title: Diarrhea in medical care workers with severe acute respiratory syndrome.
abstract: OBJECTIVE
  Several known coronavirus species cause a variety of diseases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission.
  
  
  METHODS
  Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by enzyme-linked immunosorbent assays at the convalescent phase.
  
  
  RESULTS
  The incidence of watery diarrhea was 18.8% (3 of 16). The RT-PCR of coronavirus was positive in three (18.8%) of 16 throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25% (1 of 16). The diarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6% (27 of 138) of the hospital-acquired outbreak in the Prince of Wales Hospital in Hong Kong (P = 0.798). In contrast to the high positive rate of feces RT-PCR (97%) in Amoy Gardens, our positive rate in rectal swab RT-PCT (0%) was significantly lower (P = 0.00000002).
  
  
  CONCLUSIONS
  Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.
authors.affiliation: Division of Gastroenterology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, Republic of China.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiu
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Wu
authors.forename: Yeh-Pin
authors.initials: YP
authors.lastname: Chou
authors.forename: Tze-Vun
authors.initials: TV
authors.lastname: Fong
authors.forename: Tung-Lung
authors.initials: TL
authors.lastname: Tsai
authors.forename: Chung-Mou
authors.initials: CM
authors.lastname: Kuo
authors.forename: Chung-Huang
authors.initials: CH
authors.lastname: Kuo
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Jhien-Wei
authors.initials: JW
authors.lastname: Liu
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D003967:Diarrhea / Q000821:virology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D010564:Personnel, Hospital; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D045473:Severe acute respiratory syndrome-related coronavirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D045169:Severe Acute Respiratory Syndrome / Q000150:complications* / Q000175:diagnosis; D013624:Taiwan / Q000453:epidemiology; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral