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Evidence for gastrointestinal infection of SARS-CoV-2

Our take —

This study examined gastrointestinal specimens from hospitalized patients with SARS-CoV-2, and provides evidence for gastrointestinal infection of SARS-CoV-2. Further research is needed to understand the potential for a fecal-oral transmission route, particularly after other respiratory symptoms have resolved and respiratory testing indicates viral clearance. Further transmission-based precautions for recovered patients with SARS-CoV-2 should be considered.

Study design

Case Series

Study population and setting

Between February 1 and 14, 2020, clinical specimens were collected from 73 hospitalized patients infected with SARS-CoV-2 at the Fifth Affiliated Hospital, Guangdong Province, China. Specimens included serum, nasopharyngeal, and oropharyngeal swabs, urine, stool, and tissues. Multiple tissue samples from the GI tract were obtained from one of the patients by using endoscopy.

Summary of Main Findings

Over half of the patients, including 25 male and 14 female patients, tested positive for SARS-CoV-2 RNA in stool. About a quarter (23.3%) continued to have positive results in stool after showing negative results in respiratory samples. Immunofluorescent data from the one patient with gastrointestinal tissue collection showed that ACE2 protein, a cell receptor for SARS-CoV-2, was expressed in the glandular cells of gastric, duodenal, and rectal epithelia, suggesting the possible entry of SARS-CoV-2.

Study Strengths

The study tested a range of specimen samples across patients, as well as gastrointestinal tissues for one patient. A biological mechanism for potential fecal-oral transmission was strengthened by the presence of identified ACE2 protein.

Limitations

Given that recruitment was not random, it is possible that those who were included in this study were not representative of all hospitalized patients.

Value added

These results highlighted the potential for fecal-oral transmission of SARS-CoV-2. Prevention of fecal-oral transmission should be further investigated and should be taken into consideration to control the spread of the virus.