Prolonged severe acute respiratory syndrome coronavirus 2 persistence, attenuated immunologic response, and viral evolution in a solid organ transplant patient

Abstract

Unlike immunocompetent hosts, the duration of viral persistence after infection with severe acute respiratory syndrome coronavirus 2 can be prolonged in immunosuppressed patients. Here, we present a case of viral persistence for over 19 weeks in a patient with a history of solid organ transplant and explore the clinical, virologic, and immunologic course. Our patient still demonstrated viral persistence at 138 days with low polymerase chain reaction cycle threshold values and evidence of continuing viral sequence evolution indicative of ongoing virus replication. These findings have important implications for infection prevention and control recommendations in immunosuppressed patients. Immune response, including neutralizing antibody titers, T cell activity, and cytokine levels, peaked around days 44–72 after diagnosis. Anti‐S trimer antibodies were low at all time points, and T cell response was attenuated by day 119. As immune response waned and viral load increased, increased genetic diversity emerged, suggesting a mechanism for the development of viral variants.

Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

“…Other studies also suggest that other immunosuppressed patients may have slightly longer median symptom duration than the general population. Some with cancer and organ transplant had very lengthy symptom duration and viral shedding 17–22. A study investigated persistent COVID-19 symptoms after hospital discharge for COVID-19 among 1969 people, of which 31 had pre-existing rheumatic or musculoskeletal disease (RMD) 23.…”

“…Some with cancer and organ transplant had very lengthy symptom duration and viral shedding. [17][18][19][20][21][22] A Infections Infections Infections study investigated persistent COVID-19 symptoms after hospital discharge for COVID-19 among 1969 people, of which 31 had pre-existing rheumatic or musculoskeletal disease (RMD). 23 They found no association of RMD with long-term post-COVID-19 symptoms, but they may have been underpowered to detect a statistical association (OR 1.46, 95% CI 0.89 to 2.40, p=0.15) and RMD may have included non-systemic conditions.…”