Coronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission, Italy, February 2020

Nicastri, Emanuele; D’Abramo, Alessandra; Faggioni, Giovanni; Santis, Riccardo De; Mariano, Andrea; Lepore, Luciana; Molinari, Filippo; Petralito, Giancarlo; Fillo, Silvia; Munzi, Diego; Corpolongo, Angela; Bordi, Licia; Carletti, Fabrizio; Castiletti, Concetta; Colavita, Francesca; Lalle, Eleonora; Bevilacqua, Nazario; Giancola, Maria Letizia; Scorzolini, Laura; Lanini, Simone; Palazzolo, Claudia; Domenico, Angelo De; Spinelli, Maria Anna; Scognamiglio, Paola; Piredda, Paolo; Iacomino, Raffaele; Mone, Andrea; Puro, Vincenzo; Petrosillo, Nicola; Battistini, Antonio; Vairo, Francesco; Lista, Florigio; Ippolito, Giuseppe

doi:10.2807/1560-7917.es.2020.25.11.2000230

Cited by 70 publications

(70 citation statements)

References 9 publications

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“…A total of 824 patients were included across the studies and 540 were tested for faecal viral RNA [7–32]. Positive faecal RT‐PCR tests occurred in 291 (53.9%).…”

Section: Resultsmentioning

confidence: 99%

Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

et al. 2020

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Aim In addition to respiratory symptoms, COVID‐19 can present with gastrointestinal complaints suggesting possible faeco‐oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS‐CoV‐2 in patients with COVID‐19. Methods A systematic literature review identified studies describing COVID‐19 patients tested for faecal virus. Search terms for MEDLINE included ‘clinical’, ‘faeces’, ‘gastrointestinal secretions’, ‘stool’, ‘COVID‐19’, ‘SARS‐CoV‐2’ and ‘2019‐nCoV’. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence‐Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco‐oral transmission of the virus. Results Twenty‐six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID‐19 is transmitted via faecally shed virus. Conclusion There is a high rate of positive polymerase chain reaction tests with persistence of SARS‐CoV‐2 in faecal samples of patients with COVID‐19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco‐oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.

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“…A total of 824 patients were included across the studies and 540 were tested for faecal viral RNA [7–32]. Positive faecal RT‐PCR tests occurred in 291 (53.9%).…”

Section: Resultsmentioning

confidence: 99%

Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

et al. 2020

View full text Add to dashboard Cite

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“…All studies had information regarding our primary aim of reporting faecal samples for the virus in those with COVID-19. Of these, 16 [7,10,11,[14][15][16][17][18][19]23,24,[26][27][28][29][30] provided information on the duration of these tests after symptom onset and evidence of positive faecal samples after symptom recovery, discharge from the hospital or negative nasopharyngeal RT-PCR. A total of 824 patients were included across the studies and 540 were tested for faecal viral RNA .…”

Section: Resultsmentioning

confidence: 99%

Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review

Gupta

Parker

Smits

et al. 2020

Preprint

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AimIn addition to respiratory symptoms, patients with COVID-19 can present with gastrointestinal complaints suggesting a possible faeco-oral transmission route. The primary aim of this review is to establish the incidence and timing of positive faecal samples for the SARS-CoV-2 virus in patients with COVID-19. Methods A systematic literature review was performed to identify studies describing COVID-19 patients tested for the virus in their stool. Data were extracted concerning the nature of the test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and any evidence of viable faecal virus or faeco-oral transmission of the virus. ResultsThere were 26 relevant articles identified. Combining these results demonstrated that 53·9% of those tested for faecal RNA in these studies were positive. Duration of faecal viral shedding ranged from 1 to 33 days after nasopharyngeal swab turned negative with one result remaining positive after 47 days of onset of symptoms. There was insufficient evidence to draw firm conclusions about the proportion of cases potentially transmitted through infection via faecally shed virus. ConclusionThere is a relatively high rate of positive tests and persistence of the SARS-CoV-2 virus in faecal samples of selected patients with COVID-19. Further research is needed to demonstrate how much these positive tests correlate with viable virus and transmission through the faeco-oral route. This may have important implications for duration of isolation, precautions recommended in individuals undertaking a period of isolation, protective equipment for health professionals and interventional procedures involving the gastrointestinal tract. What does this paper add to the existing literature?We synthesise all available evidence from multiple sources and clarify the uncertainty around faecal shedding of SARS-CoV-2 virus, its persistence and duration from onset of symptoms, and after negative nasopharyngeal swabs. Evidence for faeco-oral transmission is plausible and demonstrated in one study though its relative contribution to transmission remains unclear. Persistent viral shedding of SARS-CoV-2 in faeces -a rapid review

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“…case. Nicastri et al [12] reported a paucisymptomatic case with transient mild conjunctivitis and low fever with fluctuating PCR results. However, IgG response was detected when this case was isolated in the hospital along with a positive PCR result.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of commercial and automated SARS-CoV-2 IgG and IgA ELISAs using coronavirus disease (COVID-19) patient samples

et al. 2020

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Antibody-screening methods to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) need to be validated. We evaluated SARS-CoV-2 IgG and IgA ELISAs in conjunction with the EUROLabworkstation (Euroimmun, Lübeck, Germany). Overall specificities were 91.9% and 73.0% for IgG and IgA ELISAs, respectively. Of 39 coronavirus disease patients, 13 were IgG and IgA positive and 11 IgA alone at sampling. IgGs and IgAs were respectively detected at a median of 12 and 11 days after symptom onset.

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Coronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission, Italy, February 2020

Abstract: Rapid communicationCoronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission,

Cited by 70 publications

References 9 publications

Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review

Evaluation of commercial and automated SARS-CoV-2 IgG and IgA ELISAs using coronavirus disease (COVID-19) patient samples

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