Abstract
A few molecularly proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases of symptomatic reinfection are currently known worldwide, with a resolved first infection followed by a second infection after a 48 to 142-day intervening period. We report a multiple-component study of a clinically severe and prolonged viral shedding coronavirus disease 2019 (COVID-19) case in a 17-year-old Portuguese female. She had two hospitalizations, a total of 19 RT-PCR tests, mostly positive, and criteria for releasing from home isolation at the end of 97 days. The viral genome was sequenced in seven serial samples and in the diagnostic sample from her infected mother. A human genome-wide array (>900 K) was screened on the seven samples, and in vitro culture was conducted on isolates from three late samples. The patient had co-infection by two SARS-CoV-2 lineages, which were affiliated in distinct clades and diverging by six variants. The 20A lineage was absolute at the diagnosis (shared with the patient’s mother), but nine days later, the 20B lineage had 3% frequency, and two months later, the 20B lineage had 100% frequency. The 900 K profiles confirmed the identity of the patient in the serial samples, and they allowed us to infer that she had polygenic risk scores for hospitalization and severe respiratory disease within the normal distributions for a Portuguese population cohort. The early-on dynamic co-infection may have contributed to the severity of COVID-19 in this otherwise healthy young patient, and to her prolonged SARS-CoV-2 shedding profile.
Highlights
A nasopharyngeal swab performed during the initial workup detected SARS-CoV-2 RNA (Table S2), and the patient was transferred to our referral center for Emerging Infectious Diseases at Centro Hospitalar
Discussions We illustrate a severe presentation of COVID-19 in a young healthy patient with prolonged viral shedding of SARS-CoV-2
We illustrate a severe presentation of COVID-19 in a young healthy patient with proclinical diagnosis, and only the molecular study allowed us to shed light into its classificalonged viral shedding of SARS-CoV-2
Summary
Long shedding cases are not rare, and a survey of 378 Covid-19 patients from Wuhan revealed that 36 continued to shed the virus longer than 30 days (mean of 54 days; longest 83 days; [4]). This extended or recurrent positivity could be due to (1) a reactivation of the virus after a period of clinical latency; (2) SARS-CoV-2 reinfection; (3) or RT-PCR tests detecting viral remains and not necessarily active viral particles. To check for the last possibility, the inclusion of infectivity studies might help understand if the virus retains both viability and integrity [6]
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