The clinical features of COVID-19 patients with positive viral RNA stool test results and possibility of fecal-oral transmission : A Systematic Review

Selina Natalia, Felicia Imanuella Thorion, Luky Adlino, Clifford Eltin John, A. Kurniawan, N. Lugito
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Abstract

Objective : Coronavirus disease 2019 (COVID-19) has been declared as an international public health emergency by the World Health Organization (WHO), with outbreaks in over 200 countries and causing over 390,000 deaths globally. ACE-2 receptors are highly expressed in the upper and lower gastrointestinal system, providing a prerequisite for SARS-CoV-2 infection in the gastrointestinal tract. In addition, over half of the COVID-19 patients have viral nucleic acid detected in their feces and almost one-quarter of the cases, the stool samples test positive even when respiratory samples are negative. The aim of this systematic review is to summarize literature and to evaluate the clinical characteristics of patients with positive viral RNA stool test for COVID-19 and if there is a possibility of fecal-oral transmission of SARS-CoV-2 virus. Method : This systematic review has been registered in PROSPERO ( CRD42020183049 ). A systematic search of the literature for observational study and randomized control trial was conducted in PubMed central and Google Scholar through May 5 th , 2020. Three reviewers independently searched and selected. The risk of bias was evaluated using Newcastle-Ottawa Quality assessment tool. Results : 340 articles were screened, then from which eight articles were selected. Of eight articles that were included in this study, we sought for three main categories of the clinical manifestation; gastrointestinal, respiratory, and others. Each study was reviewed systematically to gain demographic data and evidence regarding the possibility of fecal oral transmission in SARS-CoV-2. Two studies reported prolongation of positive stool test results after the respiratory specimen conversion to negative which support the theory of fecal oral transmission. Conclusion : In conclusion, diarrhea, cough, and fever are the most common clinical manifestations in COVID-19 patients with positive RNA stool test results. Fecal oral transmission may be possible due to the ACE-2 receptors in the lining of the gastrointestinal tract. RNA stool test should be used as addition in discharging COVID-19 patients.
病毒核糖核酸粪便检测结果呈阳性的新冠肺炎患者的临床特征和粪口传播的可能性:系统综述
目的:2019冠状病毒病(COVID-19)已被世界卫生组织(世卫组织)宣布为国际突发公共卫生事件,疫情在200多个国家暴发,全球死亡人数超过39万人。ACE-2受体在上消化道和下消化道高表达,为SARS-CoV-2在胃肠道感染提供了先决条件。此外,超过一半的COVID-19患者在其粪便中检测到病毒核酸,近四分之一的病例即使呼吸道样本呈阴性,粪便样本也呈阳性。本系统综述的目的是总结文献,评价COVID-19病毒RNA粪便检测阳性患者的临床特征以及是否存在粪口传播SARS-CoV-2病毒的可能性。方法:本系统评价已在PROSPERO注册(CRD42020183049)。2020年5月5日,在PubMed central和谷歌Scholar上系统检索观察性研究和随机对照试验的文献。三位审稿人独立搜索和选择。偏倚风险采用Newcastle-Ottawa质量评估工具进行评估。结果:共筛选文献340篇,从中筛选出8篇。在本研究纳入的八篇文章中,我们寻求临床表现的三个主要类别;胃肠道,呼吸道和其他。对每项研究进行了系统审查,以获得关于SARS-CoV-2粪便-口腔传播可能性的人口统计数据和证据。两项研究报告了在呼吸道标本转为阴性后大便试验阳性结果延长,这支持了粪口传播理论。结论:总之,腹泻、咳嗽、发热是RNA粪便检测阳性的COVID-19患者最常见的临床表现。由于胃肠道内壁的ACE-2受体,粪口传播可能是可能的。在新冠肺炎患者出院时,应将RNA粪便检测作为补充。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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