Michele Spinicci1,2, Alessio Mazzoni3, Marco Coppi3, Alberto Antonelli3, Lorenzo Salvati3, Laura Maggi3, Gregorio Basile3, Lucia Graziani3, Nicoletta Di Lauria4, Vincenzo Di Pilato5, Seble Tekle Kiros3, Enrico Beccastrini6, Riccardo Saccardi3,6, Manuela Angileri7, Michele Cecchi7, Maria Grazia Cusi8, Gian Maria Rossolini3,9, Francesco Annunziato3,10, Alessandro Bartoloni3,4, Paola Parronchi3,11. 1. Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. michele.spinicci@unifi.it. 2. Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy. michele.spinicci@unifi.it. 3. Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. 4. Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy. 5. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy. 6. Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy. 7. Pharmacy AD Preparation Unit, Careggi University Hospital, Florence, Italy. 8. Department of Medical Biotechnologies, University of Siena, Siena, Italy. 9. Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy. 10. Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), Careggi University Hospital, Florence, Italy. 11. Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy.
Abstract
PURPOSE: SARS-CoV-2 infection in immunocompromised hosts is challenging, and prolonged viral shedding can be a common complication in these patients. We describe the clinical, immunological, and virological course of a patient with eosinophilic granulomatosis with polyangiitis, who developed the status of long-term asymptomatic SARS-CoV-2 carrier for more than 7 months. METHODS: Over the study period, the patient underwent 20 RT-PCR tests for SARS-CoV-2 detection on nasopharyngeal swabs. In addition, viral cultures and genetic investigation of SARS-CoV-2 were performed. As for immunological assessment, serological and specific T-cell testing was provided at different time points. RESULTS: Despite the patient showing a deep drug-induced B and T adaptive immunity impairment, he did not experience COVID-19 progression to severe complications, and the infection remained asymptomatic during the follow-up period, but he was not able to achieve viral clearance for more than 7 months. The infection was finally cleared by SARS-CoV-2-specific monoclonal antibody treatment, after that remdesivir and convalescent plasma failed in this scope. The genetic investigations evidenced that the infection was sustained by multiple viral subpopulations that had apparently evolved intra-host during the infection. CONCLUSION: Our case suggests that people with highly impaired B- and T-cell adaptive immunity can prevent COVID-19 progression to severe complications, but they may not be able to clear SARS-CoV-2 infection. Immunocompromised hosts with a long-term infection may play a role in the emergence of viral variants.
PURPOSE: SARS-CoV-2 infection in immunocompromised hosts is challenging, and prolonged viral shedding can be a common complication in these patients. We describe the clinical, immunological, and virological course of a patient with eosinophilic granulomatosis with polyangiitis, who developed the status of long-term asymptomatic SARS-CoV-2 carrier for more than 7 months. METHODS: Over the study period, the patient underwent 20 RT-PCR tests for SARS-CoV-2 detection on nasopharyngeal swabs. In addition, viral cultures and genetic investigation of SARS-CoV-2 were performed. As for immunological assessment, serological and specific T-cell testing was provided at different time points. RESULTS: Despite the patient showing a deep drug-induced B and T adaptive immunity impairment, he did not experience COVID-19 progression to severe complications, and the infection remained asymptomatic during the follow-up period, but he was not able to achieve viral clearance for more than 7 months. The infection was finally cleared by SARS-CoV-2-specific monoclonal antibody treatment, after that remdesivir and convalescent plasma failed in this scope. The genetic investigations evidenced that the infection was sustained by multiple viral subpopulations that had apparently evolved intra-host during the infection. CONCLUSION: Our case suggests that people with highly impaired B- and T-cell adaptive immunity can prevent COVID-19 progression to severe complications, but they may not be able to clear SARS-CoV-2 infection. Immunocompromised hosts with a long-term infection may play a role in the emergence of viral variants.
Authors: Julia M Neuhann; Jannik Stemler; Antonio Carcas; Jesús Frías-Iniesta; Ullrich Bethe; Sarah Heringer; Lea Tischmann; Marouan Zarrouk; Arnd Cüppers; Franz König; Martin Posch; Oliver A Cornely Journal: Trials Date: 2022-10-08 Impact factor: 2.728