Abstract
Objective: This study aimed to assess fecal viral shedding in children who have been confirmed COVID-19 by real time polymerase chain reaction (RT-PCR).
Material and Methods: We enrolled fifty inpatient children who have been confirmed COVID-19 during first wave of outbreak in our region. All of the patients have been twice confirmed by RT-PCR within nasopharyngeal swabs. Each case was evaluated with clinical data, laboratory tests and rectal swabs. The rectal swabs were obtained five days after nasopharyngeal positivity. The clinical data was recorded within two basic categories, including common symptoms or digestive symptoms. Detection of SARS-CoV-2 in rectal swabs was performed by RT-PCR method.
Results: Fifteen patients (30%) had digestive symptoms. On the 5th day, 50 rectal swabs were studied with PCR-RT. Only one of them was positive (2%). The only patient who was positive for SARS-CoV-2 on rectal swab was a symptomatic threeand-a-half-year-old girl. The patient, who became asymptomatic in the follow-up, was retested with a nasopharyngeal swab one week later, the result was negative and she was discharged on the 10th day. The second rectal smear of the patient was negative.
Conclusion: We found very low rate (2%) fecal viral shedding with rectal swab PCR among children who have been confirmed COVID-19 by nasopharyngeal swab PCR. We thought that this result was due to the mild clinical course of the patients who has been diagnosed with COVID-19 we followed up. However, fecal oral transmission might still matter in children.
References
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382:727-33. Tezer H, Bedir Demirdag T. Novel coronavirus disease (COVID-19) in children. Review Article. Turk J Med Sci 2020;50: 592-603. Available from: URL: https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/
- Di Gennaro F, Pizzol D, Marotta C, Antunes M, Racalbuto V, Veronese N, et al. Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health 2020;17:2690.
- Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatrica 2020;109:1088–95.
- Ren SY, Wang BW, Hao YG, Zang HR, Wang ZC, Chen YL, Gao RD. Stability and infectivity of coronaviruses in inanimate environments. World J Clin Cases 2020; 8:1391–9.
- Yeo C, Kaushal S, and Yeo D. Enteric involvement of coronaviruses: is fecal–oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol 2020; 4: 335–7.
- Cheung KS , Hung I FN, Chan P PY, Lung KC, Tso E, Liu R, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis. Gastroenterology 2020;159:81-95.
- Liang W, Z Feng, Rao S, Xiao C, Xue X, Lin Z, et al. Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. Gut 2020;69:1141-3.
- Hasan MR, Sundararaju S, Manickam C, Mirza F, Al-Hail H, Lorenz S, et al. A novel point mutation in the N gene of SARS-CoV-2 may affect the detection of the virus by RT-qPCR. J Clin Microbiol 2021;59:e03278-20.
- Xu CLH, Raval M, Schnall, JA, Kwong, JC, Holmes NE. Duration of Respiratory and Gastrointestinal Viral Shedding in Children With SARS-CoV-2: A Systematic Review and Synthesis of Data. Pediatr Infect Dis J 2020;39:e249-56.
- Available from: URL:https://COVID19bilgi.saglik.gov.tr/depo/rehberler/COVID19_Rehberi.pdf
- Zhang JC, Wang SB, Xue YD. Fecal specimen diagnosis 2019 novel coronavirus–infected pneumonia. J Med Virol 2020;92:680–2.
- Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020;26: 502–5.
- Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 395:470-3.
- Zhang N, Gong Y, Meng, Shi Y, Wang J, Mao P, et al. Comparative study on virus shedding patterns in nasopharyngeal and fecal specimens of COVID-19 patients. Sci China Life Sci 2020;5:1-3. doi: 10.1007/s11427-020-1783-9.
- Chan KH, Poon LLM, Cheng VCC, Guan Y, Hung IFN, Kong J et al. Detection of SARS Coronavirus in Patients with Suspected SARS. Emerg Infect Dis 2004 ;2:294–9.
- Xing YH, Ni W, Wu Q,Li WJ, Li GJ, Wang WD, et al. Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019. J Microbiol Immunol Infect 2020;53:473-80.
- Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis 2020;39:469-77.
- Wang X, Zheng J, Guo L, Yao H, Wang L, Xia XD, et al. Fecal viral shedding in COVID19 patients: Clinical significance, viral load dynamics and survival analysis.Virus Res 2020; 289:198147
- Santos VS, Gurgel RQ, Cuevas LE, Martins-Filho PR. Prolonged fecal shedding of SARSCoV-2 in pediatric patients. A quantitative evidence synthesis. Meta-Analysis J Pediatr Gastroenterol Nutr 2020;71:150-2.
Abstract
Amaç: Bu çalışmada nazal sürüntüde real-time polimeraz zincir reaksiyonu (RT-PCR) ile COVID-19 tanısı doğrulanmış çocuklarda , fekal viral bulaşmayı değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Bölgemizdeki ilk salgın dalgası sırasında COVID-19 tanılı yatarak tedavi gören elli çocuğu çalışmaya dahil ettik. Tüm hastaların nazofaringeal sürüntüleri RT-PCR ile iki kez pozitifti. Her vaka klinik veriler, laboratuvar testleri ve rektal sürüntü ile değerlendirildi. Rektal sürüntüler nazofarengeal pozitiflikten beş gün sonra alındı. Klinik veriler, genel semptomlar veya sindirim semptomları dahil olmak üzere iki temel kategoride kaydedildi. Rektal sürüntülerde SARS-CoV-2’nin tespiti, RNA’ya bağımlı RNA polimeraz genini hedefleyen RT-PCR yöntemi ile gerçekleştirildi.
