Reactivation of COVID-19 pneumonia: A report of two cases

Ravioli, Svenja; Ochsner, Hannah; Lindner, Gregor

doi:10.1016/j.jinf.2020.05.008

Cited by 66 publications

(70 citation statements)

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“…Almost 97% of patients subsequently improved or recovered. Among 1350 cases, four patients died after presumptive recurrence, but it is not clear if the episode could be due to recurrence of COVID-19 [26]. Interestingly, Lafaye et al described a geriatric case (case 1) with probable COVID-19 recurrence as he had clinical and radiological worsening, absence of neutralizing antibody, and positive cell culture during the second episode [77].…”

Section: Discussionmentioning

confidence: 99%

Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature

Gidari

Nofri

Saccarelli

et al. 2020

Eur J Clin Microbiol Infect Dis

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Can a patient diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) be infected again? This question is still unsolved. We tried to analyze local and literature cases with a positive respiratory swab after recovery. We collected data from symptomatic patients diagnosed with SARS-CoV-2 infection in the Italian Umbria Region that, after recovery, were again positive for SARS-CoV-2 in respiratory tract specimens. Samples were also assessed for infectivity in vitro. A systematic review of similar cases reported in the literature was performed. The study population was composed of 9 patients during a 4-month study period. Among the new positive samples, six were inoculated in Vero-E6 cells and showed no growth and negative molecular test in culture supernatants. All patients were positive for IgG against SARS-CoV-2 nucleoprotein and/or S protein. Conducting a review of the literature, 1350 similar cases have been found. The presumptive reactivation occurred in 34.5 days on average (standard deviation, SD, 18.7 days) after COVID-19 onset, when the 5.6% of patients presented fever and the 27.6% symptoms. The outcome was favorable in 96.7% of patients, while the 1.1% of them were still hospitalized at the time of data collection and the 2.1% died. Several hypotheses have been formulated to explain new positive respiratory samples after confirmed negativity. According to this study, the phenomenon seems to be due to the prolonged detection of SARS-CoV-2 RNA traces in respiratory samples of recovered patients. The failure of the virus to replicate in vitro suggests its inability to replicate in vivo.

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Section: Discussionmentioning

confidence: 99%

Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature

Gidari

Nofri

Saccarelli

et al. 2020

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

show abstract

“…It is also observed that some COVID-19 recovery cases may experience a fluctuating period between the relief of clinical symptoms or pulmonary imaging and real recovery from SARS-CoV-2 infections. Some studies have reported that the clinical features and the potential risk factors of SARS-CoV-2 turned positive in patients after they were discharged [7][8][9][10][11][12][13][14][15][16][17]. The reported recurrence rate ranged from 9.09% to 21.43% [7,12,16].…”

Section: Discussionmentioning

confidence: 99%

“…All of the recurrent cases met the discharge criteria according to the diagnosis and treatment protocol for novel coronavirus pneumonia (NCP; trial version 7), which including negative result for nuclei acid tests twice consecutively on respiratory tract specimens such as nasopharyngeal swabs and sputum (24 h sampling interval at least). Recently, the number of recurrent cases has increased, and/or test results of discharged patients of COVID-19 undergoing real-time reverse transcription-polymerase chain reaction (RT-PCR) test turned positive [7][8][9][10]. However, the typical clinical characteristics, risk factors or predictive markers, and therapeutic strategies of the recurrent cases remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Can elevated concentrations of ALT and AST predict the risk of ‘recurrence’ of COVID-19?

et al. 2020

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'Recurrence' of coronavirus disease 2019 (COVID-19) has triggered numerous discussions of scholars at home and abroad. A total of 44 recurrent cases of COVID-19 and 32 control cases admitted from 11 February to 29 March 2020 to Guanggu Campus of Tongji Hospital affiliated to Tongji Medical College Huazhong University of Science and Technology were enrolled in this study. All the 44 recurrent cases were classified as mild to moderate when the patients were admitted for the second time. The gender and mean age in both cases (recurrent and control) were similar. At least one concomitant disease was observed in 52.27% recurrent cases and 34.38% control cases. The most prevalent comorbidity among them was hypertension. Fever and cough being the most prevalent clinical symptoms in both cases. On comparing both the cases, recurrent cases had markedly elevated concentrations of alanine aminotransferase (ALT) (P = 0.020) and aspartate aminotransferase (AST) (P = 0.007). Moreover, subgroup analysis showed mild to moderate abnormal concentrations of ALT and AST in recurrent cases. The elevated concentrations of ALT and AST may be recognised as predictive markers for the risk of 'recurrence' of COVID-19, which may provide insights into the prevention and control of COVID-19 in the future.

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“…Ye et al reported 5 patients with clinical reactivation presenting mostly with fatigue and fever, but none of them developed severe COVID-19 pneumonia or died [3]. Ravioli et al reported two elderly patients who developed COVID-19, recovered and tested negative by PCR, and then developed a new COVID-19 pneumonia, with one patient dying and the other remaining hospitalized at the time of the report [4].…”

mentioning

confidence: 99%

Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia

Lancman¹,

Mascarenhas²,

Bar-Natan³

2020

J Hematol Oncol

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SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblastic leukemia who experienced a viral reactivation after receiving rituximab, cytarabine, and dasatinib. She was initially hospitalized with COVID-19 in April and developed a high antibody titer with two negative nasal polymerase chain reaction (PCR) swabs for SARS-CoV-2 on discharge. After recovery, she resumed treatment in June for her leukemia, which included rituximab, cytarabine, and dasatinib. She promptly lost her COVID-19 antibodies, and her nasal PCR turned positive in June. She developed a severe COVID-19 pneumonia with lymphopenia, high inflammatory markers, and characteristic bilateral ground-glass opacities on chest CT, requiring high-flow nasal cannula and transfer to the intensive care unit. She received steroids, anticoagulation, and convalescent plasma, and within 48 h she was off oxygen. She was discharged home in stable condition several days later. Given the short time frame from leukemia treatment to PCR positivity and the low case rate in mid-June in New York City, reinfection appears to have been unlikely and SARS-CoV-2 reactivation is a possible explanation. This case illustrates the risks of treating recently recovered COVID-19 patients with immunosuppressive therapy, particularly lymphocyte- and antibody-depleting therapy, and raises new questions about the potential of SARS-CoV-2 reactivation.

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Reactivation of COVID-19 pneumonia: A report of two cases

Cited by 66 publications

References 1 publication

Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature

Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature

Can elevated concentrations of ALT and AST predict the risk of ‘recurrence’ of COVID-19?

Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia

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