Diarrhea in Medical Care Workers With Severe Acute Respiratory Syndrome

Abstract

Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.

Severe Acute Respiratory Syndrome (SARS)

“…This was attributed to nosocomial respiratory spread. 48 Preventing spread of SARS-CoV is made difficult by: (1) the potential spread by fomites, and conversion from droplet to airborne transmission 49 ; (2) an incubation period averaging 6.4 days (usually 2-10 days; Hong Kong and Toronto 4.7 days, 50 but it may be as long as 16 days); (3) 3 to 5 days between disease onset and hospitalization; (4) the absence of specific symptoms; (5) often presenting as atypical (communityacquired) pneumonia 51 ; (6) the lack of a reliable diagnostic test for early disease, putting HCWs at particular risk; (7) atypical presentations including diarrhea and bloody diarrhea without respiratory symptoms; and (8) early diagnosis depending solely on exposure to SARS or travel through epidemic or endemic areas. 3,5,[52][53][54][55] This makes SARS-CoV an ideal agent for terrorists.…”

“…70 Table 1 enumerates clinical presentations. 3,4,7,32,48,51,52,[71][72][73][74][75] Table 2 describes the laboratory findings. 4,51,74,76,77 Watery diarrhea is part of the initial presentation in approximately 20% of patients.…”

“…In the outbreak at Amoy Gardens, Hong Kong, 73% of patients developed diarrhea with positive RT-PCR for SARS-CoV in 97% of their stool samples. 48,71 Cumulatively, 38.4% of patients develop a self-limited watery diarrhea (mean: 3.7 AE 2.7 days' duration) some time during their illness. 32,71 In HCWs who were believed to have acquired SARS by the respiratory route, 18.8% to 19.6% developed diarrhea.…”

“…In 1 study, none of the HCWs had positive rectal swabs for SARS-CoV (by RT-PCR). 48 Some contacts of SARS patients have been asymptomatically infected. 78 The most frequent symptom is fever higher than 38 C for more than 24 hours.…”

“…65,73 Hospital-acquired SARS less frequently presents with diarrhea (18.8%) 73 Data from Refs. 3,4,7,32,48,51,52,[71][72][73][74][75] Severe Acute Respiratory Syndrome…”