Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
Department of Respiration, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
BMC Infect Dis. 2020 Jul 11;20(1):500. doi: 10.1186/s12879-020-05231-z.
The rapid spread of coronavirus disease 2019 (COVID-19) was declared as an emerging public health threat by the World Health Organization. As various measures have been taken successfully to combat the epidemic caused by SARS-CoV-2, a growing number of fully recovered patients have been discharged from hospitals. However, some of them have relapsed. Little is known about the causes that triggered the relapse.
We report a case of a 40 years old man who suffered from recurrent pulmonary infection with progression of lesions on chest computed tomography (CT), elevated levels of ferritin and IL2R, reduced lymphocyte count and positive oropharyngeal swab test for SARS-CoV-2 again after 5 days discharge from hospital. The anti-SARS-CoV-2 antibody level of this patient was very low at the time of relapse, suggesting a weak humoral immune response to the virus. Total exon sequencing revealed mutations in TRNT1 gene, which may be responsible for B cell immunodeficiency. Therefore, uncleared SARS-CoV-2 at his first discharge was likely to lead to his recurrence. However, viral superinfection and non-infectious organizing pneumonia could not be completely excluded.
COVID-19 relapse may occur in a part of discharged patients with low titers of anti-SARS-CoV-2 antibodies. These patients should be maintained in isolation for longer time even after discharge. A more sensitive method to detect SARS-CoV-2 needs to be established and serological testing for specific antibodies may be used as a reference to determine the duration of isolation.
世界卫生组织宣布，2019 年冠状病毒病（COVID-19）的迅速传播构成新出现的公共卫生威胁。随着成功采取了各种措施来应对由 SARS-CoV-2 引起的疫情，越来越多的完全康复的患者已从医院出院。但是，其中一些人已经复发。对于引发复发的原因知之甚少。
我们报告了一例 40 岁男性患者，他在出院后 5 天再次出现反复肺部感染，胸部 CT 上的病变进展，铁蛋白和 IL2R 水平升高，淋巴细胞计数减少，口咽拭子 SARS-CoV-2 检测再次阳性。该患者在复发时的抗 SARS-CoV-2 抗体水平非常低，表明对该病毒的体液免疫反应较弱。全外显子组测序显示 TRNT1 基因发生突变，这可能导致 B 细胞免疫缺陷。因此，他首次出院时未清除的 SARS-CoV-2 可能导致其复发。但是，不能完全排除病毒再感染和非传染性机化性肺炎。
一部分出院患者的 SARS-CoV-2 抗体滴度较低，可能会发生 COVID-19 复发。即使在出院后，这些患者也应保持更长时间的隔离。需要建立更敏感的 SARS-CoV-2 检测方法，并且可以使用针对特定抗体的血清学检测作为确定隔离持续时间的参考。
