Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis.
Betacoronavirus
/ genetics
COVID-19
COVID-19 Testing
Clinical Laboratory Techniques
Coronavirus Infections
/ diagnosis
Diarrhea
/ diagnosis
Endoscopy, Gastrointestinal
/ standards
Feces
/ virology
Gastrointestinal Tract
/ diagnostic imaging
Hong Kong
/ epidemiology
Humans
Infection Control
/ standards
Infectious Disease Transmission, Patient-to-Professional
/ prevention & control
Pandemics
/ prevention & control
Pneumonia, Viral
/ diagnosis
Prevalence
RNA, Viral
/ isolation & purification
SARS-CoV-2
Viral Load
Fecal-to-Oral Transmission
PRISMA
SARS
Viral Persistence
Journal
Gastroenterology
ISSN: 1528-0012
Titre abrégé: Gastroenterology
Pays: United States
ID NLM: 0374630
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
16
03
2020
revised:
23
03
2020
accepted:
26
03
2020
pubmed:
7
4
2020
medline:
8
8
2020
entrez:
7
4
2020
Statut:
ppublish
Résumé
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong. We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model. Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.
Sections du résumé
BACKGROUND & AIMS
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong.
METHODS
We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model.
RESULTS
Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log
CONCLUSIONS
In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.
Identifiants
pubmed: 32251668
pii: S0016-5085(20)30448-0
doi: 10.1053/j.gastro.2020.03.065
pmc: PMC7194936
pii:
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
81-95Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Biosci Trends. 2020 Mar 16;14(1):64-68
pubmed: 32037389
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
Pediatr Pulmonol. 2020 May;55(5):1169-1174
pubmed: 32134205
Transl Pediatr. 2020 Feb;9(1):51-60
pubmed: 32154135
Euro Surveill. 2020 Feb;25(5):
pubmed: 32046819
Lancet. 2020 Feb 15;395(10223):514-523
pubmed: 31986261
Nature. 2020 Mar;579(7798):270-273
pubmed: 32015507
Clin Infect Dis. 2020 Jul 28;71(15):706-712
pubmed: 32109279
Stat Med. 2002 Jun 15;21(11):1539-58
pubmed: 12111919
Eur J Nucl Med Mol Imaging. 2020 May;47(5):1275-1280
pubmed: 32107577
BMJ. 2009 Jul 21;339:b2700
pubmed: 19622552
Osong Public Health Res Perspect. 2020 Feb;11(1):8-14
pubmed: 32149037
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Clin Infect Dis. 2020 Sep 12;71(6):1547-1551
pubmed: 32112072
Zhonghua Jie He He Hu Xi Za Zhi. 2020 May 12;43(5):427-430
pubmed: 32087623
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
N Engl J Med. 2020 Feb 27;382(9):872-874
pubmed: 31991079
J Microbiol Immunol Infect. 2020 Jun;53(3):481-484
pubmed: 32111449
J Infect. 2020 Apr;80(4):388-393
pubmed: 32112884
JAMA. 2020 Mar 17;323(11):1092-1093
pubmed: 32031568
J Med Virol. 2020 Jun;92(6):680-682
pubmed: 32124995
Clin Infect Dis. 2016 Feb 15;62(4):477-483
pubmed: 26565003
BMJ. 2020 Feb 19;368:m606
pubmed: 32075786
Zhonghua Er Ke Za Zhi. 2020 Mar 2;58(3):182-184
pubmed: 32135587
Gut. 2020 Jun;69(6):1141-1143
pubmed: 32102928
Invest Radiol. 2020 Jun;55(6):327-331
pubmed: 32118615
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):209-214
pubmed: 32164090
Zhonghua Bing Li Xue Za Zhi. 2020 May 8;49(5):418-423
pubmed: 32114744
