Relapse of clinical symptoms of COVID-19 or probable reinfection in a laboratory professional: a case report from Northeast Brazil

Kledoaldo Lima,Madi Veiga Diniz,Wagner Roberto Cirilo Da Silva,Ana Karolina Vanderlei Macedo,Aline Cavalcante De Lira,Alexsandro Pedro Da Silva,Arione Vieira Do Nascimento

doi:10.33448/rsd-v10i5.14730

Abstract

Healthcare professionals constitute one of the groups that are most vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we report the case of a non-overweight and non-smoking 42-year-old woman with thrombophilia due to methylenetetrahydrofolate reductase (MTHFR) gene mutation, hereditary renal cysts, and no history of diabetes or arterial hypertension, who presented the first symptoms between 10 and 17 August 2020, with a SARS-CoV-2-positive naso-oropharyngeal swab by qualitative real-time polymerase chain reaction (RT-PCR). However, the result for SARS-CoV-2 immunoglobulin G (IgG) was non-reactive 41 days after (21 September 2020) the onset of symptoms. Nevertheless, on 7 October 2020 (57 days after the first symptoms), the patient presented new symptoms suggestive of COVID-19, with another SARS-CoV-2-positive RT-PCR result, and on 21 October 2020, SARS-CoV-2 immunoglobulin G was positive. Considering this, we interrogated the results to determine whether the case was reinfection or reactivation. This outcome highlights the importance of surveillance over relapses or reinfections.

Highlights

Atypical pneumonia was first identified in Wuhan, Hubei Province, China, in December 2019, with a rapid increase in hospitalisations
The time interval between the two positive real-time polymerase chain reaction (RT-PCR) was 55 days. On both occasions when RT-PCR for SARS-CoV-2 was performed, no computed tomography (CT) scans and assays for other respiratory viruses or bacterial cultures of the upper or lower respiratory tracts were performed
We report a case of a health professional with recurrence of COVID-19 symptoms within 57 days

Summary

Introduction

Atypical pneumonia was first identified in Wuhan, Hubei Province, China, in December 2019, with a rapid increase in hospitalisations. SARS-CoV-2, because it is a more complex genome when compared to other RNA viruses, has shown different mutations in the Spike (S) region of its genome, which have aroused the interest of researchers, as they may be related increases in transmissibility, pathogenicity or immune escape from vaccines (Altmann, Rosemary & Beale, 2021). These variants, with a great possibility of pandemic impact, are called variants of concern (VOCs) and are classified according to the presence of different non-synonymous mutations present in the S region of the SARS-CoV-2 genome. Despite the greater resistance to some neutralizing antibodies, until now, it has been evaluated that vaccines cope well in controlling VOCs (Gómes, Perdiguero & Esteban, 2021)

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