icon-    folder.gif   Conference Reports for NATAP  
  Conference on Retroviruses
and Opportunistic Infections
Will be Virtual
Boston USA
March 6-10, 2021
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COVID Virus Can Linger in Gut a Half-Year After Symptoms Clear
  CROI 2021, Conference on Retroviruses and Opportunistic Infections, March 6-10, 2021
Mark Mascolini
SARS-CoV-2 antigen-and presumably viral particles-can persist in small intestine up to 7 months after other COVID-19 symptoms resolve, according to results of a 29-person study [1]. Yet later detection of viral antigen in gut did not correlate with gastrointestinal (GI) symptoms during acute infection, and intestinal Inflammation was mild or absent in most cases.
Researchers from New York's Icahn School of Medicine at Mount Sinai noted that GI symptoms represent the most frequent nonlung problem with COVID-19. SARS-CoV-2 RNA can be found in fecal samples of COVID-19 patients after RNA no longer appears on nasopharyngeal swabs. Lab studies show that SARS-CoV-2 can infect intestinal enterocytes, but the COVID-19 virus had not been assessed in gut cells of people until this study.
The analysis involved 29 people who had clinically indicated endoscopy during or after active COVID-19 infection. Researchers collected biopsies of the duodenum, terminal ileum, or both and assessed cells from all 29 people by histology, from 25 by immunofluorescence, and from 14 by electron microscopy or electron tomography.
The 29 participants averaged 51.5 years in age, and 19 (65.5%) were men. An average 56.6 days elapsed since COVID-19 symptom onset and endoscopy. During COVID-19 care, clinicians noted GI symptoms in only 8 people (28%).
Immunofluorescence or electron microscopy detected SARS-CoV-2 antigen in 16 of these 29 people (55%). Antigen and viral particles appeared primarily in goblet cells (column-shaped cells in the respiratory and intestinal tracts). But most people with detectable viral antigen in gut cells had mild related inflammation or no inflammation. Thirteen of 29 people (45%) had histologic signals of inflammation, such as neutrophils and increased intraepithelial lymphocytes. In 16 of 29 people (55%), histology of biopsy samples looked normal. Half of the biopsies showing viral products had normal histology.
An average 47 days passed between COVID-19 symptom onset and endoscopy in people who had detectable viral antigen or particles in gut cells. Only 4 of 16 people (25%) with viral antigen or particles in intestinal cells had GI symptoms in the acute phase of their COVID-19. In one person who continues to have abdominal pain and weight loss, viral antigen could be spotted in intestinal cells 7 months after other COVID-19 symptoms resolved.
The Mount Sinai investigators concluded that SARS-CoV-2 infects intestinal enterocytes in people diagnosed with COVID-19, and viral signals can persist in these gut cells for more than a half-year after other COVID-19 symptoms clear up. But lingering SARS-CoV-2 in intestinal cells could not be tied to intestinal inflammation and does not seem linked to GI symptoms during acute COVID-19 infection.
1. Tokuyama M, Ladinsky MS, Jha D, et al. SARS-CoV-2 persists in intestinal enterocytes up to 7 months after symptom resolution. CROI 2021, Conference on Retroviruses and Opportunistic Infections, March 6-10, 2021. Abstract 115.