The presence of SARS-CoV-2 RNA in the feces of COVID-19 patients.
Level 4 - case-series / case-control
Case series of COVID-19 patients evaluating viral shedding without a control group
PubMed 32243607 · doi:10.1002/jmv.25825
What was done
Medical records of 42 laboratory-confirmed COVID-19 patients were analyzed for clinical characteristics, laboratory results, and radiological findings. Pharyngeal swabs, stool specimens, and urine specimens (from 10 patients) were collected at multiple time points and tested for SARS-CoV-2 RNA using real-time reverse transcription PCR. Viral shedding duration was evaluated against gastrointestinal symptoms and illness severity.
What was found
Of 42 patients, 8 (19.05%) had gastrointestinal symptoms. SARS-CoV-2 RNA was detected in stool specimens of 28 patients (66.67%), with no association found between stool positivity and gastrointestinal symptoms, disease severity, demographics, laboratory findings, or radiological findings. Among stool-positive patients, 18 (64.29%) remained positive for viral RNA in feces after pharyngeal swabs became negative. The duration of fecal viral shedding after negative pharyngeal conversion was 7 (6-10) days regardless of severity. Viral RNA was not detected in urine specimens from 10 patients.
Why it matters
This study shows that SARS-CoV-2 RNA can persist in feces for over a week after respiratory clearance, highlighting the potential for fecal-oral transmission even in patients without gastrointestinal symptoms.
Limits
The sample size was small with 42 total patients and only 10 tested for urine shedding. The study measured viral RNA via RT-PCR rather than viable infectious virus via culture, and long-term clinical outcomes were not assessed.
Cited by
- supports Reports from China indicate that SARS-CoV-2 continues to be shed in stool even after patients test negative on consecutive throat and nasopharyngeal swabs.