Molecular identification and characterization of SARS-Co V-2 from the clinical stool and sewage samples to study waste water-based epidemiology and monitoring circulating virus

The Coronaviridae family's severe acute respiratory syndrome corona virus 2 (SARS-Co V-2) outbreak has infected a large number of the population during the COVID- 19 pandemic. The most prominent mode of virus transmission is considered through respiratory droplets of the infected person. Virus-mediated respiratory infection depends upon the binding between spike protein and the Angiotensinconverting enzyme 2 (ACE2) receptor expressed in lung alveolar type 2 cells. But some studies reported that gastrointestinal infection is also one of the prominent symptoms of COVID-19 because of the high expression of the ACE2 receptor in absorptive enterocytes of the small intestine. In a country like India, with high population density and due to unhygienic sanitation, it is crucial to understand the potential fecal-oral transmission route of SARS-CoV-2 during infection because of presence of ACE2 in small intestine. Therefore in our study, we aim to trace the potential fecal-oral transmission route of SARS-Co V-2 by examining human stool (collected from hospital settings) and nearby sewage water systems, followed by molecular characterization and viral load kinetics evaluation of SARSCOV- 2. qRT-PCR and NGS sequencing methods were used. The presence of SARS-COV-2 was reported in around 70% of samples (both clinical and environmental), this will help us to establish the epidemiological link between clinical and environmental samples after genomic analysis to alter the circulation of silent SARS Co V2 in the community.

Solar desalination/purification (solar stills, humidification-dehumidification, solar disinfection) in high altitude during COVID19: Insights of gastrointestinal manifestations and systems' mechanism.

From the starting of the pandemic different transmission routes of the pathogen was brought into the spotlight by researchers from different disciplines. This matter in high-altitudes was more boosted as the main parameters were not exactly realized. In this review we are about to highlight the possibility of consuming contaminated water generated form solar water desalination/disinfection systems in highlands. Three systems including solar still, solar disinfection (which experimented by the authors in 2019 in high altitude) and humidification-dehumidification were consider in this context. Ascribe to the risks of pathogens transmission in solar desalination/disinfection systems where the water resources are heavily polluted in every corner of the world, highlighting the risk of consuming water in high-altitude where there are many other parameters associated with spread of pathogen is of great importance. As it was reported, reliability of solar desalination and solar water disinfections systems against contaminated water by the novel coronavirus remained on the question because the virus can be transmitted by vapor in solar stills due to tiny particle size (60-140 nm) and would not be killed by solar disinfections due to low-temperature of operation <40 °C while for HDH contamination of both water and air by sars-cov-2 could be a concern. Although the SARS-CoV-2 is not a waterborne pathogen, its capability to replicate in stomach and infection of gastrointestinal glandular suggested the potential of transmission via fecal-oral. Eventually, it was concluded that using solar-based water treatment as drinking water in high altitude regions should be cautiously consider and recommendations and considerations are presented. Importantly, this critical review not only about the ongoing pandemic, but it aims is to highlight the importance of produced drinking water by systems for future epidemic/pandemic to prevent spread and entering a pathogen particularly in high-altitude regions via a new routes.

Assessment of Fecal Viral Shedding Among Children Who Have COVID-19 by Polymerase Chain Reaction

Objective: This study aimed to assess fecal viral shedding in children who have been confirmed COVID-19 by real time polymerase chain reaction (RT-PCR). Material(s) and Method(s): We enrolled fifty inpatient children who have been confirmed COVID-19 during first wave of outbreak in our region. All of the patients have been twice confirmed by RT-PCR within nasopharyngeal swabs. Each case was evaluated with clinical data, laboratory tests and rectal swabs. The rectal swabs were obtained five days after nasopharyngeal positivity. The clinical data was recorded within two basic categories, including common symptoms or digestive symptoms. Detection of SARS-CoV-2 in rectal swabs was performed by RT-PCR method. Result(s): Fifteen patients (30%) had digestive symptoms. On the 5th day, 50 rectal swabs were studied with PCR-RT. Only one of them was positive (2%). The only patient who was positive for SARS-CoV-2 on rectal swab was a symptomatic threeand-a-half-year-old girl. The patient, who became asymptomatic in the follow-up, was retested with a nasopharyngeal swab one week later, the result was negative and she was discharged on the 10th day. The second rectal smear of the patient was negative. Conclusion(s): We found very low rate (2%) fecal viral shedding with rectal swab PCR among children who have been confirmed COVID-19 by nasopharyngeal swab PCR. We thought that this result was due to the mild clinical course of the patients who has been diagnosed with COVID-19 we followed up. However, fecal oral transmission might still matter in children. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Persistence and occurrence of SARS-CoV-2 in water and wastewater environments: a review of the current literature.

