Persistent SARS-COV-2 RNA positivity in a patient for 92 days after disease onset

Abstract

Background: Recently, patients with COVID-19 who showed persistently positive SARS-CoV-2 nucleic acid test results despite resolved clinical symptoms have attracted a lot of attention. We report the case of a patient with mild symptoms of coronavirus disease (COVID-19), who achieved clinical recovery but showed persistently positive SARS-CoV-2 nucleic acid test results until Day 92 after disease onset.Case presentation: The patient is a 50-year-old man with mild symptoms of coronavirus disease (COVID-19). He was quarantined for 105 days. Of these, inpatient quarantine lasted for 75 days. When the nucleic acid test results were negative for 3 consecutive days, the patient was discharged at Day 75 after disease onset. During this period, multiple samples were collected from the patient’s body surface, the surrounding environment, and physical surfaces, but none of these tested positive for SARS-CoV-2. These samples included those from anal swabs, hands, inner surface of mask, cell phone, bed rails, floor around the bed, and toilet bowl surface. However, nucleic acid retest results on Day 80 and Day 92 after disease onset were positive for SARS-CoV-2 nucleic acids. The patient continued with quarantine and observation at home. After the test results on Days 101 and 105 after disease onset were negative, quarantine was terminated at last.Conclusion: Per our knowledge, this is the longest known time that a patient has tested positive for SARS-CoV-2 nucleic acids. No symptoms were observed during follow-up. During hospitalization, the SARS-CoV-2 nucleic acid positivity was not observed in samples from the body surface and surrounding environment, and no verified transmission event occurred during the quarantine at home. After undergoing clinical recovery a minority of patients with COVID-19 have shown long-term positive results for the presence of the SARS-CoV-2 nucleic acid. This has provided new understanding and research directions for coronavirus infection. Long-term follow-up and quarantine measures have been employed for such patients. Further studies are required to analyze potential infectivity in such patients and determine whether more effective antiviral drugs or regimens to enable these patients to completely clear viral infection should be researched.

Understanding viral shedding of severe acute respiratory coronavirus virus 2 (SARS-CoV-2): Review of current literature

“…21,23,25,38,51,56,58,81 Tests were frequently done in anticipation of discharge from the hospital. 57,81 One report estimated that 26%-49% of patients were positive again after a negative test, but in other studies re-positivity varied between 3% and 35%. 17,21,25,27,28,51,56,81 Wang et al 57 described a case report of a patient that was discharged 75 days after illness onset following 3 consecutive negative tests.…”

“…48 Intermittent PCR positivity did occur through day 92 from symptom onset in 1 case reportthat patient had previously tested negative at day 72 followed by repeat positive PCR. 57 In a study of 56 serially tested hospitalized patients with mild-to-moderate disease, 66.1% of NP and OP swabs were still positive at 3 weeks. Positivity rates then declined weekly and all PCR tests were negative by week 6.…”

“…48,58,[67][68][69]78,80 Among all studies we reviewed, the longest duration of PCR positivity from a NP swab of a patient with mild illness was 92 days after symptom onset. 57 The pooled median duration of viral RNA shedding from respiratory sources among patients with mild-to-moderate illness, based upon 10 studies that reported sufficient data (Appendix Table 1 online), was 17.2 days (95% CI, 14.0-20.5). Again, there was high heterogeneity among these studies (I 2 = 95.64%; P < .01).…”

“…There were multiple reports of patients with intermittently positive PCR results from respiratory specimens. 17,21,25,27,28,51,[56][57][58]79,81 Although not consistently defined, cessation of shedding was most often described as 2 consecutive negative PCR results ≥24-48 hours apart. 21,23,25,38,51,56,58,81 Tests were frequently done in anticipation of discharge from the hospital.…”

Understanding the outcomes of COVID-19 – does the current model of an acute respiratory infection really fit?

“…Published reviews report mean durations of SARS-CoV-2 shedding for acute infection of 17-18 days ( Fig. 1) [1,2], and 20 days in severe cases [2], with numerous individual case reports of immunocompetent subjects remaining PCR-positive for longer than 50 days, and in some cases shedding virus for up to 104 days [3][4][5][6]. These durations of shedding are systematically and substantially longer than the mean shedding durations of 9.5 and 5.7 days determined by PCR-based follow-up of immunocompetent adults and children infected with RSV [1,[7][8][9][10] and IAV [1,[11][12][13][14], respectively.…”