title: Severe acute respiratory syndrome associated coronavirus is detected in intestinal tissues of fatal cases.
abstract: OBJECTIVE
  A significant percentage of confirmed severe acute respiratory syndrome (SARS) patients experienced gastrointestinal symptoms, and the viral sequence was detectable in the stool of most patients. At present, the knowledge of the pathology of the digestive system in SARS patients is limited. Because a resurgence of the SARS epidemic is constantly possible, there is an urgent need to understand the involvement of the digestive system in this new disease.
  
  
  METHODS
  We performed seven SARS autopsies in which samples of alimentary tract and digestive glands were examined with routine pathology, electron microscopy (EM), in situ hybridization (ISH), immunohistochemistry, and real-time polymerase chain reaction (PCR).
  
  
  RESULTS
  The main histopathological finding was atrophy of the mucosal lymphoid tissue. A few mucosal epithelial cells and lymphocytes in the intestine were positively stained for coronavirus with ISH. SARS-coronavirus (CoV)-like particles were found in the mucosal epithelial cells under EM and mild focal inflammation was detected in the alimentary tract. One patient who experienced severe diarrhea had pseudomembranous enteritis of the ileum. Fatty degeneration and central lobular necrosis were observed in the liver. No evidence of direct viral infection was found in the esophagus, the stomach, the salivary gland, the liver, or the pancreas.
  
  
  CONCLUSIONS
  In addition to the lungs, the gastrointestinal tract is another target of SARS-CoV infection, as the intestinal epithelial cells and mucosal lymphoid tissue are infected. The findings provide possible explanations for the gastrointestinal symptoms and the presence of virus in the stool of SARS patients.
authors.affiliation: Department of Pathology, Peking University Health Science Center, Beijing, China.
authors.forename: Xueying
authors.initials: X
authors.lastname: Shi
authors.forename: Encong
authors.initials: E
authors.lastname: Gong
authors.forename: Dongxia
authors.initials: D
authors.lastname: Gao
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
authors.forename: Zifen
authors.initials: Z
authors.lastname: Gao
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Zhong
authors.forename: Wanzhong
authors.initials: W
authors.lastname: Zou
authors.forename: Bingquan
authors.initials: B
authors.lastname: Wu
authors.forename: Weigang
authors.initials: W
authors.lastname: Fang
authors.forename: Songlin
authors.initials: S
authors.lastname: Liao
authors.forename: Shenglan
authors.initials: S
authors.lastname: Wang
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Xie
authors.forename: Min
authors.initials: M
authors.lastname: Lu
authors.forename: Lin
authors.initials: L
authors.lastname: Hou
authors.forename: Haohao
authors.initials: H
authors.lastname: Zhong
authors.forename: Hongquan
authors.initials: H
authors.lastname: Shao
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Congrong
authors.initials: C
authors.lastname: Liu
authors.forename: Fei
authors.initials: F
authors.lastname: Pei
authors.forename: Jingping
authors.initials: J
authors.lastname: Yang
authors.forename: Yuping
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Han
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Shi
authors.forename: Qianying
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jiangfeng
authors.initials: J
authors.lastname: You
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhu
authors.forename: Jiang
authors.initials: J
authors.lastname: Gu
mesh_terms: D000328:Adult; D001344:Autopsy; D005260:Female; D005767:Gastrointestinal Diseases / Q000378:metabolism / Q000473:pathology / Q000821:virology; D041981:Gastrointestinal Tract / Q000378:metabolism / Q000473:pathology* / Q000821:virology*; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D045473:Severe acute respiratory syndrome-related coronavirus / Q000302:isolation & purification*; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000378:metabolism / Q000473:pathology*