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The presence of live SARS-CoV-2 viruses in the fecal specimens and the positive results for SARS-CoV-2 RNA in gastrointestinal samples after respiratory specimens had become negative indicate that there may be a risk of transmission of the disease not only through the respiratory tract but also through the fecal-oral route. The study aim is to determine the time period that the SARS-CoV-2 virus remains in the fecal specimens of discharged COVID-19 patients to reveal the time interval in which the risk of transmission continues.

Livestock industry efficiency strongly depends on the livability of young animals, mainly during the early postnatal period. Infectious gastroenteritis of newborns manifested as diarrhea occupies the leading place among the diseases of young animals and brings the production and economic losses. The cause of numerous gastrointestinal disorders are physiological, hygienic, infectious and other factors. This pathology is reported in 50–80% of newborn calves, while 15–55% of diseased animals die. The investigations of the etiology of numerous diarrhea cases revealed rota-, corona-, parvo-, enteroviruses and bovine viral diarrhea virus in fecal samples from calves. Inactivated vaccines have been developed in the Russian Federation to prevent viral diarrhea in cattle. Despite their high antigenicity and field effectiveness, numerous cases of diarrhea in newborn calves have been reported in a number of large livestock farms. In fecal samples collected from diseased individuals, noroviruses along with the above-mentioned viruses were detected by electron microscopy. The noroviruses were detected in fecal samples from humans, cattle, pigs, sheep, dogs, cats, mice, as well as in pork and milk samples. The norovirus genome is prone to mutations, resulting in antigenic shifts and recombination, as well as the emergence and rapid spread of new epidemic and epizootic variants. Epidemiological features of norovirus infection include: prolonged shedding of the virus by the diseased animals and carriers, various transmission routes (fecal-oral, contact) and high contagiousness. In late 20th and early 21st century a large number of dairy and meat cattle were imported to the Russian Federation from various countries, including norovirus-infected countries. All this suggests the need to take noroviruses and other viruses (neboviruses, toroviruses, astroviruses, kobuviruses) into account when investigating the etiology of numerous diarrhea cases in newborn calves and necessitates the development of norovirus diagnostic tools and methods, as well as control measures.

Hand hygiene is a crucial tool to limit the transmission of common respiratory and gastrointestinal infections. While hand sanitizers were ubiquitous early in the COVID-19 pandemic, the number of food establishments that have adequately maintained them remains unknown. Through systematic observations in 89 New York City food establishments, we found that hand sanitizer dispensers were present in only 40% of the stores, and only 23% had functional ones. This scarcity highlights the necessity of providing ongoing support to small business owners nationwide to promote and maintain primary prevention measures at all times, extending beyond periods of public health crises. [ABSTRACT FROM AUTHOR]

Aim: To identify regional epidemiological features of infectious diseases spread by fecal-oral transmission and the factors influencing them in four regions of Vietnam.Materials and methods: Retrospective epidemiological analysis of data of 10 infectious diseases spread by fecal-oral transmission in Vietnam for the period 2017-2022. Maps of incidence by province was created using the QGIS 3.28 program. Correlation coefficients between the incidence of the studied diseases and socio-economic factors were established.Results: It was revealed that the incidence of the 10 studied diseases was 443.1±113.5 0 /0000 and tends to decrease. The highest incidence was recorded in Tay Nguyen. Cases of diarrheal syndrome (330.1±73.8 0 /0000) and enteroviral vesicular stomatitis (HMFD) (93.6±33.4 0 /0000) accounted for 95.65% of all registered cases. Diarrhea is distributed mainly among children under 4 years of age (1090.3±384.8 0 /0000) and 5-9 years old (60.9±18.5 0 /0000). Regional epidemiological features of diarrhea and HMFD are shown. The highest incidence of the HMFD was recorded among children under 4 years of age in Dong Thap (4635.8 0 /0000) and Ho Chi Minh City (4210.5 0 /0000), and the highest incidence of diarrheal syndrome was in Kon Tum (2621.2 0 /0000), Thai Binh (2556.6 0 /0000) and Dien Bien (1461.9 0 /0000). Relationships were established between the incidence of diarrhea and levels of access to safe water (rSpearman = – 0.393; p = 0.001), to the sanitation system (rSpearman = – 0.267; p = 0.035), average monthly income (rSpearman = – 0.424; p = 0.001), poverty levels (rSpearman = 0.403; p = 0.001).Conclusion: The high incidence of infectious diseases spread by fecal-oral transmission in Vietnam is due to the high incidence of diarrhea and HMFD. A high incidence of diarrhea is typical for provinces with low levels of access to safe water and sanitation systems, high levels of poverty and low average monthly income. Incidence of HMFD is high among children under 4 years old, especially in the southern provinces with high population density in the summer and autumn seasons.

Background: Streptococcus gallolyticus subsp. pasteurianus (SGSP) is a commensal in the intestinal tract and a potential pathogen of neonatal sepsis. During an 11-month period, four consecutive cases of SGSP sepsis were identified in one postnatal care unit (unit A) without evidence of vertical transmission. Therefore, we initiated this study to investigate the reservoir and mode of transmission of SGSP. Method: We performed cultures of stool samples from healthcare workers in unit A and unit B (another unit without SGSP sepsis). If SGSP was positive in feces, we performed isolate pulsotyping and genotyping by using pulsed-field gel electrophoresis (PFGE) and analyzing random amplified polymorphic DNA (RAPD) patterns, respectively. Results: Five staff members in unit A showed positivity for SGSP. All samples from unit B were negative. We identified two major pulsogroups (groups C and D) by PFGE. In group D, the strains isolated from 3 consecutive sepsis patients (P1, P2 and P3) were closely related and clustered together as those from 2 staff members (C1/C2, C6). One staff (staff 4) had a direct contact history with patient (P1) confirmed to have the same clone. The last isolate of the patient in our study (P4) belonged to a distinct clone. Conclusion: We found prolonged gut colonization of SGSP in healthcare workers and its epidemiological relatedness to neonatal sepsis. Fecal-oral or contact transmission is a possible route of SGSP infection. Fecal shedding among staff may be associated with neonatal sepsis in healthcare facilities.

