Persistent viral shedding despite seroconversion in a kidney transplant recipient with severe extrapulmonary COVID-19

Italiano, Jack; Bush, Rachel; Acharya, Ratna; Upadhyay, Kiran

doi:10.1136/bcr-2020-239612

Cited by 13 publications

(12 citation statements)

References 21 publications

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“…Of the four patients, all had suspected hospital-acquired COVID-19 and significant comorbidities: two had a history of chronic liver disease, and two had previous haematological malignancies, one of whom was still on immunosuppressive treatment. Immunosuppression has been associated with prolonged viral shedding ( Italiano et al, 2020 ; Avanzato et al, 2020 ). One superspreader was confused and mobile on the ward.…”

Section: Resultsmentioning

confidence: 99%

Superspreaders drive the largest outbreaks of hospital onset COVID-19 infections

Illingworth

Hamilton

Warne

et al. 2021

eLife

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SARS-CoV-2 is notable both for its rapid spread, and for the heterogeneity of its patterns of transmission, with multiple published incidences of superspreading behaviour. Here, we applied a novel network reconstruction algorithm to infer patterns of viral transmission occurring between patients and health care workers (HCWs) in the largest clusters of COVID-19 infection identified during the first wave of the epidemic at Cambridge University Hospitals NHS Foundation Trust, UK. Based upon dates of individuals reporting symptoms, recorded individual locations, and viral genome sequence data, we show an uneven pattern of transmission between individuals, with patients being much more likely to be infected by other patients than by HCWs. Further, the data were consistent with a pattern of superspreading, whereby 21% of individuals caused 80% of transmission events. Our study provides a detailed retrospective analysis of nosocomial SARS-CoV-2 transmission, and sheds light on the need for intensive and pervasive infection control procedures.

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Section: Resultsmentioning

confidence: 99%

Superspreaders drive the largest outbreaks of hospital onset COVID-19 infections

Illingworth

Hamilton

Warne

et al. 2021

eLife

View full text Add to dashboard Cite

show abstract

“…1 . Most included studies were case reports (n=89) [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] ...…”

Section: Resultsunclassified

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Quante

Brake

Tolios

et al. 2021

Transplantation Proceedings

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Background : The SARS-CoV-2 pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, an inexorable number of case reports, case series and ultimately various systematic reviews have been published reporting on morbidity and mortality risk of SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even the expert reader. Methods : We performed a structured literature review comprising electronic databases, transplant journals and included literature from previous systematic reviews covering the entire year 2020. From 164 included articles we identified 3451 cases of SARS-CoV-2 infected SOT recipients. Results : Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions (ICU) in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after COVID-19 was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT patients. Conclusions : COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT patients diseased with COVID-19.

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“…Of the four patients, all had suspected hospitalacquired COVID-19 and significant comorbidities: two had a history of chronic liver disease, and two had previous haematological malignancies, one of whom was still on immunosuppressive treatment. Immunosuppression has been associated with prolonged viral shedding 28,29 . One superspreader was confused and mobile on the ward.…”

Section: Resultsmentioning

confidence: 99%

Superspreaders drive the largest outbreaks of hospital onset COVID-19 infection

Illingworth¹,

Hamilton²,

Warne³

et al. 2021

Preprint

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The SARS-CoV-2 virus has been noted both for its rapid spread, but also for the heterogeneity of transmission, with incidences noted of superspreading behaviour. We here applied a novel network reconstruction algorithm to infer patterns of viral transmission occurring between patients and health care workers (HCWs) in the largest clusters of COVID-19 infection identified during the first wave of the epidemic at Cambridge University Hospitals NHS Foundation Trust, UK. Based upon dates of individuals reporting symptoms, recorded individual locations, and viral genome sequence data, we show an uneven pattern of transmission between individuals, with patients being much more likely to be infected by other patients than by HCWs. Further, the data were consistent with a pattern of superspreading, whereby 20% of individuals caused 80% of transmission events. Our study provides a detailed retrospective analysis of nosocomial SARS-CoV-2 transmission, and sheds light on the need for intensive and pervasive infection control procedures.

show abstract

Persistent viral shedding despite seroconversion in a kidney transplant recipient with severe extrapulmonary COVID-19

Cited by 13 publications

References 21 publications

Superspreaders drive the largest outbreaks of hospital onset COVID-19 infections

Superspreaders drive the largest outbreaks of hospital onset COVID-19 infections

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

Superspreaders drive the largest outbreaks of hospital onset COVID-19 infection

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