Case Report: Prolonged Viral Shedding in Six COVID-19 Patients (original) (raw)
Related papers
Journal of Clinical Medicine, 2020
Background: The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a major global public health issue. SARS-CoV-2 infection is confirmed by the detection of viral RNA using reverse transcription polymerase chain reaction (RT-PCR). Prolonged viral shedding has been reported in patients with SARS-CoV-2 infection, but the presence of viral RNA does not always correlate with infectivity. Therefore, the present study aimed to confirm the presence of viable virus in asymptomatic or mildly symptomatic patients in the later phase of the disease, more than two weeks after diagnosis. Method: Asymptomatic or mildly symptomatic COVID-19 patients who had been diagnosed with the disease at least two weeks previously and admitted to a community treatment center (CTC) from 15 March to 10 April 2020 were enrolled in this study. Nasopharyngeal and salivary swab specimens were collected from each patient. Using these specimens, R...
The Journal of Infectious Diseases, 2021
Background To better understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding and infectivity, we estimated SARS-CoV-2 RNA shedding duration, described participant characteristics associated with the first negative rRT-PCR test (resolution), and determined if replication-competent viruses was recoverable ≥10 days after symptom onset. Methods We collected serial nasopharyngeal specimens from 109 individuals with rRT-PCR–confirmed COVID-19 in Utah and Wisconsin. We calculated viral RNA shedding resolution probability using the Kaplan-Meier estimator and evaluated characteristics associated with shedding resolution using Cox proportional hazards regression. We attempted viral culture for 35 rRT-PCR–positive nasopharyngeal specimens collected ≥10 days after symptom onset. Results The likelihood of viral RNA shedding resolution at 10 days after symptom onset was approximately 3%. Time to shedding resolution was shorter among participants aged <18 years (adjuste...
2020
ObjectivesA few molecularly proven SARS-CoV-2 cases of symptomatic reinfection are currently known worldwide, with a resolved first infection followed by a second infection after a 48 to 142-day intervening period. We report a multiple-component study of a clinically severe and prolonged viral shedding COVID-19 case in a teenager Portuguese female. She had two hospitalisations, a total of 19 RT-PCR tests, mostly positive, and criteria for releasing from home isolation at the end of 97 days.MethodsThe viral genome was sequenced in seven serial samples and in the diagnostic sample from an infected close relative. A human genome-wide array (>900K) was screened on the seven samples, and in vitro culture was conducted on isolates from three late samples.ResultsThe patient had co-infection by two SARS-CoV-2 strains, affiliated in distinct clades and diverging by six variants. The 20A lineage was absolute at the diagnosis (shared with a cohabitating relative), but nine days later the 20...
Clinical Case Reports, 2020
, epidemiological and clinical characteristics of patients with COVID-19 are being reported worldwide. A recent study of 191 Chinese patients reported a median viral shedding duration of 20.0 days (IQR 17.0-24.0) in survivors. However, SARS-CoV-2 was detectable until death in nonsurvivors. Moreover, 37 days were reported to be the longest observed duration of viral shedding in survivors. 1 We report the case of a 25 years old woman, working as a resident at the dental clinic of Brest University Hospital, who developed the symptoms of COVID-19 and was tested positive for SARS-CoV-2 RNA twice during 53 days. 2 | METHODS A summary of patient's history, family history, environment, background, clinical examination, biological data, diagnosis, and treatments of the clinical case is provided in Table 1. 3 | RESULTS On 15 March 2020, this young lady presented with the first phase of COVID-19 symptoms, that is, digestive disorders, diarrhea, rhinitis, rheum, buccal aphthous, dry cough, and a 38°C fever. She was previously in good health, non-smoker, without any medication, or known risk factor for COVID-19. She only reported a history of psoriasis of the hand, elbow, and scalp once a year in the past 10 years. Given her healthcare provider status and her mild symptoms, after a first positive SARS-CoV-2 RNA PCR on March 18, she was placed in quarantine at her home. This symptomatic period was associated with appearance of chills, fever (38°C), high fatigue, and ageusia. In addition, she presented with a worsening (upon ante flexion) headache, localized at the forehead and the temporal region. She also presented with body aches especially in the cervical region, the upper back, and the legs during the first week. Additionally, cutaneous manifestations (pruritic lesions) covered all her limbs with approximately 10 × 2 mm of red
Frontiers in Medicine, 2021
The evolving nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated periodic revisions of COVID-19 patient treatment and discharge guidelines. Since the identification of the first COVID-19 cases in November 2019, the World Health Organization (WHO) has played a crucial role in tackling the country-level pandemic preparedness and patient management protocols. Among others, the WHO provided a guideline on the clinical management of COVID-19 patients according to which patients can be released from isolation centers on the 10th day following clinical symptom manifestation, with a minimum of 72 additional hours following the resolution of symptoms. However, emerging direct evidence indicating the possibility of viral shedding 14 days after the onset of symptoms called for evaluation of the current WHO discharge recommendations. In this review article, we carried out comprehensive literature analysis of viral shedding with specific focus on the durat...
