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SARS-CoV-2 Gastrointestinal Shedding in Hospitalized Children
Insights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gastrointestinal (GI) shedding is common in children who test positive on nasopharyngeal (NP) swabs, with GI symptoms being a key indicator. Importantly, SARS-CoV-2 GI shedding was not detected in children who tested negative on NP swabs.
Area of Science:
- Virology
- Pediatric Infectious Diseases
- Gastroenterology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can manifest with gastrointestinal (GI) symptoms.
- Viral RNA detection in stool has been observed weeks after respiratory clearance.
- The potential for SARS-CoV-2 stool shedding in children with negative nasopharyngeal (NP) swabs remains unclear.
Purpose of the Study:
- To determine the prevalence of SARS-CoV-2 stool shedding in children based on NP swab PCR results.
- To identify clinical factors associated with GI shedding of SARS-CoV-2 in pediatric patients.
Main Methods:
- A cross-sectional study involving hospitalized children (0-21 years) with respiratory and/or GI symptoms.
- Participants were categorized by SARS-CoV-2 NP swab PCR results (positive or negative).
- Stool samples underwent viral PCR testing, with Fisher's exact test used for statistical analysis.
Main Results:
- Of 33 patients included, 17 were NP-positive and 16 were NP-negative for SARS-CoV-2.
- Eight of 17 NP-positive children (47%) showed SARS-CoV-2 in stool samples (P < .01).
- No SARS-CoV-2 stool shedding was detected in any of the 16 NP-negative children.
Conclusions:
- Gastrointestinal shedding of SARS-CoV-2 is prevalent in NP-positive children and linked to GI symptoms.
- SARS-CoV-2 gastrointestinal shedding was not observed in children testing negative via NP swab.
- Findings suggest NP swab results are reliable indicators for assessing SARS-CoV-2 GI shedding risk in pediatric populations.
Background:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus that can cause gastrointestinal (GI) symptoms, with studies demonstrating detection of stool viral RNA weeks after respiratory tract clearance. It is unknown if children who test negative for SARS-CoV-2 on a nasopharyngeal (NP) swab may be shedding the virus in their stool.
Objective:
To measure the prevalence of SARS-CoV-2 stool shedding in children with positive and negative SARS-CoV-2 NP polymerase chain reactions (PCR) tests, and to determine clinical factors associated with GI shedding.
Methods:
In this cross-sectional study, we enrolled hospitalized patients 0 to 21 years old with a positive or a negative SARS-CoV-2 NP PCR test who had respiratory and/or GI symptoms. Participants were surveyed, and stool samples were sent for viral PCR testing. Fisher's exact test was used to evaluate bivariate associations of stool PCR test positivity with categorical variables.
Results:
Sixty-seven patients were consented; 34 patients did not provide stool samples so 33 patients were included: 17 NP-positive and 16 NP-negative for SARS-CoV-2. Eight of the 17 NP-positive patients had a positive stool PCR test for SARS-CoV-2, while none of the 16 SARS-CoV-2 NP-negative patients had a positive result (P < .01). For the 17 SARS-CoV-2 NP-positive patients, GI symptoms were associated with a positive stool PCR test (P = .05) for SARS-CoV-2, but this association was not found for all 33 patients (P = .11). No associations were found with patients in an immunocompromised state or those with a comorbid condition, fever and/or chills, respiratory symptoms, headache and/or myalgias, or anosmia and/or ageusia.
Conclusions:
SARS-CoV-2 GI shedding is common and associated with GI symptoms in NP-positive children, with 47% having positive stool PCRs for SARS-CoV-2. GI shedding was not demonstrated in SARS-CoV-2 NP-negative children.
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