Background For people with human immunodeficiency virus (PWH) who have no serological responses to their primary hepatitis A virus (HAV) vaccination or have seroreversion after successful primary vaccination, the optimal revaccination strategy remains unclear. Methods In this open-label, randomized clinical trial, PWH who tested negative for anti-HAV antibodies after receiving a standard 2-dose series of primary HAV vaccination were enrolled and assigned in a 1:1 ratio to receive either 1 dose (the 1-dose group) or 2 doses of HAV vaccine administered 4 weeks apart (the 2-dose group). Serological response rates and anti-HAV antibody titers were compared at weeks 24 and 48. Results Of the 153 participants (77 in the 1-dose group and 76 in the 2-dose group), the overall serological response rates at week 48 after revaccination were similar between the 2 groups (2- vs 1-dose, 80.2% vs 71.4%, P =.20). However, anti-HAV antibody titers were consistently higher in the 2-dose group than in the 1-dose group. In subgroup analysis, PWH who were nonresponders to primary HAV vaccination were significantly more likely to mount a serological response after 2-dose HAV revaccination (68.4% vs 44.1%, P =.038). No severe adverse events were reported throughout the study. Conclusions Two-dose HAV revaccination administered 4 weeks apart yielded similar serological responses as 1-dose revaccination among PWH who were nonresponders or had seroreversion after primary HAV vaccination. The 2-dose revaccination schedule generated significantly higher anti-HAV antibody titers and was more likely to elicit serological responses at week 48 among PWH who were nonresponders to primary HAV vaccination. Clinical Trials Registration. NCT03855176. [ABSTRACT FROM AUTHOR]

At the end of 2019 the mankind had to face a new coronavirus infection with higher virulence which resulted in its rapid spread all over the world and in an ultimate pandemic. Initially a new virus which causes COVID-19 was called 2019-nCoV but it soon acquired its well-known name, SARS-CoV-2. We can positively state that this new coronavirus infection will remain in the history of world public healthcare as a disease that caused a collapse in rendering medical aid. Undoubtedly, this new coro-navirus infection has changed customary lifestyle of the overall world population. This review can be considered problematic in its essence and focuses on examining contemporary trends in the official epidemiologic situation in the world regarding the new coronavirus infection (SARS-CoV-2). Having analyzed several foreign and domestic documents, the authors revealed a necessity to enhance levels and quality of COVID-19 epidemiologic diagnostics. There is a suggestion being considered at the moment on including additional clinical and diagnostic activities aimed at preventing further spread of the new coronavirus infection. We should note that data on COVID-19-related mortality and morbidity are renewed every day and every hour. Given that, it seems rather difficult to keep in line with the latest trends in COVID-19 prevention and epidemiologic diagnostics. However, the authors made an attempt to possibly collect all the latest data on epidemiological peculiarities related to the clinical course of the new coronavirus infection. The authors have a hope that this review will be useful for epidemiologists when they detect new cases of the disease as well as for lecturers at medical higher educational establishments when they train students and resident physicians.

Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has recently become the number one problem affecting global health. Coronavirus disease 2019 is principally recognized by its respiratory manifestations; however, recent studies have shown an increasing number of patients with gastrointestinal complaints like diarrhea, nausea, vomiting, and abdominal discomfort. Severe acute respiratory syndrome coronavirus 2 infects the gastrointestinal tract via the angiotensin-converting enzyme II receptor, expressed on the ileum and colon enterocytes. Usually, gastrointestinal symptoms manifest later than respiratory symptoms. Concern for fecal-oral transmission has been raised following the detection of severe acute respiratory syndrome coronavirus 2 RNA in fecal samples for prolonged periods, even after respiratory clearance. In this review, we summarize the effects of severe acute respiratory syndrome coronavirus 2 on the gastrointestinal system. [ABSTRACT FROM AUTHOR]

Abstract Background Gastrointestinal symptoms are common in COVID-19 patients and SARS-CoV-2 RNA has been detected in the patients’ feces, which could lead to fecal–oral transmission. Therefore, fecal sample testing with real-time RT-PCR is highly recommended as a routine test for SARS-CoV-2 infection. However, varying rates of detection in fecal sample have been reported. The aim of this study was to provide insights into the detection rates of SARS-CoV-2 in COVID-19 patients’ fecal sample by using four real-time RT-PCR kits and two pretreatment methods (inactive and non-inactive). Results The detection rate of Trizol pretreatment group was slightly higher than that of Phosphate Buffered Saline (PBS) groups, showing that pretreatment and inactivation by Trizol had no influence to SARS-CoV-2 nucleic acid test (NAT) results. 39.29% detection rate in fecal sample by DAAN was obtained, while Bio-germ was 40.48%, Sansure 34.52%, and GeneoDx 33.33%. The former three kits had no significant difference. The DAAN kit detection rates of ORF1ab and N gene were nearly equal and Ct value distribution was more scattered, while the Bio-germ kit distribution was more clustered. The positive rate of SARS-COV-2 in fecal samples correlated with the severity of the disease, specifically, severe cases were less likely to be identified than asymptomatic infection in the DAAN group (adjusted OR 0.05, 95%CI = 0.00 ~ 0.91). Conclusions Trizol should be of choice as a valid and safe method for pretreatment of fecal samples of SARS-CoV-2. All real-time RT-PCR kits assessed in this study can be used for routine detection of SARS-CoV-2 in fecal samples. While DAAN, with high NAT positive rate, could be the best out of the 4 kits used in this study. SARS-CoV-2 positive rate in fecal sample was related to the severity of illness.

