Abstract
Background: Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed.
Methods: We describe the viral evolution, immunologic response and clinical course of a patient with a lymphoma in complete remission who had received therapy with rituximab and remained SARS-CoV-2 RT-qPCR positive for 161 days.
Results: The patient remained hospitalised for 10 days, after which he fully recovered and remained asymptomatic. A progressive increase in Ct-value, coinciding with a progressive rise in lymphocyte count, was seen from day 137 onward. Culture of a nasopharyngeal swab on day 67 showed growth of SARS-CoV-2. Whole genome sequencing (WGS) demonstrated that the virus belonged to the wildtype SARS-CoV-2 clade 20B/GR, but rapidly accumulated a high number of mutations as well as deletions in the N-terminal domain of its spike protein.
Conclusion: SARS-CoV-2 persistence in immunocompromised individuals has important clinical implications, but halting immunosuppressive therapy might result in a favourable clinical course. The long-term shedding of viable virus necessitates customized infection prevention measures in these individuals. The observed accelerated accumulation of mutations of the SARS-CoV-2 genome in these patients might facilitate the origin of new VOCs that might subsequently spread in the general community.
Keywords: SARS-CoV-2; immunocompromised host; persistent infection; variants of concern (voc); viral evolution.
【저자키워드】 SARS-CoV-2, Immunocompromised host, variants of concern (VOC), persistent infection, viral evolution., 【초록키워드】 therapy, Mutation, VoC, variants of concern, Immunocompromised patients, virus, variants, rituximab, Spike protein, Immunocompromised patient, Spread, Lymphocyte count, Nasopharyngeal swab, lymphocyte, RT-qPCR, Clinical course, Whole genome sequencing, Viral, Asymptomatic, Culture, persistence, SARS-CoV-2 genome, viral evolution, qPCR, lymphoma, Patient, Infection prevention, Immunocompromised, Community, Deletion, clade, Ct-value, persistent infection, WGS, immunosuppressive therapy, N-terminal domain, Prolonged, immunosuppressive, immunologic response, Complete Remission, immunocompromised individuals, growth, accumulation, measure, wildtype, positive, deletions, whole genome, clinical implications, Complete, hospitalised, described, remained, facilitate, demonstrated, increase in, individuals, accelerated, accumulated, immunocompromised individual, the SARS-CoV-2 genome, 【제목키워드】 persistent infection, persistent,