Serial CT features in discharged COVID-19 patients with positive RT-PCR re-test

Abstract

The Coronavirus Disease 2019 appeared in December 2019 in China and has infected more than 100,000 patients in China since then. After MDT (multi-disciplinary team treatment), more than 60,000 patients were cured and discharged from the isolation wards of designated hospitals. All of the discharged patients were negative as assayed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) tests.Based on Chinese government guidelines, these discharge patients needed to remain in isolation in the home for 2 weeks followed by additional follow-up nucleic acid testing and chest CT examination. However, some discharged patients have retested positive using nucleic acid tests. Reports of these scattered cases have drawn huge scrutiny. Unfortunately, there are some relevant issues needing resolution. First, the capacity for transmission between persons with these patients after positive diagnosis still needs to be determined. Second, the features of serial chest CT scans need to be analyzed to improve our awareness of these cases. Finally, the reason causing these positive retest results should be discussed.We report here the serial CT examination features of two cluster transmission cases with positive follow-up nucleic acid test results after discharge.

The lingering manifestations of COVID-19 during and after convalescence: update on long-term pulmonary consequences of coronavirus disease 2019 (COVID-19)

“…While significantly improved from the last CTs of their hospital admissions, both follow-up CT scans showed persistent abnormalities. The study notes no evidence of reinfection or person-to-person transmission [9]. In Fu W et al, three patients previously discharged tested positive on subsequent RT-PCR, prompting readmission although asymptomatic.…”

“…While not mentioned in many studies from China, standardized discharge criteria for COVID-19 have been recommended by the China National Health Commission [9]. As noted by Zheng et al, studies have commonly used the following discharge criteria: (1) two consecutive negative RT-PCR tests; (2) improvements in chest radiography or chest CT; (3) improvement in clinical symptoms, vitals, and laboratory studies; and (4) corticosteroids completely discontinued for more than 1 week with the other criteria met.…”

“…Despite these discharge criteria, studies have shown laboratory and clinical abnormalities, persistent and/or relapsing. Cases of RT-PCR positivity after hospital discharge have been reported [9,10,12]. RT-PCR testing of the lower respiratory tract may show positivity for up to two weeks, while testing urine or stool may show positivity for up to four weeks.…”

Re-positive coronavirus disease 2019 PCR test: could it be a reinfection?

“…presented a case report from Jiangsu, China, in which a 56-year-old man and his daughter (21 years old) were diagnosed with COVID-19 and were discharged after negative results. However, 17 days later, both had positive results for nucleic acid swab tests [ 22 ]. Lan et al.…”

Diagnostic role of chest computed tomography in coronavirus disease 2019

“…Case reports from China are also appearing of using post-discharge follow-up CT to evaluate patients who re-tested positive with RT-PCR after they had had negative test results and had been discharged from a hospital [42,45].…”