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      "titulo" => "Viral metagenomics performed in patients with acute febrile syndrome during <span class="elsevierStyleItalic">Toxoplasma gondii</span> outbreak in south Brazil"
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            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Phylogenetic analysis of Parvovirus B19 &#40;B19V&#41;&#46; Only complete genomes were used for tracing the phylogenetic history of B19V&#46; The nucleotide substitution model used was TN<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>F<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>R2 for tree reconstruction&#44; which was chosen by BIC &#40;Bayesian Information Criterion&#41; statistic model&#44; utilizing 10&#44;000 ultrafast bootstrap replicates for statistical significance&#46; Only values of above 75&#37; were demonstrated on important tree branches&#46; The phylogenetic tree was constructed using the IQtree software v&#46;16&#46;12&#44; applying the maximum likelihood approach&#46;</p>"
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            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Timeline of the main events related to phage&#39;s research during the last decades&#46; At the top of the figure&#44; world events related to phage research&#44; while in the bottom&#44; the main researches that were conducted in Brazil&#46; The investigations involving phages in Brazil were obtained through research in the PubMed&#44; using the indicators &#8220;Bacteriophages AND Brazil&#8221; or &#8220;Phages AND Brazil&#8221;&#46; For a better understanding or to request more information about events shown on the top of the figure&#44; we suggest reading Salmond and Fineran&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a> Additionally&#44; for more information about the early studies carried out in Brazil&#44; we suggest reading Almeida and Sundberg&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a></p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Normal chest CT findings at different sections&#58; A and D&#44; B and E&#44; and C and F represent the same levels&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Severe acute respiratory syndrome coronavirus 2 &#40;SARS-CoV-2&#41; emerged in Wuhan and has spread rapidly in China&#44; South Korea&#44; and worldwide&#46; Since December 2019&#44; more than 120&#44;000 people have been infected&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#8211;3</span></a> The SARS-CoV-2 genome has a nucleotide identity of 89&#37; with bat SARS-like-CoVZXC21 and 82&#37; with human SARS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most common symptoms of infection are fever &#40;43&#46;8&#37; on admission and 88&#46;7&#37; during hospitalization&#41; and cough &#40;67&#46;8&#37;&#41;&#46; Diarrhea is uncommon &#40;3&#46;8&#37;&#41;&#46; The median incubation period is four days &#40;interquartile range 2&#8211;7&#41;&#46; On admission&#44; ground-glass opacities are the most common radiological finding on chest computed tomography &#40;CT&#41; &#40;56&#46;4&#37;&#41;&#46; No radiographic or CT abnormality was found in 157 of 877 patients &#40;17&#46;9&#37;&#41; with non-severe disease or in 5 of 173 patients &#40;2&#46;9&#37;&#41; with severe disease&#46; Lymphocytopenia was present in 83&#46;2&#37; of the patients on admission&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> The diagnosis is confirmed by testing pharyngeal or nasal swabs for viral nucleic acids&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a Chinese Center for Disease Control and Prevention &#40;CDC&#41; report&#44; the overall case-fatality rate was 2&#46;3&#37;&#44; with 1023 deaths among 44&#44;672 confirmed cases&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The pandemic has caused many social public health problems&#44; leading to economic recession and panic&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> This is a global health problem and not just a problem in China&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">While patients with positive pharyngeal or nasal swabs have received much attention&#44; asymptomatic or mildly ill patients with positive anal swabs have not&#46; We know little about these patients&#44; who may be shadows in the sun&#46; However&#44; they are potential sources of infection via fecal&#8211;oral transmission&#46; Here&#44; we present an asymptomatic baby in whom anal swabs were positive while pharyngeal swabs were persistently negative by real-time PCR testing&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">An 8-month-8-day-old girl was hospitalized with one day history of cough and runny nose on Feb 25&#44; 2020&#46; The patient was afebrile with no shortness of breath&#44; clubbing&#44; cyanosis&#44; or abdominal distension&#46; The patient was given oral ambroxol hydrochloride solution 15<span class="elsevierStyleHsp" style=""></span>mg&#44; three times per day&#44; with no improvement&#46; The patient&#39;s mother&#44; diagnosed with SARS-CoV-2 2 days earlier&#44; had positive pharyngeal swab by real-time PCR testing and chest CT showing ground-glass opacities&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On physical examination&#44; the patient had a body temperature of 38<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; pulse of 116<span class="elsevierStyleHsp" style=""></span>beats&#47;min&#44; respiratory rate of 30<span class="elsevierStyleHsp" style=""></span>breaths&#47;min&#44; and oxygen saturation in room air of 99&#37;&#46; She was conscious and