Three COVID-19 cases with a long-term viral shedding period in Tunisia

Bennasrallah, Cyrine; Bannour, R; Jlassi, O.; Kacem, M.; Fredj, Manel Ben; Abroug, Héla; Zemni, Imen; Garrach, Behaeddine; Bahri, Rihab; Charfeddine, Nesrine; Triki, Sayda; Sriha, Asma Belguith

doi:10.11604/pamj.supp.2020.35.2.24950

Cited by 5 publications

(5 citation statements)

References 7 publications

(8 reference statements)

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“…Altogether, these findings are consistent with the presence of a persisting nucleocapsid antigen reservoir resulting in enhanced N-specific Tfh cell activation in CN patients. Clinical reports have identified cases of persistent SARS-CoV-2 infection in the nasopharynx lasting up to 63 days (Bennasrallah et al, 2020) and many patients re-tested RT-PCR+ for SARS-CoV-2 up to 38 days post-discharge (Dao et al, 2021). Though many of our CN patients have not re-tested RT-PCR+ by nasal swab (data not shown), others have yet to be tested.…”

Section: Discussionmentioning

confidence: 90%

T cell responses to SARS-CoV-2 in people with and without neurologic symptoms of long COVID

Visvabharathy

Hanson

Orban

et al. 2021

Preprint

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The high prevalence of post-acute sequelae of SARS-CoV-2 infection (PASC) is a significant health concern. In particular, virus-specific immunity in patients who suffer from chronic neurologic symptoms after mild acute COVID remain poorly understood. Here, we report that neuro-PASC patients have a specific signature composed of humoral and cellular immune responses that are biased towards different structural proteins compared to healthy COVID convalescents. Interestingly, the severity of cognitive deficits or quality of life markers in neuro-PASC patients are associated with reduced effector molecule expression in memory T cells. Furthermore, we demonstrate that T cell responses to SARS-CoV-2 mRNA vaccines are aberrantly elevated in longitudinally sampled neuro-PASC patients compared with healthy COVID convalescents. These data provide a framework for the rational design of diagnostics and predictive biomarkers for long-COVID disease, as well as a blueprint for improved therapeutics.

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Section: Discussionmentioning

confidence: 90%

T cell responses to SARS-CoV-2 in people with and without neurologic symptoms of long COVID

Visvabharathy

Hanson

Orban

et al. 2021

Preprint

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“…PCR testing can remain positive for several months after SARS-Cov-2 infection. [ 23 ] Although no patients were observed to have worsening respiratory symptoms or chest CT findings, persistent ongoing infection could not be fully ruled out. Regarding vasculopathy, serum D-dimer levels were mildly elevated in 3 patients, and normal in 3 patients.…”

Section: Discussionmentioning

confidence: 99%

Delayed encephalopathy after COVID-19: A case series of six patients

et al. 2022

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Rationale: Acute encephalopathy is a severe neurological complication of coronavirus disease 2019 (COVID-19). Most cases of acute encephalopathy associated with COVID-19 occur within several weeks of COVID-19 onset. We describe a case series of 6 patients who developed delayed encephalopathy (DE) after COVID-19. Patient concerns and diagnoses: We evaluated patients who recovered from COVID-19 and showed acute disturbance of consciousness or focal neurological deficits without recurrence of pneumonitis. Six patients, 2 females and 4 males, with ages ranging from 65 to 83 years were included. Durations of hospitalization due to COVID-19 were between 25 and 44 days. The severity of COVID-19 was moderate in 5 and severe in 1 patient. Patients were rehospitalized for acute disturbance of consciousness concomitant with postural tremor and, abnormal behavior, hemiplegia, aphasia, or apraxia between 34 and 67 days after the onset of COVID-19. Chest computed tomography showed no exacerbation of pneumonitis. Brain magnetic resonance imaging showed no specific findings except in 1 patient with an acute lacunar infarction. Electroencephalogram demonstrated diffuse slowing in all patients. Repeat electroencephalogram after recovery from encephalopathy demonstrated normal in all patients. One of the 6 patients had cerebrospinal fluid (CSF) pleocytosis. CSF protein levels were elevated in all patients, ranging from 51 to 115 mg/dL. CSF interleukin-6 levels ranged from 2.9 to 10.9 pg/mL. The immunoglobulin index was 0.39 to 0.44. Qlim(alb) < QAlb indicating dysfunction of the blood–brain barrier was observed in all patients. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction of CSF was negative in all patients. Neuronal autoantibodies were absent in serum and CSF. Interventions and outcomes: Immunotherapy including steroid pulses was administered to 3 patients; however, symptoms of encephalopathy resolved within several days in all patients, regardless of treatment with immunotherapy, and their consciousness levels were recovered fully. Notably, postural tremor remained for 2 weeks to 7 months. Lessons: In our patients, DE after COVID-19 was characterized by symptoms of acute encephalopathy accompanied with tremor in the absence of worsening pneumonitis after the fourth week of COVID-19 onset. Our findings indicate blood–brain barrier dysfunction may contribute to the pathogenesis of DE after COVID-19.

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“…We analyzed 14 articles separately ( Bennasrallah et al, 2020 ;Chen et al, 2020a ;Hase et al, 2020 ;Luvira et al, 2020 ;Lv et al, 2020 ;Shao et al, 2020 ;Xia et al, 2020 ;Xing et al, 2020 ;Xu et al, 2020 ;Tajima et al, 2020 ;Sakanashi et al, 2021 ;Uda et al, 2021 ;Wan et al, 2021 ;Zheng et al, 2021 ) that reported two or more RT-PCR tests on upper or lower respiratory tract specimens after symptom onset. Figure 3 shows positivity over time, with data regarding how many tests were performed and how many of these were positive in each period.…”

Section: Temporal Profile Of Rt-pcr Testsmentioning

confidence: 99%