Legend: NS, nasal swab; RS, rectal swab;ND, no data;*median were not available for one/two positive value.
The transmission of SARS-CoV-2 through direct contact with infected secretion or aerosol droplets is well known.5 However, in the past epidemics caused by other Coronavirus (SARS-CoV-1 and MERS-CoV), viral RNA was also detected in several clinical specimens such as 42% urine, 97% stool and 50% plasma.6-8 In this respect, these materials have been considered as useful clinical samples to improve laboratory diagnosis.
Also, the possibility of different SARS-CoV-2 transmission routes could be contemplated. In this brief report, we described the presence of the virus in different clinical samples, including RS, plasma, and urine, supporting the evidence of a potential shed of the virus through fecal-oral or body fluid routes.
In this study, the highest rate of positive RT-PCR for SARS-CoV-2 was detected in RS specimens (10.3%), suggesting that SARS-CoV-2 may be transmitted by the fecal route.5 However, this rate is lower than SARS-CoV-1.
Focusing on plasma samples, we reported only a few cases of positive RNA detection in plasma (7.7%), but higher than that reported by Wang et al.,5 suggesting a systemic infection can occur although less frequently with respect to 50% SARS-CoV-1.9
The SARS-CoV-2 was rarely detected in urine, and, to date, no other authors reported a significant presence of the virus in urine of COVID-19 patients.
Although SARS-CoV-2 was detected in specimens from multiple sites of patients with positive NS for COVID-19, no positive results were obtained in patients with negative NS, supporting the hypothesis that respiratory samples represent the gold standard for COVID-19 molecular diagnosis.
Transmission of SARS-CoV-2 by respiratory droplets and other way routes highlights the risk of contagious via environmental contamination with infected clinical specimens, highlighting the importance of protection and decontamination procedures despite extensive contamination of inanimate surfaces.10 Longitudinal studies should be performed to evaluate the incidence of SARS-CoV-2 RNA in specimens different from respiratory samples.