or during the follow up, with a total of 79 stool samples. SARS-CoV-2 RNA was detected in stool samples from 27 (43.5%) out of the 62 patients. Replicative virus, measured by the generation of cytopathic effect in cell culture and subsequent RT-PCR confirmation of a decrease in the Ct values, was not found in any of these stool samples. Fecal virus excretion was not associated with the presence of gastrointestinal symptoms, or with differences in the evolution of COVID-19 patients. Our results suggest that SARS-CoV-2 replicative capacity is null or very limited in stool samples, and thus, the fecal–oral transmission of SARS-CoV-2 as an alternative infection route is highly unlikely. In our study, the detection of SARS-CoV-2 RNA in feces at the beginning of the disease is not associated with any clinical factor nor with an unfavorable clinical outcome.

In Vivo Fate of Cowpea Mosaic Virus In Situ Vaccine: Biodistribution and Clearance

“…To further validate this finding, we carried out Western blot and RT-PCR analysis on the plant sap extracted from individual leaves, and CPMV could not be detected, neither on the protein nor at the RNA level (Figure B,C), which suggests that the RNA detected in stool may not be infectious toward plants. This is congruent with data surrounding SARS-CoV-2, where viral RNA with a mitigated replicative capacity can be detected in stool samples …”

“…This is congruent with data surrounding SARS-CoV-2, where viral RNA with a mitigated replicative capacity can be detected in stool samples. 74 From a translational perspective, these data convey that shedding of infectious CPMV was not evident after I.T. or oral dosing.…”

Assessment of two volumetrically different concentration approaches to improve sensitivities for SARS-CoV-2 detection during wastewater monitoring

“…Similar to a few existing examples in the literature ( Rimoldi et al, 2020 , Westhaus et al, 2021 ), no endogenous infectious SARS-CoV-2 was detected in the wastewater samples collected for this study. These results indicate that SARS-CoV-2 is either quickly inactivated in wastewater, irreversibly adheres to wastewater particulates, or as recent studies have suggested, infected individuals do not excrete detectable infectious virus in their stool (2001, 2001; Ahmed et al, 2020b ; Albert et al, 2021 ; Carducci et al, 2020 ; Cerrada-Romero et al, 2022 ; Tiwari et al, 2021 ). Taken together, these findings suggest the need to further understand the feasibility and importance of monitoring infectious SARS-CoV-2 in environmental matrices (e.g., wastewater).…”

Gut as an Alternative Entry Route for SARS-CoV-2: Current Evidence and Uncertainties of Productive Enteric Infection in COVID-19

“…Despite SARS-CoV-2 RNA being detected in stools, and the persistent viral shedding of SARS-CoV-2 in feces, current data from different studies are conflicting regarding the detection of infectious particles in feces. Infectious viral particles may be retrieved from anecdotal cases, although studies indicate that the vast majority of individuals infected with SARS-CoV-2 do not release infectious particles from stools [ 125 ]. While high viral RNA concentrations were observed in stools in two different studies (9 and 10 patients, respectively), infectious virus was not recovered in those samples [ 33 , 125 , 126 ].…”

“…Infectious viral particles may be retrieved from anecdotal cases, although studies indicate that the vast majority of individuals infected with SARS-CoV-2 do not release infectious particles from stools [ 125 ]. While high viral RNA concentrations were observed in stools in two different studies (9 and 10 patients, respectively), infectious virus was not recovered in those samples [ 33 , 125 , 126 ]. In contrast, replicating SARS-CoV-2 virus was detected in feces in [ 127 ] and viable SARS-CoV-2 particles in stool samples in [ 128 ].…”