Journal
CLINICAL INFECTIOUS DISEASES
Volume 73, Issue 3, Pages 361-366Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa925
Keywords
SARS-CoV-2; coronavirus disease 2019; COVID-19; intestinal infection rectal cancer
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Funding
- National Science and Technology Major Projects [2020YFC0846200]
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The study investigated the presence of SARS-CoV-2 virions and pathological changes in the rectal tissues of a COVID-19 patient with rectal adenocarcinoma. Results showed evidence of active replication of SARS-CoV-2 in the patient's rectum during the incubation period, potentially explaining fecal-oral transmission of the virus.
Background. Currently, there is no direct evidence to prove the active replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the intestinal tract and relevant pathological changes in the colon and rectum. We investigated the presence of virions and pathological changes in surgical rectal tissues of a patient with clinically confirmed coronavirus disease 2019 (COVID-19) with rectal adenocarcinoma. Methods. The clinical data were collected during hospitalization and follow-up of this patient. Quantitative reverse transcriptase-polymerasechain reaction (RT-PCR) was performed on the rectal tissue specimens obtained from surgical resection, succus entericus and intestinal mucosa of ileostomy, and rectal mucosa during follow-up after recovery. Ultrathin sections of surgical samples were observed for SARS-CoV-2 virions using electron microscopy. Histopathological examination was performed using hematoxylin-eosin stain. Immunohistochemical analysis and immunofluorescence were carried out on rectal tissues to evaluate the distribution of SARS-CoV-2 antigen and immune cell infiltrations. Results. The patient had fever and cough on day 3 postoperatively, was diagnosed with COVID-19 on day 7, and was discharged from the hospital on day 41. RNA of SARS-CoV-2 was detected in surgically resected rectal specimens but not in samples collected 37 days after discharge. Notably, coincident with rectal tissues of surgical specimens testing nucleic acid positive for SARS-CoV-2, typical coronavirus virions in rectal tissue were observed under electron microscopy. Moreover, abundant lymphocytes and macrophages (some were SARS-CoV-2 positive) infiltrating the lamina propria were found with no significant mucosal damage. Conclusions. We first report the direct evidence of active SARS-CoV-2 replication in a patient's rectum during the incubation period, which might explain SARS-CoV-2 fecal-oral transmission.
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