The Possibility and Cause of Relapse After Previously Recovering From COVID-19: A Systematic Review

Elsayed, Sarah; Reddy, Mithun K; Murthy, Pooja M; Gupta, Ishita; Valiuskyte, Monika; Sánchez, Diana Ivonne Rodríguez; Diaz, Mark Anthony

doi:10.7759/cureus.10264

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…One of these focused on the relapse of the disease, which is one of the potential causes of repeated positivity. It is noteworthy that none of the patients included in this study were asymptomatic at the time of relapse, which could act well to differentiate between reinfection and relapse [ 20 ]. In accordance, another study of 182 patients reported that repeated positivity during isolation after the initial episode of infection is rarely associated with the recurrence of disease if symptoms are absent [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Repeated SARS-CoV-2 Positivity: Analysis of 123 Cases

Váncsa

Dembrovszky

Farkas

et al. 2021

Viruses

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Repeated positivity and reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is a significant concern. Our study aimed to evaluate the clinical significance of repeatedly positive testing after coronavirus disease 2019 (COVID-19) recovery. We performed a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. With available individual patient data reporting on repeatedly SARS-CoV-2 positive (RSP) patients, case reports, and case series were included in this analysis. We performed a descriptive analysis of baseline characteristics of repeatedly positive cases. We assessed the cases according to the length of their polymerase chain reaction (PCR) negative interval between the two episodes. Risk factors for the severity of second episodes were evaluated. Overall, we included 123 patients with repeated positivity from 56 publications, with a mean repeated positivity length of 47.8 ± 29.9 days. Younger patients were predominant in the delayed (>90 days) recurrent positive group. Furthermore, comparing patients with RSP intervals of below 60 and above 60 days, we found that a more severe disease course can be expected if the repeated positivity interval is shorter. Severe and critical disease courses might predict future repeatedly positive severe and critical COVID-19 episodes. In conclusion, our results show that the second episode of SARS-CoV-2 positivity is more severe if it happens within 60 days after the first positive PCR. On the other hand, the second episode’s severity correlates with the first.

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Section: Discussionmentioning

confidence: 99%

Repeated SARS-CoV-2 Positivity: Analysis of 123 Cases

Váncsa

Dembrovszky

Farkas

et al. 2021

Viruses

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“…Immune response is the body's response to viral infection. Macrophages, neutrophils and dendritic cells produce a nonspecific innate response that slows the virus' progress and may even prevent the virus from causing symptoms [142] . After this non-specific response, the body will generate an adaptive immune response that specifically binds to the virus, and the adaptive response of this combination may clear the virus from the body [141] .…”

Section: Discussionmentioning

confidence: 99%

“…Although six systematic reviews and/or meta-analyses have been already published [ 142 , [151] , [152] , [153] , [154] , [155] ], none of them were comprehensive in terms of literature search. For example, one systematic review did not report the results of a systematic search, the number of included studies was uncertain [151] .…”

Section: Discussionmentioning

confidence: 99%

“…For example, one systematic review did not report the results of a systematic search, the number of included studies was uncertain [151] . Another one systematic review only described the number of days from discharge to relapse and the symptoms of PR patients, which provided less information [142] . Three meta-analysis included small numbers of cases, including 17 [155] , 14 [154] and 9 [153] cases, respectively.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

Ren

Lou

et al. 2021

EClinicalMedicine

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Background With the increased number of patients discharged after having COVID-19, more and more studies have reported cases whose retesting was positive (RP) during the convalescent period, which brings a new public health challenge to the world. Methods We searched PubMed, Web of Science, The Cochrane Library, CNKI, WanFang and VIP from December 1, 2019 to December 31, 2020. The included studies were assessed using JBI critical appraisal tools and Newcastle-Ottawa Scale. The RP rate of discharge patients was analyzed by a meta-analysis. We adhered to PRISMA reporting guideline. Findings We have included 117 studies with 2669 RP participants after discharge. The methodological quality of 66 case reports were low to high, 42 case series and 3 cohort study were moderate to high, 3 case-control studies were moderate and 3 cross-sectional studies were low to moderate. The clinical manifestations of most RP patients were mild or asymptomatic, and CT imaging and laboratory examinations were usually normal. The existing risk factors suggest that more attention should be paid to sever patients, elderly patients, and patients with co-morbidities. The summary RP rate was 12·2% (95% CI 10·6–13·7) with high heterogeneity ( I 2 = 85%). Interpretation To date, the causes and risk factors of RP result in discharged patients are not fully understood. High-quality etiological and clinical studies are needed to investigate these issues to further help us to make strategies to control and prevent its occurrence.

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“…Our results show that late asymptomatic RT-PCR re-positivity does occur after COVID-19, even 6 months later, and does not necessarily represent new infection, despite the prolonged time interval elapsed and the negativity of subsequent RT-PCR tests since the first diagnosis. Although asymptomatic and symptomatic SARS-CoV-2 re-positivity had been reported, median time to recurrence was usually lower, around 1-2 months [ 6 , 7 ]. We found that the CDC criteria showed to satisfactorily predict reinfection, since none of patients not meeting the proposed criteria showed to be reinfected after genomic sequencing testing, while reinfection was actually confirmed in the suspected case according to criteria.…”

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confidence: 99%