Melissa Niyonkuru1,2, Rune Micha Pedersen3,4, Kristian Assing5, Thomas Emil Andersen3,4, Marianne Nielsine Skov3,4, Isik Somuncu Johansen6,7, Lone Wulff Madsen6,7. 1. Department of Infectious Diseases, Odense University Hospital, J.B Winsløws Vej 4, 5000, Odense C, Denmark. melissa.niyonkuru@rsyd.dk. 2. Research Unit for Infectious Diseases, University of Southern Denmark, Odense, Denmark. melissa.niyonkuru@rsyd.dk. 3. Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark. 4. Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark. 5. Department of Clinical Immunology, Odense University Hospital, Odense, Denmark. 6. Department of Infectious Diseases, Odense University Hospital, J.B Winsløws Vej 4, 5000, Odense C, Denmark. 7. Research Unit for Infectious Diseases, University of Southern Denmark, Odense, Denmark.
Abstract
BACKGROUND: The duration of viable Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) shedding in immunocompromised patients is still unknown. This case report describes the duration of viable SARS-CoV-2 in two immunocompromised patients with completely different clinical courses and further addresses the immunological aspects. CASE PRESENTATIONS: Oropharyngeal swaps were collected continuously during hospitalization for two immunocompromised patients infected with SARS-CoV-2 and sent for analysis to real time reverse transcription polymerase chain reaction (RT-PCR), viral culture assessed by plaque assay and full genome sequencing. Blood samples for flow cytometry and further immunological analysis were taken once during admission. One patient was without symptoms of Coronavirus disease 2019 (COVID-19) whereas the other had severe respiratory symptoms requiring a stay at an intensive care unit (ICU) and treatment with remdesivir and dexamethasone. Despite their difference in clinical courses, they both continuously shed SARS-CoV-2 with high viral loads in culture. Both patients had undetectable anti SARS-CoV-2 IgG levels about 2 weeks after the first positive real time RT-PCR test of SARS-CoV-2, marked expansions of virus reactive CD8+ T cells but cellular markers indicative of attenuated humoral immunity. CONCLUSIONS: Our case illustrates the importance of distinguishing isolation guidelines for patients infected with SARS-CoV-2 according to their immunological status. Furthermore, it demonstrates the need for immune markers relating to viral shedding in immunocompromised patients.
BACKGROUND: The duration of viable Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) shedding in immunocompromised patients is still unknown. This case report describes the duration of viable SARS-CoV-2 in two immunocompromised patients with completely different clinical courses and further addresses the immunological aspects. CASE PRESENTATIONS: Oropharyngeal swaps were collected continuously during hospitalization for two immunocompromised patientsinfected with SARS-CoV-2 and sent for analysis to real time reverse transcription polymerase chain reaction (RT-PCR), viral culture assessed by plaque assay and full genome sequencing. Blood samples for flow cytometry and further immunological analysis were taken once during admission. One patient was without symptoms of Coronavirus disease 2019 (COVID-19) whereas the other had severe respiratory symptoms requiring a stay at an intensive care unit (ICU) and treatment with remdesivir and dexamethasone. Despite their difference in clinical courses, they both continuously shed SARS-CoV-2 with high viral loads in culture. Both patients had undetectable anti SARS-CoV-2 IgG levels about 2 weeks after the first positive real time RT-PCR test of SARS-CoV-2, marked expansions of virus reactive CD8+ T cells but cellular markers indicative of attenuated humoral immunity. CONCLUSIONS: Our case illustrates the importance of distinguishing isolation guidelines for patientsinfected with SARS-CoV-2 according to their immunological status. Furthermore, it demonstrates the need for immune markers relating to viral shedding in immunocompromised patients.
Authors: Jonathan S Hausmann; Julia F Simard; Jeffrey A Sparks; Michael DiIorio; Kevin Kennedy; Jean W Liew; Michael S Putman; Emily Sirotich; Sebastian E Sattui; Gary Foster; Carly Harrison; Maggie J Larché; Mitchell Levine; Tarin T Moni; Lehana Thabane; Suleman Bhana; Wendy Costello; Rebecca Grainger; Pedro M Machado; Philip C Robinson; Paul Sufka; Zachary S Wallace; Jinoos Yazdany; Monique Gore-Massy; Richard A Howard; More A Kodhek; Nadine Lalonde; Laura-Ann Tomasella; John Wallace; Akpabio Akpabio; Deshiré Alpízar-Rodríguez; Richard P Beesley; Francis Berenbaum; Inita Bulina; Eugenia Yupei Chock; Richard Conway; Alí Duarte-García; Eimear Duff; Tamer A Gheita; Elizabeth R Graef; Evelyn Hsieh; Lina El Kibbi; David Fl Liew; Chieh Lo; Michal Nudel; Aman Dev Singh; Jasvinder A Singh; Namrata Singh; Manuel F Ugarte-Gil Journal: RMD Open Date: 2022-09