Test-based de-isolation in COVID-19 immunocompromised patients: Cycle threshold value versus SARS-CoV-2 viral culture

Abstract

Background Immunocompromised COVID-19 patients have prolonged infectious viral shedding for more than 20 days. A test-based approach is suggested for de-isolation of these patients. Methods We evaluated this strategy by comparing SARS-CoV-2 viral load (Ct values) and viral cultures at the time of hospital discharge in a series of immunocompetent (6 patients) and immunocompromised (5 solid organ transplants, 1 patient with lymphoma and one patient with hepatocellular carcinoma) COVID-19 patients. Results 3/13 (23%) patients had positive viral cultures: one patient with lymphoma at day 16 and two immunocompetent patients at day 7 and 11. Of the patients, 80% had negative viral cultures and had mean Ct value 20.5. None of the solid organ transplants recipients had positive viral cultures. Conclusion The mean Ct values for negative viral cultures was 20.5 in our case series of immunocompromised patients. Unlike hematological malignancies, none of the solid organ transplants had positive viral cultures. Adopting the test-based approach for all immunocompromised patients may lead to prolonged quarantine. Large scale studies in disease specific populations are needed whether a test-based approach versus a symptom-based approach or a combination is applicable for the de-isolation of various immunocompromised patients.

Assessment of the Health-Promoting Behaviors of Hospitalized Patients with Non-Communicable Diseases During the Second Wave of COVID-19

“…2 Most of the patients often develop severe symptoms leading to death, including pregnant women, children aged 6 months to 2 years, older adults, disabled people, and thalassemia or immunocompromised patients. 5,6 In addition, obese people with a body mass index (BMI) of 35 kg/m 2 and people with chronic diseases, particularly non-communicable diseases (NCDs), are also especially vulnerable to the disease. [7][8][9] NCDs are the most important public health problems and the leading cause of death, rehospitalization, and care expenditure.…”

Duration of viable SARS-CoV-2 shedding from respiratory tract in different human hosts and its impact on isolation discontinuation polices revision; a narrative review

“…However, the decision of discontinuing isolation in such an entity of patients remains an ample challenge. Though a combination of test based along with symptoms-based approaches could help guide the decision-making process in such entities of patients as proposed by Alshukairi et al ( Alshukairi et al, 2021 Jul ).…”

Viral cultures, Polymerase Chain Reaction Cycle Threshold Values and Viral Load Estimation for SARS-CoV-2 Infectious Potential Assessment in Hematopoietic Stem Cell and Solid Organ Transplant Patients: A Systematic Review

“…Five patients reported by Alshukairi et al were all culture-negative; this was in samples taken on days 9,12, 17,18 and day 26 since symptom onset, respectively 6 .…”

“…Five patients reported by Alshukairi et al were all culture-negative; this was in samples taken on days 9,12, 17,18 and day 26 since symptom onset, respectively 6 . Eight kidney transplant patients described by Benotmane and colleagues had positive viral cultures 7 .…”

“…Of the nine included studies (Figure 1 5 ) they reported data for 30 transplant patients (7 females and 23 males): renal (21), cardiac (5), bone marrow transplant (1), liver (2), bilateral lung (1). The 30 patients were in six countries: Saudi Arabia 6 , France 7 8 , Germany 9 10 11 , Austria 12 , Denmark 13 , and Canada 14 , and were aged between 26 and 75 years old.…”