The importance of fecal nucleic acid detection in patients with coronavirus disease (COVID-19): A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 35174515 · doi:10.1002/jmv.27652
What was done
Systematic review and meta-analysis evaluating 46 studies and pooled data from 2,352 hospitalized COVID-19 patients to determine the prevalence of fecal SARS-CoV-2 RNA shedding, its association with gastrointestinal (GI) symptoms and disease severity, persistent shedding after respiratory clearance, and re-positivity after hospital discharge (4 studies, 848 patients).
What was found
Pooled prevalence of fecal viral RNA was 46.8% (95% CI: 0.383-0.554). Among fecal RNA-positive patients, total GI symptoms occurred in 28.5% (95% CI: 0.125-0.44), both respiratory and GI symptoms in 21.9% (95% CI: 0.09-0.346), only GI symptoms in 19.8% (95% CI: 0.107-0.288), and only respiratory symptoms in 50.5% (95% CI: 0.267-0.744). Fecal RNA positivity did not differ significantly between severe and nonsevere cases (OR = 2.009, 95% CI: 0.922-4.378, p = 0.079). After respiratory samples turned negative, 55.4% (95% CI: 0.418-0.669) of fecal-positive patients had persistent fecal RNA shedding. In 848 discharged patients with prior negative stool samples, re-positive rates were 18.1% (95% CI: 0.028-0.335) for stool swabs, 22.8% (95% CI: 0.003-0.452) for respiratory swabs, 19.1% (95% CI: 0.019-0.363) for both, and 9.6% (95% CI: 0.010-0.203) for stool swabs only.
Why it matters
Demonstrates that gastrointestinal viral RNA shedding is common and often outlasts respiratory clearance in hospitalized patients, highlighting the diagnostic potential of stool testing for identifying persistent shedding.
Limits
Included studies were observational and restricted to hospitalized cohorts. Detection of viral RNA by PCR does not establish the presence of live, infectious virus or confirm viable fecal-oral transmission. Heterogeneity, sampling time points, and PCR assay thresholds were not detailed in the abstract.
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.