As the world continues to cope with the COVID-19 pandemic, emerging evidence indicates that respiratory transmission may not the only pathway in which the virus can be spread. This review paper aims to summarize current knowledge surrounding possible fecal-oral transmission of SARS-CoV-2. It covers recent evidence of proliferation of SARS-CoV-2 in the gastrointestinal tract, as well as presence and persistence of SARS-CoV-2 in water, and suggested future directions. Research indicates that SARS-CoV-2 can actively replicate in the human gastrointestinal system and can subsequently be shed via feces. Several countries have reported SARS-CoV-2 RNA fractions in wastewater systems, and various factors such as temperature and presence of solids have been shown to affect the survival of the virus in water. The detection of RNA does not guarantee infectivity, as current methods such as RT-qPCR are not yet able to distinguish between infectious and non-infectious particles. More research is needed to determine survival time and potential infectivity, as well as to develop more accurate methods for detection and surveillance.

Gastrointestinal Manifestations in Covid-19:A Prospective Study

Introduction: Gastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. They can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. Aims & Methods: The current study reports major gastrointestinal manifestations as initial symptoms of COVID-19. This prospective, descriptive, cross-sectional, and single-center study of 713 cases was conducted in a field hospital over a 5-week period from June 21 to July 25, 2020. Result(s): The average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases. Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases. In multivariate analysis, following adjustment of the studied parameters, only the presence of gastroin- testinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286-1.698;p < 0.001) and treat- ment side effects (OR = 1.069, CI: 1.020-1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. Conclusion(s): Gastrointestinal manifestations are common during COVID- 19 and seem to be linked to a longer duration of disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal-oral transmission. Therefore, hygiene is extremely important, espe- cially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.

COVID-19 in the gut and liver

Coronavirus disease 2019 (COVID-19) is known to result in gastrointestinal symptoms and liver damage. Consideration needs to be given to COVID-19 as a potential cause of new-onset gastrointestinal symptoms. Awareness of special issues affecting patients with chronic gastrointestinal and liver diseases in a pandemic is important. © 2021 Medicine Today Pty Ltd. All rights reserved.

Study of the correlation between Covid-19 cases and deaths and basic sanitation in Brazil: Is this a possible secondary route of virus transmission?

People with COVID-19 may excrete viable SARS-CoV-2 virus through urine and faeces, which has raised concerns about the possibility of transmission of COVID-19 via water contaminated or sewage. These concerns are especially exacerbated in underdeveloped countries like Brazil, where untreated sewage is usually discharged to surface water or soil. Because of that, a hypothesis emerged that was addressed in this study, which seeks to understand whether access to basic sanitation services can influence the proliferation of the virus. A correlation study was carried out between the cases of COVID-19 and the indicators of basic sanitation from all regions of Brazil. The results showed that there was a correlation only with the water supply indicator. A hypothesis that would explain the presented correlation would be the inefficiency of the water treatment systems in Brazil, not totally inactivating the virus, or possible contamination of the water distribution networks by sanitary sewage. In general, the data presented reinforce the need to expand and monitor basic sanitation services, especially to ensure the effective and efficient disinfection of drinking water. This monitoring could be useful for early warning surveillance of the spread of the virus.

Control at the sewers to curb the COVID-19 pandemic in Indiais the negligence perilous?

COVID 19 PANDEMIC has stricken in multiple waves, crippling the nation with each strike. Attempts at curbing its spread has been focused on a few established modes of transmission. Current literature evidence suggests possibility of Feco-oral transmission, detection of viable virus in stools of covid infected individuals, viral shedding several weeks post recovery and potential persistence of viable virus in sewage. Guidelines and protocols laid down have not included this potentially dangerous mode of spread. Many countries including Australia, Finland etc have utilized waste water epidemiology as a tool in surveillance. This can be used as a warning signal for early detection and control. This review article proposes the addition of new guidelines in this spectre to aid in curbing the spread of pandemic as well as adopting sewage surveillance as a tool in primary prevention.

