key: cord-1026296-x83zptw3
authors: Wu, Yongjian; Guo, Cheng; Tang, Lantian; Hong, Zhongsi; Zhou, Jianhui; Dong, Xin; Yin, Huan; Xiao, Qiang; Tang, Yanping; Qu, Xiujuan; Kuang, Liangjian; Fang, Xiaomin; Mishra, Nischay; Lu, Jiahai; Shan, Hong; Jiang, Guanmin; Huang, Xi
title: Prolonged presence of SARS-CoV-2 viral RNA in faecal samples
date: 2020-03-20
journal: Lancet Gastroenterol Hepatol
DOI: 10.1016/s2468-1253(20)30083-2
sha: bfa847bf27adf07a07f6f380bcd0dd239ed8c90f
doc_id: 1026296
cord_uid: x83zptw3

nan

In the study, respiratory and fecal specimens were collected every 1-2 days depending on its availability until two sequential negative results were shown. Patients (41 out of 74, 55.4%) were defined as fecal sample positive because the SARS-CoV-2 viral RNA was detected by real-time PCR for at least one time. The diagnosis of real-time RT-PCR were performed in both our hospital and the local CDC. The majority of Real-time RT-PCR results shown in this study were performed in our hospital, while respiratory tract samples of suspected cases were required to be further tested in local CDC for official confirmation. The real-time RT-PCR was only performed to feces specimens after Feb 2 nd in our hospital, so we don't know the status of SARS-CoV-2 viral RNA in patient before Feb 2 nd for most patients.

In the Fifth Affiliated Hospital of Sun Yat-Sen University, extraction of nucleic acids from the respiratory and fecal samples was performed with the commercialized nucleic acid extraction kits (QIAamp Viral RNA Mini Kit, Catalog #: 52904, QIAGEN). The Real-time RT-PCR performed in The Fifth Affiliated Hospital of Sun Yat-Sen University was using the Novel Coronavirus (2019-nCoV) Real Time RT-PCR kit from LifeRiver Ltd. (Catalog #: RR-0479-02). Nucleocapsid gene (N), membrane gene (E) and RNA dependent RNA polymerase gene (RdRp) were the three targeted genes simultaneously amplified and tested. Detailed protocol is described at the website (1). The diagnosis of COVID-19 pneumonia performed in local CDC was based on the New Coronavirus Pneumonia Prevention and Control Program (6th edition) published by the National Health Commission of China (2). All reagents and protocols used are CFDA approved.

The numerical values in this study are presented as mean (±SD) for continuous variables, and the proportion of categorical variables are presented in number (n/N, %). Statistical analyses including Chi-square test, two-way Wilcox test and correlation analysis were performed using Prism 6.1 (GraphPad Software).

Tables: Table S1 . Clinical characteristics of patients with SARS-CoV-2 infection in this study. The patients positive for viral RNA (n=41) were further divided into two groups: "FS(+) ≥14 group" (patient1 -patient19) in which patient's feces was positive for viral RNA ≥14 days after respiratory swabs tested negative for viral RNA, and"FS(+) <14 group"(patient20 -patient41) in which patient's feces was positive for viral RNA <14 days after respiratory swabs tested negative for viral RNA. 14 days cutoff time was used to create two subgroups because 14 days is the recommended time for selfquarantine at home after being discharged from the hospital according to the New Coronavirus Pneumonia Prevention and Control Program (6th edition) by the National Health Commission of China.

The numeric values (e.g., Age) in the table presents Discussion: In many patients with feces positive for viral RNA, ACE2 receptors were found in higher abundance in gastrointestinal system when compared to patients with feces negative for viral RNA. ACE2 receptors are prerequisite for SARS-CoV-2 infection and potential viral shedding 1 . Our data suggest that patients no positivity for fecal viral RNA may be attributed to relative low expression of ACE2 in their intestinal tract, which needs to be experimental validated. Gut microbiome can also play an important role in regulating the viral transmission in the intestinal tract while its composition is individual dependent 2 . The hyphen sign in the cell indicates the information is not applicable.

XH had roles in the study design, clinical management, patient recruitment, data collection, data analysis, data interpretation, literature search, and writing of the manuscript. ZH, JZ, XD and HY had roles in the experiments, data collection, data analysis, and data interpretation. QX, YT, XQ, LK, XF, NM, and JL had roles in recruitment, data collection, and clinical management