Latest research paper published in the “Journal of gastroenterology and hepatology” that comes from join efforts of The Chinese University of Hong Kong,Institute of Digestive Disease and Department of Medicine and Therapeutics bring us not so good news.
According to this research SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract.
Patients infected with the new SARS-CoV-2 virus typically develop Coronavirus disease 2019 ( COVID-19 ) and usually they have fever and respiratory symptoms,nevertheless, some patients also have gastrointestinal manifestations with diarrhea,vomiting and abdominal pain.
Multiple other studies made in China have identified the SARS-CoV-2 RNA in anal/rectal swabs and stool specimens of Covid-19 patients even after the clearance of the virus in the upper respiratory tract.
Furthermore, the viral receptor angiotensin converting enzyme 2 (ACE2) was found to be expressed in gastrointestinal epithelial cells.
All these findings suggest that SARS-CoV-2 can actively infect and replicate in the astrointestinal tract and that this information have important implications to the new disease management strategies for developing better protocols for transmission and infection control.
Occurrence of diarrhea and other gastrointestinal manifestations is found in all coronavirus infections. Although at a lower frequency compared to SARS and MERS this manifestations in COVID-19 are probably because of possible tropism of SARS-CoV-2 to the gastrointestinal tract, claim based on SARS and MERS research papers.
The SARS-CoV RNA could be readily detected in stool specimens of SARS patients, and electron microscopy on biopsy and autopsy specimens showed active viral replications in both small and large intestines. Similarly, enteric infection could occur with MERS-CoV, as human intestinal epithelial cells were highly susceptible to the virus and could sustain robust viral replication.
The tropism of SARS-CoV-2 to the gastrointestinal tract, its positive detection in stool, and its associated gastrointestinal symptoms, have important implications to both patient care and infection control.
Clinicians should be alert of the gastrointestinal symptomatology of Covid-19, especially as they may occur before the onset of pyrexia and respiratory symptoms.
The gastrointestinal involvement of Covid-19 would necessitate a need to consider several clinical policies, such as incorporation of rectal swab testing before discharging patients most because other studies have suggested that viral shedding from the gastrointestinal tract may be abundant, and may last long after resolution of clinical symptoms.
We can just pray that SARS-CoV-2 viral dynamics inside gastrointestinal tract will be little different from the dynamics of the SARS-CoV where viral RNA could still be detected after 30 days in stool of SARS patients