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Brazilian Journal of Infectious Diseases

Print version ISSN 1413-8670On-line version ISSN 1678-4391

Braz J Infect Dis vol.24 no.4 Salvador Jul./Aug. 2020  Epub Oct 02, 2020 

Letters to the editor

Mild and asymptomatic cases of COVID-19 are potential threat for faecal–oral transmission

1Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brazil

The recent Coronavirus Disease 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was firstly reported on December 2019 in Wuhan, China. Despite the classical respiratory symptoms, some case studies have reported gastrointestinal symptoms and the presence of SARS-CoV-2 (RNA or live virus) in feces of patients diagnosed with COVID-19.1,2 In this sense, the present Journal recently published an article that touches on this issue. Li et al.3 reported a mild SARS-CoV-2 infection in an 8-month-8-day-old girl. Curiously, her rectal swabs remained positive for eight days, whereas her nasopharyngeal swabs were persistently negative by real-time reverse transcription PCR (RT–PCR). In a similar way, other study reported that among 10 children infected with SARS-CoV-2, eight children persistently tested positive on rectal swabs even after nasopharyngeal RT-PCR testing be negative.4 Therefore, the present case report published in this Journal have corroborated significantly with previous findings from the current literature: (i) rectal swabs may be used to confirm diagnosis of COVID-19, even when nasopharyngeal testing is negative; (ii) another possible route of transmission might be fecal–oral; (iii) mild and asymptomatic cases, especially in children, are potential sources of fecal–oral transmission.


This study was supported by CNPq, CAPES, and FAPEMIG.


1 Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;:. [ Links ]

2 Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;:. [ Links ]

3 Li J, Feng J, Liu T, Xu F, Song G. An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report. Braz J Infect Dis. 2020;:. [ Links ]

4 Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;:. [ Links ]

Received: May 20, 2020; Accepted: June 14, 2020

Author’s contribution

S.C.T. developed the hypothesis, drafted and critically edited the manuscript. The author read and approved the final manuscript.

Ethical approval

Not required.

Conflicts of interest

The author declares no conflicts of interest.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivative License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited and the work is not changed in any way.