Breaking! New Studies Shows How Coronavirus Affects GI Tract and Also Highlights Fecal Transmissions As Another Route For Viral Spread
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In a two new studies by Chinese researchers that were just published in Gastroenterology, the journal of the American Gastrolenterology Association, the investigators highlighted the impacts of the coronavirus on the digestive tract.
Among some of the significant findings, it was observed that a large proportion of coronavirus patients exhibited diarrhea, nausea, vomiting and/or abdominal discomfort prior to respiratory symptoms developing. The researchers recommend monitoring patients with initial GI stress, which will allow for earlier detection, diagnosis, isolation and intervention.
In pathological observations, SARS-CoV-2 RNA detection and intracellular staining of viral nucleocapsid protein in gastric, duodenal and rectal epithelia demonstrate that SARS-CoV-2 infects these gastrointestinal glandular epithelial cells. Although viral RNA was also detected in esophageal mucous tissue, absence of viral nucleocapsid protein staining in esophageal mucosa indicates low viral infection in esophageal mucosa.
This indicates that the virus can enter the human body not only through the respiratory routes but also through the mouth and GI tract.
In was also observed that the new coronavirus was able to also infiltrate and attack the liver, mild to moderate liver injury including elevated aminotransferases, hypoproteinemia and prothrombin time prolongation has been reported. These were also observed in studies involving the SARS and MERS coronaviruses but unlike these, surprisingly, single cell RNA sequencing data from two independent cohorts revealed a significant enrichment of ACE2 expression in cholangiocytes (59.7% of cells) instead of hepatocytes (2.6% of cells) suggesting that SARS-CoV-2 might lead to direct damage of intrahepatic bile ducts.
After viral entry in the GI tract, virus-specific RNA and proteins are synthesized in the cytoplasm to assembly new virions, which can be released to gastrointestinal tract. The continuous positive detection of the viral RNA from feces suggests that the infectious virions are secreted from the virus-infected gastrointestinal cells.
Viral RNA is detectable in stool of patients with suspected coronavirus; it is now clear that the virus sheds into the stool.
It was noted that viral gastrointestinal infection and potential fecal-oral transmission can last even after viral clearance in respiratory tract.
The researchers suggest that prevention of fecal-oral transmission should be taken into consideration to control the spread the virus
References : COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission, By Jinyang Gu, Shanghai Jiaotong University School of Medicine Xinhua Hospital, China, et al. www.gastrojournal.org/article/ … (20)30281-X/fulltext
Evidence for gastrointestinal infection of SARS-CoV-2, By Fei Xiao, Sun Yat-sen University, Zhuhai, Guangdong Province, China, et al. www.gastrojournal.org/article/ … (20)30282-1/fulltext
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