Fecal–Oral Transmission of SARS-COV-2: Practical Implications

Abstract

In fact, it was shown that approximately 10% of gene escape occurs selectively in specific tissues. 7 These molecular aspects are of medical importance because they could explain sex differences in the natural course of human diseases, including COVID-19.A recent systematic survey of the landscape of human Xlinked genes inactivation using RNA sequencing-based approaches showed that ACE2 presents remarkable differences in male-female expression levels. 8 Tukiainen et al 8 suggested that tissue differences in X escape can directly translate into tissue-specific sex biases in gene expression. 8 Specifically, the study showed not only that ACE2 is among the 82 X-escaping genes, but also highlighted that there might be differences in the liver and lung ACE2 expression levels between males and females. 8 Paradoxically, escape of ACE2 from X inactivation resulted in low levels of expression in the liver, lung, and visceral adipose tissue of women. 8 Conversely, ACE2 expression levels in colon transverse and subcutaneous adipose tissue were significantly higher in females than males. 8 Collectively, these novel observations may have important clinical implications for patients with COVID-19. First, differences between men and women in liver ACE2 expression levels may help to explain potential clinical differences in the course of COVID-19 in patients with underlying chronic liver disease. Second, differences between men and women in ACE2 expression levels in gastrointestinal tissues due to escaping from X inactivation, including the colon, could result in different transmission patterns, including fecal-oral transmission. Third, sex-linked differential expression levels in adipose tissue and/or visceral fat might also shed light into potential differences in the odds of presenting severe complications and in-hospital death associated with comorbidities, including severe obesity.

Clinical Presentation, Treatment, and Mortality Rate in Liver Transplant Recipients With Coronavirus Disease 2019: A Systematic Review and Quantitative Analysis

“…Baseline immune suppression regimen was detailed in 52.0% (116/223) of recipients ( Table 2 ) and was subsequently augmented in 17.0% (38/223) of cases. Of these, there was either a reduction or cessation of antimetabolite in 76.3% (29/38) or calcineurin inhibitor in 52% (20/38) [ 9 , 10 , 14 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , 26 ]. A total of 93 of 141 (66%) patients were prescribed hydroxychloroquine, with 35 cases documenting patient survival outcome and no survival benefit trend observed.…”

Clinical characteristics of different subtypes and risk factors for the severity of illness in patients with COVID-19 in Zhejiang, China

“…Recently, two independent laboratories from China declared that they have successfully isolated live SARS-CoV-2 from the stool of patients [24]. An increasing number of studies remind us that digestive system might serve as an alternative route of infection for SARS-CoV-2 [25]. We consider the digestive tract transmission of SARS-CoV-2 might impair the function of intestinal mucosal barriers and increase the production of inflammatory factors, further aggravating the severity of illness.…”

SARS-CoV-2 / COVID-19: Salient Facts and Strategies to Combat Ongoing Pandemic

“…Small particles loaded with virus may diffuse of up to 10 m distance from source of infection, which is of high concerns in spreading this virus dominantly by air-borne route 45 . SARS-CoV-2 RNA was also detected in sewage and wastewater, hence water-borne route of transmission need to be checked and investigated by wastewaterbased epidemiology, sewage surveillance along with emphasis on fecal-oral transmissions, which would aid in prevention and control strategies to check spread of this pandemic virus [46][47][48][49][50] . There was no significant relation between temperature, humidity, and the virus distribution 51 .…”