Detection of SARS-CoV-2 in Fecal Samples From Patients With Asymptomatic and Mild COVID-19 in Korea
Detection of SARS-CoV-2 in Fecal Samples From Patients With Asymptomatic and Mild COVID-19 in Korea
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DOI：
10.1016/j.cgh.2020.06.005
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发表时间：
2021-06-17
影响因子：
12.6
通讯作者：
Joo, Eun-Jeong
中科院分区：
文献类型：
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作者：
Park, Soo-kyung;Lee, Chil-Woo;Joo, Eun-Jeong
背景与目的：虽然2019冠状病毒病（COVID-19）的特征是发烧和呼吸道症状，但有些患者没有症状或症状轻微。严重急性呼吸综合征冠状病毒（SARS-CoV-2）已在患者粪便中检测到。我们调查了无症状或轻度COVID-19患者的胃肠道症状和病毒进入粪便的情况。方法：我们收集了46名无症状或轻度COVID-19（无发热和肺炎）患者（中位年龄26岁; 46%男性）的数据，这些患者在2020年4月4日至2020年4月24日期间在韩国被隔离，并延长了SARS-CoV-2的呼吸道脱落。呼吸道标本包括上呼吸道标本（鼻咽和口咽拭子）和下呼吸道标本（痰液），每周采集两次。从COVID-19诊断到开始采集粪便样本的中位间隔时间为37天（范围为29-41天）;从46名患者中采集了213份粪便样本。结果：46例患者中有16例（35%）出现胃肠道症状，腹泻最常见（15%），其次为腹痛（11%）、消化不良（11%）和恶心（2%）。在2例无胃肠道症状的患者粪便中检测到病毒RNA（4%）。从隔离检疫到粪便采集的平均循环阈值，粪便样本中检出病毒的患者往往低于粪便样本中未检出病毒的患者（第1周分别为29.91 vs 33.67，第5周分别为29.47 vs 35.71）。病毒在粪便中的脱落持续到诊断后第50天;粪便样本在呼吸道样本也开始检测为阴性之前或大约在这个时间开始检测为阴性。在对韩国隔离的COVID-19患者的粪便和呼吸道标本进行分析时，我们发现胃肠道可能是SARS-CoV-2的传播途径，即使在无症状或轻微疾病的患者中，也没有胃肠道症状。在该组患者中，呼吸道标本的病毒载量似乎与病毒脱落到粪便中有关。
BACKGROUND & AIMS: Although coronavirus disease 2019 (COVID-19) is characterized by fever and respiratory symptoms, some patients have no or mild symptoms. Severe acute respiratory syndromecoronavirus (SARS-CoV-2) has been detected in feces of patients. We investigated gastrointestinal symptoms and shedding of virus into feces of patients with asymptomatic or mild COVID-19.METHODS: We collected data from 46 patients (median age, 26 y; 46% men) with asymptomatic or mild COVID-19 (without fever and pneumonia) and prolonged respiratory shedding of SARS-CoV-2, quarantined from April 4, 2020, through April 24, 2020, in Korea. Respiratory specimens included upper respiratory specimens (nasopharyngeal and oropharyngeal swabs) and lower respiratory specimens (sputum), and were collected twice per week. The median interval between COVID-19 diagnosis to the start of fecal sample collection was 37 days (range, 29-41 d); 213 stool specimens were collected from 46 patients. We used real-time reverse-transcription polymerase chain reaction to detect SARS-CoV-2 in the respiratory and fecal specimens.RESULTS: Gastrointestinal manifestations were observed in 16 of the 46 patients (35%); diarrhea was the most common (15%), followed by abdominal pain (11%), dyspepsia (11%), and nausea (2%). Virus RNA was detected in feces from 2 patients without gastrointestinal symptoms (4%). Mean cycle threshold values from the time of quarantine to the time of fecal collection tended to be lower in patients with virus detected in fecal samples than in patients without virus in fecal samples (29.91 vs 33.67 in the first week, 29.47 vs 35.71 in the fifth week, respectively). Shedding of virus into feces persisted until day 50 after diagnosis; fecal samples began to test negative before or at approximately the time that respiratory specimens also began to test negative.CONCLUSIONS: In an analysis of fecal and respiratory specimens from patients with COVID-19 in quarantine in Korea, we found that the gastrointestinal tract could be a route of transmission of SARS-CoV-2 even in patients with asymptomatic or mild disease, with no gastrointestinal symptoms. The viral load of the respiratory specimens appears be related to shedding of the virus into feces in this group of patients.