2021
Inpatient COVID-19 cases present enormous costs to patients and health systems. Many hospitalized patients may still test COVID-19 positive, even after resolution of symptoms. Thus, a pressing concern for clinicians is the safety of discharging these asymptomatic patients if they have any remaining infectivity. This case report explores the viral viability in a patient with persistent COVID-19 over the course of a two-month hospitalization. Positive nasopharyngeal swab samples, analyzed by quantitative reverse transcription polymerase chain reactions (qRT-PCR), were collected and isolated in the laboratory, and infectious doses were analyzed throughout the hospitalization period. The patient experienced waning symptoms by hospital day 40 and had no viable virus growth in the laboratory by hospital day 41, suggesting no risk of infectivity, despite positive RT-PCR results, which prolonged his hospital stay. Notably, this case showed infectivity for at least 24 days from disease onset...
Journal of Medical Virology
The viral dynamics of SARS-CoV-2 infections with non-Delta strains has followed a typical trajectory of viral RNA shedding for a mean duration of 17 days, accompanied by progressive decline in viral load and subsequent virus culture negativity. 1 However, the Delta variant is known to be more contagious, has a longer duration of virologic shedding, and more likely to result in severe illness than other variants of SARS-CoV-2. 2 Here, we report prolonged shedding of SARS-CoV-2 Delta variant (B.1.617.2) for over 29 days in six patients with severe coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in Australia. One patient (P6) remained culture-positive 33 days after onset of disease (GISAID Accession: EPI_ISL_3874692). These features, including the persistence of high viral load (C t < 30) in these patients, present new uncertainties concerning the safe discharge of patients from isolation into the general inpatient population.
Presymptomatic viral shedding and infective ability of SARS-CoV-2; a case report
Heliyon, 2021
Possible pre-or asymptomatic transmission has been reported, both from SARS-CoV and from MERS-CoV outbreaks, although this appears to be uncommon. In contrast, during the COVID-19 pandemic, an increasing number of studies and case reports indicate that pre-or asymptomatic transmission of SARS-CoV-2 is not only possible but also occurs frequently. We report repeated rRT-PCR detection of SARS-CoV-2 in a health care worker and demonstrate infective ability up to three days prior to mild COVID-19 symptoms. rRT-PCR indicated high viral levels approximately three days after exposure. Viral samples collected one and three days prior to symptoms exhibited infectivity on Vero E6 cells, confirmed by detection of double-stranded RNA by immunofluorescence, assessment of cytopathic effect (CPE) and rRT-PCR. SARS-CoV-2 specific IgM and IgG antibodies were detected by day 9 and 15, respectively, after symptom onset. We propose that this provides evidence for potential early presymptomatic transmission of SARS-CoV-2 and that infectivity may be manifest shortly after exposure.
Prolonged viral shedding and antibody persistence in patients with COVID-19
Microbes and Infection, 2021
SARS-CoV-2 as a new global threat has affected global population for one year. Despite the great effort to eradicate this infection, there are still some challenges including different viral presentation, temporal immunity in infected individuals and variable data of viral shedding. We studied 255 COVID-19 suspected individuals to assess the viral shedding duration and also the antibody development against SARS-CoV-2 among the cases. Real Time RT-PCR assay was applied to determine the virus presence and SARS-CoV-2 antibodies were evaluated using SARS-CoV-2 IgM and IgG kits. 113 patients were confirmed for COVID-19 infection. The patients were followed until negative PCR achieved. The median viral shedding among studied population was obtained 34.16 (±17.65) days which was not significantly associated with age, sex and underlying diseases. Shiver and body pain were found in prolonged form of the infection and also patients who had gastrointestinal problems experienced longer viral shedding. Moreover, IgG was present in 84% of patients after 150 days. According to this data, the median viral shedding prolongation was 34.16 days which indicates that 14 days isolation might not be enough for population. In addition, IgG profiling indicated that it is persistent in a majority of patients for nearly 6 months which has brought some hopes in vaccine efficacy and application.