Persistent SARS-CoV-2 Alpha Variant Infection in Immunosuppressed Patient, France, February 2022

Fourati, Slim; Gautier, Guillaume; Chovelon, Myriam; Soulier, Alexandre; N’Debi, Mélissa; Démontant, Vanessa; Kennel, Céline; Rodriguez, Christophe; Pawlotsky, Jean‐Michel

doi:10.3201/eid2807.220467

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…Our analysis identified B cell dysfunction/depletion due to lymphoma or myeloma, or anti-CD20/anti-CD19 therapy, as a strong risk factor for longer duration of SARS-CoV-2 infection among the immunocompromised population (see also [51]). This is consistent with published case reports, where nearly all of those with infections lasting >150 days had B cell malignancy with receipt of anti-CD20 antibodies or CAR-T cells [7,9,[15][16][17][18][52][53][54][55][56][57][58][59][60][61][62][63][64][65]]. Although we enrolled 59 SOT and HSCT patients with ongoing T cell immunosuppression -due to tacrolimus, prednisone, and/or mycophenolate -only one had infection lasting >56 days.…”

Section: Discussionsupporting

confidence: 89%

SARS-CoV-2 shedding and evolution in immunocompromised hosts during the Omicron period: a multicenter prospective analysis

Raglow,

Surie,

Chappell

et al. 2023

Preprint

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Background: Prolonged SARS-CoV-2 infections in immunocompromised hosts may predict or source the emergence of highly mutated variants. The types of immunosuppression placing patients at highest risk for prolonged infection and associated intrahost viral evolution remain unclear. Methods: Adults aged >18 years were enrolled at 5 hospitals and followed from 4/11/2022-2/1/2023. Eligible patients were SARS-CoV-2 positive in the previous 14 days and had a moderate or severely immunocompromising condition or treatment. Nasal specimens were tested by rRT-PCR every 2-4 weeks until negative in consecutive specimens. Positive specimens underwent viral culture and whole genome sequencing. A Cox proportional hazards model was used to assess factors associated with duration of infection. Results: We enrolled 150 patients with: B cell malignancy or anti-B cell therapy (n=18), solid organ or hematopoietic stem cell transplant (SOT/HSCT) (n=59), AIDS (n=5), non-B cell malignancy (n=23), and autoimmune/autoinflammatory conditions (n=45). Thirty-eight (25%) were rRT-PCR positive and 12 (8%) were culture-positive ≥21 days after initial SARS-CoV-2 detection or illness onset. Patients with B cell dysfunction had longer duration of rRT-PCR positivity compared to those with autoimmune/autoinflammatory conditions (aHR 0.32, 95% CI 0.15-0.64). Consensus (>50% frequency) spike mutations were identified in 5 individuals who were rRT-PCR positive >56 days; 61% were in the receptor-binding domain (RBD). Mutations shared by multiple individuals were rare (<5%) in global circulation.

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Section: Discussionsupporting

confidence: 89%

SARS-CoV-2 shedding and evolution in immunocompromised hosts during the Omicron period: a multicenter prospective analysis

Raglow,

Surie,

Chappell

et al. 2023

Preprint

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“…Lastly, our survey focused on the management of persistent SARS-CoV-2 positivity, a condition frequently encountered in immunocompromised patients. [13][14][15][16] The majority of our respondents would not treat asymp-…”

Section: Discussionmentioning

confidence: 99%

“…Baricitinib, on the other hand, appears to be less used in this patient population. Lastly, our survey focused on the management of persistent SARS‐CoV‐2 positivity, a condition frequently encountered in immunocompromised patients 13–16 . The majority of our respondents would not treat asymptomatic patients, citing cycle thresholds and viral loads as useful tools for their clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

Current management of SARS‐CoV‐2 infection in solid organ transplant recipients: Experience derived from an ESGICH–ESOT survey

Visentin,

Pickavance,

San‐Juan

et al. 2024

Transplant Infectious Dis

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ObjectiveSolid organ transplant (SOT) recipients have a poorer SARS‐CoV‐2 vaccine response and higher risk for COVID‐19‐associated complications. However, there is no consensus on the current management of COVID‐19 and data on persistent COVID‐19 rates in SOT recipients are lacking.MethodsAn electronic survey concerning the management of COVID‐19 in SOT recipients was distributed among all members of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) and of the European Society for Organ Transplantation (ESOT). Four major sections were covered: prevention, early COVID‐19, late COVID‐19, and persistent COVID‐19. We developed a structured questionnaire including eight multiple‐choice questions with branching logic in case of positive answers and three open‐ended questions related to clinical practice. Questions were asked separately for lung and non‐lung transplantation.ResultsThirty‐two physicians from 24 different centers participated. Most answers (n = 30) were provided by European physicians. Thirty of 32 (93.75%) physicians managed non‐lung transplant recipients and 12 of 32 (33.3%) lung transplant recipients. There was a huge variability in practice regarding the treatment of COVID‐19, and particularly noticeable when considering lung and non‐lung transplant recipients. Main discordances included the use of nirmatrelvir alone or in combination therapy for early COVID‐19, the use of immunomodulatory drugs other than steroids for late COVID‐19, and the need for treating asymptomatic viral shedding in persistent COVID‐19. There was more similarity in terms of prophylaxis recommendations.ConclusionDespite a low number of respondents, this survey shows that there are many differences on how experts manage SARS‐CoV‐2 infections in SOT recipients. image

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“… 19 In some patients persistently positive SARS-CoV-2 PCR tests may be a harmless laboratory testing artifact, while in others it represents ongoing infection with the capacity to generate new and more infectious/virulent mutants, serve as a source of ongoing spread of virus and lead to resistance to existing antiviral therapy. 20 , 21 , 22 , 23 The terminology and classification of persistent infection remains unsettled and has been variably defined as recurrence, relapse or as a subset of long COVID. Both practically and scientifically, PCR positivity is often insufficiently reliable to establish the diagnosis of persistent infection, viable (or active) culture is the gold standard.…”

Section: Prolonged Viral Shedding Among Immunocompromised Patientsmentioning

confidence: 99%

Vaccines and therapeutics for immunocompromised patients with COVID-19

Shoham¹,

Batista²,

Amor³

et al. 2023

eClinicalMedicine

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Persistent SARS-CoV-2 Alpha Variant Infection in Immunosuppressed Patient, France, February 2022

Abstract: 3. Chauhan RP, Gordon ML. A systematic review analyzing the prevalence and circulation of influenza viruses in swine population worldwide. Pathogens. 2020;9:E355.

Cited by 5 publications

References 9 publications

SARS-CoV-2 shedding and evolution in immunocompromised hosts during the Omicron period: a multicenter prospective analysis

SARS-CoV-2 shedding and evolution in immunocompromised hosts during the Omicron period: a multicenter prospective analysis

Current management of SARS‐CoV‐2 infection in solid organ transplant recipients: Experience derived from an ESGICH–ESOT survey

Vaccines and therapeutics for immunocompromised patients with COVID-19

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