Biodistribution and serologic response in SARS-CoV-2 induced ARDS: A cohort study

Abstract

Background The viral load and tissue distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain important questions. The current study investigated SARS-CoV-2 viral load, biodistribution and anti-SARS-CoV-2 antibody formation in patients suffering from severe corona virus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS). Methods This is a retrospective single-center study in 23 patients with COVID-19-induced ARDS. Data were collected within routine intensive care. SARS-CoV-2 viral load was assessed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). Overall, 478 virology samples were taken. Anti-SARS-CoV-2-Spike-receptor binding domain (RBD) antibody detection of blood samples was performed with an enzyme-linked immunosorbent assay. Results Most patients (91%) suffered from severe ARDS during ICU treatment with a 30-day mortality of 30%. None of the patients received antiviral treatment. Tracheal aspirates tested positive for SARS-CoV-2 in 100% of the cases, oropharyngeal swabs only in 77%. Blood samples were positive in 26% of the patients. No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate. Serologic testing revealed significantly lower concentrations of SARS-CoV-2 neutralizing IgM and IgA antibodies in survivors compared to non-survivors (p = 0.009). Conclusions COVID-19 induced ARDS is accompanied by a high viral load of SARS-CoV-2 in tracheal aspirates, which remained detectable in the majority throughout intensive care treatment. Remarkably, SARS-CoV-2 RNA was never detected in dialysate even in patients with RNAemia. Viral load or the buildup of neutralizing antibodies was not associated with 30-day survival or disease severity.

Predictive Analysis of the Neutralization Activity in Convalescent Plasmas From COVID-19 Recovered Patients in Zhejiang Province, China, January-March, 2020

“…NAbs are antibodies that can directly interfere with virus’ replication and prevent virus from entering target cells. In SARS-CoV-2 specific-NAbs, IgG and IgM are the predominant antibody followed by the IgA ( Rojas et al., 2020 ; Schlesinger et al., 2020 ). Neutralizing antibody titers were in accordance with anti-SARS-CoV-2 IgG and IgM antibody titers ( Figueiredo-Campos et al., 2020 ; To et al., 2020 ).…”

Innate Receptor Activation Patterns Involving TLR and NLR Synergisms in COVID-19, ALI/ARDS and Sepsis Cytokine Storms: A Review and Model Making Novel Predictions and Therapeutic Suggestions

“…For example, Zhou et al [ 229 ] demonstrated that, in severe COVID-19 patients coinfected with S. pneumoniae, Haemophilus parainfluenzae or Neisseria meningitides , the numbers of SARS-CoV-2 virions were significantly lower than in uncomplicated SARS-CoV-2 infections. Similarly, Schlesinger et al [ 230 ] reported that, among COVID-19 patients admitted to the intensive care unit, “No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate.…”

Pathophysiology of infection with SARS‐CoV‐2—What is known and what remains a mystery

“…With clinical COVID-19, there have been a number of publications on viral RNA in the blood with the first publication using data from the early 2020 Wuhan outbreak. 81,82 Since then, more extensive publications from Spain, 83,84 Germany, 85,86 United States [87][88][89] and Norway 90 have been published using outpatients, hospital ward patients and critically ill patients. The positive detection rate is between 28% and 32% of hospitalized patients; however, those in intensive care have rates up to 78%.…”