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COVID-19 Disease With Positive Fecal and Negative Pharyngeal and Sputum Viral Tests

Chen, Lijuan PhD1; Lou, Jianghua MD1; Bai, Yan MD1; Wang, Meiyun PhD, MD1

Author Information
The American Journal of Gastroenterology: May 2020 - Volume 115 - Issue 5 - p 790
doi: 10.14309/ajg.0000000000000610
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An epidemic of the coronavirus disease 2019 (COVID-19) has spread in China and has affected 26 countries worldwide since December 2019 (1). The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is transmitted from person to person, principally through respiratory droplets or contact (2). Severe acute respiratory syndrome coronavirus (SARS-CoV) and middle east respiratory syndrome coronavirus (MERS-CoV) are possibly transmitted through the fecal-oral route (3,4), suggesting similar transmission of the COVID-19 virus. We report a case of COVID-19 with a positive result of virus nucleic acid in a fecal specimen and negative results on multiple pharyngeal and sputum samples.

A 25-year-old woman contacted her brother on January 18, 2020, after he had traveled from the epidemic center of Wuhan, China. On January 24, she had respiratory symptoms and fever (39.6 °C). Outpatient and inpatient symptomatic treatments were ineffective, and she was hospitalized at our facility on February 3. Laboratory tests revealed a leukocyte count of 6.2 × 109/L (normal, 3.9–9.9), a lymphocyte count of 0.9 × 109/L (normal, 1.1–3.2), an erythrocyte sedimentation rate of 27 mm/hr (normal, 0–20), and a serum amyloid A of 110.4 mg/L (normal, 0–10). Chest computed tomography revealed “ground-glass” pulmonary opacities bilaterally. The SARS-CoV-2 real-time reverse transcription-polymerase chain reaction test on a pharyngeal swab sample was negative. The following day, the SARS-CoV-2 reverse transcription-polymerase chain reaction test on a fecal sample was positive. During 7 days after admission, the test was negative on 2 more pharyngeal swab samples and 2 sputum samples. After anti-infective and antiviral treatment, her fever disappeared and symptoms and computed tomography abnormalities improved, allowing hospital discharge. Our understanding of SARS-CoV-2 infection routes is still limited. This case indicates that the virus can proliferate in the digestive tract and potentially undergo fecal-oral transmission.


Guarantor of the article: Meiyun Wang, PhD, MD.

Specific author contributions: Lijuan Chen, PhD and Jianghua Lou, MD contributed equally to the work. L.C.: contributed to this article with literature review, data analysis, and drafting the manuscript. J.L.: data acquisition, analysis, and interpretation. Y.B.: critical revision and editing for intellectual content, M.W.: conception and design of the study and final approval of the final version.

Financial support: None to report.

Potential competing interests: None to report.


1. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med [Epub ahead of print February 18, 2020.]
2. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. N Engl J Med [Epub ahead of print February 28, 2020.]
3. Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective study. Lancet 2003;361(9371):1767–72.
4. Goh GK, Dunker AK, Uversky V. Prediction of intrinsic disorder in MERS-CoV/HCoVEMC supports a high oral-fecal transmission. PLoS Curr 2013;5.
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