Clinical and Laboratory Characteristics of COVID-19 Patients with Fecal SARS-CoV-2 Detection at a Tertiary Hospital in Indonesia

Transmission prevention is important to prevent the spread of COVID-19. Although most cases are transmitted through droplets and aerosols, several studies have shown the possibility of transmission through fecal material. It is important to identify which patients are more likely to shed SARS-CoV-2 to raise awareness of the virus transmission via their feces. This study aims to determine the association of clinical and laboratory characteristics of COVID-19 patients with the SARS-CoV-2 detection in feces. From May to December 2020, fecal specimens from confirmed COVID-19 patients were collected, processed, and tested for the SARS-CoV-2 RNA presence. Clinical and laboratory parameters were compared between patients with and without SARS-CoV-2 RNA in their feces. Categorical variables were analyzed using Chi-square or Fisher’s Exact test, whereas non-categorical variables were analyzed using Independent T test and Mann-Whitney U test. From 51 COVID-19 patients of whom fecal specimen were collected, SARS-CoV-2 RNA was found in the feces of 26 (50.9%). The SARS-CoV-2 presence in the feces was associated with cough (p=0.002), dyspnea (p=0.017), bilateral pneumonia (p=0.011), lower SARS-CoV-2 CT-values in nasopharyngeal and oropharyngeal swabs (p=0.015), and clinical severity (p=0.0023). In conclusion, several clinical characteristics contributing to the COVID-19 severity and higher SARS-CoV-2 viral load in the respiratory tract were associated with the SARS-CoV-2 RNA detection in feces.