High prevalence of SARS-CoV-2 detection and prolonged viral shedding in stools: A systematic review and cohort study

Objectives: To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2. Methods:We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed asystematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using Kaplan---Meier curves. Results: We included 32 patients; mean age was 43.7 +/- 17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients haddetectable viral RNA in stools. The median clearance time in stools of the cohort was 11[10-15] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studieswere performed in children and 55% were male. The pooled prevalence of viral detection instools was 34.6% (twenty-four studies, 1393 patients; 95%CI:25.4-45.1); heterogeneity was high( I2:91.2%, Q:208.6; p = 0.001). A meta-regression demonstrates an association between femalegender and lower presence in stools (p = 0.004). The median clearance time in stools was 22days (nineteen studies, 140 patients; 95%CI:19-25). After 34 days, 19.9% (95%CI:11.3-29.7) ofpatients have a persistent detection in stools. Conclusions: Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARSCoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions.

Automated summary

The frequency of viral RNA detection in stools is high among patients infected with SARS-CoV-2. The clearance time of SARS-CoV-2 in stools is longer than in nasopharyngeal secretions.