Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
J Clin Microbiol. 2021 Jan 21;59(2). doi: 10.1128/JCM.02277-20.
The purpose of this study was to detect coronavirus disease 2019 (COVID-19) cases with persistent positive reverse transcription-PCR (RT-PCR) results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for which viable virus can be inferred due to the presence of subgenomic (SG) viral RNA, which is expressed only in replicating viruses. RNA remnants purified from diagnostic nasopharyngeal specimens were used as the templates for RT-PCR-specific detection of SG E gene RNA. As controls, we also detected viral genomic RNA for the E gene and/or a human housekeeping gene (RNase P). We assessed the samples of 60 RT-PCR-positive cases with prolonged viral SARS-CoV-2 shedding (24 to 101 days) since the first diagnostic RT-PCR. SG viral RNA was detected in 12/60 (20%) of the persistent cases, 28 to 79 days after the onset of symptoms. The age range of the cases with prolonged viral shedding and the presence of SG RNA was quite wide (40 to 100 years), and the cases were equally distributed between males (42%) and females (58%). No case was HIV positive, although seven were immunosuppressed. According to the severities of the COVID-19 episodes, they were mild (40%), intermediate (20%), and severe (40%). In a percentage of persistent SARS-CoV-2 PCR-positive cases, the presence of actively replicating virus may be inferred, far beyond diagnosis. We should not assume a universal lack of infectiousness for COVID-19 cases with prolonged viral shedding.
本研究旨在检测持续出现新型冠状病毒(SARS-CoV-2)阳性逆转录-聚合酶链反应(RT-PCR)结果的 2019 年冠状病毒病(COVID-19)病例,因为存在亚基因组(SG)病毒 RNA,可推断出有存活病毒,因为只有复制病毒才能表达亚基因组 RNA。将从诊断性鼻咽标本中纯化的 RNA 残留物用作 RT-PCR 特异性检测 SG E 基因 RNA 的模板。作为对照,我们还检测了用于 E 基因和/或人类管家基因(RNase P)的病毒基因组 RNA。我们评估了 60 例延长病毒 SARS-CoV-2 脱落(24 至 101 天)的持续阳性 RT-PCR 病例的样本。在症状出现后 28 至 79 天,12/60(20%)的持续病例中检测到 SG 病毒 RNA。具有延长病毒脱落和 SG RNA 的病例的年龄范围相当广泛(40 至 100 岁),并且男性(42%)和女性(58%)之间的病例分布均匀。尽管有 7 例免疫抑制,但没有 HIV 阳性病例。根据 COVID-19 发作的严重程度,它们为轻度(40%)、中度(20%)和重度(40%)。在持续的 SARS-CoV-2 PCR 阳性病例中,存在活跃复制的病毒可能被推断,远远超出了诊断范围。我们不应该假设具有延长病毒脱落的 COVID-19 病例普遍缺乏传染性。
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