PMC:7212965 / 25638-27967 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7212965","sourcedb":"PMC","sourceid":"7212965","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7212965","text":"Stool shedding\nOur study selection criteria prioritized including studies with diarrhea as a GI manifestation and avoiding overlap in populations and, therefore, did not include a comprehensive set of studies reporting on stool shedding. A recently published systematic review by Cheung et al10 found a 48.1% (95% CI, 38.3%–59.7%) pooled prevalence of stool samples positive for virus RNA in 12 studies. Stool RNA was positive in 70.3% of samples taken from patients after respiratory specimens were no longer positive for the virus.\nFrom the 57 studies included in our analysis, 4 studies reported on presence of viral RNA in stool.24 , 32 , 57 , 68 Of these, 3 studies were published after the systematic review by Cheung et al.10 First, Dreher et al68 conducted a retrospective cohort study in Germany, stratifying patients by presence of acute respiratory distress syndrome. In this study, 8 of 50 patients had diarrhea, and stool PCR was positive in 15 of 50 patients. In a US study by Kujawski et al,57 stool PCR was positive in 7 of 10 patients. Finally, in a case series from Germany by Wolfel et al,32 the authors not only examined stool RNA but also tried to isolate virus from laboratory specimens. In this study, 2 of 9 patients had diarrhea as an initial symptom and stool PCR remained positive for up to 11 days, but notably, the authors were unable to isolate infectious virus, despite a high stool viral RNA load, even though the virus was successfully isolated from respiratory specimens. The authors concluded that stool is not a primary source of spread of infection.32 Conversely, in a letter published by Wang et al,78 the authors collected 1070 specimens from 205 hospitalized patients with COVID-19 and 44 of 153 stool specimens (29%) were positive for viral RNA. Four specimens with high copy numbers were cultured and electron microscopy was performed to detect live virus, which was observed in the stool from 2 patients who did not have diarrhea. The authors concluded that although this does not confer infectivity, it raised the possibility of fecal–oral transmission.78 The small sample size of the reports that assessed the presence of live virus in stool combined with the conflicting findings limit our certainty in the evidence and thus the question of fecal–oral transmission remains 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