{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:10:18Z","timestamp":1790169018093,"version":"4.1.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T00:00:00Z","timestamp":1594080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2020YFC0846200"],"award-info":[{"award-number":["2020YFC0846200"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The clinical data were collected during hospitalization and follow-up of this patient. Quantitative reverse transcriptase\u2013polymerasechain 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We first report the direct evidence of active SARS-CoV-2 replication in a patient\u2019s rectum during the incubation period, which might explain SARS-CoV-2 fecal\u2013oral transmission.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa925","type":"journal-article","created":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T03:19:21Z","timestamp":1593573561000},"page":"361-366","source":"Crossref","is-referenced-by-count":129,"title":["Direct Evidence of Active SARS-CoV-2 Replication in the Intestine"],"prefix":"10.1093","volume":"73","author":[{"given":"Qun","family":"Qian","sequence":"first","affiliation":[{"name":"Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China"},{"name":"Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China"},{"name":"Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, China"},{"name":"Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan, China"},{"name":"Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifang","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hubei Cancer Hospital, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weicheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China"},{"name":"Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China"},{"name":"Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, China"},{"name":"Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan, China"},{"name":"Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junqiu","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hubei Cancer Hospital, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingwei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Hubei Cancer Hospital, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianliang","family":"Ke","sequence":"additional","affiliation":[{"name":"CAS Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Center for Biosafety Mega-Science, CAS Center for Influenza Research and Early Warning, Chinese Academy of Sciences, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China"},{"name":"Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China"},{"name":"Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, China"},{"name":"Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan, China"},{"name":"Quality Control Center of 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