Chen Chen, G. Gao, Yanli Xu, L. Pu, Q. Wang, Liming Wang, Wenling Wang, Y. Song, Meiling Chen, Linghang Wang, Fengting Yu, Siyuan Yang, Yunxia Tang, Li Zhao, Huijuan Wang, Yajie Wang, H. Zeng, Fujie Zhang
Annals of Internal Medicine, 2020
SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19 Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a global public health problem. In the absence of a specific therapy or vaccine, timely diagnosis and the establishment of a sufficient isolation period for infected individuals are critical to containment efforts. Real-time quantitative fluorescence polymerase chain reaction (RTqPCR) testing of respiratory specimens for SARS–CoV-2 RNA is currently used for case diagnosis and to guide the duration of patient isolation or hospital discharge (1). Specimens that are positive on RT-qPCR have, however, also been reported from blood (2), feces (3), and urine (4). Whether testing of multiple body sites is important when considering patient isolation has not been thoroughly studied. Objective: To assess the results of RT-qPCR for SARS– CoV2 RNA of sputum and fecal samples from a group of patients after conversion of their pharyngeal samples from positive to negative. Methods and Findings: We retrospectively identified a convenience sample of patients admitted to Beijing Ditan Hospital, Capital Medical University, with a diagnosis of COVID-19 and paired RT-qPCR testing of pharyngeal swabs with either sputum or feces samples. A diagnosis of COVID-19 required at least 2 RT-qPCR–positive pharyngeal swabs, and patients underwent treatments as well as initial and follow-up testing of pharyngeal, sputum, or fecal samples at the discretion of treating clinicians. Hospital discharge required meeting 4 criteria: afebrile for more than 3 days, resolution of respiratory symptoms, substantial improvement of chest computed tomographic findings, and 2 consecutive negative RTqPCR tests for SARS–CoV2 in respiratory samples obtained at least 24 hours apart (1). We report the findings of patients with at least 1 initial or follow-up RT-qPCR positive sputum or fecal sample obtained within 24 hours of a follow-up negative RT-qPCR pharyngeal sample. The RT-qPCR assay targeted the open reading frame 1ab (ORF1ab) region and nucleoprotein (N) gene with a negative control. A cycle threshold value of 37 or less was interpreted as positive for SARS–CoV-2, according to Chinese national guidelines. Among 133 patients admitted with COVID-19 from 20 January to 27 February 2020, we identified 22 with an initial or follow-up positive sputum or fecal samples paired with a follow-up negative pharyngeal sample. Of these patients, 18 were aged 15 to 65 years, and 4 were children; 14 were male; and 11 had a history of either travel to or exposure to an individual returning from Hubei Province in the past month. Fever was the most common initial onset symptom. Five patients had at least 1 preexisting medical condition (Table). All patients met criteria and were discharged from the hospital. We collected 545 specimens from 22 patients, including 209 pharyngeal swabs, 262 sputum samples, and 74 feces samples (Figure). In these patients, sputum and feces re-
Cited by 70 publications.
Field of study: Medicine