Possibility Of Fecal-oral Transmission Research Articles

Characteristics of COVID-19 Patients With SARS-CoV-2 Positivity in Feces.

BackgroundSARS-CoV-2 is highly contagious and poses a great threat to epidemic control and prevention. The possibility of fecal-oral transmission has attracted increasing concern. However, viral shedding in feces has not been completely investigated.MethodsThis study retrospectively reviewed 97 confirmed coronavirus disease 2019 (COVID-19) patients hospitalized at the First Affiliated Hospital, School of Medicine, Zhejiang University, from January 19 to February 17, 2020. SARS-CoV-2 RNA in samples of sputum, nasopharyngeal or throat swabs, bronchoalveolar lavage and feces was detected by real-time reverse transcription polymerase chain reaction (RT–PCR). Clinical characteristics and parameters were compared between groups to determine whether fecal RNA was positive.ResultsThirty-four (35.1%) of the patients showed detectable SARS-CoV-2 RNA in feces, and 63 (64.9%) had negative detection results. The median time of viral shedding in feces was approximately 25 days, with the maximum time reaching 33 days. Prolonged fecal-shedding patients showed longer hospital stays. Those patients for whom fecal viral positivity persisted longer than 3 weeks also had lower plasma B-cell counts than those patients in the non-prolonged group [70.5 (47.3-121.5) per μL vs. 186.5 (129.3-376.0) per μL, P = 0.023]. Correlation analysis found that the duration of fecal shedding was positively related to the duration of respiratory viral shedding (R = 0.70, P < 0.001) and negatively related to peripheral B-cell counts (R = -0.44, P < 0.05).ConclusionsCOVID-19 patients who shed SARS-CoV-2 RNA in feces presented similar clinical characteristics and outcomes as those who did not shed SARS-CoV-2 RNA in feces. The prolonged presence of SARS-CoV-2 nucleic acids in feces was highly correlated with the prolonged shedding of SARS-CoV-2 RNA in the respiratory tract and with lower plasma B-cell counts.

Gastrointestinal Involvement in The Confirmed Covid-19 Patients

The current pandemic of Coronavirus disease 2019, or known as COVID-19, has been claimed as Public Health Emergency of International Concern by WHO on 30 January 2020. According to WHO, there 47.362.304 confirmed cases and 1.211.986 deaths reported due to COVID-19 and still counting. This article investigates the involvement of gastrointestinal symptoms in COVID-19 related to the pathogenesis, transmission, and severity of the disease. The data was collected by keyword searching through EBSCO, PubMed, Google scholar, and additional references from retrieved articles. This article analyzes studies investigating gastrointestinal symptoms in Covid-19. The studies found gastrointestinal symptoms in COVID-19 confirmed patients such as abdominal pain, diarrhea, nausea, vomiting, constipation, and melena. Two studies showed that COVID-19 patients with gastrointestinal symptoms tended to have more severe disease. ACE2, as the receptor of S protein, was found abundantly in intestinal enterocytes besides in the respiratory system. Enterocyte abnormality induces decreased absorption of NA+, water, and mucosal disaccharides. It leads to increased undigested mono and disaccharides, carbohydrates, fats, and protein into the colon. As a result, the colon is unable to absorb sufficient water, leading to diarrhea. Gastrointestinal symptoms are commonly found in patients with COVID‐19, and the trend is increasing in the later stage of the epidemic. SARS‐CoV‐2 enters gastrointestinal epithelial cells and the feces of COVID‐19 patients are potentially infectious. The virus also found in wastewater system and may cause water pollution. Hence, further studies investigating gastrointestinal symptoms and possibility of fecal oral transmission should be conducted.

