Possibility of COVID-19 be transmitted through oral-faecal transmission


COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) which first emerged in China on December 2019 has spread worldwide with a reported 58,03,416 confirmed cases and 3,59,791 deaths as of 29th May 2020. The infection is typically characterized by respiratory symptoms, which indicate droplet transmission. However, many studies recently have reported the gastrointestinal symptoms observed in patients with SARS-Co V-2 infection with viral RNA present in faeces which suggests another possible route might be faecal-oral transmission.

According to the review done by Tian Y et al and team suggests that an incidence of gastrointestinal symptoms which includes anorexia, diarrhea, vomiting, nausea, abdominal pain and gastrointestinal bleeding. Diarrhoea was the common gastrointestinal symptom exhibited before and after the diagnosis of the virus. Angiotensin converting enzyme 2 and virus nucleocapsid protein was detected in gastrointestinal cells. Infectious virus particles were isolated faeces. In a cohort study published in New England Journal of Medicine done in 1,099 patients 5% of the patients were presented with nausea or vomiting while 3% with diarrhea. American Journal of Gastroenterology had published preliminary studies showing 60% of the patients presented gastrointestinal symptoms.

The possible mechanism is SARS-CoV-2 use ACE-2 as a viral receptor and ACE2 mRNA is highly expressed in the gastrointestinal system. All these results are preliminary works, so further research is needed. It can be assumed that many asymptomatic children and adults may shed the virus particles in the stool leading to infection in others. 

Reference:

1.      Jinyang GU, Bing Han and Jian Wang. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 1-2.

2.      Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Alimentary Pharmacology and Therapeutics 2020; 51: 843 – 851.

3.      Xu, Y et al. Characteristics of pediatric SARS-Co V-2 infection and potential evidence for persistent fecal viral shedding. Nature Reviews Gastroenterology and Hepatology, 2020.

4.      Li Y et al. Positive result of SARS-CoV-2 in faeces and sputum from discharged patient with COVID-19 in Yiwu, China. Journal of Medical Virology 2020.

5.      Chen Lijuan, Lou J, Bai Y and Wang M. COVID-19 disease with positive fecal and negative pharyngeal and sputum viral tests. The American Journal of Gastroenterology 2020.

6.      Debojyoti D and Abhishek M. Gut microbiota and COVID-19 possible link and its implications. Virus Research 2020.

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