Diarrhea Is Associated With Prolonged Symptoms and Viral Carriage in Corona Virus Disease 2019

Clin Gastroenterol Hepatol. 2020 Jul;18(8):1753-1759.e2. doi: 10.1016/j.cgh.2020.04.030. Epub 2020 Apr 18.


Background & aims: We compared clinical, laboratory, radiological, and outcome features of patients with SARS-CoV-2 infection (COVID-19) with pneumonia, with vs without diarrhea.

Methods: We performed a retrospective, single-center analysis of 84 patients with SARS-CoV-2 pneumonia in Wuhan Union Hospital, China, from January 19 through February 7, 2020. Cases were confirmed by real-time reverse-transcriptase PCR of nasal and pharyngeal swab specimens for SARS-CoV-2 RNA. Blood samples were analyzed for white blood cell count, lymphocyte count, alanine aminotransferase, creatine kinase, lactate dehydrogenase, D-dimer, C-reactive protein, and in some cases, immunoglobulins, complement, lymphocyte subsets, and cytokines. Virus RNA was detected in stool samples by real-time PCR.

Results: Of the 84 patients with SARS-CoV-2 pneumonia, 26 (31%) had diarrhea. The duration of fever and dyspnea in patients with diarrhea was significantly longer than those without diarrhea (all P < .05). Stool samples from a higher proportion of patients with diarrhea tested positive for virus RNA (69%) than from patients without diarrhea (17%) (P < .001). As of February 19, a lower proportion of patients with diarrhea had a negative result from the latest throat swab for SARS-CoV-2 (77%) than patients without diarrhea (97%) (P = .010), during these patients' hospitalization. Of 76 patients with a negative result from their latest throat swab test during hospitalization, a significantly higher proportion of patients with diarrhea had a positive result from the retest for SARS-CoV-2 in stool (45%) than patients without diarrhea (20%) (P = .039).

Conclusions: At a single center in Wuhan, China, 31% of patients with SARS-CoV-2 pneumonia had diarrhea. A significantly higher proportion of patients with diarrhea have virus RNA in stool than patients without diarrhea. Elimination of SARS-CoV-2 from stool takes longer than elimination from the nose and throat.

Keywords: COVID-19; Diarrhea; Pneumonia; SARS-CoV-2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus / isolation & purification*
  • Blood Cell Count
  • Blood Chemical Analysis
  • COVID-19
  • Carrier State / virology*
  • China
  • Coronavirus Infections / complications*
  • Coronavirus Infections / pathology*
  • Diarrhea / epidemiology*
  • Diarrhea / etiology*
  • Diarrhea / pathology
  • Feces / virology
  • Female
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Nasal Mucosa / virology
  • Pandemics
  • Pharynx / virology
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / pathology*
  • RNA, Viral / analysis
  • Real-Time Polymerase Chain Reaction
  • Retrospective Studies
  • SARS-CoV-2
  • Young Adult


  • RNA, Viral