BREAKING! COVID-19 News: Immunocompromised Individuals Contracting COVID-19 Can Exhibit Prolonged SARS-CoV-2 Shedding For Weeks To Months!

COVID-19 News: Researchers from University of Michigan have made a startling discovery that immunocompromised individuals contracting COVID-19 can exhibit prolonged viral shedding for weeks to even months!


 
The study team presented a case report of a chronic COVID-19 patient with hematologic malignancy. The patient shed infectious SARS-CoV-2 coronavirus for over 119 days. This case highlights unique challenges in infection control and the clinical management of immunocompromised hosts.
 
The case report was published in the peer reviewed Journal of Infectious Diseases. https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa666/5934826
 
Corresponding author, Dr Adam S. Lauring from the department of Microbiology and Immunology, University of Michigan, Ann Arbor told Thailand Medical news, “Our research team was not surprised that someone with immune problems might have a longer disease course and be contagious for more time than your typical patient. But this went on for over 100 days with ups and downs along the way."
 
Although individuals with COVID-19 can test positive for SARS-CoV-2 RNA up to six weeks after symptom onset, infectious virus is generally not detected beyond seven days after symptom onset,  past research suggests.https://jamanetwork.com/journals/jama/fullarticle/2768391
 
https://pubmed.ncbi.nlm.nih.gov/32306036/
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314198/
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499497/

Dr Lauring warned however that patients with primary or secondary immunodeficiencies have been underrepresented in most studies and may differ in their degree of shedding, kinetics of immune clearance and disease severity.
 
The study team describes the virological and clinical course of a 60-year-old male with a history of refractory mantle-cell lymphoma and COVID-19. Upon initial presentation, the patient was afebrile but neutropenic and a nasopharyngeal swab tested positive for SARS-CoV-2 RNA by RT-PCR.
 
It was reported that on day 7 of his illness, the patient was admitted for monitoring in the setting of chemotherapy-associated neutropenia and severe thrombocytopenia. He was discharged home with improved symptoms six days later (day 13).
 
The patient returned to the emergency department on day 22 after his symptoms worsened. A nasopharyngeal swab was again positive for SARS-CoV-2 by RT-PCR. On day 29, repeat nasopharyngeal and sputum samples were both positive for SARS-CoV-2 by RT-PCR.
 
Interestingly serologic testing on day 30 was negative for antibodies to SARS-CoV-2, but his sputum remained positive for SARS-CoV-2 on days 33 and 38. He was again discharged home in improved condition on day 39.
 
Another repeat serologic tes ting on day 66 detected IgG antibodies to SARS-CoV-2, and nasopharyngeal testing for SARS-CoV-2 RNA remained positive on days 47, 57, 66, 81, and 106.
 
Even on day 156 of illness, when the patient was readmitted due to progression of his lymphoma, SARS-CoV-2 testing remained positive.
 
Importantly respiratory tract specimens cultured on Vero E6 cells demonstrated the presence of infectious virus from days 7 through 119 of the patient's illness.
 
Detailed sequencing of the virus demonstrated progressive evolution with additional substitutions over time, but phylogenetic analysis essentially ruled out reinfection.
 
Dr Lauring commented, "Clinically, this case raised real challenges related to how to manage both his COVID-19 and his cancer. He got better each time he was treated with remdesivir and convalescent plasma, but these treatments were not enough to clear the virus. It kept coming back."
 
He added, "From a public-health perspective, we assumed this patient was potentially contagious the whole time. This has made us think hard about how to manage immunocompromised patients in our health system. The CDC guidelines suggest that you should assume that immunocompromised individuals will be contagious for up to 20 days. However, this patient may have been contagious for much, much longer. He didn't 'fit' the guidelines."
 
Dr Lauring warned, "We have a lot to learn about which immunocompromised patients we need to worry about. Cases like this one are probably pretty rare, but I am sure that there are others out there. These patients have a lot to teach us about how the body responds to SARS-CoV-2."
 
He added, "We also need better ways of determining who is still contagious. We had clues that this patient might be having prolonged viral replication, but routinely culturing the virus is not an option for most clinical labs. So, there's a need for some other test that can tell you whether the patient is infectious or not."
 
The study team concluded, “Our case illustrates that some patients with defective immune responses can shed infectious virus for many more weeks than originally thought. This has important public health and infection control implications. A major limitation of our study is that it describes a single individual whose clinical course may not be broadly generalizable to other immunocompromised population. Nevertheless, we expect that additional cases such as the one described above will continue to elucidate important aspects of SARS-CoV-2 pathogenesis, evolution, and immunity.”
 
It should be noted that this is not the first case of immunocompromised COVID-19 patients exhibiting prolong viral shedding. There has been many around the world being reported by physicians but this would highlight the first documented and published case study.
 
An immunocompromised host is a patient who does not have the ability to respond normally to an infection because of an impaired or weakened immune system. This may be caused by certain diseases or conditions, such as AIDS, cancer, diabetes, malnutrition, and certain genetic disorders. It may also be caused by certain medicines or treatments, such as anticancer drugs, radiation therapy, and stem cell or organ transplant.
 
There are also more than 200 different forms of primary immune deficiency diseases (PIDDs). NIAID conducts research across all PIDDs as well as among the individual diseases that make up this broad category. The following are some of the major individual PIDDs that NIAID is currently studying.
 
Autoimmune Lymphoproliferative Syndrome (ALPS)
APS-1 (APECED)
BENTA Disease
Caspase Eight Deficiency State (CEDS)
CARD9 Deficiency and Other Syndromes of Susceptibility to Candidiasis
Chronic Granulomatous Disease (CGD)
Common Variable Immunodeficiency (CVID)
Congenital Neutropenia Syndromes
CTLA4 Deficiency
DOCK8 Deficiency
GATA2 Deficiency
Glycosylation Disorders with Immunodeficiency
Hyper-Immunoglobulin E Syndromes (HIES)
Hyper-Immunoglobulin M Syndromes
Leukocyte Adhesion Deficiency (LAD)
LRBA Deficiency
PI3 Kinase Disease
PLCG2-associated Antibody Deficiency and Immune Dysregulation (PLAID)
Severe Combined Immunodeficiency (SCID)
STAT3 Dominant-Negative Disease
STAT3 Gain-of-Function Disease
Warts, Hypogammaglobulinemia, Infections, and Myelokathexis (WHIM) Syndrome
Wiskott-Aldrich Syndrome (WAS)
X-Linked Agammaglobulinemia (XLA)
X-Linked Lymphoproliferative Disease (XLP)
XMEN Disease
 
There is also what is known as temporary acquired immune deficiencies. In this case the immune system can be weakened by certain medicines, for example. This can happen to people on chemotherapy or other medicines used to treat cancer. It can also happen to people after organ transplants who take medicine to prevent organ rejection. Also, infections such as the flu virus, mono (mononucleosis), and measles can weaken the immune system for a short time. Your immune system can also be weakened by smoking, alcohol, and poor nutrition.
 
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