The presence of SARS‐CoV‐2 RNA in the feces of COVID‐19 patients

Abstract

In December 2019, coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), emerged in Wuhan, China, and has spread globally. However, the transmission route of SARS‐CoV‐2 has not been fully understood. In this study, we aimed to investigate SARS‐CoV‐2 shedding in the excreta of COVID‐19 patients. Electronical medical records, including demographics, clinical characteristics, laboratory and radiological findings of enrolled patients were extracted and analyzed. Pharyngeal swab, stool, and urine specimens were collected and tested for SARS‐CoV‐2 RNA by real‐time reverse transcription polymerase chain reaction. Viral shedding at multiple time points in specimens was recorded, and its correlation analyzed with clinical manifestations and the severity of illness. A total of 42 laboratory‐confirmed patients were enrolled, 8 (19.05%) of whom had gastrointestinal symptoms. A total of 28 (66.67%) patients tested positive for SARS‐CoV‐2 RNA in stool specimens, and this was not associated with the presence of gastrointestinal symptoms and the severity of illness. Among them, 18 (64.29%) patients remained positive for viral RNA in the feces after the pharyngeal swabs turned negative. The duration of viral shedding from the feces after negative conversion in pharyngeal swabs was 7 (6‐10) days, regardless of COVID‐19 severity. The demographics, clinical characteristics, laboratory and radiologic findings did not differ between patients who tested positive and negative for SARS‐CoV‐2 RNA in the feces. Viral RNA was not detectable in urine specimens from 10 patients. Our results demonstrated the presence of SARS‐CoV‐2 RNA in the feces of COVID‐19 patients and suggested the possibility of SARS‐CoV‐2 transmission via the fecal‐oral route.