Characteristics of COVID-19 Patients With SARS-CoV-2 Positivity in Feces.

Background: SARS-CoV-2 is highly contagious and poses a great threat to epidemic control and prevention. The possibility of fecal-oral transmission has attracted increasing concern. However, viral shedding in feces has not been completely investigated. Methods: This study retrospectively reviewed 97 confirmed coronavirus disease 2019 (COVID-19) patients hospitalized at the First Affiliated Hospital, School of Medicine, Zhejiang University, from January 19 to February 17, 2020. SARS-CoV-2 RNA in samples of sputum, nasopharyngeal or throat swabs, bronchoalveolar lavage and feces was detected by real-time reverse transcription polymerase chain reaction (RT-PCR). Clinical characteristics and parameters were compared between groups to determine whether fecal RNA was positive. Results: Thirty-four (35.1%) of the patients showed detectable SARS-CoV-2 RNA in feces, and 63 (64.9%) had negative detection results. The median time of viral shedding in feces was approximately 25 days, with the maximum time reaching 33 days. Prolonged fecal-shedding patients showed longer hospital stays. Those patients for whom fecal viral positivity persisted longer than 3 weeks also had lower plasma B-cell counts than those patients in the non-prolonged group [70.5 (47.3-121.5) per µL vs. 186.5 (129.3-376.0) per µL, P = 0.023]. Correlation analysis found that the duration of fecal shedding was positively related to the duration of respiratory viral shedding (R = 0.70, P < 0.001) and negatively related to peripheral B-cell counts (R = -0.44, P < 0.05). Conclusions: COVID-19 patients who shed SARS-CoV-2 RNA in feces presented similar clinical characteristics and outcomes as those who did not shed SARS-CoV-2 RNA in feces. The prolonged presence of SARS-CoV-2 nucleic acids in feces was highly correlated with the prolonged shedding of SARS-CoV-2 RNA in the respiratory tract and with lower plasma B-cell counts.

COVID-19 Gastrointestinal Tract Affection: An Updated Review

Although it was initially believed that the coronavirus disease 2019 (COVID-19) only attacked the respiratory system, reports over time demonstrated that this disease could attack the gastrointestinal tract (GIT) as well. The predominant presenting symptoms in patients infected with COVID-19 were gastrointestinal (GI), resulting in GI pathological changes. While clinicians' concerns are mostly related to respiratory system manifestations, GI symptoms should be monitored and managed appropriately. This review summarizes the essential information about COVID-19 GIT infection in terms of pathogenesis, major pathological changes, microbiological bases of infection, the possibility of feco-oral transmission, the severity of associated symptoms, the major radiological findings, the impact on GI surgery, the role of therapeutic agents in induction or magnification of GI symptoms, and a pitfall on the nutritional supplementation in COVID-19 patients.

Gastrointestinal Manifestations in Patients Infected with SARS-CoV-2

Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has recently become the number one problem affecting global health. Coronavirus disease 2019 is principally recognized by its respiratory manifestations;however, recent studies have shown an increasing number of patients with gastrointestinal complaints like diarrhea, nausea, vomiting, and abdominal discomfort. Severe acute respiratory syndrome coronavirus 2 infects the gastrointestinal tract via the angiotensin-converting enzyme II receptor, expressed on the ileum and colon enterocytes. Usually, gastrointestinal symptoms manifest later than respiratory symptoms. Concern for fecal-oral transmission has been raised following the detection of severe acute respiratory syndrome coronavirus 2 RNA in fecal samples for prolonged periods, even after respiratory clearance. In this review, we summarize the effects of severe acute respiratory syndrome coronavirus 2 on the gastrointestinal system. [ FROM AUTHOR] Copyright of Iranian Journal of Medical Microbiology is the property of Iranian Society of Microbiology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

EPIDEMIOLOGIC ASPECTS IN PREVENTION OF THE NEW CORONAVIRUS INFECTION (COVID-19) (LITERATURE REVIEW)

At the end of 2019 the mankind had to face a new coronavirus infection with higher virulence which resulted in its rapid spread all over the world and in an ultimate pandemic. Initially a new virus which causes COVID-19 was called 2019-nCoV but it soon acquired its well-known name, SARS-CoV-2. We can positively state that this new coronavirus infection will remain in the history of world public healthcare as a disease that caused a collapse in rendering medical aid. Undoubtedly, this new coronavirus infection has changed customary lifestyle of the overall world population. This review can be considered problematic in its essence and focuses on examining contemporary trends in the official epidemiologic situation in the world regarding the new coronavirus infection (SARS-CoV-2). Having analyzed several foreign and domestic documents, the authors revealed a necessity to enhance levels and quality of COVID-19 epidemiologic diagnostics. There is a suggestion being considered at the moment on including additional clinical and diagnostic activities aimed at preventing further spread of the new coronavirus infection. We should note that data on COVID-19-related mortality and morbidity are renewed every day and every hour. Given that, it seems rather difficult to keep in line with the latest trends in COVID-19 prevention and epidemiologic diagnostics. However, the authors made an attempt to possibly collect all the latest data on epidemiological peculiarities related to the clinical course of the new coronavirus infection. The authors have a hope that this review will be useful for epidemiologists when they detect new cases of the disease as well as for lecturers at medical higher educational establishments when they train students and resident physicians. © Butaev T.M., Tsirikhova A.S., Kabaloeva D.V., Kudukhova D.O., 2022

Research progress of coronavirus disease 2019 in digestive system

The coronavirus disease 2019 (COVID‑19) is caused by the SARS‑CoV‑2 infection, and has become a public health event in the world. In addition to pneumonia, some COVID‑19 patients also show various gastrointestinal symptoms, and even take the gastrointestinal symptoms as the first symptom. Doctors should be alert to the spread of fecal oral transmission. Nutritional support and intestinal microecological balance play an important role in the treatment of COVID‑19. This paper summarizes the research progress of COVID‑19 in the digestive system by consulting relevant literatures, in order to provide a reference for the clinical diagnosis and treatment of the disease. © 2022, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Ogilvie Syndrome and COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) is an airborne infection transmitted via respiratory droplets and aerosolized material; however, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the same angiotensin-converting enzyme type 2 receptor present in the respiratory epithelial cells to bind surface epithelial cells in the gastrointestinal tract. Here we report a case of Ogilvie syndrome in a patient who tested positive for SARS-CoV-2 a month prior to hospital admission. Quick recognition of Ogilvie syndrome as a potential complication of COVID-19 infection, prompt treatment with conservative measures, and prevention of possible fecal-oral transmission of the virus are crucial steps.

A Child Infected with COVID-19 in China-A Case Report.

A 16-month-old boy was admitted with cough for 2 days and fever for 1 day. Chest computed tomography (CT) scan of the child revealed large areas of ground-glass opacities in both lungs. Nucleic acid amplification tests (NAATs) were performed repeatedly to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the results were all negative. On day 13 of hospitalization, no clinical symptoms except diarrhea were present in the patient, and re-examination by chest CT revealed lesion shrinkage, but the NAAT on throat swabs was positive. On day 22 of hospitalization, the NAAT on throat swabs was negative and the fecal samples were positive. Positive fecal samples nucleic acid lasted for 62 days. Suggesting that pediatric patients may be important sources of infection during the recovery phase of clinical symptoms and whether SARS-CoV-2 has fecal-oral transmission needs further study.

Traditional Chinese Medicine Enema Therapy in a Patient With a Confirmed Negative SARS-CoV-2 Test in the Respiratory Tract but Positive in the Intestinal Tract: A Case Report.

We report the case of a 43-year-old man who was infected with SARS-CoV-2 in February 2020 and actively cooperated with treatment in the hospital. During the course of treatment, we found that the respiratory SARS-CoV-2 nucleic acid became negative, but remained positive in the intestinal tract. As a result, we adjusted the treatment plan to include traditional Chinese medicine enema treatment. The patient had negative intestinal SARS-CoV-2 nucleic acid test within 4 days, and the subsequent repeated review of intestinal SARS-CoV-2 nucleic acid was negative, and the virus was undetectable. It is suggested that traditional Chinese medicine enema treatment may be helpful to remove the SARS-CoV-2 in the intestines of patients with COVID-19 infection, and may support the treatment of patients with respiratory SARS-CoV-2 nucleic acid negative and positive in the intestinal tract.