The clinical features of COVID-19 patients with positive viral RNA stool test results and possibility of fecal-oral transmission : A Systematic Review

Objective : Coronavirus disease 2019 (COVID-19) has been declared as an international public health emergency by the World Health Organization (WHO), with outbreaks in over 200 countries and causing over 390,000 deaths globally. ACE-2 receptors are highly expressed in the upper and lower gastrointestinal system, providing a prerequisite for SARS-CoV-2 infection in the gastrointestinal tract. In addition, over half of the COVID-19 patients have viral nucleic acid detected in their feces and almost one-quarter of the cases, the stool samples test positive even when respiratory samples are negative. The aim of this systematic review is to summarize literature and to evaluate the clinical characteristics of patients with positive viral RNA stool test for COVID-19 and if there is a possibility of fecal-oral transmission of SARS-CoV-2 virus.Method : This systematic review has been registered in PROSPERO (CRD42020183049). A systematic search of the literature for observational study and randomized control trial was conducted in PubMed central and Google Scholar through May 5th, 2020. Three reviewers independently searched and selected. The risk of bias was evaluated using Newcastle-Ottawa Quality assessment tool.Results : 340 articles were screened, then from which eight articles were selected. Of eight articles that were included in this study, we sought for three main categories of the clinical manifestation; gastrointestinal, respiratory, and others. Each study was reviewed systematically to gain demographic data and evidence regarding the possibility of fecal oral transmission in SARS-CoV-2. Two studies reported prolongation of positive stool test results after the respiratory specimen conversion to negative which support the theory of fecal oral transmission.Conclusion : In conclusion, diarrhea, cough, and fever are the most common clinical manifestations in COVID-19 patients with positive RNA stool test results. Fecal oral transmission may be possible due to the ACE-2 receptors in the lining of the gastrointestinal tract. RNA stool test should be used as addition in discharging COVID-19 patients.

Significance of nucleic acid positive anal swab in COVID-19 patients

Abstract Aim We compared the clinical characteristics of patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) positive and negative anal swabs during coronavirus disease 2019 (COVID-19) recovery and investigated the clinical significance and influence factors of anal swab detection. Methods This study retrospectively analyzed 23 moderate COVID-19 patients in the recovery phase. They were divided into anal swab positive group (n = 13) (negative for pharyngeal swabs but positive for anal swabs) and anal swab negative group (n = 10) (negative for pharyngeal and anal swabs). The epidemiology, clinical symptoms, time of pharyngeal swabs turning negative, and laboratory results were compared. Results The time of pharyngeal swabs turning negative in the anal swab positive group was 6 (5–8.5) days, significantly longer than that in the anal swab negative group (1 (1–4.25) days), P = 0.0002). The platelet count of the anal swab positive group was significantly lower than that of the anal swab negative group (198 (135–235) × 109/L vs 240.5 (227–264.75) × 109/L, P = 0.0248). No significant difference was observed between the two groups in other variables. Conclusions The time of pharyngeal swab turning negative in anal swab positive patients is longer than that in anal swab negative patients. The platelet count can be used as an indicator for viral infection evaluation. For patients with a longer time of pharyngeal swabs turning negative, the combined testing of the anal swab and platelet counts may help to avoid pharyngeal swab false negatives, premature discharge, and the possibility of fecal-oral transmission.

SARS-CoV-2 and Risk to Food Safety.

The COVID-19 pandemic has brought about a consideration of our understanding of transmission of the causal agent, SARS-CoV-2 to humans and its potential effect on food safety and food security. The main routes of transmission are reported to be person-to-person, by respiratory droplets and to a lesser degree, by fomites. Concerns have been raised on the possibility of transmission via food and food packaging and whether the virus poses a risk to food safety. The current contribution provides an exposé of updated literature and reports applicable to various components of food safety and its linkage to SARS-CoV-2. The article focuses on SARS-CoV-2 survival in food, on food contact materials and food packaging, and its categorization as a foodborne vs. respiratory virus, the possibility of fecal-oral transmission and the likelihood of infection via the gastro-intestinal system. The survival and inactivation of SARS-CoV-2 in food through thermal and non-thermal inactivation methods as well as the survival and inactivation on inanimate surfaces and effective disinfection of food contact surfaces, are discussed. Ultimately, the article endeavors to add to the body of knowledge pertaining to the role of SARS-CoV-2 in food safety and thereby contribute to an agile and robust fraternity that is equipped to absorb and weather the ongoing effects of the pandemic on the food sector.

