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. 2003 Oct;125(4):1011-7.
doi: 10.1016/s0016-5085(03)01215-0.

Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection

Wai K Leung  1 , Ka-Fai To, Paul K S Chan, Henry L Y Chan, Alan K L Wu, Nelson Lee, Kwok Y Yuen, Joseph J Y Sung
Affiliations

Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection

Wai K Leung et al. Gastroenterology. 2003 Oct.

Abstract

Background and aims: Severe acute respiratory syndrome (SARS) is a recently emerged infection from a novel coronavirus (CoV). Apart from fever and respiratory complications, gastrointestinal symptoms are frequently observed in patients with SARS but the significance remains undetermined. Herein, we describe the clinical, pathologic, and virologic features of the intestinal involvement of this new viral infection.

Methods: A retrospective analysis of the gastrointestinal symptoms and other clinical parameters of the first 138 patients with confirmed SARS admitted for a major outbreak in Hong Kong in March 2003 was performed. Intestinal specimens were obtained by colonoscopy or postmortem examination to detect the presence of coronavirus by electron microscopy, virus culture, and reverse-transcription polymerase chain reaction.

Results: Among these 138 patients with SARS, 28 (20.3%) presented with watery diarrhea and up to 38.4% of patients had symptoms of diarrhea during the course of illness. Diarrhea was more frequently observed during the first week of illness. The mean number of days with diarrhea was 3.7 +/- 2.7, and most diarrhea was self-limiting. Intestinal biopsy specimens obtained by colonoscopy or autopsy showed minimal architectural disruption but the presence of active viral replication within both the small and large intestine. Coronavirus was also isolated by culture from these specimens, and SARS-CoV RNA can be detected in the stool of patients for more than 10 weeks after symptom onset.

Conclusions: Diarrhea is a common presenting symptom of SARS. The intestinal tropism of the SARS-CoV has major implications on clinical presentation and viral transmission.

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Figures

Figure 1
Figure 1
Percentage of SARS patients with diarrhea during the first 21 days of illness.
Figure 2
Figure 2
Histologic and ultrastructural appearances of the colon in a patient with SARS-CoV infection. (A) Endoscopic colonic biopsy specimens with scattered lipofusin-ladened macrophages in the lamina propria indicative of melanosis coli. The macrophages are indicated by the red arrows, and there were no significant inflammatory cell infiltrates (H&E; original magnification 200×). (B) Dilated cytoplasmic vesicles, which were consistent with dilated endoplasmic reticulum, were seen toward the apical cytoplasm (indicated by red arrowheads) and some were filled with viral particles. A number of viral particles were also seen on the surface microvilli (indicated by black arrows). (C) Higher magnification of the virus-containing vesicles. The viral particles had mild variation in size and ranged from 60 to 90 nm in dimension, which is consistent with coronavirus morphologically. (D) Viral particles were detected on the luminal surface of the enterocytes. Some viral particles appeared to attach onto the microvilli, whereas some appeared to be detached from the cell.
Figure 3
Figure 3
Histologic and ultrastructural appearances of the small intestine in patients with SARS-CoV infection. (A) Section of the small intestine of an autopsy specimen with unremarkable mucosa, submucosa, and muscle layer (H&E; original magnification 40×). (B) Endoscopic ileal biopsy specimen with no inflammatory process (tangentially sectioned, H&E; original magnification 200×). (C) Dilated cytoplasmic vesicles filled with viral particles in the small intestine (indicated by red arrowheads). Scattered viral particles were also detected on the surface microvilli of this surface enterocyte (indicated by black arrow). (D) Higher magnification of a virus-containing vesicle.
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References

    1. Department of Health. Latest figures on severe acute respiratory syndrome. Available at: http://www.info.gov.hk/dh/diseases/ap/eng/infected.htm/. Accessed June 3, 2003.
    1. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt G.M, Ahuja A, Yung M.Y, Leung C.B, To K.F, Lui S.F, Szeto C.C, Chung S, Sung J.J. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–1994. - PubMed
    1. World Heath Organization. Cumulative number of reported probable cases of SARS. Available at: http://www.who.int/csr/sars/country/2003_05_31/en/. Accessed June 2, 2003.
    1. Donnelly C.A, Ghani A.C, Leung G.M, Hedley A.J, Fraser C, Riley S, Abu-Raddad L.J, Ho L.M, Thach T.Q, Chau P, Chan K.P, Lam T.H, Tse L.Y, Tsang T, Liu S.H, Kong J.H, Lau E.M, Ferguson N.M, Anderson R.M. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361:1761–1766. - PMC - PubMed
    1. Ksiazek T.G, Erdman D, Goldsmith C.S, Zaki S.R, Peret T, Emery S, Tong S, Urbani C, Comer J.A, Lim W, Rollin P.E, Dowell S.F, Ling A.E, Humphrey C.D, Shieh W.J, Guarner J, Paddock C.D, Rota P, Fields B, DeRisi J, Yang J.Y, Cox N, Hughes J.M, JeDuc J.W, Bellini W.J, Anderson L.J, SARS Working Group A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953–1966. - PubMed