The longest persistence of viable SARS-CoV-2 with recurrence of viremia and relapsing symptomatic COVID-19 in an immunocompromised patient – a case study
The longest persistence of viable SARS-CoV-2 with recurrence of viremia and relapsing symptomatic COVID-19 in an immunocompromised patient – a case study
Abstract BackgroundImmunocompromised patients show prolonged shedding of SARS-CoV-2 in nasopharyngeal swabs. We report a case of a prolonged persistence of viable SARS-CoV-2 associated with clinical relapses of COVID-19 in a lymphoma patient. MethodsNasopharyngeal swabs and blood samples were tested for SARS-CoV-2 by Real time-PCR (RT-PCR). On five positive nasopharyngeal swabs, we performed viral culture and next generation sequencing. We analysed the patients’ adaptive and innate immunity to characterize T and NK cell subsets. FindingsSARS-CoV-2 RT-PCR on nasopharyngeal swabs samples remained positive with cycle threshold mean values of 22 ± 1·3 for over 8 months. All five performed viral cultures were positive and genomic analysis confirmed a persistent infection with the same strain. Viremia resulted positive in three out of four COVID-19 clinical relapses and cleared each time after remdesivir treatment. T and NK cells dynamic was different in aviremic and viremic samples and no SARS-CoV-2 specific antibodies were detected throughout the disease course. InterpretationIn our patient, SARS-CoV-2 persisted with proven infectivity for over eight months. Viremia was associated with COVID-19 relapses and remdesivir treatment was effective in viremia clearance and symptoms remission, although it was unable to clear the virus from the upper respiratory airways. During the viremic phase, we observed a low frequency of terminal effector CD8+ T lymphocytes in peripheral blood that are probably recruited in inflammatory tissue for viral eradication. In addition we found a high level of NK cells repertoire perturbation with a relevant involvement during SARS-CoV-2 viremia. FundingNone.
Sepulcri Chiara、Bergna Annalisa、De Maria Andrea、Lai Alessia、Parodi Alessia、Delfino Emanuele、Bartalucci Giulia、Orsi Andrea、Di Biagio Antonio、Ballerini Filippo、Bassetti Matteo、Silvestri Guido、Mikulska Malgorzata、Dentone Chiara、Zehender Gianguglielmo、Fenoglio Daniela、Altosole Tiziana、De Palma Raffaele、Bozzano Federica、Bonora Stefano、Bruzzone Bianca
Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of GenoaDepartment of Biomedical and Clinical Sciences Luigi Sacco, University of MilanInfectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa||Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesDepartment of Biomedical and Clinical Sciences Luigi Sacco, University of MilanBiotherapy Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesInfectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesClinic of Hematology, Department of Internal Medicine (DiMI), University of GenoaHygiene Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences Genoa||Hygiene Unit, Department of Health Sciences (DISSAL), University of GenoaInfectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa||Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesHematology Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences GenoaInfectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa||Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesDepartment of Pathology and Laboratory Medicine, Emory University School of Medicine||Division of Microbiology and Immunology Yerkes National Primate Research Center, Emory Vaccine CenterInfectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa||Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesInfectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesHygiene Unit, Department of Biomedical and Clinical Sciences Luigi Sacco, University of MilanCenter of Excellence for Biomedical Research, Cytofluorimetry Unit, University of Genoa||Biotherapy Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesCenter of Excellence for Biomedical Research, Cytofluorimetry Unit, University of GenoaBiotherapy Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences||Immunology Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesInfectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and NeurosciencesInfectious Diseases Unit, Ospedale Amedeo di Savoia, University of TurinHygiene Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences Genoa
医学研究方法临床医学内科学
SARS-CoV-2viral sheddingviral persistenceviremiahematological immunological response
Sepulcri Chiara,Bergna Annalisa,De Maria Andrea,Lai Alessia,Parodi Alessia,Delfino Emanuele,Bartalucci Giulia,Orsi Andrea,Di Biagio Antonio,Ballerini Filippo,Bassetti Matteo,Silvestri Guido,Mikulska Malgorzata,Dentone Chiara,Zehender Gianguglielmo,Fenoglio Daniela,Altosole Tiziana,De Palma Raffaele,Bozzano Federica,Bonora Stefano,Bruzzone Bianca.The longest persistence of viable SARS-CoV-2 with recurrence of viremia and relapsing symptomatic COVID-19 in an immunocompromised patient – a case study[EB/OL].(2025-03-28)[2025-08-09].https://www.medrxiv.org/content/10.1101/2021.01.23.21249554.点此复制
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