Viral Shedding among Re-Positive Severe Acute Respiratory Syndrome Coronavirus-2 Positive Individuals in Republic of Korea

Kim, Jeong‐Min; Ryu, Boyeong; Choe, Young June; Jo, Hye-Jun; Lee, Hyeokjin; Kim, Heui Man; Lee, Nam-Joo; Rhee, Jee Eun; Chung, Youngjin; Han, Myung Guk; Kim, Eun Jin; Park, Young-Joon; Gwack, Jin; Jin, Youngho; Song, Jeongsuk; Seo, Seyoung; Gill, Byoungchul; Kim, Hyunyeong; Park, Yeeun; Yoo, Cheon-Kwon; Jeong, Eun Kyeong

doi:10.3390/v13102089

Cited by 5 publications

(2 citation statements)

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“…A positive PCR test within 3 months of past COVID-19 infection in an asymptomatic individual with a CT value higher than 35 is usually considered a PCR re-positivity, and there is no need for respiratory isolation [ 28 , 29 ]. However, all CT values were lower than 35 in our case during more than 6 months of follow-up (Table 2 ), which could be explained by the patient’s immunosuppressed status [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Severe acute respiratory syndrome coronavirus-2 Alpha variant (B.1.1.7), original wild-type severe acute respiratory syndrome coronavirus 2, and cytomegalovirus co-infection in a young adult with acute lymphoblastic leukemia, case report, and review of the possible cytomegalovirus reactivation mechanisms

et al. 2023

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Background Like other viral infections, severe acute respiratory syndrome coronavirus-2 infection could affect different human body systems, including host immune responses. Three years after its pandemic, we learn more about this novel coronavirus. As we expected, different co-infections with various organisms, such as viruses, bacteria, and even fungi, have been reported. However, concurrent infection with two severe acute respiratory syndrome coronavirus-2 strains and cytomegalovirus is extremely unusual. We have only a rudimentary understanding of such co-infections and their long-term consequences for patients with cancer. Case presentation An 18-year-old young Iranian adult with acute lymphoblastic leukemia presented with abdominal pain, diarrhea, nausea, and vomiting following a recent history of severe acute respiratory syndrome coronavirus-2 infection. The patient never experienced respiratory symptoms, and the chest imaging study was normal on admission. His primary laboratory investigation revealed prerenal azotemia and severe abnormal liver function tests (blood urea nitrogen 32 mg/dL, creatinine 1.75 mg/dL, prothrombin time 66 s, partial thromboplastin time 44.5 s, international normalized ratio 5.14, total bilirubin 2.9 mg/dL, and direct bilirubin 2.59 mg/dL). Cytomegalovirus disease was diagnosed by polymerase chain reaction in his blood and stool samples. The patient’s gastrointestinal signs and symptoms improved shortly after receiving intravenous ganciclovir treatment. His gastrointestinal symptoms continued intermittently for weeks despite maintenance valganciclovir prescription, necessitating frequent hospitalizations. The patient was complicated by the recurrence of gastrointestinal symptoms during the sixth hospitalization, even though he had no respiratory symptoms, and the nasopharyngeal test revealed severe acute respiratory syndrome coronavirus-2 Wuhan strain for the first time. Remdesivir and valganciclovir were administrated due to persistent enteritis and evidence of intestinal tissue invasion by severe acute respiratory syndrome coronavirus 2 and cytomegalovirus on multiple intestinal biopsies, which led to partial clinical responses. Cytomegalovirus and severe acute respiratory syndrome coronavirus-2 fecal shedding continued for more than 6 months despite repeated antiviral therapy, and the Wuhan and Alpha strains were also detected in his nasopharyngeal samples through repeated sampling (confirmed by four nasopharyngeal sampling and multiple stool specimens and several intestinal biopsies). Finally, during the Delta-variant (B.1.617.2) outbreak in Iran, the patient was admitted again with febrile neutropenia and decreased level of consciousness, necessitating respiratory support and mechanical ventilation. During the Delta-variant peak, the patient’s nasopharyngeal sample once more tested positive for severe acute respiratory syndrome coronavirus 2. The patient died a few days later from cardiopulmonary arrest. Conclusion The coronavirus disease 2019 pandemic has encountered patients with cancer with critical diagnostic and treatment challenges. Patients who are immunocompromised may co-infect with multiple severe acute respiratory syndrome coronavirus-2 strains and cytomegalovirus, and even with timely diagnosis and treatment, the prognosis may be poor.

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Section: Discussionmentioning

confidence: 99%

Severe acute respiratory syndrome coronavirus-2 Alpha variant (B.1.1.7), original wild-type severe acute respiratory syndrome coronavirus 2, and cytomegalovirus co-infection in a young adult with acute lymphoblastic leukemia, case report, and review of the possible cytomegalovirus reactivation mechanisms

et al. 2023

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“…The fifth section covers the epidemiology of SARS-CoV-2 and includes four communication articles describing viral shedding among re-positive SARS-CoV-2 individuals in the Republic of Korea (26), the lack of evidence for SARS-CoV-2 spillover in free-living neotropical non-human primates in Brazil (27), the neutralizing activity of serum against the B.1.17, B.1.351, and P.1 SARS-CoV-2 VoCs in hospitalized COVID-19 patients (28), and SARS-CoV-2 re-infection in a healthcare worker despite the presence of neutralizing antibodies (29). This section also includes two case reports describing the first detection of the SARS-CoV-2 B.1.1.7 VoC in an asymptomatic dog in Spain (30) and a genomic surveillance of SARS-CoV-2 in Lebanon (31), and eleven original research articles describing different aspects of the epidemiology of SARS-CoV-2 (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42).…”

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confidence: 99%