COVID-19 Virus Found in Abdominal Fluids of Liver Disease Patients Raises New Health Alarms
Nikhil Prasad Fact checked by:Thailand Medical News Team Apr 19, 2025 11 hours, 26 minutes ago
Medical News: In a troubling medical revelation, researchers in Italy have discovered the presence of SARS-CoV-2—the virus behind COVID-19—in the abdominal fluid of patients with cirrhosis, raising fresh concerns about viral spread and the hidden dangers faced by individuals with liver disease.
SARS-CoV-2 Virus Found in Abdominal Fluids of Liver Disease Patients Raises New Health Alarms
The study was conducted by a team of researchers from multiple medical institutions across Italy, including the University Hospital Policlinico “G. Rodolico-San Marco” of Catania, the University of Catania, the University of Messina, and the Department of Adult and Childhood Human Pathology “G. Barresi” at the University of Messina. Their findings were based on three real-life cases of cirrhotic patients who were also infected with COVID-19 and had tested positive for the virus in their ascitic (abdominal) fluid—a phenomenon that had rarely been documented before. This
Medical News report dives into their alarming findings and what it could mean for both patients and healthcare workers.
A Hidden Pathway for the Virus
COVID-19 is widely known to primarily attack the respiratory system, but doctors have increasingly noted that the virus can also be found in multiple organs and bodily fluids, including the liver, kidneys, and even the gastrointestinal tract. Now, this new study adds the peritoneal cavity—the space in the abdomen where fluid can accumulate—as a new potential reservoir for SARS-CoV-2.
The three cases involved elderly male patients, all of whom had advanced liver disease and a variety of comorbid conditions including heart disease and diabetes. They were hospitalized for COVID-19 and later developed worsening abdominal symptoms. Doctors performed a procedure called paracentesis to drain excess abdominal fluid. In each case, this fluid tested positive for SARS-CoV-2 using a sensitive PCR-based diagnostic method, even when nasal swabs were no longer showing signs of infection.
Tragically, all three patients died shortly after these findings, further highlighting how severely the virus can affect those with pre-existing liver conditions.
How Does the Virus Ends Up in the Belly
Researchers believe that the virus reaches the abdominal cavity through multiple routes. One possibility is through the bloodstream, especially since the virus has been detected in the blood of infected individuals. Another route is via the lymphatic system, which drains fluids from the gut and liver. A third mechanism may involve direct shedding of the virus from the intestines—an organ rich in ACE2 receptors, which the virus uses to enter cells. These same receptors are also found in liver cells and the lining of the bile ducts.
This interplay between the gut and the liver, known as the gut–liver axis, becomes especially important in patients with liver damage. A weakened intestinal barrier due to infection could
allow viruses and harmful substances to travel through the portal vein into the liver and nearby abdominal cavities.
A Warning for Liver Patients and Surgeons Alike
The presence of the virus in peritoneal fluid could act as a red flag for doctors, signaling a more severe form of COVID-19. In fact, the study notes that patients who carry higher amounts of the virus in their lungs and blood are more likely to have it spread to other areas, including the abdominal cavity. This means that the detection of the virus in ascitic fluid could potentially serve as a marker for poor prognosis.
For healthcare workers—especially those performing abdominal surgeries—these findings raise concerns. There is theoretical risk that SARS-CoV-2 could become aerosolized during procedures like laparoscopy, increasing the chance of exposure. However, early data suggest that current protective measures may still be effective in preventing transmission during such procedures.
Not Just a Rare Occurrence
While earlier reports of the virus in ascitic fluid were few and often dismissed as anomalies, this new study gives weight to the possibility that it may be more common in severely ill liver patients. A broader literature review conducted by the researchers supports this claim. In a total of 357 abdominal fluid samples studied globally, 5.9 percent tested positive for SARS-CoV-2. One autopsy study even found the virus in 80 percent of peritoneal fluid samples from deceased COVID-19 patients.
Implications and What Comes Next
The findings from this case series suggest that SARS-CoV-2’s behavior in the body is far more complex than initially thought. Its ability to persist in areas beyond the respiratory tract—even after nasal swabs turn negative—indicates the possibility of hidden viral reservoirs within the body.
While the study does not prove that the presence of the virus in ascitic fluid directly causes worse outcomes, it strongly implies that such viral spread is associated with more severe disease and greater risk of death in liver patients. This could mean that regular monitoring of abdominal fluids in these individuals might help doctors make more informed decisions, especially when signs of liver failure emerge.
Conclusion
The detection of SARS-CoV-2 in the abdominal fluid of cirrhotic patients opens up new questions about how the virus behaves in vulnerable populations and may force the medical community to rethink how it monitors and treats COVID-19 in patients with liver disease. Given the high mortality observed in the reported cases, it becomes critical to closely monitor individuals with pre-existing liver conditions for gastrointestinal symptoms and to consider abdominal viral testing where appropriate. Furthermore, if future studies confirm these findings in larger patient groups, routine screening of ascitic fluid might become a vital tool in assessing disease progression and risks. This also reinforces the need to enhance protective strategies for healthcare workers involved in abdominal procedures. Only through expanded research and vigilant care can we hope to minimize the impact of such complex viral manifestations.
The study findings were published in the peer reviewed journal: COVID.
https://www.mdpi.com/2673-8112/5/4/58
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