Transmissibility and viral replication of SARS‐COV‐2 in immunocompromised patients

Beran, Azizullah; Zink, Evan; Mhanna, Mohammed; Abugharbyeh, Aya; Hanrahan, Jennifer; Duggan, Joan; Assaly, Ragheb

doi:10.1002/jmv.26970

Cited by 14 publications

(16 citation statements)

References 11 publications

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“…Prolonged shedding of viable virus (>20 days) has been reported in some adults, either with severe COVID-19 or among immunocompromised patients. 10 However, both of the cases reported here did not report any previous comorbidity and presented with a mild form of the disease with no clinical complications or need for hospitalization.…”

Section: Discussionmentioning

confidence: 66%

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Prolonged presence of replication‐competent SARS‐CoV‐2 in mildly symptomatic individuals: A report of two cases

Corrêa

Leal

Boas

et al. 2021

Journal of Medical Virology

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It has been estimated that individuals with COVID-19 can shed replicationcompetent virus up to a maximum of 20 days after initiation of symptoms. The majority of studies that addressed this situation involved hospitalized individuals and those with severe disease. Studies to address the possible presence of SARS-CoV-2 during the different phases of COVID-19 disease in mildly infected individuals, and utilization of viral culture techniques to identify replicationcompetent viruses, have been limited. This report describes two patients with mild forms of the disease who shed replication-competent virus for 24 and 37 days, respectively, after symptom onset.

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Section: Discussionmentioning

confidence: 66%

“…[3][4][5][6][7][8][9] However more recently, prolonged shedding of the viable virus has been described in immunocompromised patients. In a recent review, Beran et al 10 described a few studies among immunocompromised patients, who reported positive viral cultures with a median time of 26 days (interquartile range, 19-94.5).…”

Section: Introductionmentioning

confidence: 99%

Prolonged presence of replication‐competent SARS‐CoV‐2 in mildly symptomatic individuals: A report of two cases

Corrêa

Leal

Boas

et al. 2021

Journal of Medical Virology

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“…In addition, potential drug–drug interactions between immunosuppressive medications and antiviral therapy could complicate and worsen the clinical condition [ 81 ]. In patients who recovered from COVID-19, those with immunocompromised status may still experience longer viral shedding from the respiratory tract than the general population [ 82 ]. The increased susceptibility to infection and delayed viral clearance both indicate that immunocompromised status contributes to higher mortality in kidney transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Mortality, Acute Kidney Injury and Graft Loss in Adult Kidney Transplant Recipients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis

Chen

Kuo

Lee

et al. 2021

JCM

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The adverse impact of Coronavirus disease 2019 (COVID-19) on kidney function has been reported since the global pandemic. The burden of COVID-19 on kidney transplant recipients, however, has not been systematically analyzed. A systematic review and meta-analysis with a random-effect model was conducted to explore the rate of mortality, intensive care unit admission, invasive mechanical ventilation, acute kidney injury, kidney replacement therapy and graft loss in the adult kidney transplant population with COVID-19. Sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: we demonstrated a pooled mortality rate of 21% (95% CI: 19−23%), an intensive care unit admission rate of 26% (95% CI: 22–31%), an invasive ventilation rate among those who required intensive care unit care of 72% (95% CI: 62–81%), an acute kidney injury rate of 44% (95% CI: 39–49%), a kidney replacement therapy rate of 12% (95% CI: 9–15%), and a graft loss rate of 8% (95% CI: 5–15%) in kidney transplant recipients with COVID-19. The meta-regression indicated that advancing age is associated with higher mortality; every increase in age by 10 years was associated with an increased mortality rate of 3.7%. Regional differences in outcome were also detected. Further studies focused on treatments and risk factor identification are needed.

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“…Generally, SARS-CoV-2 causes acute respiratory syndrome with a rapid and broad clinical outcome. However, some studies had reported viral RNA (vRNA) and infectious particles for an atypical considered period (14)(15)(16). Other studies that characterized the intra-host viral diversity in patients with persistent infection showed a strong selection bias, with the introduction of neutralizing antibody cocktails or several interventions to treat secondary symptoms to the virus action (11,12).…”

Section: Introductionmentioning

confidence: 99%

Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution in a Mildly Affected Symptomatic Patient

Cunha¹,

Vilela²,

Molina³

et al. 2021

Front. Med.

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is caused by a respiratory virus with a wide range of manifestations, varying from asymptomatic to fatal cases, with a generally short outcome. However, some individuals present long-term viral shedding. We monitored 38 individuals who were mildly affected by the SARS-CoV-2 infection. Out of the total studied population, three (7.9%) showed atypical events regarding the duration of positivity for viral RNA detection. In one of these atypical cases, a previously HIV-positive male patient presented a SARS-CoV-2 RNA shedding and subgenomic RNA (sgRNA) detected from the upper respiratory tract, respectively, for 232 and 224 days after the onset of the symptoms. The SARS-CoV-2 B.1.1.28 lineage, one of the most prevalent in Brazil in 2020, was identified in this patient in three serial samples. Interestingly, the genomic analyses performed throughout the infectious process showed an increase in the genetic diversity of the B.1.1.28 lineage within the host itself, with viral clearance occurring naturally, without any intervention measures to control the infection. Contrasting widely spread current knowledge, our results indicate that potentially infectious SARS-CoV-2 virus might be shed by much longer periods by some infected patients. This data call attention to better adapted non-pharmacological measures and clinical discharge of patients aiming at preventing the spread of SARS-CoV-2 to the population.

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Transmissibility and viral replication of SARS‐COV‐2 in immunocompromised patients

Abstract: T A B L E 2 Detailed data regarding positivity of viral culture and subgenomic RNA for each patient in the included studies Patient number Study, year Choi, 2020 Positive (Days 75 and 143) NR Abbreviation: NR, not reported.

Cited by 14 publications

References 11 publications

Prolonged presence of replication‐competent SARS‐CoV‐2 in mildly symptomatic individuals: A report of two cases

Prolonged presence of replication‐competent SARS‐CoV‐2 in mildly symptomatic individuals: A report of two cases

Incidence of Mortality, Acute Kidney Injury and Graft Loss in Adult Kidney Transplant Recipients with Coronavirus Disease 2019: Systematic Review and Meta-Analysis

Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution in a Mildly Affected Symptomatic Patient

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