Clinical features in coronavirus disease 2019 (COVID-19) patients with early clearance and prolonged shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA

Zhou, Yan; Ding, Fangrui; Bao, Wuping; Xue, Yishu; Han, Lei; Zhang, Xue; Zhang, Pengyu; Ji, Yong; Yin, Dongning; Bao, Ande; Luo, Shukun; Xu, Zengchao; Li, Jun; Zhang, Min

doi:10.21037/atm-21-445

Cited by 16 publications

(15 citation statements)

References 33 publications

(31 reference statements)

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“…These findings are in accordance with some previous analyses demonstrating that the viral load increases with age [ 21 ] and is higher in females [ 22 ]. However, we also cannot use underlying comorbidities, such as arterial hypertension and diabetes, as moderator variables, which have been related to a slower viral shedding [ 23 , 24 ]. Moreover, the intrinsic and unmodifiable heterogeneities existing among laboratories have also doubtlessly influenced our results.…”

Section: Discussionmentioning

confidence: 99%

Viral Load Difference between Symptomatic and Asymptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

Zuin

Gentili

Cervellati

et al. 2021

Infectious Disease Reports

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We conducted a systematic review and meta-analysis to investigate the possible difference in the SARS-CoV-2 viral load between asymptomatic and symptomatic COVID-19 patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE, Scopus, Web of Science and Google Scholar for all investigations in the English language, reporting data on the threshold cycle (Ct) from real-time RT-PCR assays for the RNA-dependent RNA polymerase (RdRp), envelope (E) and nucleocapsid (N) SARS-CoV-2 genes in asymptomatic and symptomatic COVID-19 patients. Results: Overall, 703 COVID-19 patients (553 symptomatic and 150 asymptomatic) were analyzed. Five investigations reported the mean age of patients, evidencing that asymptomatic patients were younger than symptomatic patients (34.0 vs. 40.3 years, respectively). Pooled data regarding the levels of expression of the RdRp gene revealed no significant difference between symptomatic and asymptomatic subjects. Similarly, no differences were observed comparing the mean Ct values for the E and N genes. Based on real-time RT-PCR data, no differences exist in the viral load between symptomatic and asymptomatic COVID-19 subjects considering Ct values for RdRp, E and N genes’ expression. Asymptomatic subjects may represent a reservoir of the infection and significantly contribute to the maintenance of the pandemic.

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Section: Discussionmentioning

confidence: 99%

Viral Load Difference between Symptomatic and Asymptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

Zuin

Gentili

Cervellati

et al. 2021

Infectious Disease Reports

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“…1 ). Several other studies have also revealed the presence of fever was significantly associated with prolonged DoVC ( Zhou et al, 2021 ; Bennasrallah et al, 2021 ). These patients were hypothesized to be more severely affected by the SARS-CoV-2 infection in the lungs and thus the prolonged DoVC ( Zhou et al, 2021 ).…”

Section: Discussionmentioning

confidence: 72%

“…Several other studies have also revealed the presence of fever was significantly associated with prolonged DoVC ( Zhou et al, 2021 ; Bennasrallah et al, 2021 ). These patients were hypothesized to be more severely affected by the SARS-CoV-2 infection in the lungs and thus the prolonged DoVC ( Zhou et al, 2021 ). Fever at illness onset may indicate a cytokine storm or a higher viral load at the time of symptom onset ( Chau et al, 2021 ), as the viral load was found to be associated with more severe COVID-19 and a longer virus-shedding period ( Liu et al, 2020b ).…”

Section: Discussionmentioning

confidence: 72%

Risk factors associated with prolonged viral clearance in patients with a refractory course of COVID-19: a retrospective study

Zhuang

Huang

Wang

et al. 2021

PeerJ

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Background This study aimed to characterize a cohort of patients with a refractory course of COVID-19, and to investigate factors associated with the duration of viral clearance (DoVC). Materials & Methods A total of 65 patients with refractory COVID-19 were retrospectively enrolled from Huoshenshan Hospital. Univariate analysis and multivariate analysis were performed to examine the potential association between clinicopathologic characteristics and the DoVC. Results The median DoVC in the overall study cohort was 48 days (ranged from 21 to 104 days). Multivariate analysis indicated that fever at illness onset (Hazard ratio (HR) = 4.897, 95% CI [1.809–13.260], p = 0.002), serum level of aspartate aminotransferase (AST) > 21.8 IU/L (HR = 3.010, 95% CI [1.195–7.578], p = 0.019), and titer of SARS-CoV-2 IgG > 142.09 AU/ml (HR = 3.061, 95% CI [1.263–7.415], p = 0.013) were the three independent risk factors associated with delayed viral clearance. Conclusion The current study suggested that clinical characteristics such as fever at illness onset, a high serum level of AST or SARS-CoV-2 IgG were associated with delayed viral clearance. Patients with these characteristics might need a more individualized treatment strategy to accelerate their recovery from the refractory COVID-19.

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“…Manzulli et al demonstrated that patients showed the viral clearance at viral culture three days or more after clinical recovery [36]. However, other studies reported the persistence of active infection and contagiousness in immunocompromised or severely ill patients [9,[11][12][13][14][37][38][39]. In line with these studies, long term shedding of viable virus was infrequent in our study (10 out of 138 cultured samples, 7.2%) and was nearly limited to patients with conditions associated with prolonged RT-PCR positivity and/or severe COVID-19, but the risk of transmission was still present after three weeks from diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Role of Nucleocapsid Protein Antigen Detection for Safe End of Isolation of SARS-CoV-2 Infected Patients with Long Persistence of Viral RNA in Respiratory Samples

Mencacci

Gili

Gidari

et al. 2021

JCM

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Background. In SARS-CoV-2 infection, viral RNA may persist in respiratory samples for several weeks after the resolution of symptoms. Criteria to assess the end of infectivity are not unequivocally defined. In some countries, time from diagnosis is the unique criterion used, in addition to symptom cessation. This study evaluates the role of the Lumipulse® Antigen Assay (LAA) for the safe end of isolation of patients ≥21 days after the diagnosis of infection. Methods. A total of 671 nasopharyngeal swabs from patients diagnosed with infection at least 21 days before were assessed by RT-PCR and LAA, and the role of LAA in predicting the absence of infectivity was evaluated by virus cell culture. Results. Viable virus was present in 10/138 cultured samples. Eight out of ten infective patients suffered from a concomitant disease, predisposing them to long-term shedding of infective virus. In particular, infectious virus was isolated from 10/20 RT-PCR+/LAA+ cultured samples, whereas no viable virus was found in all 118 RT-PCR+/LAA– cultured swabs. LLA and RT-PCR agreed in 484/671 (72.1%) samples, with 100% and 26.7% concordance in RT-PCR negative and positive samples, respectively. Conclusions. Viable virus can be found ≥21 days after diagnosis in immunocompromised or severely ill patients. LAA better than RT-PCR predicts non-infectivity of patients and can be safely used to end isolation in cases with long persistence of viral RNA in the respiratory tract.

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Clinical features in coronavirus disease 2019 (COVID-19) patients with early clearance and prolonged shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA

Cited by 16 publications

References 33 publications

Viral Load Difference between Symptomatic and Asymptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

Viral Load Difference between Symptomatic and Asymptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

Risk factors associated with prolonged viral clearance in patients with a refractory course of COVID-19: a retrospective study

Role of Nucleocapsid Protein Antigen Detection for Safe End of Isolation of SARS-CoV-2 Infected Patients with Long Persistence of Viral RNA in Respiratory Samples

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