Case Report: Recurrent Clinical Symptoms of COVID-19 in Healthcare Professionals: A Series of Cases from Brazil

Abstract

. We describe six cases of healthcare professionals in Brazil who recovered but again presented symptoms consistent with COVID-19, with new positive reverse transcription (RT)-PCR test results. The cases reported herein presented symptom onset between March 16, 2020 and April 9, 2020. All were health professionals (four medical doctors), five were female, with a median age of 43.5 years, and three had comorbidities. All patients were confirmed for SARS-CoV-2 detection by RT-PCR in naso and/or oropharyngeal swab samples. Among the reported cases, three (50%) underwent RT-PCR testing in the period between the two symptomatic episodes, with negative results. The time elapsed between the onset of symptoms in the two episodes ranged from 53 to 70 days (median, 56.5 days). In the first episode, the main symptoms described were fever (4/6), myalgia (3/6), sore throat (3/6), and cough (3/6). Meanwhile, during the second episode, fever (4/6) and weakness (3/6) predominated. Most of the cases progressed without complications, although one individual presented hypoxemia (minimum SatO 2 of 90%) in both episodes, and two, only in the second, one of which required intensive care unit admission, progressing with improvement after medication and receiving noninvasive ventilatory support. We report cases with recurrence of symptoms compatible with COVID-19, with positive RT-PCR results, that could represent the occurrence of viral reactivation or reinfection. The true nature of this phenomenon should be better clarified in future studies.

COVID-19: Is reinfection possible?

“…1) (References in Table 1: Abdallah et al, 2020[ 1 ]; AlFehaidi et al, 2020[ 2 ]; Amoozgar et al, 2020[ 5 ]; Bonifácio et. al., 2020[ 9 ]; Chan et al, 2020[ 10 ]; Duggan et al, 2021[ 13 ]; Fernandes Valente Takeda et al, 2020[ 14 ]; Hanif et al, 2020[ 17 ]; He et al, 2021[ 18 ]; Lafaie et al, 2020[ 20 ]; Lancman et al, 2020[ 22 ]; Mulder et al, 2020[ 24 ]; Nachmias et al, 2020[ 25 ]; Selvaraj et al, 2020[ 31 ]; Sharma et al, 2020[ 33 ]; Tillett et al, 2020[ 35 ]; To et al, 2020[ 36 ]; Torres et al, 2021[ 37 ]) presents case reports of SARS-CoV-2 reinfection in different countries. In general, it appears that the RT-qPCR tests are used to diagnose different moments in the course of the disease.…”

Recurrence of COVID-19 after recovery ? A case series in health care workers, France

“…In contrast to these cases, our patients were immunocompetent and developed SARS-CoV-2 antibodies, after the first episode. Several authors have described recurrence of COVID-19 in HCWs ( 3 , 7 ). Fernandes et al have described six cases of healthcare professionals in Brazil who recovered but again presented symptoms of COVID-19 with mild-to-moderate forms, with new RT-PCR positive results ( 7 ).…”

“…The possibility of a reactivation of COVID-19 raises a major public health concern since it could contribute to the spread of the virus in the population, especially in hospitals. In this rapidly emerging epidemic, several case reports describe clinical and/or microbiological recurrences in SARS-CoV-2–infected patients ( 3 , 4 , 5 , 6 , 7 , 8 ). We report a case series of presumed clinical and microbiological recurrence after recovery in 3 HCWs with mild forms of COVID-19.…”

Prolonged 59‐day course of COVID‐19: The case of a SARS‐CoV‐2 shedding persistency in a healthcare provider

“…Consistent with our case report, six cases of healthcare professionals in Brazil who recovered but again presented symptoms consistent with COVID-19, with new positive RT-PCR test results were also recently reported. 6…”