Gastrointestinal and Liver Diseases Research Center, GI Cancer Screening and Prevention Research Center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave, 41448-95655, Rasht, Iran.
Department of Health, Nutrition and Infectious Diseases, School of Medicine Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Virol J. 2021 Jul 1;18(1):134. doi: 10.1186/s12985-021-01599-9.
The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19.
In this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence.
The median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91-9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07-7.93), 6 days (95% CI 4.16-8.41), and 13 days (95% CI 6.96-19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively.
According to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.
新型冠状病毒病 2019（COVID-19）患者的体液中持续存在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）RNA，这可能增加病毒传播的潜在风险。目前仍不确定推荐的隔离时间是否足以降低传播风险。本研究旨在调查 COVID-19 患者鼻咽、血液、尿液和粪便样本中 SARS-CoV-2 RNA 的持续存在情况。
在这项基于医院的纵向研究中，2020 年 3 月至 2020 年 8 月在伊朗北部的吉兰省招募了 100 例确诊的 COVID-19 病例。每个参与者在入院时、出院时、出院后 1 周以及直到所有样本通过逆转录聚合酶链反应（RT-PCR）检测均为 SARS-CoV-2 RNA 阴性时，分别采集鼻咽、血液、尿液和粪便样本。还进行了生存分析以确定病毒持续存在的时间。
从入院时首次 RT-PCR 阳性结果算起，鼻咽样本中病毒 RNA 持续存在的中位数为 8 天（95%CI 6.91-9.09）；病毒排出的最长时间为 25 天。有 24%、7%和 6%的患者分别检测到阳性的血液、尿液和粪便 RT-PCR 结果。血液、尿液和粪便样本中病毒持续存在的中位数分别为 7 天（95%CI 6.07-7.93）、6 天（95%CI 4.16-8.41）和 13 天（95%CI 6.96-19.4）。此外，血液、尿液和粪便样本中病毒持续存在的最长时间分别为入院后 17、11 和 42 天。
根据本研究结果，住院患者出院后立即未发现病毒遗传物质。因此，该医院为患者选择了适当的治疗方法。但是，我们建议在多中心和前瞻性随机对照试验（RCT）中进一步研究更大的样本量，以评估不同药物对通过体液排出病毒的影响。