Abstract Background SARS-CoV-2 has been detected not only in respiratory secretions, but also in stool collections. Here were sought to identify SARS-CoV-2 by enrichment next-generation sequencing (NGS) from fecal samples, and to utilize whole genome analysis to characterize SARS-CoV-2 mutational variations in COVID-19 patients. Results Study participants underwent testing for SARS-CoV-2 from fecal samples by whole genome enrichment NGS (n = 14), and RT-PCR nasopharyngeal swab analysis (n = 12). The concordance of SARS-CoV-2 detection by enrichment NGS from stools with RT-PCR nasopharyngeal analysis was 100%. Unique variants were identified in four patients, with a total of 33 different mutations among those in which SARS-CoV-2 was detected by whole genome enrichment NGS. Conclusion These results highlight the potential viability of SARS-CoV-2 in feces, its ongoing mutational accumulation, and its possible role in fecal–oral transmission. This study also elucidates the advantages of SARS-CoV-2 enrichment NGS, which may be a key methodology to document complete viral eradication. Trial registration ClinicalTrials.gov, NCT04359836, Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359836?term=NCT04359836&draw=2&rank=1 ).

Background: SARS-CoV-2 is highly contagious and poses a great threat to epidemic control and prevention. The possibility of fecal-oral transmission has attracted increasing concern. However, viral shedding in feces has not been completely investigated. Methods: This study retrospectively reviewed 97 confirmed coronavirus disease 2019 (COVID-19) patients hospitalized at the First Affiliated Hospital, School of Medicine, Zhejiang University, from January 19 to February 17, 2020. SARS-CoV-2 RNA in samples of sputum, nasopharyngeal or throat swabs, bronchoalveolar lavage and feces was detected by real-time reverse transcription polymerase chain reaction (RT–PCR). Clinical characteristics and parameters were compared between groups to determine whether fecal RNA was positive. Results: Thirty-four (35.1%) of the patients showed detectable SARS-CoV-2 RNA in feces, and 63 (64.9%) had negative detection results. The median time of viral shedding in feces was approximately 25 days, with the maximum time reaching 33 days. Prolonged fecal-shedding patients showed longer hospital stays. Those patients for whom fecal viral positivity persisted longer than 3 weeks also had lower plasma B-cell counts than those patients in the non-prolonged group [70.5 (47.3-121.5) per μL vs. 186.5 (129.3-376.0) per μL, P = 0.023]. Correlation analysis found that the duration of fecal shedding was positively related to the duration of respiratory viral shedding (R = 0.70, P < 0.001) and negatively related to peripheral B-cell counts (R = -0.44, P < 0.05). Conclusions: COVID-19 patients who shed SARS-CoV-2 RNA in feces presented similar clinical characteristics and outcomes as those who did not shed SARS-CoV-2 RNA in feces. The prolonged presence of SARS-CoV-2 nucleic acids in feces was highly correlated with the prolonged shedding of SARS-CoV-2 RNA in the respiratory tract and with lower plasma B-cell counts. [ABSTRACT FROM AUTHOR]

Resumen: Antecedentes: Existe un incremento de reportes sobre casos de COVID-19 que presentan síntomas gastrointestinales (GI). Objetivo: Revisión de estudios que reportaron síntomas GI en COVID-19. Resultados: Quince artículos (2,800 pacientes) fueron identificados. La frecuencia de síntomas GI varió del 3.0 al 39.6%, incluyendo diarrea: 7.5%, náuseas: 4.5%, anorexia: 4.4%, vómitos: 1.3%, dolor abdominal: 0.5%, eructos/reflujo: 0.3%. Estos pueden ser la primera manifestación de COVID-19, pero existe controversia sobre si reflejan mejor o peor pronóstico. Se discute la relación potencial del receptor de la enzima conversora de angiotensina ii en el tracto digestivo como ruta de entrada del virus. Conclusión: Los síntomas GI pueden ser comunes en COVID-19 y en algunos casos ser la primera manifestación incluso antes de fiebre y síntomas respiratorios. Por ello, los clínicos y gastroenterólogos debemos estar alertas a estos casos atípicos durante la actual pandemia y sobre la probable transmisión fecal-oral, y considerar medidas preventivas. Abstract: Background: There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19. Aim: To review the studies reporting gastrointestinal symptoms in COVID-19. Results: Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed. Conclusion: Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.

Coronavirus disease 2019 (COVID-19) emerged in Hubei Province, China in December 2019 and has since become a global pandemic, with hundreds of thousands of cases and over 165 countries affected. Primary routes of transmission of the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are through respiratory droplets and close person-to-person contact. While information about other potential modes of transmission are relatively sparse, evidence supporting the possibility of a fecally mediated mode of transmission has been accumulating. Here, current knowledge on the potential for fecal transmission is briefly reviewed and the possible implications are discussed from a public health perspective.

