Persistence of intestinal SARS-CoV-2 infection in stool samples

Persistence of intestinal SARS-CoV-2 infection in stool samples. Heneghan C.

Published on July 30, 2020

Reference Xiaorong Wang, Yaya Zhou, Nanchuan Jiang et al. Persistence of intestinal SARS-CoV-2 infection in patients with COVID-19 leads to re-admission after pneumonia resolved. International Journal of Infectious Diseases, Volume 95, 2020, Pages 433-435,
Study type
Country China
Setting Hospital
Funding Details This work was supported by the Fundamental Research Funds for the Central Universities
Transmission mode Orofecal

Bottom Line

Intestine SARS-CoV-2 infection affects the disease course of COVID-19 and the digestive system is the main target organ of SARS-CoV-2 in some patients.

Evidence Summary

Case 1: The patient was discharged on day 28. One day later she was readmitted with fever combined with fatigue and watery diarrhoea 6–7 times per day. Throat swabs were negative for SARS-CoV-2 by RT-PCR on illness days 29, 35 and 40, while the stool samples were positive for SARS-CoV-2 by RT-PCR on illness days 31 and 36. Forty days after the onset of illness, the stool samples for SARS-CoV-2 turned negative.

Case 2: The throat swabs for SARS-CoV-2 by RT-PCR were negative on illness days 15 and 16, and the patient was waiting to discharge. On on day 18, she reported fatigue and stool samples for SARS-CoV-2 remained positive all the time (on illness days 18, 21, 23, 25, 30) and changes in bowel habit (defecating after eating) were not resolved.

Case 3: The throat swabs for SARS-CoV-2 turned negative on illness days 26 and 28. The stool was positive for SARS-CoV-2 without any digestive symptoms on illness days 24, 26 and 30. The patient was discharged on illness day 31. One day after discharge she appeared with a fever combined with nausea, vomiting and diarrhoea with yellow watery stools five times per day. Her throat swabs were negative but stool samples were still positive for SARS-CoV-2 by RT-PCR.

What did they do?

Three case reports of reported persistence of intestinal SARS-CoV-2 infection that led to re-admission after pneumonia resolved in three cases with COVID-19.

All the following criteria had to be met for hospital discharge of the three cases: (1) normal temperature lasting >3 days; (2) resolved respiratory symptoms; (3) substantially improved acute exudative lesions on chest computed tomography images; and (4) two consecutively negative RT-PCR test results of respiratory samples separated by at least 1 day.

Study reliability

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes Yes Partly Yes No

What else should I consider?

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings