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Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis.
Cheung, Ka Shing; Hung, Ivan F N; Chan, Pierre P Y; Lung, K C; Tso, Eugene; Liu, Raymond; Ng, Y Y; Chu, Man Y; Chung, Tom W H; Tam, Anthony Raymond; Yip, Cyril C Y; Leung, Kit-Hang; Fung, Agnes Yim-Fong; Zhang, Ricky R; Lin, Yansheng; Cheng, Ho Ming; Zhang, Anna J X; To, Kelvin K W; Chan, Kwok-H; Yuen, Kwok-Y; Leung, Wai K.
  • Cheung KS; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
  • Hung IFN; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
  • Chan PPY; Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong.
  • Lung KC; Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
  • Tso E; Department of Medicine, United Christian Hospital, Hong Kong.
  • Liu R; Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong.
  • Ng YY; Department of Medicine, Tuen Mun Hospital, Hong Kong.
  • Chu MY; Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
  • Chung TWH; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Tam AR; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Yip CCY; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Leung KH; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Fung AY; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
  • Zhang RR; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
  • Lin Y; Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
  • Cheng HM; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Zhang AJX; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
  • To KKW; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Chan KH; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
  • Yuen KY; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
  • Leung WK; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address: waikleung@hku.hk.
Gastroenterology ; 159(1): 81-95, 2020 07.
Article in English | MEDLINE | ID: covidwho-40729
ABSTRACT
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 log10 copies per milliliter in patients with diarrhea vs 3.9 log10 copies per milliliter in patients without diarrhea (P = .06). In a meta-analysis of 60 studies comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6% (95% confidence interval [CI], 12.3-24.5); 11.8% of patients with nonsevere COVID-19 had gastrointestinal symptoms (95% CI, 4.1-29.1), and 17.1% of patients with severe COVID-19 had gastrointestinal symptoms (95% CI, 6.9-36.7). In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1% (95% CI, 38.3-57.9); of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus (95% CI, 49.6-85.1).

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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Viral Load / Diarrhea / Feces / Pandemics / Betacoronavirus Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Country/Region as subject: Asia Language: English Journal: Gastroenterology Year: 2020 Document Type: Article Affiliation country: J.gastro.2020.03.065

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Viral Load / Diarrhea / Feces / Pandemics / Betacoronavirus Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Country/Region as subject: Asia Language: English Journal: Gastroenterology Year: 2020 Document Type: Article Affiliation country: J.gastro.2020.03.065