BackgroundSARS-CoV-2 is highly contagious and poses a great threat to epidemic control and prevention. The possibility of fecal-oral transmission has attracted increasing concern. However, viral shedding in feces has not been completely investigated.MethodsThis study retrospectively reviewed 97 confirmed coronavirus disease 2019 (COVID-19) patients hospitalized at the First Affiliated Hospital, School of Medicine, Zhejiang University, from January 19 to February 17, 2020. SARS-CoV-2 RNA in samples of sputum, nasopharyngeal or throat swabs, bronchoalveolar lavage and feces was detected by real-time reverse transcription polymerase chain reaction (RT–PCR). Clinical characteristics and parameters were compared between groups to determine whether fecal RNA was positive.ResultsThirty-four (35.1%) of the patients showed detectable SARS-CoV-2 RNA in feces, and 63 (64.9%) had negative detection results. The median time of viral shedding in feces was approximately 25 days, with the maximum time reaching 33 days. Prolonged fecal-shedding patients showed longer hospital stays. Those patients for whom fecal viral positivity persisted longer than 3 weeks also had lower plasma B-cell counts than those patients in the non-prolonged group [70.5 (47.3-121.5) per μL vs. 186.5 (129.3-376.0) per μL, P = 0.023]. Correlation analysis found that the duration of fecal shedding was positively related to the duration of respiratory viral shedding (R = 0.70, P < 0.001) and negatively related to peripheral B-cell counts (R = -0.44, P < 0.05).ConclusionsCOVID-19 patients who shed SARS-CoV-2 RNA in feces presented similar clinical characteristics and outcomes as those who did not shed SARS-CoV-2 RNA in feces. The prolonged presence of SARS-CoV-2 nucleic acids in feces was highly correlated with the prolonged shedding of SARS-CoV-2 RNA in the respiratory tract and with lower plasma B-cell counts.

The outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in 2019 threatens global public health. In the early stage, respiratory symptoms are the most common in patients with new coronal pneumonia, but with the spread of the disease around the world, gastrointestinal symptoms such as diarrhea, nausea and vomiting have attracted more and more attention. And some patients take diarrhea as the first symptom, which is easy to cause missed diagnosis. This paper expounds the close relationship between COVID-19 and gastrointestinal tract, and reviews the research progress of COVID-19's effect on gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Abstract Introduction The transmission pathways of coronavirus disease 2019 (COVID‐19) remain not completely clear. In this case study the test for the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in pharyngeal swab and anal swab were compared. Case presentation A 3‐month‐old girl was admitted to our hospital with COVID‐19. Her parents had both been diagnosed with COVID‐19. The results of pharyngeal swab and anal swab of the little girl were recorded and compared during the course of the disease. The oropharyngeal specimen showed negative result for SARS‐CoV‐2 on the 14th day after onset of the illness. However, the anal swab was still positive for SARS‐CoV‐2 on the 28th day after the onset of the illness. Conclusion The possibility of fecal‐oral transmission of COVID‐19 should be assessed. Personal hygiene during home quarantine merits considerable attention.

We report the case of a 43-year-old man who was infected with SARS-CoV-2 in February 2020 and actively cooperated with treatment in the hospital. During the course of treatment, we found that the respiratory SARS-CoV-2 nucleic acid became negative, but remained positive in the intestinal tract. As a result, we adjusted the treatment plan to include traditional Chinese medicine enema treatment. The patient had negative intestinal SARS-CoV-2 nucleic acid test within 4 days, and the subsequent repeated review of intestinal SARS-CoV-2 nucleic acid was negative, and the virus was undetectable. It is suggested that traditional Chinese medicine enema treatment may be helpful to remove the SARS-CoV-2 in the intestines of patients with COVID-19 infection, and may support the treatment of patients with respiratory SARS-CoV-2 nucleic acid negative and positive in the intestinal tract.

Cholera, a devastating diarrheal disease that caused several global pandemics in the last centuries, may share some similarities with the new COVID‐19. Cholera has affected many populations in history and still remains a significant burden in developing countries. The main transmission route was thought to be predominantly through contaminated drinking water. However, revisiting the historical data collected during the Copenhagen 1853 cholera outbreak allowed us to re‐evaluate the role of drinking‐water transmission in a city‐wide outbreak and reconsider some critical transmission routes, which have been neglected since the time of John Snow. Recent empirical and cohort data from Bangladesh also strengthened the dynamic potentiality of other transmission routes (food, fomite, fish, flies) for transmitting cholera. Analyzing this particular nature of the cholera disease transmission, this paper will describe how the pattern of transmission routes are similar to COVID‐19 and how the method of revisiting old data can be used for further exploration of new and known diseases. [ABSTRACT FROM AUTHOR]

A 16-month-old boy was admitted with cough for 2 days and fever for 1 day. Chest computed tomography (CT) scan of the child revealed large areas of ground-glass opacities in both lungs. Nucleic acid amplification tests (NAATs) were performed repeatedly to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the results were all negative. On day 13 of hospitalization, no clinical symptoms except diarrhea were present in the patient, and re-examination by chest CT revealed lesion shrinkage, but the NAAT on throat swabs was positive. On day 22 of hospitalization, the NAAT on throat swabs was negative and the fecal samples were positive. Positive fecal samples nucleic acid lasted for 62 days. Suggesting that pediatric patients may be important sources of infection during the recovery phase of clinical symptoms and whether SARS-CoV-2 has fecal-oral transmission needs further study. [ABSTRACT FROM AUTHOR]

