Late Reactivation of SARS-CoV-2: A Case Report

Abstract

SARS-CoV-2 is a betacoronavirus that belongs to the family Coronaviridae and the order Nidovirales (1). During December 2019, a series of pneumonia cases caused by a SARS-CoV-2 outbreak was identified in Wuhan, Hubei, China, and rapidly spread across the world. The spectrum of SARS-CoV-2 disease (COVID 19) varies from asymptomatic or paucisymptomatic forms to clinical conditions characterized by respiratory failure that necessitate mechanical ventilation and support in an intensive care unit (ICU), multiorgan and systemic manifestations, and, in terms of sepsis, septic shock, and multiple organ dysfunction syndromes (MODS) (2). Whilst many reports have characterized the clinical, epidemiological, laboratory, and radiological features, as well as treatment and clinical outcomes of patients with COVID-19 pneumonia, information on SARS-CoV-2 reactivation remains unreported. Curative and eradicative therapy for COVID-19 is not currently available (3). We report a case of a patient with PCR-confirmed COVID-19 pneumonia who experienced reactivation after 43 days and negative PCR sampling.

Clinical characteristics of SARS-CoV-2 by re-infection vs. reactivation: a case series from Iran

“…Coppolla et al reported a PCR-confirmed COVID-19 patient who experienced viral reactivation with milder symptoms after 43-day interval and negative PCR. This case had dyslipidemia and chronic ischemic heart disease as underlying diseases [20].…”

“…This highlights the risks of recently recovered COVID-19 patients who are on the treatment of immunosuppressive therapy and raises critical questions about the reactivation of SARS-CoV-2 [34]. Based on the observation, they suggested that recovered patients must be considered as the carriers of the virus and therefore an additional round of follow up and isolation are needed [20].…”

“…Reactivation seems to be more probable in those who suffers from an underlying condition or immune suppression. Subjects who are susceptible to reactivation are those with compromised immune systems such as dialysis patients or patients undergoing immune suppressive therapy [20,21].…”

Clinical Characteristics of SARS-CoV-2 by Re-infection Vs. Reactivation: A Case Series From Iran

“…Coppolla et al, reported a PCR-con rmed COVID-19 patient who experienced viral reactivation with milder symptoms after 43 days interval and negative PCR. This case had dyslipidemia and chronic ischemic heart disease as underlying diseases [20].…”

A case of SARS-CoV-2 reinfection in a patient with obstructive sleep apnea managed with telemedicine

“…5 Similarly, two cases of acute SARS-CoV-2 PCR-positive pneumonia with documented improvement of acute infection and negative SARS-CoV-2 PCR before discharge required hospital readmission for respiratory symptoms and repeat SARS-CoV-2-positive PCR 14 and 16 days after discharge from the initial hospitalisation. 6 7 Such cases may represent prolonged shedding or false-negative SARS-CoV-2 PCR as opposed to true reinfections. 8 However, recurrence of symptoms in some with repeat positive SARS-CoV-2 is suggestive of reactivation and/or repeat infection.…”