Coronavirus Disease 2019 (COVID-19) and Its Gastrointestinal and Hepatic Manifestations

Coronavirus disease 2019 (COVID-19) is a severe respiratory disease caused by the virus SARS-CoV-2 that became classified as a pandemic on March 11, 2020. COVID-19 is known to produce similar clinical manifestations to SARS of the last decade. Fever, dry cough, fatigue, myalgia, dyspnea, and sore throat are some of the most common symptoms and the median incubation period is around 4 days. While the respiratory manifestations have been widely reported, clinical manifestations on the gastrointestinal and hepatic side have often been overlooked. Diarrhea and nausea or vomiting have been reported in approximately 1-5% of cases and sometimes they precede respiratory symptoms. COVID-19 has also been reported to cause hemorrhagic colitis in one case Live SARS-CoV-2 have been detected in stool so, there is a possibility of fecal-oral transmission thus it recommended that non-urgent and low prior endoscopies be postponed. For endoscopies that cannot be postponed, SARS-CoV-2 screening of patients, minimal personnel, infection control training, and usage of negative pressure rooms are recommended. Evidence of abnormal liver-associated biomarker values have been commonly reported, however, there is evidence of extrahepatic causes those abnormal biomarker values. The evidence suggest that COVID-19 patients can have true liver injury, however, it is mild and the abnormal liver-associated biomarker values may be caused, at least partially, but muscle injury. Drugs with hepatotoxicity should be used with increased caution in COVID-19 patients.

Clinical features of children with SARS-CoV-2 infection: an analysis of 13 cases from Changsha, China

To study the clinical features of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A retrospective analysis was performed for the clinical data of 13 children with SARS-CoV-2 infection who hospitalized in a Changsha hospital. All 13 children had the disease onset due to family aggregation. Of the 13 children, 2 had no symptoms, and the other 11 children had the clinical manifestations of fever, cough, pharyngeal discomfort, abdominal pain, diarrhea, convulsions, or vomiting. As for clinical typing, 7 had mild type, 5 had common type, and 1 had severe type. The median duration of fever was 2 days in 6 children. All 13 children had normal levels of peripheral blood lymphocyte counts, immunoglobulins, CD4, CD8, and interleukin-6. The median time to clearance of SARS-CoV-2 was 13 days in the nasopharyngeal swabs of the 13 children. Three children presented false negatives for RT-PCR of SARS-CoV-2. SARS-CoV-2 RNA remained detectable in stools for 12 days after the nasopharyngeal swab test yielded a negative result. Abnormal CT findings were observed in 6 children. All 13 children were cured and discharged and they were normal at 2 weeks after discharge. Intra-family contact is the main transmission route of SARS-CoV-2 infection in children, and there is also a possibility of fecal-oral transmission. Mild and common types are the major clinical types in children with SARS-CoV-2 infection, and cytokine storm is not observed. Children with SARS-CoV-2 infection tend to have a good short-term prognosis, and follow-up is needed to observe their long-term prognosis. Multiple nucleic acid tests should be performed for patients with SARS-CoV-2 infection and their close contacts by multiple site sampling.