Bulgular: On beş hastada (%30) sindirim sistemi ilişkili belirtiler görüldü. Hastalarda yoğun bakıma veya daha fazla tedaviye ihtiyaç duyulmadı. 5. günde PCR-RT ile 50 rektal sürüntü çalışıldı. Bunlardan sadece biri pozitifti (%2). Rektal sürüntüde SARS-Cov 2 pozitif gelen tek hasta semptomatik ve üç buçuk yaşında bir kızdı. İzlemde asemptomatik hale gelen hasta bir hafta sonra nazofaringeal sürüntü ile tekrar test edildi, sonucu negatif geldi ve 10. gün taburcu edildi. Olgunun ikinci rektal sürüntüsü negatif olarak sonuçlandı.
Sonuç: Nazofaringeal sürüntü PCR ile COVID-19 doğrulanmış çocuklar arasında rektal sürüntü PCR ile dışkıda viral bulaşma oranının çok düşük olduğunu (%2) bulduk. Bu sonucun, takip ettiğimiz COVID-19 tanısı alan hastaların hafif klinik seyrine bağlı olduğunu düşündük. Bununla birlikte, fekal oral yolla bulaşma çocuklarda hala önemini korumaktadır.
References
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382:727-33. Tezer H, Bedir Demirdag T. Novel coronavirus disease (COVID-19) in children. Review Article. Turk J Med Sci 2020;50: 592-603. Available from: URL: https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/
- Di Gennaro F, Pizzol D, Marotta C, Antunes M, Racalbuto V, Veronese N, et al. Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health 2020;17:2690.
- Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatrica 2020;109:1088–95.
- Ren SY, Wang BW, Hao YG, Zang HR, Wang ZC, Chen YL, Gao RD. Stability and infectivity of coronaviruses in inanimate environments. World J Clin Cases 2020; 8:1391–9.
- Yeo C, Kaushal S, and Yeo D. Enteric involvement of coronaviruses: is fecal–oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol 2020; 4: 335–7.
- Cheung KS , Hung I FN, Chan P PY, Lung KC, Tso E, Liu R, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis. Gastroenterology 2020;159:81-95.
- Liang W, Z Feng, Rao S, Xiao C, Xue X, Lin Z, et al. Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. Gut 2020;69:1141-3.
- Hasan MR, Sundararaju S, Manickam C, Mirza F, Al-Hail H, Lorenz S, et al. A novel point mutation in the N gene of SARS-CoV-2 may affect the detection of the virus by RT-qPCR. J Clin Microbiol 2021;59:e03278-20.
- Xu CLH, Raval M, Schnall, JA, Kwong, JC, Holmes NE. Duration of Respiratory and Gastrointestinal Viral Shedding in Children With SARS-CoV-2: A Systematic Review and Synthesis of Data. Pediatr Infect Dis J 2020;39:e249-56.
- Available from: URL:https://COVID19bilgi.saglik.gov.tr/depo/rehberler/COVID19_Rehberi.pdf
- Zhang JC, Wang SB, Xue YD. Fecal specimen diagnosis 2019 novel coronavirus–infected pneumonia. J Med Virol 2020;92:680–2.
- Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020;26: 502–5.
- Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 395:470-3.
- Zhang N, Gong Y, Meng, Shi Y, Wang J, Mao P, et al. Comparative study on virus shedding patterns in nasopharyngeal and fecal specimens of COVID-19 patients. Sci China Life Sci 2020;5:1-3. doi: 10.1007/s11427-020-1783-9.
- Chan KH, Poon LLM, Cheng VCC, Guan Y, Hung IFN, Kong J et al. Detection of SARS Coronavirus in Patients with Suspected SARS. Emerg Infect Dis 2004 ;2:294–9.
- Xing YH, Ni W, Wu Q,Li WJ, Li GJ, Wang WD, et al. Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019. J Microbiol Immunol Infect 2020;53:473-80.
- Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis 2020;39:469-77.
- Wang X, Zheng J, Guo L, Yao H, Wang L, Xia XD, et al. Fecal viral shedding in COVID19 patients: Clinical significance, viral load dynamics and survival analysis.Virus Res 2020; 289:198147
- Santos VS, Gurgel RQ, Cuevas LE, Martins-Filho PR. Prolonged fecal shedding of SARSCoV-2 in pediatric patients. A quantitative evidence synthesis. Meta-Analysis J Pediatr Gastroenterol Nutr 2020;71:150-2.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences, Internal Diseases |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Publication Date | May 30, 2022 |
| Submission Date | March 2, 2021 |
| Published in Issue | Year 2022 Volume: 16 Issue: 3 |
The publication language of Turkish Journal of Pediatric Disease is English.
Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.
The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.