3 Apr 2020

Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis

Gut (gastrointestinal) symptoms have been reported in patients infected with SARS-CoV-2. A team of experts from HKUMed found traces of the virus in stool samples from infected patients in Hong Kong. Genetic material of the virus (viral RNA) was detected in 9 of the 59 patients (15.3%) in the study, suggesting that the virus may be able to spread via the ‘fecal-oral route’, whereby the virus is transmitted via unhygienic practices from feces to the mouth, for example: when a person does not wash hands properly after going to the toilet then touches or prepares food that is eaten by other people. 

The study also analyzed 4,243 patients from 6 countries and found that 17.6% of these patients also had gut symptoms. Common symptoms included eating problems, vomiting, diarrhea and stomachache.

Key takeaways from the study:

  1. The virus was found in stool samples even in patients who did not show any gut symptoms.
  2. Patients who had diarrhea had more viral RNA in their stool.
  3. The disease was more severe in patients who had gut symptoms than those who did not.
  4. 48.1% of patients had detectable viral traces in stool when they were ill.
  5. 70.3% of patients had viral RNA in their stool even when they tested negative for the virus in their lungs.
  6. The virus was still present in stool samples 33 days after the first symptoms appeared.

This work shows that it is reasonable to test patients with gut symptoms for SARS-CoV-2 even when they do not have fever or respiratory symptoms. As the virus persists longer in the gut, healthcare workers must take precautions when collecting stool samples or performing a colonoscopy, a procedure that uses a probe to examine inside the large intestine (colon).

To read the original article published in Gastroenterology, click here.