Positive SARS-CoV-2 RNA recurs repeatedly in a case recovered from COVID-19: dynamic results from 108 days of follow-up

Liu, Fang; Cai, Zhen; Huang, Jinsong; Yu, Wenyan; Niu, Hai-ying; Zhang, Yan; Sui, Dongming; Wang, Fei; Xue, Li-Zhi; Xu, Aiqiang

doi:10.1093/femspd/ftaa031

Cited by 23 publications

(20 citation statements)

References 15 publications

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“…Among the reported patients, eight cases were reported that had experienced recurrence more than once; two times in four patients [ 20 , 58 , 69 ], three times in two patients [ 14 , 50 ], and four times in two patients [ 48 , 62 ]. In a more detailed review of five cases with positive RT-PCR test for repeated times, most of them were asymptomatic or presented mild symptoms [ 14 , 48 , 50 , 58 , 69 ]. Among them, an eight year-old boy showed the second positive RT-PCR test after 17 days of discharge, and his test remained positive for the next 20 days [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, two men, 33 and 35-year old showed the second positive RT-PCR at nearly 2 weeks after discharge. They tested positive for the fourth and third times on days 111 and 49 days of hospital discharge, respectively [ 48 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Within the first admission, considering 1064 patients, the majority of re-positive cases ( n = 987; 92.7%) were asymptomatic or had mild to moderate symptoms [ 1 , 3 , 13 , 14 , 16 , 17 , 19 , 21–24 , 26–28 , 30–33 , 36–45 , 47 , 48 , 50–52 , 54 , 56 , 58 , 59 , 61 , 62 , 64–67 , 69–73 , 75 , 77 ], but some of them had severe or critical disease ( n = 77, 7.3%) [ 1 , 13 , 18 , 21 , 23 , 24 , 27 , 30 , 31 , 35 , 36 , 39 , 42 , 43 , 46 , 49 , 55 , 60 , 63 , 68 , 74 ]. To compare the severity of disease during the first and second courses of illness in re-positive patients, 57 studies including 858 re-positive patients, it was reported that the disease severity decreased or remained unchanged in 835 cases (97.3%) [ 13 , 15–20 , 23 , 24 , 26 , 28–31 , 33 , 36–48 , 50 , 52–54 , 58–61 , 65–68 , 70 , 71 , …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations

Piri

Edalatfar

Shool

et al. 2021

Infectious Diseases

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Background Since late 2019, SARS-CoV-2 which leads to coronavirus disease 2019 (COVID-19), has caused thousands of deaths. There are some pieces of evidence that SARS-CoV-2 genome could be re-detectable in recovered patients. Methods We performed a systematic review in the PubMed/Medline database to address the risk of SARS-CoV-2 recurrence. The last update was for 20 November 2020. Among the 1178 initially found articles, 66 met the inclusion criteria and were considered. Findings In total, 1128 patients with at least one-time recurrence of SARS-CoV-2 were included. Recurrence rate has been reported between 2.3% and 21.4% in cohort studies, within a mean of 20 (ranged 1–98) days after discharge; younger patients are being affected more. Following the second course of disease, the disease severity decreased or remained unchanged in 97.3% while it increased in 2.6%. Anti-SARS-CoV-2 IgG and IgM were positive in 11–95% and 58.8–100%, respectively. Based on the literature, three possibilities include reactivation of previous disease, reinfection with the same virus, and false negative, which have been discussed in details. Conclusion There is a relatively notable risk of disease recurrence in previously recovered patients, even those who are immunised against the virus. More studies are required to clarify the underlying cause of this phenomenon.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations

Piri

Edalatfar

Shool

et al. 2021

Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…The time interval between discharge and re-positive RT-PCR results in our cohort was 11–20 days, which was longer than previously reported [ 2 , 6 , 7 ]. It was reported that the viral shedding duration lasted for 65 days in a recovered COVID-19 patient [ 8 ]. Together these findings raise concerns about the shedding window of COVID-19 and the current criteria for discontinuation of quarantine.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and outcomes of re-positive nucleic acid tests in discharged COVID-19 patients

Chen

Pan

et al. 2020

Eur J Clin Microbiol Infect Dis

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The prevalence and outcomes of patients who had re-activation of coronavirus disease 2019 (COVID-19) after discharge remain poorly understood. We included 126 consecutively confirmed cases of COVID-19 with 2-month follow-up data after discharge in this retrospective study. The upper respiratory specimen using a reverse-transcription polymerase chain reaction test of three patients (71 years [60-76]) were positive within 11-20 days after their discharge, with an event rate of 19.8 (95%CI 2.60-42.1) per 1,000,000 patient-days. Moreover, all re-positive patients were asymptomatic. Our findings suggest that few recovered patients may still be virus carriers even after reaching the discharge criteria.

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“…18 Similarly, Wang et al reported 2.29% readmission because of fever or positive SARS-CoV-2 retest. 5 In a case report by Liu et al, 9 they reported a 108-day follow-up on dynamic clinical manifestation in a COVID-19 patient, who was hospitalized three times due to the positive recurrence of SARS-CoV-2 after discharge.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 reinfection: “New baseline” imaging concept in the era of COVID-19

2021

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Recent reports have suggested COVID-19 relapse or reinfection may lead to readmission, which may cause a diagnostic challenge between recently infected patients and reinfections. Compounding this problem is the post-viral lung sequela that may be expected after COVID-19 pneumonia, similar to both SARS and MERS. Although chest imaging may play a role in the diagnosis of primary SARS-CoV-2 infection, reinfection or relapse of COVID-19 will have similar imaging findings. A “new-baseline” imaging can be obtained from COVID-19 patients at the time of hospital discharge or clinical recovery. This new reference can not only determine if readmissions are from relapse or reinfection of COVID-19, resolving COVID-19 or potentially a different viral infection (influenza), but also for long term sequela of COVID-19 lung infection. Strategic use of imaging before discharge may be helpful in the subset of the population at the highest risk of a secondary viral infection such as influenza. Determining the residual abnormalities in post-discharge imaging can guide us in the long-term management of patients for many years to come.

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Positive SARS-CoV-2 RNA recurs repeatedly in a case recovered from COVID-19: dynamic results from 108 days of follow-up

Cited by 23 publications

References 15 publications

A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations

A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations

Prevalence and outcomes of re-positive nucleic acid tests in discharged COVID-19 patients

SARS-CoV-2 reinfection: “New baseline” imaging concept in the era of COVID-19

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