Background and Aim: A worldwide outbreak of coronavirus disease 2019 (COVID‐19) has drawn global attention. Several reports have described the gastrointestinal (GI) manifestations in the infected patients. The systematic review was designed to highlight the gaps in our knowledge about the prevalence and clinical significance of GI symptoms in patients with COVID‐19. Methods: We searched PubMed database and Google articles published in both English and Chinese up to June 3, 2020, using search terms "clinical features," "2019 novel coronavirus," "2019‐nCoV," "COVID‐19," or "SARS‐Cov‐2." Observational studies, case reports, or letters describing the clinical features or observational studies regarding the detection and/or isolation of severe acute respiratory syndrome coronavirus 2 viruses in stools were included. Results: A total of 22 publications were finally selected. It was reported that GI symptoms occurred in about 3–40.7% of patients. GI manifestations included nausea, diarrhea, anorexia, vomiting, abdominal pain, belching, abdominal distension, and GI hemorrhage. Diarrhea was the most common GI symptom. Infected patients had various degrees of liver dysfunction, and the severity of liver dysfunction was significantly associated with the severity of the disease. Therapy focusing on digestive system like liver supportive therapy or nutrition support or probiotics has been demonstrated to be effective interventions, which greatly improve prognosis. Fecal–oral transmission route is a potential risk for transmission. Conclusions: GI symptoms are common in COVID‐19. Strengthening the recognition on abnormalities in digestive system of patients with COVID‐19 is crucial for early identification and timely treatment, especially for those atypical patients. Hygiene protection and keeping the drainpipe free flowing are necessary for everyone. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has been declared as an international public health emergency by the World Health Organization (WHO). 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. 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 from PubMed central and Google Scholar through May 5th, 2020. Observational and clinical trial were included. Systematic reviews and case reports were excluded. 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. Diarrhea, nausea, abdominal pain, gastrointestinal bleeding reported as the common symptoms and signs of gastrointestinal involvements. Prolongation of positive stool test results after the respiratory specimen conversion to negative was reported, which support the theory of fecal oral transmission. A positive stool test can be found on COVID-19 patients with any symptoms. 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 ACE2 receptors in the lining of the gastrointestinal tract. RNA stool test should be used as addition in discharging COVID-19 patients. [ABSTRACT FROM AUTHOR]

Purpose: The objective was to collect the data available regarding the presence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gastrointestinal system and to evaluate whether the digestive system could contribute to viral transmission. Methods: Bibliographic databases were searched to identify all studies documenting, in adult patients with a confirmed diagnosis of coronavirus disease 2019 (COVID-19): (1) the presence of SARS-CoV-2 ribonucleic acid in the feces; (2) the presence of SARS-CoV-2 ribonucleic acid in the intestinal cells; (3) live SARS-CoV-2 in the feces. Results: Twenty seven met the inclusion criteria. In 26 studies, the presence or absence of SARS-CoV-2 ribonucleic acid in the feces of COVID-19 patients had been reported. Out of the 671 patients, 312 (46.5%) had a positive stool sample for viral nucleic acid. Of these patients, 63.9% remained positive for viral nucleic acid in the feces after pharyngeal swabs became negative; Three studies also evaluated the viral ribonucleic acid in the gastrointestinal tissues and the presence of SARS-CoV-2 nucleic acid was found in samples of 3 patients out of 8 examined (37.5%). The presence of the live virus in stool samples was confirmed in two studies but no in in a recent study from Germany. These results suggested that SARS-CoV-2 could infect gastrointestinal epithelial cells and it may be transmitted through the digestive tract. Conclusion: In order to control the pandemic, every effort should be made to understand all the possible routes of transmission of the infections, even the less important ones. [ABSTRACT FROM AUTHOR]

COVID-19 is a pandemic infectious disease. Whether SARS-CoV-2 was transmitted through breast milk is unknown. Here, we report a breastfeeding woman with COVID-19 presenting with gastrointestinal symptoms and persistent SARS-CoV-2 RNA positivity in both her oropharyngeal swabs and feces, but negativity in her breastmilk. After appearance of serum SARS-CoV-2-IgG, she began to bottle feed her baby with breastmilk without transmission. This report facilitates the understanding of breastfeeding-related risks in COVID-19.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The infection started as an outbreak of pneumonia-like symptoms in Wuhan, China. Within a few weeks, it spread across the entire globe resulting in millions of cases and thousands of deaths. While respiratory symptoms and complications are well-defined and can be severe, non-respiratory symptoms of COVID-19 are increasingly being recognized. Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and abdominal pain have been added to the list of common COVID-19 symptoms. Their prevalence has been increasing, probably due to increased recognition and experience with the pandemic. Furthermore, diarrhea and stool testing may change prevalence and transmission rates due to suspicion for fecal-oral transmission of the COVID-19. Due to this risk, various countries have started testing wastewater and sewage systems to examine its role in the spread of SARS-CoV-2 among communities. In this review article, we describe the common gastrointestinal manifestations in COVID-19, their prevalence based upon the current literature, and highlight the importance of early recognition and prompt attention. We also note the role of fecal-oral transmission. Furthermore, the mechanisms of these symptoms, the role of medications, and potential contributing factors are also elaborated.

