Yang Dennis, Perbtani Yaseen B, Loeb Julia, Liu Nanlong, Draganov Peter V, Estores David E, Lauzardo Michael, Maurelli Anthony, Lednicky John A, Morris J Glenn
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States.
Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States.
Endosc Int Open. 2021 Aug;9(8):E1276-E1282. doi: 10.1055/a-1490-9234. Epub 2021 Jul 16.
The clinical significance of SARS-CoV-2 RNA in the stool remains unclear. We aimed to determine whether SARS-CoV-2 is detected via real-time reverse transcriptase polymerase chain reaction (rRT-PCR) in the gastrointestinal tracts of patients scheduled for endoscopy and if the virus obtained from these clinical specimens could be isolated in culture. All patients underwent symptom screening and had negative nasopharyngeal testing for SARS-CoV-2 within 72 hours of their scheduled procedure. Study samples were collected via nasopharyngeal swab, rectal swab, and fluid from the upper gastrointestinal tract and/or colon based on their endoscopic procedure(s). Samples were tested for SARS-CoV-2 via rRT-PCR. SARS-CoV-2 positive specimens were isolated and cultured in Vero-E6 cells. 243 patients (mean age 63.1 years;54.3 % men) were enrolled from July 15, 2020 to September 2, 2020. SARS-CoV-2 testing was performed from 242 (99.6 %) nasopharyngeal, 243 (100 %) rectal, 183 (75.3 %) upper gastrointestinal tract and 73 (30 %) colon samples. SARS-CoV-2 RNA was detected in the nasopharynx and gastrointestinal specimens in one patient (0.4 %). After a 14-day incubation period, there was no evidence of virus growth in cells incubated with any of these specimens. SARS-CoV-2 was rarely detected in the gastrointestinal tract of patients with negative nasopharyngeal testing prior to endoscopy. No live virus was detected by culture, further highlighting that presence of viral genome on its own is not sufficient proof of infectivity. PCR-based screening provides limited insight into virus infectivity and its results should be interpreted carefully as to avoid unnecessary delays in clinical care or inadvertent risk exposure.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）RNA在粪便中的临床意义仍不清楚。我们旨在确定计划接受内镜检查的患者胃肠道中是否能通过实时逆转录聚合酶链反应（rRT-PCR）检测到SARS-CoV-2，以及从这些临床标本中获得的病毒是否能在培养物中分离出来。所有患者均接受症状筛查，且在预定检查前72小时内鼻咽部SARS-CoV-2检测呈阴性。根据内镜检查程序，通过鼻咽拭子、直肠拭子以及上消化道和/或结肠的液体采集研究样本。通过rRT-PCR对样本进行SARS-CoV-2检测。将SARS-CoV-2阳性标本分离并在Vero-E6细胞中培养。2020年7月15日至2020年9月2日共纳入243例患者（平均年龄63.1岁；男性占54.3%）。对242份（99.6%）鼻咽样本、243份（100%）直肠样本、183份（75.3%）上消化道样本和73份（30%）结肠样本进行了SARS-CoV-2检测。在一名患者（0.4%）的鼻咽和胃肠道标本中检测到了SARS-CoV-2 RNA。经过14天的潜伏期后，用这些标本中的任何一种培养的细胞均未出现病毒生长迹象。在内镜检查前鼻咽检测呈阴性的患者胃肠道中很少检测到SARS-CoV-2。培养未检测到活病毒，这进一步表明仅病毒基因组的存在不足以证明具有传染性。基于PCR的筛查对病毒传染性的了解有限，其结果应谨慎解读，以免在临床护理中造成不必要的延误或意外的风险暴露。
