A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2

Abstract

Patient: Male, 57-year-old Final Diagnosis: COVID-19 pneumonia • reinfection Symptoms: Cough • fever Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: Coronavirus disease 2019 (COVID-19) has radically changed the world, and promising vaccine trials are currently underway. The immune responses in asymptomatic and symptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still under investigation, and data are evolving. While it is known that humoral and cell-mediated immune responses against SARS-CoV-2 are elicited, it is uncertain whether these responses protect against reinfection or that they provide definitive evidence of viral clearance. Very few cases have been reported in the literature regarding reinfection with SARS-CoV-2. Case Report: We present a case of a middle-aged man with asymptomatic SARS-CoV-2 infection who later developed mild symptomatic COVID-19 after a period of 3 months. The source of reinfection was likely from the community, which had a soaring burden of infection with the highest number of COVID-19 cases per million in the world at that time. The patient had 2 negative COVID-19 polymerase chain reaction (PCR) tests 2 weeks after the initial infection. During the second infection, a nasopharyngeal reverse-transcription PCR test and tests for the presence of COVID-19 immunoglobulin (Ig)M and IgG antibodies were all positive. Conclusions: Reinfection with SARS-CoV-2 is a strong possibility. This case raises concerns that asymptomatic infections may not provide long-term protective immunity to all patients, which could make them susceptible to rein-fection. Possible explanations for reinfection include an interval decrease in protective antibodies titers after SARS-CoV-2 infection that may be more prevalent in patients who had an asymptomatic infection. Other possibilities include viral reactivation after a prolonged carriage of the virus or delayed immune response.

COVID-19: Is reinfection possible?

“…1) (References in Table 1: Abdallah et al, 2020[ 1 ]; AlFehaidi et al, 2020[ 2 ]; Amoozgar et al, 2020[ 5 ]; Bonifácio et. al., 2020[ 9 ]; Chan et al, 2020[ 10 ]; Duggan et al, 2021[ 13 ]; Fernandes Valente Takeda et al, 2020[ 14 ]; Hanif et al, 2020[ 17 ]; He et al, 2021[ 18 ]; Lafaie et al, 2020[ 20 ]; Lancman et al, 2020[ 22 ]; Mulder et al, 2020[ 24 ]; Nachmias et al, 2020[ 25 ]; Selvaraj et al, 2020[ 31 ]; Sharma et al, 2020[ 33 ]; Tillett et al, 2020[ 35 ]; To et al, 2020[ 36 ]; Torres et al, 2021[ 37 ]) presents case reports of SARS-CoV-2 reinfection in different countries. In general, it appears that the RT-qPCR tests are used to diagnose different moments in the course of the disease.…”

From SIR to SEAIRD: A novel data-driven modeling approach based on the Grey-box System Theory to predict the dynamics of COVID-19

“…Furthermore, symptomatic people have a high probability to "recover" or to temporary lose the COVID-19 symptoms as reinfection and persistence are newly claimed [20,21]. For asymptomatic individuals, no clear conclusion can be drawn about their recovery potential [19,22]. Whether, they may continue to support the transmission of the virus with a high load still remain to be explored.…”

“…In December 2019, an outbreak of an emerging disease (COVID- 19) due to a novel coronavirus, the SARS-CoV-2, began in Wuhan, China and quickly spread in a substantial number of countries [1,2]. The COVID-19 pandemic, as a major global health threat, was declared by the WHO on 11 March 2020 [2].…”

“…Previous estimates of the proportion of asymptomatic people from COVID-19 provided values between 5% and 80% of people being tested positive for COVID-19 but without any symptoms [17,18]. However, it is crucial to better characterize the magnitude of the contribution of asymptomatic people to the spread of SARS-CoV-2 in order to be able to develop better strategies to halt this epidemic, not taking into account the possibility of reinfection of some recently infected people [19][20][21][22].…”

It's not over till it's over: a narrative review of Long COVID

“…A case study reports that a 57-year-old man with a confirmed but asymptomatic case of COVID developed a mild but symptomatic case of COVID about three months later. It is not clear whether this was reinfection from a communitybased source, viral reinfection, or a delayed immune response [49]. Cases of potential reinfection are rare but have been reported; there is no strong evidence with respect to whether a recovered COVID patient can become reinfected.…”