Background: Gastrointestinal symptoms are common in COVID-19 patients and SARS-CoV-2 RNA has been detected in the patients' feces, which could lead to fecal–oral transmission. Therefore, fecal sample testing with real-time RT-PCR is highly recommended as a routine test for SARS-CoV-2 infection. However, varying rates of detection in fecal sample have been reported. The aim of this study was to provide insights into the detection rates of SARS-CoV-2 in COVID-19 patients' fecal sample by using four real-time RT-PCR kits and two pretreatment methods (inactive and non-inactive). Results: The detection rate of Trizol pretreatment group was slightly higher than that of Phosphate Buffered Saline (PBS) groups, showing that pretreatment and inactivation by Trizol had no influence to SARS-CoV-2 nucleic acid test (NAT) results. 39.29% detection rate in fecal sample by DAAN was obtained, while Bio-germ was 40.48%, Sansure 34.52%, and GeneoDx 33.33%. The former three kits had no significant difference. The DAAN kit detection rates of ORF1ab and N gene were nearly equal and Ct value distribution was more scattered, while the Bio-germ kit distribution was more clustered. The positive rate of SARS-COV-2 in fecal samples correlated with the severity of the disease, specifically, severe cases were less likely to be identified than asymptomatic infection in the DAAN group (adjusted OR 0.05, 95%CI = 0.00 ~ 0.91). Conclusions: Trizol should be of choice as a valid and safe method for pretreatment of fecal samples of SARS-CoV-2. All real-time RT-PCR kits assessed in this study can be used for routine detection of SARS-CoV-2 in fecal samples. While DAAN, with high NAT positive rate, could be the best out of the 4 kits used in this study. SARS-CoV-2 positive rate in fecal sample was related to the severity of illness. [ABSTRACT FROM AUTHOR]

Background: SARS-CoV-2 has been detected not only in respiratory secretions, but also in stool collections. Here were sought to identify SARS-CoV-2 by enrichment next-generation sequencing (NGS) from fecal samples, and to utilize whole genome analysis to characterize SARS-CoV-2 mutational variations in COVID-19 patients. Results: Study participants underwent testing for SARS-CoV-2 from fecal samples by whole genome enrichment NGS (n = 14), and RT-PCR nasopharyngeal swab analysis (n = 12). The concordance of SARS-CoV-2 detection by enrichment NGS from stools with RT-PCR nasopharyngeal analysis was 100%. Unique variants were identified in four patients, with a total of 33 different mutations among those in which SARS-CoV-2 was detected by whole genome enrichment NGS. Conclusion: These results highlight the potential viability of SARS-CoV-2 in feces, its ongoing mutational accumulation, and its possible role in fecal–oral transmission. This study also elucidates the advantages of SARS-CoV-2 enrichment NGS, which may be a key methodology to document complete viral eradication. Trial registration ClinicalTrials.gov, NCT04359836, Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359836?term=NCT04359836&draw=2&rank=1). [ABSTRACT FROM AUTHOR]

The new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease 2019. Some authors reported pieces of evidence that patients with SARS-CoV-2 infection could have direct involvement of the gastrointestinal tract, and in symptomatic cases, gastrointestinal symptoms (diarrhea, nausea/vomiting, abdominal pain) could be very common. In this article, we reviewed current-published data of the gastrointestinal aspects involved in SARS-CoV-2 infection, including prevalence and incidence of specific symptoms, the presumptive biological mechanism of GI infection, prognosis, clinical management, and public health-related concerns on the possible risk of oral-fecal transmission. Different clues point to direct virus infection and replication in mucosal cells of the gastrointestinal tract. In vitro studies showed that SARS-CoV-2 could enter into the gastrointestinal epithelial cells by the Angiotensin-Converting enzyme two membrane receptor. These findings, coupled with the identification of viral RNA found in stools of patients, clearly suggest that direct involvement of the gastrointestinal tract is very likely. This can justify most of the gastrointestinal symptoms but also suggest a risk for an oral-fecal route for transmission, additionally or alternatively to the main respiratory route. [ABSTRACT FROM AUTHOR]

Diarrhea was not uncommon in patients with coronavirus disease 2019 (COVID-19), but the significance remains undetermined. This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who were admitted to Wuhan Union Hospital from January 20 to February 29, 2020. Clinical characteristics, the course and the outcome of patients with diarrhea were analyzed. The correlation between diarrhea and fecal presence of coronavirus was also determined. The overall morbidity of diarrhea was 27.8% (157/564) in COVID-19 patients. Among them, 38 cases presented only with diarrhea, and 119 cases in both diarrhea and respiratory symptoms. Patients with diarrhea and respiratory symptoms had higher levels of inflammatory activity, longer hospital stay (27.5 vs. 23.0 vs. 22.0 days, p =.029) and higher odds ratio of mortality (3.2 times and 2.2 times, respectively) than those with diarrhea only or respiratory symptoms only. However, patients with diarrhea had longer time from onset to admission (14.5 days vs. 11.0 days, p =.04), higher positive viral RNA in stool (80.0% vs. 52.4%, p =.016) than those with both diarrhea and respiratory symptoms. Diarrhea caused by high enteric viral burden may lead to long course and poor outcome in COVID-19 patients. The patients with diarrhea and respiratory symptoms were prone to serious condition, and had worse outcomes. However, the patients with diarrhea alone showed mild illness but delayed health-seeking. [ABSTRACT FROM AUTHOR]