Lancet. 2020 Mar 7;395(10226):809-815
pubmed: 32151335
J Infect Dis. 2020 May 11;221(11):1757-1761
pubmed: 32067043
Lancet Infect Dis. 2020 Apr;20(4):425-434
pubmed: 32105637
Chin Med J (Engl). 2020 May 5;133(9):1015-1024
pubmed: 32004165
N Engl J Med. 2020 Mar 5;382(10):929-936
pubmed: 32004427
J Hosp Infect. 2018 Jun;99(2):162-168
pubmed: 28958834
Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67
pubmed: 31573350
J Virol. 2020 Mar 17;94(7):
pubmed: 31996437
Lancet Infect Dis. 2013 Sep;13(9):752-61
pubmed: 23891402
Lancet Infect Dis. 2020 May;20(5):534-535
pubmed: 32119823
Travel Med Infect Dis. 2020 Jul - Aug;36:101606
pubmed: 32114074
J Korean Med Sci. 2020 Feb 24;35(7):e86
pubmed: 32080991
J Med Virol. 2020 May;92(5):461-463
pubmed: 32073161
J Thorac Oncol. 2020 May;15(5):e63-e64
pubmed: 32147577
Emerg Infect Dis. 2004 Feb;10(2):294-9
pubmed: 15030700
J Infect. 2020 May;80(5):578-606
pubmed: 32119884
N Engl J Med. 2020 Mar 19;382(12):1177-1179
pubmed: 32074444
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Jun 24;48(6):450-455
pubmed: 32120458
Gastroenterology. 2003 Oct;125(4):1011-7
pubmed: 14517783
Sci Adv. 2017 Nov 15;3(11):eaao4966
pubmed: 29152574
Zhonghua Er Ke Za Zhi. 2020 Mar 2;58(3):179-182
pubmed: 32135586
J Travel Med. 2020 Mar 13;27(2):
pubmed: 32052846
JAMA. 2020 Apr 21;323(15):1488-1494
pubmed: 32125362
Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Apr 10;41(4):494-497
pubmed: 32133831
Lancet Infect Dis. 2020 May;20(5):536
pubmed: 32145189
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Eur Respir J. 2020 Apr 23;55(4):
pubmed: 32139464
Gut. 2020 Jun;69(6):1143-1144
pubmed: 32139552
Zhonghua Er Ke Za Zhi. 2020 Feb 17;58(0):E009
pubmed: 32065520
Clin Imaging. 2020 Jul;63:7-9
pubmed: 32120312
Wkly Epidemiol Rec. 2003 Oct 24;78(43):373-5
pubmed: 14601330
AJR Am J Roentgenol. 2020 May;214(5):1072-1077
pubmed: 32125873
Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Apr 10;41(4):489-493
pubmed: 32133830
Sci China Life Sci. 2020 Mar;63(3):364-374
pubmed: 32048163
Allergy. 2020 Jul;75(7):1730-1741
pubmed: 32077115
Invest Radiol. 2020 Jun;55(6):332-339
pubmed: 32134800
AJR Am J Roentgenol. 2020 Jun;214(6):1287-1294
pubmed: 32134681
Nature. 2012 Jul 25;487(7408):477-81
pubmed: 22837003
Lancet. 2020 Feb 15;395(10223):507-513
pubmed: 32007143
JAMA. 2020 May 12;323(18):1843-1844
pubmed: 32159775
Emerg Microbes Infect. 2020 Dec;9(1):386-389
pubmed: 32065057
Invest Radiol. 2020 May;55(5):257-261
pubmed: 32091414
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
Chin Med J (Engl). 2020 May 5;133(9):1039-1043
pubmed: 32118639
J Infect. 2020 Apr;80(4):394-400
pubmed: 32109443
Water Sci Technol. 2005;52(8):213-21
pubmed: 16312970
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):215-218
pubmed: 32164091
J Formos Med Assoc. 2020 Mar;119(3):747-751
pubmed: 32113824
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Apr 12;43(4):327-331
pubmed: 32118390
Radiology. 2020 Jun;295(3):715-721
pubmed: 32053470
Emerg Infect Dis. 2004 Sep;10(9):1550-7
pubmed: 15498155
Chin Med J (Engl). 2020 May 5;133(9):1025-1031
pubmed: 32044814
Gastroenterology. 2020 May;158(6):1831-1833.e3
pubmed: 32142773
Zhonghua Er Ke Za Zhi. 2020 Apr 2;58(4):269-274
pubmed: 32118389