key: cord-0788662-7odpslba
authors: Xiao, Fei; Tang, Meiwen; Zheng, Xiaobin; Li, Chunna; He, Jianzhong; Hong, Zhongsi; Huang, Siwen; Zhang, Zhenyi; Lin, Xianqi; Fang, Zhaoxiong; Lai, Renxu; Chen, Shoudeng; Liu, Jing; Huang, Jin; Xia, Jinyu; Li, Zhonghe; Jiang, Guanmin; Liu, Ye; Li, Xiaofeng; Shan, Hong
title: Evidence for gastrointestinal infection of SARS-CoV-2
date: 2020-02-20
journal: nan
DOI: 10.1101/2020.02.17.20023721
sha: fe685aa676e739bd52ba2585a7e5b27c55e2d0d6
doc_id: 788662
cord_uid: 7odpslba

The new coronavirus (SARS-CoV-2) outbreak originating from Wuhan, China, poses a threat to global health. While it's evident that the virus invades respiratory tract and transmits from human to human through airway, other viral tropisms and transmission routes remain unknown. We tested viral RNA in stool from 73 SARS-CoV-2-infected hospitalized patients using rRT-PCR. 53.42% of the patients tested positive in stool. 23.29% of the patients remained positive in feces even after the viral RNA decreased to undetectable level in respiratory tract. The viral RNA was also detected in gastrointestinal tissues. Furthermore, gastric, duodenal and rectal epithelia showed positive immunofluorescent staining of viral host receptor ACE2 and viral nucleocapsid protein in a case of SARS-CoV-2 infection. Our results provide evidence for gastrointestinal infection of SARS-CoV-2, highlighting its potential fecal-oral transmission route.

CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. According to a recent case report, SARS-CoV-2 RNA was detected in a stool CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (Table 1) . Duration time of positive stool ranges from 120 1 to 12 days till the date of writing the manuscript on February 14, 2020 (Table 1) . (Table 1) .

Gastrointestinal endoscopy was performed on the patient described in Supplementary   124 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Table 1 ).

The mucous epithelium of esophagus, stomach, duodenum and rectum showed no is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https://doi.org/10.1101/2020.02.17.20023721 doi: medRxiv preprint specific target cells or organs are determinants of viral transmission routes. 146 Receptor-dependent viral entry is the first step of SARS-CoV-2 infection. Our 147 immunofluorescent data showed that ACE2 protein, which has been proved to be the CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 

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A Novel Coronavirus Emerging in 199

China -Key Questions for Impact Assessment

Quantitative mRNA expression 201 profiling of ACE 2, a novel homologue of angiotensin converting enzyme

Early Transmission Dynamics in Wuhan, China, of 204 Novel Coronavirus-Infected Pneumonia

Hepatitis C virus cell-cell transmission and 206 resistance to direct-acting antiviral agents

CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not peer-reviewed) The copyright holder for this preprint

Coronavirus pathogenesis and the emerging pathogen 213 severe acute respiratory syndrome coronavirus

Interim Considerations for Disposition of Hospitalized Patients with 216 2019-nCoV Infection

Table 1. Clinical characteristics of patients with SARS-CoV-2 infection

R: respiratory specimens, S+: tested positive in stool during hospitalization, CT: computerized tomography, PPIs: proton pump inhibitors, ICU: Intensive care unit, NSAID= Non-steroidal anti-inflammatory drugs, ~R+S+: remained positive in both R and S till the date of writing the manuscript on February 14th, 2020, ~R-S+: tested negative in R but remained positive in stool till the date of writing the manuscript on February 14th, 2020.. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint . https://doi.org/10.1101/2020.02.17.20023721 doi: medRxiv preprint