In December 2019, coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), emerged in Wuhan, China, and has spread globally. However, the transmission route of SARS‐CoV‐2 has not been fully understood. In this study, we aimed to investigate SARS‐CoV‐2 shedding in the excreta of COVID‐19 patients. Electronical medical records, including demographics, clinical characteristics, laboratory and radiological findings of enrolled patients were extracted and analyzed. Pharyngeal swab, stool, and urine specimens were collected and tested for SARS‐CoV‐2 RNA by real‐time reverse transcription polymerase chain reaction. Viral shedding at multiple time points in specimens was recorded, and its correlation analyzed with clinical manifestations and the severity of illness. A total of 42 laboratory‐confirmed patients were enrolled, 8 (19.05%) of whom had gastrointestinal symptoms. A total of 28 (66.67%) patients tested positive for SARS‐CoV‐2 RNA in stool specimens, and this was not associated with the presence of gastrointestinal symptoms and the severity of illness. Among them, 18 (64.29%) patients remained positive for viral RNA in the feces after the pharyngeal swabs turned negative. The duration of viral shedding from the feces after negative conversion in pharyngeal swabs was 7 (6‐10) days, regardless of COVID‐19 severity. The demographics, clinical characteristics, laboratory and radiologic findings did not differ between patients who tested positive and negative for SARS‐CoV‐2 RNA in the feces. Viral RNA was not detectable in urine specimens from 10 patients. Our results demonstrated the presence of SARS‐CoV‐2 RNA in the feces of COVID‐19 patients and suggested the possibility of SARS‐CoV‐2 transmission via the fecal‐oral route. Research Highlights: Two thirds of COVID‐19 patients tested positive for SARS‐CoV‐2 RNA in stool specimens.The presence of SARS‐CoV‐2 RNA in the feces of COVID‐19 patients was not associated with gastrointestinal symptoms and the severity of illness.More than 60% patients remained positive for viral RNA in feces after pharyngeal swabs turned negative.The duration of viral shedding from feces after negative conversion in pharyngeal swabs was 7 (6‐10) days, regardless of COVID‐19 severity.Fecal‐oral route may serve as an alternative transmission route for SARS‐CoV‐2. [ABSTRACT FROM AUTHOR]

Coronaviruses are found in all mammalian and avian species. Due to its mild infection on upper respiratory tract, this virus was not considered as a serious human pathogen until the outbreaks of SARS-CoV and MERS-CoV in 2002 and 2012, respectively. Recently the third and the biggest outbreak of coronavirus "COVID-19" or "SARS-CoV-2" has erupted and the world is now in a struggle to combat this disease. Although everything has not yet been fully clarified about this new type of virus, the data obtained from the studies conducted so far provides guidance on how to deal with SARS-CoV-2. In this context, this review provides information about pathogenesis, clinical symptoms, presence in animals, potential transmission routes of SARS-CoV-2 as well as the detection methods used in the world and Turkey. [ABSTRACT FROM AUTHOR]

Background Beginning from 2015–2016, unprecedented large outbreaks of acute hepatitis A that predominantly affected men who have sex with men (MSM) reemerged across the continents. We assessed the impact of an early initiated hepatitis A virus (HAV) vaccination campaign that targeted MSM living with human immunodeficiency virus (HIV) during the 2015–2017 hepatitis A outbreak in Taiwan. Methods First, we ascertained the effectiveness of HAV vaccination for MSM living with HIV using a nested case-control study of 1470 persons living with HIV who were initially HAV-seronegative. We then fitted a model of HAV transmission among MSM, risk-structured by HIV status, to the actual epidemic curve of reported acute hepatitis A cases in Taiwan during 2015–2017. Results Fifty-five cases of acute hepatitis A were matched to 220 controls. Single-dose and 2-dose HAV vaccination provided protection rates of 96.1% and 97.8% among recipient MSM living with HIV, respectively. Model fitting yielded basic reproductive number estimates of 7.26 (MSM living with HIV) and 3.04 (MSM not living with HIV). In a counterfactual scenario without an HAV vaccination campaign, the outbreak would have involved 7153 hepatitis A cases during 2015–2017 in contrast to the 1352 that were observed. We therefore estimated that the HAV vaccination campaign averted 80.7% (sensitivity analysis, 48.8%–92.7%) of acute hepatitis A cases that would otherwise have occurred by the end of 2017. Conclusions The early initiated HAV vaccination campaign, which targeted MSM living with HIV, very effectively curtailed the 2015–2017 hepatitis A outbreak in Taiwan. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 can be excreted in feces and can reach sewage systems. Determining the presence of infective viral particles in feces and sewage is necessary to take adequate control measures and to elucidate new routes of transmission. Here, we have developed a sample concentration methodology that allows us to maintain viral infectivity. Feces of COVID-19 patients and wastewater samples have been analyzed both by molecular methods and cell culture. Our results show no evidence of infective viral particles, suggesting that fecal–oral transmission is not a primary route. However, larger-scale efforts are needed, especially with the emergence of new viral variants. [ABSTRACT FROM AUTHOR]

