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Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review.
Colorectal Dis. 2020 06; 22(6):611-620.CD

Abstract

AIM

In addition to respiratory symptoms, COVID-19 can present with gastrointestinal complaints suggesting possible faeco-oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS-CoV-2 in patients with COVID-19.

METHODS

A systematic literature review identified studies describing COVID-19 patients tested for faecal virus. Search terms for MEDLINE included 'clinical', 'faeces', 'gastrointestinal secretions', 'stool', 'COVID-19', 'SARS-CoV-2' and '2019-nCoV'. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence-Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco-oral transmission of the virus.

RESULTS

Twenty-six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID-19 is transmitted via faecally shed virus.

CONCLUSION

There is a high rate of positive polymerase chain reaction tests with persistence of SARS-CoV-2 in faecal samples of patients with COVID-19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco-oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.

Authors+Show Affiliations

Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.Division of Infection and Immunity, Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK.Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

32418307

Citation

Gupta, S, et al. "Persistent Viral Shedding of SARS-CoV-2 in Faeces - a Rapid Review." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 22, no. 6, 2020, pp. 611-620.
Gupta S, Parker J, Smits S, et al. Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review. Colorectal Dis. 2020;22(6):611-620.
Gupta, S., Parker, J., Smits, S., Underwood, J., & Dolwani, S. (2020). Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 22(6), 611-620. https://doi.org/10.1111/codi.15138
Gupta S, et al. Persistent Viral Shedding of SARS-CoV-2 in Faeces - a Rapid Review. Colorectal Dis. 2020;22(6):611-620. PubMed PMID: 32418307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review. AU - Gupta,S, AU - Parker,J, AU - Smits,S, AU - Underwood,J, AU - Dolwani,S, Y1 - 2020/06/04/ PY - 2020/04/20/received PY - 2020/05/02/revised PY - 2020/05/09/accepted PY - 2020/5/18/pubmed PY - 2020/7/1/medline PY - 2020/5/18/entrez KW - COVID-19 KW - SARS-CoV-2 KW - faeces KW - gastrointestinal KW - viral shedding SP - 611 EP - 620 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 22 IS - 6 N2 - AIM: In addition to respiratory symptoms, COVID-19 can present with gastrointestinal complaints suggesting possible faeco-oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS-CoV-2 in patients with COVID-19. METHODS: A systematic literature review identified studies describing COVID-19 patients tested for faecal virus. Search terms for MEDLINE included 'clinical', 'faeces', 'gastrointestinal secretions', 'stool', 'COVID-19', 'SARS-CoV-2' and '2019-nCoV'. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence-Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco-oral transmission of the virus. RESULTS: Twenty-six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID-19 is transmitted via faecally shed virus. CONCLUSION: There is a high rate of positive polymerase chain reaction tests with persistence of SARS-CoV-2 in faecal samples of patients with COVID-19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco-oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract. SN - 1463-1318 UR - https://www.unboundmedicine.com/medline/citation/32418307/Persistent_viral_shedding_of_SARS_CoV_2_in_faeces___a_rapid_review_ L2 - https://doi.org/10.1111/codi.15138 DB - PRIME DP - Unbound Medicine ER -