Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection

By W. K. Leung, K. To, P. Chan, H. Chan, A. Wu, N. Lee, Kwok-Yung Yuen, J. Sung. Gastroenterology, 2003

671 citations recorded by the source corpus.

Background & Aims: Severe acute respiratory syndrome (SARS) is a recently emerged infection from a novel coronavirus (CoV). Apart from fever and respiratory complications, gastrointestinal symptoms are frequently observed in patients with SARS but the significance remains undetermined. Herein, we describe the clinical, pathologic, and virologic features of the intestinal involvement of this new viral infection. Methods: A retrospective analysis of the gastrointestinal symptoms and other clinical parameters of the first 138 patients with confirmed SARS admitted for a major outbreak in Hong Kong in March 2003 was performed. Intestinal specimens were obtained by colonoscopy or postmortem examination to detect the presence of coronavirus by electron microscopy, virus culture, and reverse-transcription polymerase chain reaction. Results: Among these 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness. Diarrhea was more frequently observed during the first week of illness. The mean number of days with diarrhea was 3.7 ± 2.7, and most diarrhea was self-limiting. Intestinal biopsy specimens obtained by colonoscopy or autopsy showed minimal architectural disruption but the presence of active viral replication within both the small and large intestine. Coronavirus was also isolated by culture from these specimens, and SARS-CoV RNA can be detected in the stool of patients for more than 10 weeks after symptom onset. Conclusions: Diarrhea is a common presenting symptom of SARS. The intestinal tropism of the SARS-CoV has major implications on clinical presentation and viral transmission.

Subfields: Infectious Diseases

View Paper: https://www.semanticscholar.org/paper/3d27100957d3b0a977b0a47d7089492aa2072be3

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In Infectious Diseases

1. Kwok-Yung Yuen
2. Susanna K. P. Lau
3. J. Chan
4. K. To
5. Yi-Wei Tang
6. V. Cheng
7. Kwok-Hung Chan
8. Shuofeng Yuan

Citations in the corpus

• Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus (2003, background): “Active viral replication in the small and large intestine has been observe”
• Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis (2020, positive): “We FLA 5.6.0 DTD YGAST63335_proo previously reported the high prevalence of enteric symptoms in patients with SARS and demonstrated acute viral replication in the small intestinal mucosa of patients with SARS.6 It is estimated that 16%–73% of patients had diarrhea during the course of SARS illness.”
• Infection and Rapid Transmission of SARS-CoV-2 in Ferrets (2020, neutral): “Because gastrointestinal involvement is a characteristic of coronavirus infections of animals and humans (Leung et al., 2003), we also collected fecal and urine specimens.”
• Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection (2007, background): “7 10(8) copies/ml between days 10 and 43 for large intestinal tissue (96) in enterocytes of both terminal ileum and colonic biopsy specimens; no villous atrophy or inflammation (205); atrophy of mucosal lymphoid tissue (298)”
• Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis (2004, background): “Active viral replication in the enterocytes of the small intestine has been reported by Leung et al [20] and SARS-CoV RNA can be detected in patients’ stool samples [16,17,20].”
• COVID-19: Transmission, prevention, and potential therapeutic opportunities (2020, positive): “Moreover, SARS-CoV-2 can affect the cardiovascular system [16], gastrointestinal tract [20], and can cause acute kidney failure [2,19].”
• Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis (2020, neutral): “These results are also consistent with previous studies, [21] and are also frequently identified in MERS and SARS. [57] [58] [59] In this systematic review and meta-analysis, we found a CFR of 3.6%, which is closer to the estimate (2.3%) in a report by the Chinese Center for Disease In our analysis,”
• Laboratory Diagnosis of COVID-19: Current Issues and Challenges (2020, methodology): “from stool during the 2002-2003 SARS outbreak (26, 28, 31), and SARS-CoV-2 has”
• A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster (2020, positive): “21 On microbiological testing, we did not find any evidence of other known respiratory viral or bacterial infections, but specific RT-PCR assays for two widely separated genome targets—the highly conserved RdRp and the highly variable S genes—were positive for this novel 2019-nCoV.”
• Mechanisms of SARS-CoV-2 Transmission and Pathogenesis (2020, positive): “Accordingly, gastrointestinal illness has been frequently reported in patients with COVID-19 [40,41], consistent with the recovery of SARS-CoV from stool samples of patients with SARS [42], suggesting a potential fecal–oral route of transmission for these two CoVs.”