Immunocompromised Patients at Risk for Prolonged Infectiousness of SARS-CoV-2

Observations made from 3 deeply immunocompromised patients indicated a pattern of long-term carriage and infectiousness of SARS-CoV-2. These findings were published in the Journal of Infectious Diseases.

Researchers from Hôpital Bichat Claude Bernard and Centre Hospitalier René Dubos in France recruited 3 immunocompromised patients for this study. These patients provided respiratory samples and sera, which were tested for SARS-CoV-2 by polymerase chain reaction (PCR) and for anti-SARS-CoV-2 nucleocapsid and spike immunoglobulin G antibodies. Researchers cultured viral samples to assess cytopathogenic effects and sequenced viral genomes to identify specific variants.

Patient 1 was a 66-year-old African man with HIV-1, cerebrospinal fluid positive for human polyomavirus, and progressive multifocal leukoencephalopathy. He was admitted to the hospital on June 4, 2020, and although he did not display dyspnea or respiratory symptoms, he had increasing COVID-19 lesions and progressive neurological deterioration. He continued to test positive for COVID-19 by nasopharyngeal swab until day 124 and never tested positive for serology. The viral strain had 14 mutations compared with the original strain that originated from Wuhan, China, which was used as reference.

Patient 2 was a 71-year-old European man who had a previous heart transplant, diabetes mellitus, chronic kidney disease, and was receiving combinatorial therapy of prednisone, mycophenolic acid, and belatacept. He was admitted to the hospital on April 15, 2020, for approximately 6 weeks with dry cough, myalgia, asthenia, and low-grade fever. On day 76 of symptoms, he was again admitted to the hospital due to cardiac decompensation. He remained positive at his last PCR assessment on day 120 and was seronegative for antibodies.

Patient 3 was a 35-year-old man from Tunisia who had rheumatoid arthritis treated with rituximab. He tested positive for SARS-CoV-2 on April 28, 2020, and presented with fever, cough, and mild dyspnea. Discharged on day 3, the patient’s symptoms continued through day 49 when he was readmitted to the hospital but tested negative by PCR on day 51. On day 56, he had a positive bronchoalveolar lavage test and symptoms soon progressed. He was treated with corticosteroids. He next tested negative for COVID-19 on day 104 and remained seronegative through day 121. Earlier and later viral samples during his infection revealed a coinfection with a strain that had 7 additional mutations, likely causing the symptom relapse on day 73.

This was a small, observational study and may not reflect the majority of patients who are deeply immunocompromised.

The observations from these 3 patients indicated immunodeficiency may prolong viral shedding among patients who have no respiratory symptoms, symptom relapse, and/or superinfection. Further study is needed to determine how long these patients remain infectious, such that effective isolation policies may be implemented.

Reference

Tarhini H, Recoing A, Bridier-Nahmias A, et al. Long term SARS-CoV-2 infectiousness among three immunocompromised patients: from prolonged viral shedding to SARS-CoV-2 superinfection. J Infect Dis. 2021;jiab075. doi:10.1093/infdis/jiab075.

This article originally appeared on Infectious Disease Advisor