The Presence of SARS-CoV-2 RNA in the Feces of COVID-19 Patients

J Med Virol. 2020 Jul;92(7):833-840. doi: 10.1002/jmv.25825. Epub 2020 Apr 25.

Abstract

In December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, and has spread globally. However, the transmission route of SARS-CoV-2 has not been fully understood. In this study, we aimed to investigate SARS-CoV-2 shedding in the excreta of COVID-19 patients. Electronical medical records, including demographics, clinical characteristics, laboratory and radiological findings of enrolled patients were extracted and analyzed. Pharyngeal swab, stool, and urine specimens were collected and tested for SARS-CoV-2 RNA by real-time reverse transcription polymerase chain reaction. Viral shedding at multiple time points in specimens was recorded, and its correlation analyzed with clinical manifestations and the severity of illness. A total of 42 laboratory-confirmed patients were enrolled, 8 (19.05%) of whom had gastrointestinal symptoms. A total of 28 (66.67%) patients tested positive for SARS-CoV-2 RNA in stool specimens, and this was not associated with the presence of gastrointestinal symptoms and the severity of illness. Among them, 18 (64.29%) patients remained positive for viral RNA in the feces after the pharyngeal swabs turned negative. The duration of viral shedding from the feces after negative conversion in pharyngeal swabs was 7 (6-10) days, regardless of COVID-19 severity. The demographics, clinical characteristics, laboratory and radiologic findings did not differ between patients who tested positive and negative for SARS-CoV-2 RNA in the feces. Viral RNA was not detectable in urine specimens from 10 patients. Our results demonstrated the presence of SARS-CoV-2 RNA in the feces of COVID-19 patients and suggested the possibility of SARS-CoV-2 transmission via the fecal-oral route.

Keywords: coronavirus disease 2019; fecal-oral transmission; severe acute respiratory syndrome coronavirus 2; viral RNA; viral shedding.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Betacoronavirus / pathogenicity*
  • China / epidemiology
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / transmission*
  • Disease Outbreaks*
  • Electronic Health Records
  • Feces / virology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pharynx / virology
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / transmission*
  • RNA, Viral / genetics
  • RNA, Viral / isolation & purification*
  • Retrospective Studies
  • Severity of Illness Index
  • Virus Shedding*

Substances

  • RNA, Viral

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2