Reinfection of COVID‐19 after 3 months with a distinct and more aggressive clinical presentation: Case report

Torres, Danielle de Araujo; Ribeiro, Luciana do Carmo Bueno; Riello, Anna Patrícia de Freitas Linhares; Horovitz, Dafne Dain Gandelman; Pinto, Luís Felipe Ribeiro; Croda, Júlio

doi:10.1002/jmv.26637

Cited by 54 publications

(52 citation statements)

References 7 publications

(8 reference statements)

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“…24 There have been cases reporting COVID-19 symptom recurrence. [29][30][31] It has been argued that virus may be present in a latent state, in the lysogenic part (viral reproduction), inactive or hidden in cells, not causing disease for some time and then reactivating. 15 , 32 The main risk factors include: (1) host status, (2) viral factors and (3) environmental factors.…”

Section: Discussionmentioning

confidence: 99%

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

Santos

Filho

Silva

et al. 2021

Journal of Infection

109

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Background: There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term. Methods: Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation > 14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database. Results: Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p < 0.0 0 01)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19 (2.4 ± 0.610; p < 0.0 0 01) and after recurrence (6.4 ± 11.34; p = 0.007). Virus genome sequencing identified reinfection by a different isolate in one patient. Conclusions: This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.

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Section: Discussionmentioning

confidence: 99%

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

Santos

Filho

Silva

et al. 2021

Journal of Infection

109

View full text Add to dashboard Cite

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“…The authors attributed the re-detection of SARS-CoV-2 RNA to long-term carriers of the virus, as shown by others (Avanzato et al, 2020;Fu et al, 2020;Lan et al, 2020). The COVID-19 caused by SARS-CoV-2 reinfections may be more severe than the primary infection (Lee et al, 2020a;Selvaraj et al, 2020;Torres et al, 2020). The diagnosis of SARS-CoV-2 reinfection requires a high technical hurdle (different sequences of the viral strains involved).…”

Section: Are Recovered Covid-19 Patients Protected From Reinfection?mentioning

confidence: 97%

“…As discussed above, although a majority of COVID-19 patients developed one or more antigen-specific antibodies to SARS-CoV-2, the rapid decline of antibodies in most of the convalescent COVID-19 patients and the weak antibody responses in asymptomatic and mild cases as well as immunosuppressed patients suggest that SARS-CoV-2 reinfection may be more common than currently appreciated. Numerous case reports have been published on COVID-19 reinfection Lee et al, 2020a;Li et al, 2020a;McGrath et al, 2020;Prado-Vivar et al, 2020;Sanyaolu et al, 2020;Selvaraj et al, 2020;Tillett et al, 2020;Torres et al, 2020). One report showed that three patients free of viral load but having low levels of anti-S and N-specific antibodies were re-infected (Li et al, 2020a).…”

Section: Are Recovered Covid-19 Patients Protected From Reinfection?mentioning

confidence: 99%

Antibody response and therapy in COVID-19 patients: what can be learned for vaccine development?

Zhang

Zhan

et al. 2020

Sci. China Life Sci.

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The newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people and caused tremendous morbidity and mortality worldwide. Effective treatment for coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 infection is lacking, and different therapeutic strategies are under testing. Host humoral and cellular immunity to SARS-CoV-2 infection is a critical determinant for patients’ outcomes. SARS-CoV-2 infection results in seroconversion and production of anti-SARS-CoV-2 antibodies. The antibodies may suppress viral replication through neutralization but might also participate in COVID-19 pathogenesis through a process termed antibody-dependent enhancement. Rapid progress has been made in the research of antibody response and therapy in COVID-19 patients, including characterization of the clinical features of antibody responses in different populations infected by SARS-CoV-2, treatment of COVID-19 patients with convalescent plasma and intravenous immunoglobin products, isolation and characterization of a large panel of monoclonal neutralizing antibodies and early clinical testing, as well as clinical results from several COVID-19 vaccine candidates. In this review, we summarize the recent progress and discuss the implications of these findings in vaccine development.

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“…Emerging evidence suggests Ct values and viral loads at the time of diagnosis maybe implicated in pathogenesis and disease severity (22). A handful of confirmed SARS-CoV-2 reinfection have been published on the basis of genome variation observed in the viruses between the two episodes with varying clinical manifestations between the episodes (2,3,23,24). The European Center for Disease Control and Prevention (ECDC) (25) and United States Center for Disease Control and Prevention (US CDC) (26) have considered multiple criteria to investigate a case of suspected reinfection.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Serological, Whole Genome Sequence Analyses to Confirm SARS-CoV-2 Reinfection in Patients From Mumbai, India

et al. 2021

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Background: SARS-CoV-2 infection may not provide long lasting post-infection immunity. While hundreds of reinfections have reported only a few have been confirmed. Whole genome sequencing (WGS) of the viral isolates from the different episodes is mandatory to establish reinfection.Methods: Nasopharyngeal (NP), oropharyngeal (OP) and whole blood (WB) samples were collected from paired samples of four individuals who were suspected of SARS-CoV-2 reinfection based on distinct clinical episodes and RT-PCR tests. Details from their case record files and investigations were documented. RNA was extracted from the NP and OP samples and subjected to WGS, and the nucleotide and amino acid sequences were subjected to genome and protein-based functional annotation analyses. Serial serology was performed for Anti-N IgG, Anti- S1 RBD IgG, and sVNT (surrogate virus neutralizing test).Findings: Three patients were more symptomatic with lower Ct values and longer duration of illness. Seroconversion was detected soon after the second episode in three patients. WGS generated a genome coverage ranging from 80.07 to 99.7%. Phylogenetic analysis revealed sequences belonged to G, GR and “Other” clades. A total of 42mutations were identified in all the samples, consisting of 22 non-synonymous, 17 synonymous, two in upstream, and one in downstream regions of the SARS-CoV-2 genome. Comparative genomic and protein-based annotation analyses revealed differences in the presence and absence of specific mutations in the virus sequences from the two episodes in all four paired samples.Interpretation: Based on the criteria of genome variations identified by whole genome sequencing and supported by clinical presentation, molecular and serological tests, we were able to confirm reinfections in two patients, provide weak evidence of reinfection in the third patient and unable to rule out a prolonged infection in the fourth. This study emphasizes the importance of detailed analyses of clinical and serological information as well as the virus's genomic variations while assessing cases of SARS-CoV-2 reinfection.

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Reinfection of COVID‐19 after 3 months with a distinct and more aggressive clinical presentation: Case report

Cited by 54 publications

References 7 publications

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

Antibody response and therapy in COVID-19 patients: what can be learned for vaccine development?

Clinical, Serological, Whole Genome Sequence Analyses to Confirm SARS-CoV-2 Reinfection in Patients From Mumbai, India

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