appeared acutely ill&#46; There were no fluctuations in the nasal wings but some secretion in the nasal cavity&#44; with redness&#44; congestion&#44; and a normal voice was observed&#46; The breath sounds were normal in both lungs&#44; with no dry or wet rales&#46; Heart auscultation was normal&#46; The abdomen was soft&#44; and bowel sounds were normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Laboratory tests were negative for influenza A and B viral antigens&#46; The leukocyte count was 11&#46;91<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L&#44; with a neutrophil count of 2&#46;91<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L &#40;24&#46;4&#37;&#41; and lymphocyte count of 7&#46;87<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L &#40;66&#46;1&#37;&#41;&#46; The C-reactive protein level was 3&#46;49<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; The prothrombin time and <span class="elsevierStyleSmallCaps">d</span>-dimer level were normal&#44; as well as alanine transaminase&#44; alanine transaminase&#44; urea nitrogen&#44; and creatinine levels&#46; Chest CT results had no abnormal findings &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Recombinant human interferon alfa-1b via atomization inhalation &#40;20<span class="elsevierStyleHsp" style=""></span>&#181;g&#44; twice&#47;day&#41; was initiated&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Anal swabs were positive on February 27 and March 4&#46; The symptoms improved on March 7&#44; and anal swabs were negative on March 9 and 10&#46; The patient was discharged on March 11&#46; Throat swabs were persistently negative throughout the hospital stay&#46; Real-time PCR for COVID-19 on pharyngeal and anal swabs were performed by the Pengzhou &#40;Sichuan Province&#44; China&#41; CDC&#46; The Chengdu CDC repeated the PCR testing and obtained the same results&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Diagnosis of SARS-CoV-2 depends on imaging&#44; epidemiological history&#44; and nucleic acid testing&#46; During the early stage of the pandemic&#44; most patients were in China&#44; especially in Wuhan&#44; Hubei Province&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> As the number of patients grew geometrically&#44; the Chinese government locked down Wuhan and effectively isolated infected people from non-infected people&#46; In early March 2020&#44; the disease was effectively controlled in China&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; many confirmed and suspected cases have appeared in other regions and countries&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> It has become a global pandemic&#44; and its rapid spread and high lethality require special attention&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although the infection and mortality rates are lower in infants and young children than in adults&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> young patients cannot communicate effectively&#44; which limits the ability to obtain their medical history&#46; Our patient developed a sudden onset cough&#44; and her mother was confirmed to be infected&#46; Although the baby&#39;s pharyngeal swabs and chest CT were negative&#44; her anal swabs remained positive for eight days&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Not enough attention is given to asymptomatic or mildly infected patients with positive anal swabs&#46; Here&#44; we present a mildly ill baby whose anal swabs were real-time PCR positive for SARS-CoV-2&#44; while many pharyngeal swabs were negative&#46; SARS-CoV-2 was stable under the conditions tested&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The main host receptor is angiotensin converting enzyme 2&#44; which is located on gastrointestinal epithelial cells&#44; and the feces of 20&#37; of SARS-CoV-2 patients remain positive for viral RNA after negative conversion of viral RNA in the respiratory tract&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Wang et al&#46; detected live SARS-CoV-2 in stool samples from two confirmed patients&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Unfortunately&#44; our laboratory lacked the capacity to determine whether the stool virus was still active&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Physicians should be aware that asymptomatic or mildly ill children with history of exposure and negative pharyngeal&#47;nasal swabs and positive anal swabs are potential sources of infection via fecal&#8211;oral transmission for COVID-19&#46; In addition to nasal&#47;pharyngeal swabs&#44; we believe that children should be tested for SARS-CoV-2 using anal swabs&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Infants with a history of SARS-CoV-2 exposure and mild symptoms should be tested using anal swabs&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical approval</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study was approved by Pidu District People&#39;s Hospital &#40;Batch 2020-03-18-001&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">No founding&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study was a retrospective observational nature study&#44; patient identity remained anonymous&#44; and have no invasive procedure&#44; so the ethics committee waived informed consent&#46;</p></span></span>"
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Case report
An infant with a mild SARS-CoV-2 infection detected only by anal swabs: a case report
Juan Lia, Jing Fenga, Tian-hu Liub, Feng-cheng Xub, Guo-qiang Songc,
Corresponding author
wzyxysgq@126.com

Corresponding author.
