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Faecal calprotectin indicates intestinal inflammation in COVID-19
  1. Maria Effenberger1,
  2. Felix Grabherr1,
  3. Lisa Mayr1,
  4. Julian Schwaerzler1,
  5. Manfred Nairz2,
  6. Markus Seifert2,
  7. Richard Hilbe2,
  8. Stefanie Seiwald2,
  9. Sabine Scholl-Buergi3,
  10. Gernot Fritsche2,
  11. Rosa Bellmann-Weiler2,
  12. Günter Weiss2,
  13. Thomas Müller3,
  14. Timon Erik Adolph1,
  15. Herbert Tilg1
  1. 1 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Tirol, Austria
  2. 2 Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
  3. 3 Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Tirol, Austria
  1. Correspondence to Professor Herbert Tilg, Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck 6020, Austria; herbert.tilg{at}

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GI symptoms such as diarrhoea, nausea and vomiting are frequent coronavirus disease (COVID-19) symptoms and affect up to 28% of patients.1–5 The pathophysiology of COVID-19-associated GI symptoms is currently unclear. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-RNA was detected in the faeces in ~50% of patients with COVID-193 5 6; SARS-CoV-2 viral particles were observed by electron microscopy in stool samples from two patients without diarrhoea2; and one study reported SARS-CoV-2 infection of the oesophagus, stomach, duodenum and rectum.5

Faecal calprotectin (FC) has evolved as a reliable faecal biomarker allowing detection of intestinal inflammation in IBD and infectious colitis.7 In this pilot study, we explored a relation between GI symptoms, intestinal inflammation (determined by FC) and faecal SARS-CoV-2-RNA in hospitalised patients with COVID-19 who did not require intensive care measures.

We analysed 40 patients with COVID-19 hospitalised at the University Hospital of Innsbruck, Austria. Confirmation of SARS-CoV-2 infection was performed by nasopharyngeal swab, and faecal SARS-CoV-2-RNA detection was performed using previously described real-time PCR6 as recommended by the Centers for Disease Control and Prevention (DeKalb, Georgia). Diarrhoea was defined as loose stools >3 times/day. We excluded other causes of acute GI infection by stool analysis for common viral, …

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