The World's Heath Organization (WHO) declared the new coronavirus infection COVID-19 a pandemic in March 11 2020. The first data about the disease clinical features were reported from Wuhan China the epicenter of the outbreak; aside from the respiratory involvement, gastrointestinal manifestations have been described. Even though the exact mechanism for the new coronavirus tropism for the gastrointestinal tract is not well understood, angiotensin converting enzyme 2 receptor seems to play an important role as the entry site for the virus, since it is widespread located throughout the enteric mucosa. Fecal oral transmission is a possible contagion route, regardless of the presence of gastrointestinal symptoms, the virus has been isolated from feces even 7-12 days after a negative pharyngeal swab. COVID's-19 gastrointestinal involvement is not an infrequent event, data reports patients who present with these symptoms have worst prognosis. Knowing the possible gastrointestinal manifestations might rise our clinical suspicion in order to establish earlier and timely diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: The transmission pathways of coronavirus disease 2019 (COVID‐19) remain not completely clear. In this case study the test for the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in pharyngeal swab and anal swab were compared. Case presentation: A 3‐month‐old girl was admitted to our hospital with COVID‐19. Her parents had both been diagnosed with COVID‐19. The results of pharyngeal swab and anal swab of the little girl were recorded and compared during the course of the disease. The oropharyngeal specimen showed negative result for SARS‐CoV‐2 on the 14th day after onset of the illness. However, the anal swab was still positive for SARS‐CoV‐2 on the 28th day after the onset of the illness. Conclusion: The possibility of fecal‐oral transmission of COVID‐19 should be assessed. Personal hygiene during home quarantine merits considerable attention. [ABSTRACT FROM AUTHOR]

Background This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between human immunodeficiency virus (HIV)–infected patients and HIV-uninfected counterparts during the AHA outbreak. Methods Clinical and laboratory data were collected from the medical records of the patients with AHA at the 14 hospitals around Taiwan between May 2015 and May 2017. Results A total of 297 adult patients with AHA were included during the study period. Their mean age was 31.4 years (range, 19.0–76.1 years); 93.4% were men and 58.6% were men who have sex with men. Of 265 patients with known HIV serostatus, 166 (62.6%) were HIV infected. Compared with HIV-uninfected patients, HIV-infected patients had a lower peak alanine aminotransferase (ALT) level (median, 1312 vs 2014 IU/L, P =.003), less coagulopathy (6.0% vs 16.2%, P =.007), and less hepatomegaly or splenomegaly on imaging studies, but a higher rate of delayed resolution of hepatitis (38.8% vs 21.3%, P =.009). HIV-infected patients with plasma RNA load <1000 copies/mL while receiving combination antiretroviral therapy (cART) had a higher peak ALT level (median, 1420 vs 978 IU/L, P =.006) and less delay in resolution of hepatitis (30.6% vs 48.8%, P =.047) than patients without cART or with plasma RNA load ≥1000 copies/mL. Conclusions During an AHA outbreak, HIV-infected patients had a lower severity, but delayed resolution, of AHA than HIV-uninfected patients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infected patients. [ABSTRACT FROM AUTHOR]

Abstract Host spacing may benefit the parasites (e.g., enhance parasite transmission) or the hosts (e.g., reduce host infection), with profound consequences in epidemiology and host–parasite dynamics. In this study, we tested parasitism effects of intestinal nematodes on spacing behaviors and spatial recruitment of the Taiwan field mouse (Apodemus semotus). We tracked the locations of resident mice for 84% of the host population, with half of them experimentally reduced of their parasitic infection. We interpolated geo‐tagged data on parasite egg counts of the resident mice to create an infection risk landscape and extracted the risks to the locations of newly recruited mice. We performed parentage analysis to identify mother–offspring pairs, which allowed us to test whether in situ recruits moved toward lower‐risk areas during natal dispersal. We found that the less‐infected mice became spatially aggregated compared to the more heavily infected, and the juvenile recruits occurred preferentially in lower‐risk areas compared to the landscape, the residents, and their natal places. The spatial aggregation of less‐infected resident mice and the association of juvenile recruits with lower‐risk areas could hinder parasite transmission. This study provided some empirical support for a potential link between host recruitment process and parasitism risks.

Based on recent, historical, and circumstantial evidence, we present a multifactorial hypothesis that has potential direct implications on the epidemiology and management of chlamydial infection and disease in humans. We propose that (1) like its veterinary relatives, the oculogenital pathogen Chlamydia trachomatis evolved as a commensal organism of the human gastrointestinal (GI) tract primarily transmissible via the fecal-oral route; (2) in the modern era, C. trachomatis causes "opportunistic" infection at non-GI sites under conditions driven by improved sanitation/hygiene and reduced fecal-oral transmission; and (3) the rise in the practice of oral sex is contributing to the increased prevalence of C. trachomatis in the human GI tract. Infectious organisms produced in the GI tract and reaching the rectum may then chronically contaminate and infect the female urogenital tract, thereby potentially contributing to the most serious sequelae of chlamydial infection in women: pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. [ABSTRACT FROM AUTHOR]

Host spacing may benefit the parasites (e.g., enhance parasite transmission) or the hosts (e.g., reduce host infection), with profound consequences in epidemiology and host-parasite dynamics. In this study, we tested parasitism effects of intestinal nematodes on spacing behaviors and spatial recruitment of the Taiwan field mouse (Apodemus semotus). We tracked the locations of resident mice for 84% of the host population, with half of them experimentally reduced of their parasitic infection. We interpolated geo-tagged data on parasite egg counts of the resident mice to create an infection risk landscape and extracted the risks to the locations of newly recruited mice. We performed parentage analysis to identify mother-offspring pairs, which allowed us to test whether in situ recruits moved toward lower-risk areas during natal dispersal. We found that the less-infected mice became spatially aggregated compared to the more heavily infected, and the juvenile recruits occurred preferentially in lower-risk areas compared to the landscape, the residents, and their natal places. The spatial aggregation of less-infected resident mice and the association of juvenile recruits with lower-risk areas could hinder parasite transmission. This study provided some empirical support for a potential link between host recruitment process and parasitism risks. [ABSTRACT FROM AUTHOR]