A Case Series Describing the Recurrence of COVID-19 in Patients Who Recovered from Initial Illness in Bangladesh

Abstract

To date, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 80 million people globally. We report a case series of five clinically and laboratory confirmed COVID-19 patients from Bangladesh who suffered a second episode of COVID-19 illness after 70 symptom-free days. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), is a leading public health research institution in South Asia. icddr, b staff were actively tested, treated and followed-up for COVID-19 by an experienced team of clinicians, epidemiologists, and virologists. From 21 March to 30 September 2020, 1370 icddr,b employees working at either the Dhaka (urban) or Matlab (rural) clinical sites were tested for COVID-19. In total, 522 (38%) were positive; 38% from urban Dhaka (483/1261) and 36% from the rural clinical site Matlab (39/109). Five patients (60% male with a mean age of 41 years) had real-time reverse transcription-polymerase chain reaction (rRT-PCR) diagnosed recurrence (reinfection) of SARS-CoV-2. All had mild symptoms except for one who was hospitalized. Though all cases reported fair risk perceptions towards COVID-19, all had potential exposure sources for reinfection. After a second course of treatment and home isolation, all patients fully recovered. Our findings suggest the need for COVID-19 vaccination and continuing other preventive measures to further mitigate the pandemic. An optimal post-recovery follow-up strategy to allow the safe return of COVID-19 patients to the workforce may be considered.

Epidemiologic characteristics of cases with reinfection, recurrence, and hospital readmission due to COVID‐19: A systematic review and meta‐analysis

“… 21 In COVID‐19, based on the literature, the meaning of recurrence is referred to infection with the same species and strain of SARS‐Cov‐2 that may occur due to immunodeficiency of the host. 28 , 29 Based on another literature, COVID‐19 recurrence is defined as persons with detection of SARS‐Cov‐2 RNA within 90 days after the first detection of SARS‐Cov‐2 RNA without evidence of close‐contacts with confirmed cases. 21 In some literature, repositivity of the diagnostic test is considered similar to the concept of relapse that refers to have a positive SARS‐Cov‐2 RNA test in an asymptomatic patient up to 90 days following negative test and recovery from the initial infection.…”

Factors influencing the performance of rapid SARS‐CoV‐2 antigen tests under field condition

“…We extracted total viral RNA from 200 μL of each NP and NS specimen using the chemagic viral NA/gDNA kit (PerkinElmer, MA, USA) and tested the RNA for SARS‐CoV‐2 by rRT‐PCR targeting ORF1ab (RdRp)‐specific primers and probes following the protocol of the Chinese Center for Disease Control and Prevention (briefly as China CDC) 20 . In brief, we prepared rRT‐PCR reaction mixtures with iTaq™ Universal Probes and One‐Step Reaction Mix (Bio‐Rad Laboratories, Inc., Hercules, CA, USA), and CFX96 Touch™ Real‐time PCR Detection System (Bio‐Rad Laboratories, Inc., Hercules, CA, USA) was used 21 . We categorized all rRT‐PCR‐positive specimens as strong (Ct < 25), moderate (25–30), and weak (Ct > 30) positives.…”

“… 20 In brief, we prepared rRT‐PCR reaction mixtures with iTaq™ Universal Probes and One‐Step Reaction Mix (Bio‐Rad Laboratories, Inc., Hercules, CA, USA), and CFX96 Touch™ Real‐time PCR Detection System (Bio‐Rad Laboratories, Inc., Hercules, CA, USA) was used. 21 We categorized all rRT‐PCR‐positive specimens as strong (Ct < 25), moderate (25–30), and weak (Ct > 30) positives.…”

Clinical evaluation of SARS-CoV-2 antigen-based rapid diagnostic test kit for detection of COVID-19 cases in Bangladesh

“…RT-PCR reaction mixtures were prepared with iTaq™ Universal Probes and One-Step Reaction Mix (Bio-Rad Laboratories, Inc., Hercules, CA, USA) and CFX96 Touch™ Real-time PCR Detection System (Bio-Rad Laboratories, Inc., Hercules, CA, USA) was used. Sample with a cycle threshold (Ct) value of <37 for any of the targets (RdRp and N) was considered as a positive case [18]. Based on Ct values, specimens were categorized as strong (Ct < 25) moderate (25 < Ct < 30) and weak (Ct > 30) positives.…”