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. 2004 Feb 15;38(4):467-75.
doi: 10.1086/382681. Epub 2004 Jan 29.

Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome

V C C Cheng  1 , I F N Hung, B S F Tang, C M Chu, M M L Wong, K H Chan, A K L Wu, D M W Tse, K S Chan, B J Zheng, J S M Peiris, J J Y Sung, K Y Yuen
Affiliations

Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome

V C C Cheng et al. Clin Infect Dis. .

Abstract

The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol. Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed. Sixty-nine patients (48.6%) developed diarrhea at a mean (+/- standard deviation [SD]) of 7.6+/-2.6 days after the onset of symptoms. The diarrhea was most severe at a mean (+/-SD) of 8.8+/-2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3-24 episodes). A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log10 vs. 1.8 log10 copies/mL; P=.01) and mortality (6.2 vs. 1.7 log10 copies/mL; P<.01). However, diarrhea was not associated with mortality. The lung and the gastrointestinal tract may react differently to SARS coronavirus infection. Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.

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Figures

Table 1
Table 1
Clinical symptoms and signs for 142 patients with severe accurate respiratory syndrome at presentation.
Table 2
Table 2
Hematological and biochemical findings for 142 patients with severe acute respiratory syndrome at presentation and on day 10 after the onset of symptoms.
Table 3
Table 3
Extent of radiological involvement and microbiological findings for 142 patients with severe acute respiratory syndrome (SARS).
Figure 1
Figure 1
Percentage of patients with severe acute respiratory syndrome who had diarrhea during hospitalization
Table 4
Table 4
Demographic characteristics of 142 patients who had severe acute respiratory syndrome with or without diarrhea during hospitalization.
Figure 2
Figure 2
Frequency of bowel movements in relation to virus load in nasopharyngeal specimens on day 10 after the onset of symptoms. NPS, nasopharyngeal specimen; qPCR, quantitative RT-PCR.
See this image and copyright information in PMC

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