Could faecal viral excretion explain gastrointestinal symptoms in COVID-19 patients: co- infection involvement?

Objectives: Physiopathological mechanisms responsible for digestive symptoms during COVID-19 are still unclear. The aim of this study was to determine the influence of faecal viral shedding on digestive symptoms and propose differential diagnoses to better understand the gastrointestinal clinical spectrum during acute COVID-19. Methods: : Patients were included if one stool sample was available for microbiological investigation. Microbiological analysis consisted of syndromic PCR screening, and parasitological investigation included microsporidia and multiplex protozoa PCR. SARS-CoV-2 infection was diagnosed by viral detection (on respiratory samples and frozen stool samples) and by serology when necessary. Collected epidemiological, clinical, radiological, biological data and clinical course were compared according to COVID-19 status, faecal SARS-CoV-2 shedding and co-infection status. Results: : 50 COVID+ and 67 COVID- patients were included. Faecal viral shedding was detected in 50% of stool samples and was associated with higher viral load in the upper respiratory tract. There was no difference in the proportion of detected enteric pathogens between COVID-19 status. No impact was observed on clinical course regardless of COVID-19 status, faecal SARS-CoV-2 shedding and coinfection status. Conclusions: SARS-CoV-2 shedding and enteric pathogen involvement in gastrointestinal presentation is still unclear. However, differential diagnostic investigation revealed frequently occurring common enteric pathogens in COVID-19 patients.