Gastrointestinal SARS CoV-2 Infection and The Dynamic of Its Detection in Stool

Introduction: SARS-CoV-2 has been strongly associated with respiratory illnesses; however the incidence of SARS-CoV-2 infection of the gastrointestinal tract is not fully clear. We examined the frequency of positive stool SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) in COVID-19 patients, duration of stool viral shedding after the viral clearance of respiratory samples, and the association of SARS-CoV-2 infection with gastrointestinal symptoms. Methods: We did a search in PubMed and Google Scholar of studies published in the English language before June 30th, 2020. Search queries included: “COVID-19”, “SARS-CoV-2”, and “stool SARS-CoV-2 RT-PCR”. We excluded studies with less than 8 patients from our review. Results: Among the 707 patients who had respiratory samples positive for SARS-CoV-2, 361 (51%) patients tested positive through stool SARS-CoV-2 RT-PCR. Of 198 patients who tested positive for SARS-CoV-2 in stool, 101 (51%) patients continued testing positive after respiratory samples were negative by RT-PCR. The longest duration of positive SARS-CoV-2 in stool was 48 days, 33 days after a negative result from upper respiratory samples. Out of 200 patients who had positive fecal PCR for SARS-CoV-2, 95 patients (47.5%) had at least one gastrointestinal manifestation. Conclusions: About one-half of COVID-19 patients had positive stool SARS-CoV-2 RT-PCR, and 51% of patients had positive stool SARS CoV-2 RT-PCR after their respiratory samples became negative for SARS-CoV-2 by RT-PCR. At least one gastrointestinal symptom was reported in 47.5% of patients with a positive stool SARS-CoV-2 RT-PCR