Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection
Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection
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DOI：
10.1053/s0016-5085(03)01215-0
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发表时间：
2003-10-01
期刊：
影响因子：
29.4
通讯作者：
Sung, JJY
中科院分区：
文献类型：
--
作者：
Leung, WK;To, KF;Sung, JJY
背景与目的：严重急性呼吸综合征(SARS)是新近出现的一种新型冠状病毒(CoV)感染。除了发烧和呼吸道并发症外，SARS患者还经常出现胃肠道症状，但其意义尚不确定。在此，我们描述了这种新的病毒感染累及肠道的临床、病理和病毒学特征。方法：对2003年3月香港首次确诊的138例SARS大暴发患者的胃肠道症状及其他临床资料进行回顾性分析。通过结肠镜检查或尸检获得肠道标本，通过电子显微镜、病毒培养和逆转录聚合酶链式反应检测冠状病毒的存在。结果：138例SARS患者中，28例(20.3%)表现为水样腹泻，38.4%的患者在病程中出现腹泻症状。腹泻在患病的第一周更常见。平均腹泻天数为3.7+/-2.7天，多数为自限性腹泻。通过结肠镜或尸检获得的肠道活组织标本显示结构破坏很小，但在小肠和大肠内都存在活跃的病毒复制。从这些标本中也通过培养分离出冠状病毒，在症状出现后10周以上的患者粪便中可检测到SARS-CoV RNA。结论：腹泻是SARS的常见症状。SARS冠状病毒的肠道嗜性对临床表现和病毒传播具有重要意义。
Background & Aims: Severe acute respiratory syndrome (SARS) is a recently emerged infection from a novel coronavirus (CoV). Apart from fever and respiratory complications, gastrointestinal symptoms are frequently observed in patients with SARS but the significance remains undetermined. Herein, we describe the clinical, pathologic, and virologic features of the intestinal involvement of this new viral infection. Methods: A retrospective analysis of the gastrointestinal symptoms and other clinical parameters of the first 138 patients with confirmed SARS admitted for a major outbreak in Hong Kong in March 2003 was performed. Intestinal specimens were obtained by colonoscopy or postmortem examination to detect the presence of coronavirus by electron microscopy, virus culture, and reverse-transcription polymerase chain reaction. Results: Among these 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness. Diarrhea was more frequently observed during the first week of illness. The mean number of days with diarrhea was 3.7 +/- 2.7, and most diarrhea was self-limiting. Intestinal biopsy specimens obtained by colonoscopy or autopsy showed minimal architectural disruption but the presence of active viral replication within both the small and large intestine. Coronavirus was also isolated by culture from these specimens, and SARS-CoV RNA can be detected in the stool of patients for more than 10 weeks after symptom onset. Conclusions: Diarrhea is a common presenting symptom of SARS. The intestinal tropism of the SARS-CoV has major implications on clinical presentation and viral transmission.