Lack of evidence for infectious SARS-CoV-2 in feces and sewage.

The SARS-CoV-2 can be excreted in feces and can reach sewage systems. Determining the presence of infective viral particles in feces and sewage is necessary to take adequate control measures and to elucidate new routes of transmission. Here, we have developed a sample concentration methodology that allows us to maintain viral infectivity. Feces of COVID-19 patients and wastewater samples have been analyzed both by molecular methods and cell culture. Our results show no evidence of infective viral particles, suggesting that fecal-oral transmission is not a primary route. However, larger-scale efforts are needed, especially with the emergence of new viral variants.

COVID-19 and the gastrointestinal tract: Source of infection or merely a target of the inflammatory process following SARS-CoV-2 infection?

Gastrointestinal (GI) symptoms have been described in a conspicuous percentage of coronavirus disease 2019 (COVID-19) patients. This clinical evidence is supported by the detection of viral RNA in stool, which also supports the hypothesis of a possible fecal-oral transmission route. The involvement of GI tract in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is corroborated by the theoretical assumption that angiotensin converting enzyme 2, which is a SARS-CoV-2 target receptor, is present along the GI tract. Studies have pointed out that gut dysbiosis may occur in COVID-19 patients, with a possible correlation with disease severity and with complications such as multisystem inflammatory syndrome in children. However, the question to be addressed is whether dysbiosis is a consequence or a contributing cause of SARS-CoV-2 infection. In such a scenario, pharmacological therapies aimed at decreasing GI permeability may be beneficial for COVID-19 patients. Considering the possibility of a fecal-oral transmission route, water and environmental sanitation play a crucial role for COVID-19 containment, especially in developing countries.

Prevalence, Mechanisms, and Implications of Gastrointestinal Symptoms in COVID-19.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The infection started as an outbreak of pneumonia-like symptoms in Wuhan, China. Within a few weeks, it spread across the entire globe resulting in millions of cases and thousands of deaths. While respiratory symptoms and complications are well-defined and can be severe, non-respiratory symptoms of COVID-19 are increasingly being recognized. Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and abdominal pain have been added to the list of common COVID-19 symptoms. Their prevalence has been increasing, probably due to increased recognition and experience with the pandemic. Furthermore, diarrhea and stool testing may change prevalence and transmission rates due to suspicion for fecal-oral transmission of the COVID-19. Due to this risk, various countries have started testing wastewater and sewage systems to examine its role in the spread of SARS-CoV-2 among communities. In this review article, we describe the common gastrointestinal manifestations in COVID-19, their prevalence based upon the current literature, and highlight the importance of early recognition and prompt attention. We also note the role of fecal-oral transmission. Furthermore, the mechanisms of these symptoms, the role of medications, and potential contributing factors are also elaborated.

Examining the persistence of human Coronavirus 229E on fresh produce.

Human coronaviruses (HCoVs) are mainly associated with respiratory infections. However, there is evidence that highly pathogenic HCoVs, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle East Respiratory Syndrome (MERS-CoV), infect the gastrointestinal (GI) tract and are shed in the fecal matter of the infected individuals. These observations have raised questions regarding the possibility of fecal-oral route as well as foodborne transmission of SARS-CoV-2 and MERS-CoV. Studies regarding the survival of HCoVs on inanimate surfaces demonstrate that these viruses can remain infectious for hours to days, however, there is limited data regarding the viral survival on fresh produce, which is usually consumed raw or with minimal heat processing. To address this knowledge gap, we examined the persistence of HCoV-229E, as a surrogate for highly pathogenic HCoVs, on the surface of commonly consumed fresh produce, including: apples, tomatoes, cucumbers and lettuce. Herein, we demonstrated that viral infectivity declines within a few hours post-inoculation (p.i) on apples and tomatoes, and no infectious virus was detected at 24h p.i, while the virus persists in infectious form for 72h p.i on cucumbers and lettuce. The stability of viral RNA was examined by droplet-digital RT-PCR (ddRT-PCR), and it was observed that there is no considerable reduction in viral RNA within 72h p.i.