Severe Acute Respiratory Syndrome Coronavirus 2 Is Detected in the Gastrointestinal Tract of Asymptomatic Endoscopy Patients but Is Unlikely to Pose a Significant Risk to Healthcare Personnel

Michelle D Cherne; Andrew B Gentry; Anna Nemudraia; Artem Nemudryi; Jodi F Hedges; Heather Walk; Karlin Blackwell; Deann T Snyder; Maria Jerome; Wyatt Madden; Marziah Hashimi; T Andrew Sebrell; David B King; Raina K Plowright; Mark A Jutila; Blake Wiedenheft; Diane Bimczok

doi:10.1016/j.gastha.2022.06.002

Severe Acute Respiratory Syndrome Coronavirus 2 Is Detected in the Gastrointestinal Tract of Asymptomatic Endoscopy Patients but Is Unlikely to Pose a Significant Risk to Healthcare Personnel

Gastro Hep Adv. 2022;1(5):844-852. doi: 10.1016/j.gastha.2022.06.002. Epub 2022 Jun 24.

Authors

Michelle D Cherne¹, Andrew B Gentry², Anna Nemudraia¹, Artem Nemudryi¹, Jodi F Hedges¹, Heather Walk¹, Karlin Blackwell¹, Deann T Snyder¹, Maria Jerome¹, Wyatt Madden^{1

3}, Marziah Hashimi¹, T Andrew Sebrell¹, David B King⁴, Raina K Plowright¹, Mark A Jutila¹, Blake Wiedenheft¹, Diane Bimczok¹

Affiliations

¹ Department of Microbiology and Cell Biology, Montana State University, Bozeman, Montana.
² Department of Gastroenterology, Bozeman Health Deaconess Hospital, Bozeman, Montana.
³ Rollins School of Public Heath, Emory University, Atlanta, Georgia.
⁴ Department of Clinical Research, Bozeman Health Deaconess Hospital, Bozeman, Montana.

Abstract

Background and aims: Recent evidence suggests that the gut is an additional target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, whether SARS-CoV-2 spreads via gastrointestinal secretions remains unclear. To determine the prevalence of gastrointestinal SARS-CoV-2 infection in asymptomatic subjects, we analyzed gastrointestinal biopsy and liquid samples from endoscopy patients for the presence of SARS-CoV-2.

Methods: We enrolled 100 endoscopic patients without known SARS-CoV-2 infection (cohort A) and 12 patients with a previous COVID-19 diagnosis (cohort B) in a cohort study performed at a regional hospital. Gastrointestinal biopsies and fluids were screened for SARS-CoV-2 by polymerase chain reaction (PCR), immunohistochemistry, and virus isolation assay, and the stability of SARS-CoV-2 in gastrointestinal liquids in vitro was analyzed.

Results: SARS-CoV-2 ribonucleic acid was detected by PCR in the colonic tissue of 1/100 patients in cohort A. In cohort B, 3 colonic liquid samples tested positive for SARS-CoV-2 by PCR and viral nucleocapsid protein was detected in the epithelium of the respective biopsy samples. However, no infectious virions were recovered from any samples. In vitro exposure of SARS-CoV-2 to colonic liquid led to a 4-log-fold reduction of infectious SARS-CoV-2 within 1 hour (P ≤ .05).

Conclusion: Overall, the persistent detection of SARS-CoV-2 in endoscopy samples after resolution of COVID-19 points to the gut as a long-term reservoir for SARS-CoV-2. Since no infectious virions were recovered and SARS-CoV-2 was rapidly inactivated in the presence of colon liquids, it is unlikely that performing endoscopic procedures is associated with a significant infection risk due to undiagnosed asymptomatic or persistent gastrointestinal SARS-CoV-2 infections.

Keywords: COVID-19, coronavirus disease 2019; Colonic Liquid; E gene, envelope gene; Endoscopy; GI, gastrointestinal; N gene, nucleocapsid gene; NP, nucleocapsid protein; PFU, plaque-forming units; SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Transmission Risk; qRT-PCR, quantitative reverse transcription polymerase chain reaction.

Abstract

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