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Article: Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis

TitleGastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis
Authors
KeywordsFecal-to-Oral Transmission
PRISMA
SARS
Viral Persistence
Issue Date2020
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcgastroenterol/
Citation
BMC Gastroenterology, 2020, v. 159, p. 81-95 How to Cite?
AbstractBackground & 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.
Persistent Identifierhttp://hdl.handle.net/10722/284574
ISSN
2018 Impact Factor: 2.252
2015 SCImago Journal Rankings: 0.999
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, KS-
dc.contributor.authorHung, IFN-
dc.contributor.authorChan, PPY-
dc.contributor.authorLung, KC-
dc.contributor.authorTso, E-
dc.contributor.authorLiu, R-
dc.contributor.authorNg, YY-
dc.contributor.authorChu, MY-
dc.contributor.authorChung, TWH-
dc.contributor.authorTam, AR-
dc.contributor.authorYip, CCY-
dc.contributor.authorLeung, KH-
dc.contributor.authorFung, AYF-
dc.contributor.authorZhang, RR-
dc.contributor.authorLin, Y-
dc.contributor.authorCheng, HM-
dc.contributor.authorZhang, AJX-
dc.contributor.authorTo, KKW-
dc.contributor.authorChan, KH-
dc.contributor.authorYuen, KY-
dc.contributor.authorLeung, WK-
dc.date.accessioned2020-08-07T08:59:34Z-
dc.date.available2020-08-07T08:59:34Z-
dc.date.issued2020-
dc.identifier.citationBMC Gastroenterology, 2020, v. 159, p. 81-95-
dc.identifier.issn1471-230X-
dc.identifier.urihttp://hdl.handle.net/10722/284574-
dc.description.abstractBackground & 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.-
dc.languageeng-
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcgastroenterol/-
dc.relation.ispartofBMC Gastroenterology-
dc.rightsBMC Gastroenterology. Copyright © BioMed Central Ltd.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectFecal-to-Oral Transmission-
dc.subjectPRISMA-
dc.subjectSARS-
dc.subjectViral Persistence-
dc.titleGastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis-
dc.typeArticle-
dc.identifier.emailCheung, KS: cks634@hku.hk-
dc.identifier.emailHung, IFN: ivanhung@hkucc.hku.hk-
dc.identifier.emailCheng, HM: hmcheng@hku.hk-
dc.identifier.emailTo, KKW: kelvinto@hku.hk-
dc.identifier.emailYuen, KY: kyyuen@hkucc.hku.hk-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.authorityCheung, KS=rp02532-
dc.identifier.authorityHung, IFN=rp00508-
dc.identifier.authorityTo, KKW=rp01384-
dc.identifier.authorityYuen, KY=rp00366-
dc.identifier.authorityLeung, WK=rp01479-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1053/j.gastro.2020.03.065-
dc.identifier.pmid32251668-
dc.identifier.pmcidPMC7194936-
dc.identifier.scopuseid_2-s2.0-85088263503-
dc.identifier.hkuros312201-
dc.identifier.volume159-
dc.identifier.spage81-
dc.identifier.epage95-
dc.publisher.placeUnited Kingdom-

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