Diarrhea in medical care workers with severe acute respiratory syndrome.
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.
Chiu
Yi-Chun
YC
Division of Gastroenterology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, Republic of China.
Wu
Keng-Liang
KL
Chou
Yeh-Pin
YP
Fong
Tze-Vun
TV
Tsai
Tung-Lung
TL
Kuo
Chung-Mou
CM
Kuo
Chung-Huang
CH
Chiu
King-Wah
KW
Liu
Jhien-Wei
JW
Eng
Hock-Liew
HL
Jawan
Bruno
B
Cheng
Yu-Fan
YF
Chen
Chao-Long
CL
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
D000914:Antibodies, Viral; D012367:RNA, Viral