Clinical characteristics of “re-positive” discharged COVID-19 pneumonia patients in Wuhan, China

Abstract

To analyze the clinical characteristics of re-positive discharged COVID-19 patients and find distinguishing markers. The demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, illness severities and chest CT scan results of 267 patients were collected from 1st January to 15th February 2020. COVID-19 was diagnosed by RT-PCR. Clinical symptoms and nucleic acid test results were collected during the 14 days post-hospitalization quarantine. 30 out of 267 COVID-19 patients were detected re-positive during the post-hospitalization quarantine. Re-positive patients could not be distinguished by demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, chest CT scan results or subsequent clinical symptoms. However, re-positive rate was found to be correlated to illness severity, according the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity-of-disease classification system, and the confusion, urea, respiratory rate and blood pressure (CURB-65) score. Common clinical characteristics were not able to distinguish re-positive patients. However, severe and critical cases classified high according APACHE II and CURB-65 scores, were more likely to become re-positive after discharge.

Clinical characteristics, cause analysis and infectivity of COVID‐19 nucleic acid repositive patients: A literature review

“…6,[9][10][11][12] However, a large number of cases showed no clinical symptoms and no change in laboratory indicators or imaging findings. 3,7,8,[13][14][15][16][17][18] Furthermore, the repositive patients tended to be younger, and most of them had mild disease symptoms at the first time of admission. 6,7,13,13,18,19 Compared with other discharged patients, no clinical characteristics or indicators were found to reliably predict the risk of a patient being repositive for SARS-CoV-2, nor were any specific drugs or treatments associated with SARS-CoV-2 reactivation.…”

“…In the existing literature, strict isolation measures continue to be taken for discharged patients, and the chance of reexposure to the source of infection is very low, 7,8,11,11,17 which suggested that nucleic acid repositive patients are not reinfected with SARS-CoV-2, rather, it is likely that the virus was not completely cleared before the patients were discharged from hospital, and their previous nucleic acid test results were false negative. To ascertain why the nucleic acid results were false negative and SARS-CoV-2 is not easily cleared, the etiological and patient characteristics and laboratory tests should be analyzed in combination with the relevant literature.…”

“…According to reports of the clinical characteristics of repositive patients, some patients have recurrent clinical symptoms, such as fever and cough 6,9–12 . However, a large number of cases showed no clinical symptoms and no change in laboratory indicators or imaging findings 3,7,8,13–18 . Furthermore, the repositive patients tended to be younger, and most of them had mild disease symptoms at the first time of admission 6,7,13,13,18,19 …”

First report of COVID‐19 reinfection in a patient with beta thalassemia major

“…Although COVID‐19 reinfection was reported in a previous studies, the mechanism is not clear and it is still unknown if affected patients might present as carriers for the virus 5 …”

The relationship between SARS-COV-2 RNA positive duration and the risk of recurrent positive

“…Although there is no direct study of the relationship between SPD and recurrent positive, several related studies have been found. A study of 30 recurrent positive patients from China showed that there was a significant difference in length of hospitalization between the recurrent positive group and the non-recurrent positive group [median and IQR 36 day (30-44) vs. 25 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)] [17]. Although the study did not directly point out the difference in SPD between the two groups, there was a direct correlation between length of stay and SPD (Chinese discharge criteria are described in "Study design and participants" section, the most important of which was the test of SARS-CoV-2 RNA negative) [14].…”