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Diarrhea in Medical Care Workers With Severe Acute Respiratory Syndrome

Chiu, Yi-Chun, MD*; Wu, Keng-Liang, MD*; Chou, Yeh-Pin, MD*; Fong, Tze-Vun, MD*; Tsai, Tung-Lung, MD*; Kuo, Chung-Mou, MD*; Kuo, Chung-Huang, MD*; Chiu, King-Wah, MD*; Liu, Jhien-Wei, MD; Eng, Hock-Liew, MD; Jawan, Bruno, MD§; Cheng, Yu-Fan, MD; Chen, Chao-Long, MD

Journal of Clinical Gastroenterology: November-December 2004 - Volume 38 - Issue 10 - p 880-882
Alimentary Tract: Clinical Research

Background and goal: Several known coronavirus species cause a variety of diseases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission.

Study: Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by enzyme-linked immunosorbent assays at the convalescent phase.

Results: The incidence of watery diarrhea was 18.8% (3 of 16). The RT-PCR of coronavirus was positive in three (18.8%) of 16 throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25% (1 of 16). The diarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6% (27 of 138) of the hospital-acquired outbreak in the Prince of Wales Hospital in Hong Kong (P = 0.798). In contrast to the high positive rate of feces RT-PCR (97%) in Amoy Gardens, our positive rate in rectal swab RT-PCT (0%) was significantly lower (P = 0.00000002).

Conclusions: Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.

From the Division of *Gastroenterology, †Infection Control, ‡Pathology, §Anesthesiology, and ¶Diagnostic Radiology, and Department of Surgery, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, Republic of China.

Received for publication December 30, 2003; accepted March 15, 2004.

Reprints: King-Wah Chiu, MD, Division of Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Kaohsiung, 83305 Taiwan, Republic of China (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.