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Volume 3, Issue 6, 10 June 2022, Pages 371-387.e9
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Clinical Advances
Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection

https://doi.org/10.1016/j.medj.2022.04.001Get rights and content
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Highlights

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    Approximately one-half of COVID-19 patients shed fecal RNA in the week after diagnosis

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    Four percent of patients with COVID-19 shed fecal viral RNA 7 months after diagnosis

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    Presence of fecal SARS-CoV-2 RNA is associated with gastrointestinal symptoms

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    SARS-CoV-2 likely infects gastrointestinal tissue

Context and significance

Gastrointestinal symptoms and SARS-CoV-2 RNA shedding in feces point to the gastrointestinal tract as a possible site of infection in COVID-19. Researchers from Stanford University measured the dynamics of fecal viral RNA in patients with mild to moderate COVID-19 followed for 10 months post-diagnosis. The authors found that fecal viral RNA shedding was correlated with gastrointestinal symptoms in patients who had cleared their respiratory infection. They also observed that fecal shedding can continue to 7 months post-diagnosis. In conjunction with recent related findings, this work presents compelling evidence of SARS-CoV-2 infection in the gastrointestinal tract and suggests a possible role for long-term infection of the gastrointestinal tract in syndromes such as “long COVID.”

Summary

Background

COVID-19 manifests with respiratory, systemic, and gastrointestinal (GI) symptoms.1, SARS-CoV-2 RNA is detected in respiratory and fecal samples, and recent reports demonstrate viral replication in both the lung and intestinal tissue.2, 3, 4 Although much is known about early fecal RNA shedding, little is known about long-term shedding, especially in those with mild COVID-19. Furthermore, most reports of fecal RNA shedding do not correlate these findings with GI symptoms.5

Methods

We analyzed the dynamics of fecal RNA shedding up to 10 months after COVID-19 diagnosis in 113 individuals with mild to moderate disease. We also correlated shedding with disease symptoms.

Findings

Fecal SARS-CoV-2 RNA is detected in 49.2% [95% confidence interval, 38.2%–60.3%] of participants within the first week after diagnosis. Whereas there was no ongoing oropharyngeal SARS-CoV-2 RNA shedding in subjects at 4 months, 12.7% [8.5%–18.4%] of participants continued to shed SARS-CoV-2 RNA in the feces at 4 months after diagnosis and 3.8% [2.0%–7.3%] shed at 7 months. Finally, we found that GI symptoms (abdominal pain, nausea, vomiting) are associated with fecal shedding of SARS-CoV-2 RNA.

Conclusions

The extended presence of viral RNA in feces, but not in respiratory samples, along with the association of fecal viral RNA shedding with GI symptoms suggest that SARS-CoV-2 infects the GI tract and that this infection can be prolonged in a subset of individuals with COVID-19.

Funding

This research was supported by a Stanford ChemH-IMA grant; fellowships from the AACR and NSF; and NIH R01-AI148623, R01-AI143757, and UL1TR003142.

Keywords

COVID-19
SARS-CoV-2
fecal RNA
gastrointestinal infection
viral shedding

CAT scale

Translation to patients

Data and code availability

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    All data supporting the findings of this study have been deposited at Zenodo (https://zenodo.org/record/6374138) and are publicly available as of the date of publication.

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    All custom code and mathematical models have been deposited at Zenodo (https://zenodo.org/record/6374138) and are publicly available as of the date of publication.

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    Any additional information required to reanalyze the data reported in this paper is available from the lead contact upon request.

Cited by (0)

9

These authors contributed equally

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Lead contact

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