Mild and asymptomatic cases of COVID-19 are potential threat for faecal–oral transmission

The recent Coronavirus Disease 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was firstly reported on December 2019 in Wuhan, China. Despite the classical respiratory symptoms, some case studies have reported gastrointestinal symptoms and the presence of SARS-CoV-2 (RNA or live virus) in feces of patients diagnosed with COVID-19.^1,2 In this sense, the present Journal recently published an article that touches on this issue. Li et al.³ reported a mild SARS-CoV-2 infection in an 8-month-8-day-old girl. Curiously, her rectal swabs remained positive for eight days, whereas her nasopharyngeal swabs were persistently negative by real-time reverse transcription PCR (RT–PCR). In a similar way, other study reported that among 10 children infected with SARS-CoV-2, eight children persistently tested positive on rectal swabs even after nasopharyngeal RT-PCR testing be negative.⁴ Therefore, the present case report published in this Journal have corroborated significantly with previous findings from the current literature: (i) rectal swabs may be used to confirm diagnosis of COVID-19, even when nasopharyngeal testing is negative; (ii) another possible route of transmission might be fecal–oral; (iii) mild and asymptomatic cases, especially in children, are potential sources of fecal–oral transmission.

• Funding
  This study was supported by CNPq, CAPES, and FAPEMIG.

References

• ¹
  Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;:.
  » https://doi.org/10.1056/NEJMoa2002032
• ²
  Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;:.
  » https://doi.org/10.1053/j.gastro.2020.02.055
• ³
  Li J, Feng J, Liu T, Xu F, Song G. An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report. Braz J Infect Dis. 2020;:.
  » https://doi.org/10.1016/j.bjid.2020.04.009
• ⁴
  Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;:.
  » https://doi.org/10.1038/s41591-020-0817-4

Publication Dates

• Publication in this collection
  02 Oct 2020
• Date of issue
  Jul-Aug 2020

History

• Received
  20 May 2020
• Accepted
  14 June 2020