a Pidu District People's Hospital, Department of Infectious Diseases, Chengdu, Sichuan Province, China
b Pidu District People's Hospital, Department of Cardiology, Chengdu, Deyuan Chengdu, Sichuan Province, China
c Changxing County Hospital, of Traditional Chinese Medicine, Department of Respiratory Medicine, Huzhou, Zhejiang Province, China
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            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Phylogenetic analysis of Parvovirus B19 &#40;B19V&#41;&#46; Only complete genomes were used for tracing the phylogenetic history of B19V&#46; The nucleotide substitution model used was TN<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>F<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>R2 for tree reconstruction&#44; which was chosen by BIC &#40;Bayesian Information Criterion&#41; statistic model&#44; utilizing 10&#44;000 ultrafast bootstrap replicates for statistical significance&#46; Only values of above 75&#37; were demonstrated on important tree branches&#46; The phylogenetic tree was constructed using the IQtree software v&#46;16&#46;12&#44; applying the maximum likelihood approach&#46;</p>"
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      "titulo" => "Clinical utilization of bacteriophages&#58; a new perspective to combat the antimicrobial resistance in Brazil"
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            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Timeline of the main events related to phage&#39;s research during the last decades&#46; At the top of the figure&#44; world events related to phage research&#44; while in the bottom&#44; the main researches that were conducted in Brazil&#46; The investigations involving phages in Brazil were obtained through research in the PubMed&#44; using the indicators &#8220;Bacteriophages AND Brazil&#8221; or &#8220;Phages AND Brazil&#8221;&#46; For a better understanding or to request more information about events shown on the top of the figure&#44; we suggest reading Salmond and Fineran&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a> Additionally&#44; for more information about the early studies carried out in Brazil&#44; we suggest reading Almeida and Sundberg&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a></p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Severe acute respiratory syndrome coronavirus 2 &#40;SARS-CoV-2&#41; emerged in Wuhan and has spread rapidly in China&#44; South Korea&#44; and worldwide&#46; Since December 2019&#44; more than 120&#44;000 people have been infected&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#8211;3</span></a> The SARS-CoV-2 genome has a nucleotide identity of 89&#37; with bat SARS-like-CoVZXC21 and 82&#37; with human SARS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most common symptoms of infection are fever &#40;43&#46;8&#37; on admission and 88&#46;7&#37; during hospitalization&#41; and cough &#40;67&#46;8&#37;&#41;&#46; Diarrhea is uncommon &#40;3&#46;8&#37;&#41;&#46; The median incubation period is four days &#40;interquartile range 2&#8211;7&#41;&#46; On admission&#44; ground-glass opacities are the most common radiological finding on chest computed tomography &#40;CT&#41; &#40;56&#46;4&#37;&#41;&#46; No radiographic or CT abnormality was found in 157 of 877 patients &#40;17&#46;9&#37;&#41; with non-severe disease or in 5 of 173 patients &#40;2&#46;9&#37;&#41; with severe disease&#46; Lymphocytopenia was present in 83&#46;2&#37; of the patients on admission&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> The diagnosis is confirmed by testing pharyngeal or nasal swabs for viral nucleic acids&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a Chinese Center for Disease Control and Prevention &#40;CDC&#41; report&#44; the overall case-fatality rate was 2&#46;3&#37;&#44; with 1023 deaths among 44&#44;672 confirmed cases&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The pandemic has caused many social public health problems&#44; leading to economic recession and panic&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> This is a global health problem and not just a problem in China&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">While patients with positive pharyngeal or nasal swabs have received much attention&#44; asymptomatic or mildly ill patients with positive anal swabs have not&#46; We know little about these patients&#44; who may be shadows in the sun&#46; However&#44; they are potential sources of infection via fecal&#8211;oral transmission&#46; Here&#44; we present an asymptomatic baby in whom anal swabs were positive while pharyngeal swabs were persistently negative by real-time PCR testing&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">An 8-month-8-day-old girl was hospitalized with one day history of cough and runny nose on Feb 25&#44; 2020&#46; The patient was afebrile with no shortness of breath&#44; clubbing&#44; cyanosis&#44; or abdominal distension&#46; The patient was given oral ambroxol hydrochloride solution 15<span class="elsevierStyleHsp" style=""></span>mg&#44; three times per day&#44; with no improvement&#46; The patient&#39;s mother&#44; diagnosed with SARS-CoV-2 2 days earlier&#44; had positive pharyngeal swab by real-time PCR testing and chest CT showing ground-glass opacities&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On physical examination&#44; the patient had a body temperature of 38<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; pulse of 116<span class="elsevierStyleHsp" style=""></span>beats&#47;min&#44; respiratory