Attention to the damage of 2019 novel coronavirus to digestive system and the possibility of fecal-oral transmission

Since the end of December 2019, new coronavirus pneumonia (COVID-19) gradually rapid spread to all over the country, which with strong infectious and had become a major public health event concerned by the whole country. Although scientists devote to the research of COVID-19, however so far some public health related key factors such as the mode of virus transmission and infection route, are just known little. Current researches suggest that in addition to respiratory transmission, 2019 novel coronaviruses (2019-nCoV) may also have fecal-oral transmission. In clinical practice, it was found that part of patients initially present with gastrointestinal symptoms, and not a few patients are with digestive system injury. These findings put forward new requirements of COVID-19 prevention and therapeutic strategy. Key words: COVID-19; SARS-CoV-2; Digestive system damage; fecal-oral transmission

Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy chinese and overseas chinese adults in Asian countries

BackgroundCapsular serotypes K1 and K2 of Klebsiella pneumoniae are thought to the major virulence determinants responsible for liver abscess. The intestine is one of the major reservoirs of K. pneumoniae, and epidemiological studies have suggested that the majority of K. pneumoniae infections are preceded by colonization of the gastrointestinal tract. The possibility of fecal-oral transmission in liver abscess has been raised on the basis of molecular typing of isolates. Data on the serotype distribution of K. pneumoniae in stool samples from healthy individuals has not been previously reported. This study investigated the seroepidemiology of K. pneumoniae isolates from the intestinal tract of healthy Chinese in Asian countries. Stool specimens from healthy adult Chinese residents of Taiwan, Japan, Hong Kong, China, Thailand, Malaysia, Singapore, and Vietnam were collected from August 2004 to August 2010 for analysis.ResultsSerotypes K1/K2 accounted for 9.8% of all K. pneumoniae isolates from stools in all countries. There was no significant difference in the prevalence of K1/K2 isolates among the countries excluding Thailand and Vietnam. The antimicrobial susceptibility pattern was nearly the same in K. pneumoniae isolates. The result of pulsed-field gel electrophoresis revealed no major clonal cluster of serotype K1 isolates.ConclusionsThe result showed that Chinese ethnicity itself might be a major factor predisposing to intestinal colonization by serotype K1/K2 K. pneumoniae isolates. The prevalent serotype K1/K2 isolates may partially correspond to the prevalence of K. pneumoniae liver abscess in Asian countries.

Human Bocavirus and Gastroenteritis

To the Editor: We read with great interest the recent study by Vicente and colleagues, who suspect the human bocavirus (HBoV), a newly detected parvovirus initially described as a respiratory pathogen, to be a possible causative agent of gastroenteritis in children (1). These researchers investigated the presence of HBoV DNA in 527 stool samples from ambulatory patients (<36 months of age) with unrelated respiratory symptoms. Of these stool samples, 48 (9.1%) were positive for HBoV DNA. Other enteric pathogens were found in 58% of all HBoV-positive fecal samples. A close taxonomic relationship exists between HBoV and bovine parvovirus, an animal virus capable of causing gastrointestinal symptoms in cattle (2). Taking into account the assumed high tenacity of this parvovirus against environmental factors and hospital-grade disinfectants (3,4), we believe the possibility of fecal-oral transmission, in addition to transmission via respiratory droplets, has to be considered in interpreting the observations of Vicente et al. (1). Gastroenteric symptoms have been described in up to 25% of all patients with respiratory HBoV infections (5–7). Although these observations suggest that HBoV may contribute to gastroenteritis or even be a causative agent, further studies are needed. Such studies should include control groups of asymptomatic patients and should test stool samples for HBoV. The correlation between detection of HBoV and clinical symptoms of gastroenteritis needs further confirmation in animal models, which are still not available. Nevertheless, the study by Vicente et al. did not clarify the extent of respiratory symptoms in patients with HBoV-positive stool samples. Taking into account the nature of parvovirus particles, we believe the virus likely passed through the gastrointestinal tract, as patients frequently swallow virus-containing sputum or nasal secretions. Thus, the observation that HBoV is an enteric pathogen should be considered a preliminary finding. Finally, we suggest that the role of HBoV should be investigated through histologic examination of mucosa biopsy specimens (e.g., from patients with chronic gastrointestinal diseases) to confirm pathogenicity.