Background & Aims

Although coronavirus disease 2019 (COVID-19) is characterized by fever and respiratory symptoms, some patients have no or mild symptoms. Severe acute respiratory syndrome-coronavirus (SARS-CoV-2) has been detected in feces of patients. We investigated gastrointestinal symptoms and shedding of virus into feces of patients with asymptomatic or mild COVID-19.

Methods

We collected data from 46 patients (median age, 26 y; 46% men) with asymptomatic or mild COVID-19 (without fever and pneumonia) and prolonged respiratory shedding of SARS-CoV-2, quarantined from April 4, 2020, through April 24, 2020, in Korea. Respiratory specimens included upper respiratory specimens (nasopharyngeal and oropharyngeal swabs) and lower respiratory specimens (sputum), and were collected twice per week. The median interval between COVID-19 diagnosis to the start of fecal sample collection was 37 days (range, 29–41 d); 213 stool specimens were collected from 46 patients. We used real-time reverse-transcription polymerase chain reaction to detect SARS-CoV-2 in the respiratory and fecal specimens.

Results

Gastrointestinal manifestations were observed in 16 of the 46 patients (35%); diarrhea was the most common (15%), followed by abdominal pain (11%), dyspepsia (11%), and nausea (2%). Virus RNA was detected in feces from 2 patients without gastrointestinal symptoms (4%). Mean cycle threshold values from the time of quarantine to the time of fecal collection tended to be lower in patients with virus detected in fecal samples than in patients without virus in fecal samples (29.91 vs 33.67 in the first week, 29.47 vs 35.71 in the fifth week, respectively). Shedding of virus into feces persisted until day 50 after diagnosis; fecal samples began to test negative before or at approximately the time that respiratory specimens also began to test negative.

Conclusions

In an analysis of fecal and respiratory specimens from patients with COVID-19 in quarantine in Korea, we found that the gastrointestinal tract could be a route of transmission of SARS-CoV-2 even in patients with asymptomatic or mild disease, with no gastrointestinal symptoms. The viral load of the respiratory specimens appears be related to shedding of the virus into feces in this group of patients.

中文翻译：

---

在韩国无症状和轻度 COVID-19 患者的粪便样本中检测到 SARS-CoV-2

背景与目标

尽管 2019 年冠状病毒病 (COVID-19) 的特征是发烧和呼吸道症状，但一些患者没有症状或症状轻微。在患者的粪便中检测到严重急性呼吸系统综合症冠状病毒 (SARS-CoV-2)。我们调查了无症状或轻度 COVID-19 患者的胃肠道症状和病毒在粪便中的脱落情况。

方法

我们从 2020 年 4 月 4 日至 4 月隔离的 46 名无症状或轻度 COVID-19（无发热和肺炎）患者（中位年龄，26 岁；46% 男性）和长期呼吸道感染 SARS-CoV-2 的患者中收集了数据2020 年 2 月 24 日，在韩国。呼吸道标本包括上呼吸道标本（鼻咽和口咽拭子）和下呼吸道标本（痰），每周采集两次。从 COVID-19 诊断到开始收集粪便样本之间的中位间隔为 37 天（范围，29-41 天）；收集了 46 名患者的 213 份粪便标本。我们使用实时逆转录聚合酶链反应检测呼吸道和粪便样本中的 SARS-CoV-2。

结果

46 名患者中有 16 名 (35%) 观察到胃肠道表现；腹泻是最常见的（15%），其次是腹痛（11%）、消化不良（11%）和恶心（2%）。在 2 名没有胃肠道症状的患者 (4%) 的粪便中检测到病毒 RNA。粪便样本中检测到病毒的患者从隔离时间到粪便收集时间的平均周期阈值往往低于粪便样本中未检测到病毒的患者（第一周为 29.91 对 33.67，第五周为 29.47 对 35.71）周，分别）。病毒排入粪便中一直持续到诊断后第 50 天；粪便样本在呼吸道标本也开始检测为阴性之前或大约在此时开始检测为阴性。

结论

在对韩国隔离的 COVID-19 患者的粪便和呼吸道标本进行分析时，我们发现胃肠道可能是 SARS-CoV-2 的传播途径，即使是无症状或轻度疾病的患者，也没有胃肠道症状. 在这组患者中，呼吸道标本的病毒载量似乎与病毒进入粪便有关。