Key study findings and message GI symptoms are frequent at presentation • Viral load in stool is significantly lower than in lower respiratory tract
• Virus not cultivable from stool MERS-CoV high in healthcare environment • GI symptoms among the commonest extrapulmonary symptoms
• Intestinal epithelial cells could support viral replication
• Primary gastric infection can lead to respiratory symptoms via hematogenous or lymphatic spread Diarrhea may be associated with prolonged viral detection (p 0.069)