Case Report: Recurrence of Positive SARS-CoV-2 Results in Patients Recovered From COVID-19

Zhang, Ren-Zi; Deng, Wang; He, Jing; Song, Yuyan; Qian, Chunfang; Yu, Qian; Wang, Daoxin

doi:10.3389/fmed.2020.585485

Cited by 12 publications

(11 citation statements)

References 13 publications

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“…No close contacts or family members were infected. The first time positive Ct value upon hospitalization and second time positive Ct value after discharge, showed no significant difference Zhang et al [77] China Case report 3 1 36,54,50,55 4/- 15 d,25 d,6 d,15 d positive – – 4 IgG positive 3 IgM positive All presented with no symptoms, and the chest CT scan of three cases was normal Song et al [69] Korea Case report 3 1 73,33,31,18 month 4/- 4 d,9 d,9 d,9 d positive – – positive In 4 RP patients, the highest levels of IgG and IgM antibodies were reached after about a month of the onset of the initial symptoms. Then, the IgG titers plateaued, and the IgM titers decreased, regardless of RT-PCR results.…”

Section: Resultsmentioning

confidence: 89%

“…There were 34 studies [ 16 , 22 – 24 , 27 , 28 , 32 , 37 , 38 , 40 , 43 , 46 , 47 , 51 , 59 , 60 , 66 , 67 , 69 – 71 , 75 , 77 , 83 , 85 , 95 , 96 , 98 , 100 , 103 , 106 , 108 , 109 , 117 ] reported that viral RNA could still be detected in patients with SARS-CoV-2 specific IgM and IgG antibodies present, including 234 patients who were IgG positive and 164 who were IgM positive. Fifteen studies reported that both IgG and IgM were positive in RP patients [ 24 , 28 , 32 , 40 , 46 , 47 , 51 , 59 , 60 , 66 , 69 , 70 , 85 , 109 , 117 ].…”

Section: Resultsmentioning

confidence: 99%

“…In most patients, CT imaging had improved compared with the first admission, and pulmonary lesions were fully absorbed in some patients. However, among 656 RP patients having abnormalities in CT imaging, there were bilateral pulmonary infiltration (15·2%) [ 20 , 28 , 29 , 83 , 84 , 116 , 117 ], consolidation of lung tissue (7·8%) [ 77 , 79 , 83 , 86 , 117 ], ground-glass opacity (GGO) (7·7%) [ 20 , 44 , 67 , 78 , 84 , 86 , 89 , 104 , 119 ], pulmonary plaques (3·5%) [ 34 , 80 , 84 ], fibrinous exudation on the surface of the lung (2·7%) [ 34 , 104 , 117 ], pneumonia (1·4%) [ 20 , 29 , 104 , 116 ], the light density shadow of the lung (0·6%) [ 51 , 77 , 84 ], interstitial abnormalities (0·4%) [84] , bilateral proximal lobar pulmonary embolism (0·4%) [ 29 , 40 ], segmental and sub-segmental signs of arterial micro-embolism (0·3%) [40] , and pleural effusion (0·15%) [65] .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

Ren

Lou

et al. 2021

EClinicalMedicine

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Background With the increased number of patients discharged after having COVID-19, more and more studies have reported cases whose retesting was positive (RP) during the convalescent period, which brings a new public health challenge to the world. Methods We searched PubMed, Web of Science, The Cochrane Library, CNKI, WanFang and VIP from December 1, 2019 to December 31, 2020. The included studies were assessed using JBI critical appraisal tools and Newcastle-Ottawa Scale. The RP rate of discharge patients was analyzed by a meta-analysis. We adhered to PRISMA reporting guideline. Findings We have included 117 studies with 2669 RP participants after discharge. The methodological quality of 66 case reports were low to high, 42 case series and 3 cohort study were moderate to high, 3 case-control studies were moderate and 3 cross-sectional studies were low to moderate. The clinical manifestations of most RP patients were mild or asymptomatic, and CT imaging and laboratory examinations were usually normal. The existing risk factors suggest that more attention should be paid to sever patients, elderly patients, and patients with co-morbidities. The summary RP rate was 12·2% (95% CI 10·6–13·7) with high heterogeneity ( I 2 = 85%). Interpretation To date, the causes and risk factors of RP result in discharged patients are not fully understood. High-quality etiological and clinical studies are needed to investigate these issues to further help us to make strategies to control and prevent its occurrence.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

Ren

Lou

et al. 2021

EClinicalMedicine

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“…A Ct value of ~25 was identified as the median for virus detection in symptomatic patients, with a consistent proportion of samples (15–25%) falling above Ct 30 [ 25 , 56 ]. Low viral loads are often found in patients with prolonged COVID-19 infection [ [57] , [58] , [59] ], and five of six reported cases of potential re-infection involved samples with Ct values >30 [ 60 ], but whole-genome sequencing is nevertheless recommended to differentiate between relapse and new infections caused by a different SARS-CoV-2 variants [ 60 , 61 ]. The ability to sequence SARS-CoV-2 genomes in low-titer samples is therefore necessary to track infections and correlate different strains with disease communicability, manifestation and severity.…”

Section: Discussionmentioning

confidence: 99%

ACoRE: Accurate SARS-CoV-2 genome reconstruction for the characterization of intra-host and inter-host viral diversity in clinical samples and for the evaluation of re-infections

et al. 2021

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Sequencing the SARS-CoV-2 genome from clinical samples can be challenging, especially in specimens with low viral titer. Here we report Accurate SARS-CoV-2 genome Reconstruction (ACoRE), an amplicon-based viral genome sequencing workflow for the complete and accurate reconstruction of SARS-CoV-2 sequences from clinical samples, including suboptimal ones that would usually be excluded even if unique and irreplaceable. The protocol was optimized to improve flexibility and the combination of technical replicates was established as the central strategy to achieve accurate analysis of low-titer/suboptimal samples. We demonstrated the utility of the approach by achieving complete genome reconstruction and the identification of false-positive variants in >170 clinical samples, thus avoiding the generation of inaccurate and/or incomplete sequences. Most importantly, ACoRE was crucial to identify the correct viral strain responsible of a relapse case, that would be otherwise mis-classified as a re-infection due to missing or incorrect variant identification by a standard workflow.

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“…It is not always practicable to validate by sequencing whether specific cases constitute persistence or reinfection, so we have here used the conservative term 'recurrence', except where there are data on infection with a de novo viral sequence. [7][8][9][10] We report a case series of 33 patients with recurrence of COVID-19 symptoms and qRT-PCR positivity and compared them with a control group of 62 patients with a single episode of COVID 19, in a case-control design. Additionally, we were able to compare viral genomes recovered in the first and second episodes for one of these cases.…”

Section: Introductionmentioning

confidence: 99%

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

Santos

Filho

Silva

et al. 2021

Journal of Infection

110

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Background: There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term. Methods: Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation > 14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database. Results: Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p < 0.0 0 01)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19 (2.4 ± 0.610; p < 0.0 0 01) and after recurrence (6.4 ± 11.34; p = 0.007). Virus genome sequencing identified reinfection by a different isolate in one patient. Conclusions: This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.

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Case Report: Recurrence of Positive SARS-CoV-2 Results in Patients Recovered From COVID-19

Cited by 12 publications

References 13 publications

A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

ACoRE: Accurate SARS-CoV-2 genome reconstruction for the characterization of intra-host and inter-host viral diversity in clinical samples and for the evaluation of re-infections

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

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