Bamidele Rebecca Folasade, Fowotade Adeola, Bakare Rasheed, Bamidele Olufunso Opeyemi, Omoruyi Chukwuma Ewean, Oladunni Amos Abimbola, Alonge Temitope
Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Oyo state, Nigeria.
Biorepository Laboratory, College of Medicine, University College Hospital, Ibadan, Oyo state, Nigeria.
PLOS Glob Public Health. 2024 Aug 28;4(8):e0003571. doi: 10.1371/journal.pgph.0003571. eCollection 2024.
SARS-CoV-2 shedding in human stool has been suggested as a probable route for faeco-oral transmission of the virus due to the availing evidence on the infectivity and pathogenicity of similar highly infectious respiratory viruses. Determining association of SARS-CoV-2 shedding in stools and presenting clinical status might be useful for prediction of the viral transmission spectrum and disease outcome. This study involved a descriptive cross-sectional survey of 91 consenting hospitalized, confirmed COVID-19 patients in Infectious Disease Isolation Centre, Oyo State, Nigeria. Socio-demographic characteristics and other ancillary data were collected from patient's hospital records with the aid of a structured investigator administered questionnaire. The laboratory detection of SARS-CoV-2 RNA in the stool of patients was performed using RT-PCR method. 27 (29.7%) of the 91 COVID-19 patients shed SARS-CoV-2 in their stools. The frequency of male (38.3%) patients shedding the virus in stools was higher than female (12.9%) patients (P = 0.012). Higher proportion of patients who had symptoms (41.2%) at admission shed the virus in their stool (P <0.007); particularly, fever (0.001), fatigue (0.003), headache (0.003), catarrh (0.001), and loss of smell (0.009). The frequency of viral shedding in stool was higher among patients with loss of taste (p = 0.028). Viral shedding in stool was significantly associated with low CT values (47.2%) and moderate CT value (21.4%) (P<0.05). Multivariate analysis showed that patients with moderate CT-value (OR = 0.28, 95% CI: 0.08-0.94, P = 0.039) and high CT-value (OR = 0.08, 95% CI: 0.01-0.80, P = 0.033) were less likely to shed the virus in stool. The gastrointestinal tract could be a route of SARS-CoV-2 transmission irrespective of the patients' clinical status. The low and moderate CT values of the nasopharyngeal swab is associated with shedding of the virus in patients' stools, although infectivity will depend on viral activity obtainable from further laboratory test analyses, such as viral culture.
由于有证据表明类似的高传染性呼吸道病毒具有传染性和致病性，因此有人提出，新型冠状病毒2（SARS-CoV-2）在人类粪便中的排出可能是该病毒粪口传播的一条途径。确定SARS-CoV-2在粪便中的排出与患者临床状况之间的关联，可能有助于预测病毒传播范围和疾病结局。本研究对尼日利亚奥约州传染病隔离中心91名同意参与的住院确诊COVID-19患者进行了描述性横断面调查。借助一份由调查员填写的结构化问卷，从患者的医院记录中收集社会人口学特征和其他辅助数据。采用逆转录聚合酶链反应（RT-PCR）方法对患者粪便中的SARS-CoV-2 RNA进行实验室检测。91名COVID-19患者中有27名（29.7%）粪便中排出SARS-CoV-2。粪便中排出病毒的男性患者频率（38.3%）高于女性患者（12.9%）（P = 0.012）。入院时有症状的患者中，粪便中排出病毒的比例更高（41.2%）（P <0.007）；尤其是发热（0.001）、疲劳（0.003）、头痛（0.003）、卡他症状（0.001）和嗅觉丧失（0.009）。味觉丧失患者粪便中病毒排出频率更高（p = 0.028）。粪便中病毒排出与低CT值（47.2%）和中等CT值（21.4%）显著相关（P<0.05）。多变量分析显示，CT值中等的患者（比值比=0.28，95%置信区间：0.08 - 0.94，P = 0.039）和CT值高的患者（比值比=0.08，95%置信区间：0.01 - 0.80，P = 0.033）粪便中排出病毒的可能性较小。无论患者临床状况如何，胃肠道都可能是SARS-CoV-2的传播途径。鼻咽拭子的低CT值和中等CT值与患者粪便中病毒排出有关，尽管传染性将取决于进一步实验室检测分析（如病毒培养）可获得的病毒活性。
