Abstract Background Currently, there is no direct evidence to prove the active replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the intestinal tract and relevant pathological changes in the colon and rectum. We investigated the presence of virions and pathological changes in surgical rectal tissues of a patient with clinically confirmed coronavirus disease 2019 (COVID-19) with rectal adenocarcinoma. Methods The clinical data were collected during hospitalization and follow-up of this patient. Quantitative reverse transcriptase–polymerasechain reaction (RT-PCR) was performed on the rectal tissue specimens obtained from surgical resection, succus entericus and intestinal mucosa of ileostomy, and rectal mucosa during follow-up after recovery. Ultrathin sections of surgical samples were observed for SARS-CoV-2 virions using electron microscopy. Histopathological examination was performed using hematoxylin-eosin stain. Immunohistochemical analysis and immunofluorescence were carried out on rectal tissues to evaluate the distribution of SARS-CoV-2 antigen and immune cell infiltrations. Results The patient had fever and cough on day 3 postoperatively, was diagnosed with COVID-19 on day 7, and was discharged from the hospital on day 41. RNA of SARS-CoV-2 was detected in surgically resected rectal specimens but not in samples collected 37 days after discharge. Notably, coincident with rectal tissues of surgical specimens testing nucleic acid positive for SARS-CoV-2, typical coronavirus virions in rectal tissue were observed under electron microscopy. Moreover, abundant lymphocytes and macrophages (some were SARS-CoV-2 positive) infiltrating the lamina propria were found with no significant mucosal damage. Conclusions We first report the direct evidence of active SARS-CoV-2 replication in a patient’s rectum during the incubation period, which might explain SARS-CoV-2 fecal–oral transmission. During the incubation period, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be detected in the rectum of patients. Typical SARS-CoV-2 virions in the intestinal epithelial cells under electron microscopy were observed, which provided direct evidence of active SARS-CoV-2 replication in the intestine.
【저자키워드】 COVID-19, SARS-CoV-2, Coronavirus disease 2019, intestinal infection rectal cancer, 【초록키워드】 coronavirus disease, Macrophage, Coronavirus disease 2019, coronavirus, Lymphocytes, macrophages, Hospitalization, hospital, surgical, severe acute respiratory syndrome Coronavirus, cough, RT-PCR, discharge, RNA, Replication, lymphocyte, nucleic acid, electron microscopy, Microscopy, Fever, intestine, Patient, Incubation period, epithelial cells, Follow-up, SARS-CoV-2 antigen, immunofluorescence, respiratory, distribution, patients, SARS-CoV-2 replication, Evidence, Immune cell, Fecal–oral transmission, evidence of, reverse transcriptase, Ileostomy, Colon, acute respiratory syndrome, rectal tissues, Ultrathin sections, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, eosin, hematoxylin, Clinical data, specimen, intestinal tract, SARS-CoV-2 virions, virion, positive, histopathological examination, virions, surgical resection, intestinal epithelial cells, rectal specimens, hematoxylin-eosin stain, Immunohistochemical analysis, intestinal mucosa, lamina propria, pathological changes, rectal adenocarcinoma, rectal mucosa, rectal tissue, rectum, succus entericus, surgical rectal tissues, surgical specimens, Result, collected, evaluate, carried, investigated, clinically, provided, was performed, pathological change, discharged, explain, infiltrating, intestinal epithelial cell, coronavirus virion, diagnosed with COVID-19, mucosal damage, rectal specimen, SARS-CoV-2 virion, surgical rectal tissue, surgical specimen, Typical, Ultrathin section, 【제목키워드】 Direct,