rate of 30<span class="elsevierStyleHsp" style=""></span>breaths&#47;min&#44; and oxygen saturation in room air of 99&#37;&#46; She was conscious and appeared acutely ill&#46; There were no fluctuations in the nasal wings but some secretion in the nasal cavity&#44; with redness&#44; congestion&#44; and a normal voice was observed&#46; The breath sounds were normal in both lungs&#44; with no dry or wet rales&#46; Heart auscultation was normal&#46; The abdomen was soft&#44; and bowel sounds were normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Laboratory tests were negative for influenza A and B viral antigens&#46; The leukocyte count was 11&#46;91<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L&#44; with a neutrophil count of 2&#46;91<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L &#40;24&#46;4&#37;&#41; and lymphocyte count of 7&#46;87<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L &#40;66&#46;1&#37;&#41;&#46; The C-reactive protein level was 3&#46;49<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; The prothrombin time and <span class="elsevierStyleSmallCaps">d</span>-dimer level were normal&#44; as well as alanine transaminase&#44; alanine transaminase&#44; urea nitrogen&#44; and creatinine levels&#46; Chest CT results had no abnormal findings &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Recombinant human interferon alfa-1b via atomization inhalation &#40;20<span class="elsevierStyleHsp" style=""></span>&#181;g&#44; twice&#47;day&#41; was initiated&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Anal swabs were positive on February 27 and March 4&#46; The symptoms improved on March 7&#44; and anal swabs were negative on March 9 and 10&#46; The patient was discharged on March 11&#46; Throat swabs were persistently negative throughout the hospital stay&#46; Real-time PCR for COVID-19 on pharyngeal and anal swabs were performed by the Pengzhou &#40;Sichuan Province&#44; China&#41; CDC&#46; The Chengdu CDC repeated the PCR testing and obtained the same results&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Diagnosis of SARS-CoV-2 depends on imaging&#44; epidemiological history&#44; and nucleic acid testing&#46; During the early stage of the pandemic&#44; most patients were in China&#44; especially in Wuhan&#44; Hubei Province&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> As the number of patients grew geometrically&#44; the Chinese government locked down Wuhan and effectively isolated infected people from non-infected people&#46; In early March 2020&#44; the disease was effectively controlled in China&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; many confirmed and suspected cases have appeared in other regions and countries&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> It has become a global pandemic&#44; and its rapid spread and high lethality require special attention&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although the infection and mortality rates are lower in infants and young children than in adults&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> young patients cannot communicate effectively&#44; which limits the ability to obtain their medical history&#46; Our patient developed a sudden onset cough&#44; and her mother was confirmed to be infected&#46; Although the baby&#39;s pharyngeal swabs and chest CT were negative&#44; her anal swabs remained positive for eight days&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Not enough attention is given to asymptomatic or mildly infected patients with positive anal swabs&#46; Here&#44; we present a mildly ill baby whose anal swabs were real-time PCR positive for SARS-CoV-2&#44; while many pharyngeal swabs were negative&#46; SARS-CoV-2 was stable under the conditions tested&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The main host receptor is angiotensin converting enzyme 2&#44; which is located on gastrointestinal epithelial cells&#44; and the feces of 20&#37; of SARS-CoV-2 patients remain positive for viral RNA after negative conversion of viral RNA in the respiratory tract&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Wang et al&#46; detected live SARS-CoV-2 in stool samples from two confirmed patients&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Unfortunately&#44; our laboratory lacked the capacity to determine whether the stool virus was still active&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Physicians should be aware that asymptomatic or mildly ill children with history of exposure and negative pharyngeal&#47;nasal swabs and positive anal swabs are potential sources of infection via fecal&#8211;oral transmission for COVID-19&#46; In addition to nasal&#47;pharyngeal swabs&#44; we believe that children should be tested for SARS-CoV-2 using anal swabs&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Infants with a history of SARS-CoV-2 exposure and mild symptoms should be tested using anal swabs&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical approval</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study was approved by Pidu District People&#39;s Hospital &#40;Batch 2020-03-18-001&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">No founding&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study was a retrospective observational nature study&#44; patient identity remained anonymous&#44; and have no invasive procedure&#44; so the ethics committee waived informed consent&#46;</p></span></span>"
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The Brazilian Journal of Infectious Diseases