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Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection

2022; Elsevier BV; Volume: 3; Issue: 6 Linguagem: Inglês

10.1016/j.medj.2022.04.001

2666-6359

Aravind Natarajan, Soumaya Zlitni, Erin F. Brooks, Summer E. Vance, Alex Dahlen, Haley Hedlin, Ryan Park, Alvin Han, Danica T. Schmidtke, Renu Verma, Karen B. Jacobson, Julie Parsonnet, Hector Bonilla, Upinder Singh, Benjamin A. Pinsky, Jason R. Andrews, Prasanna Jagannathan, Ami S. Bhatt,

Long-Term Effects of COVID-19

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. 2–4 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.