Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States.
Department of Pathology, Westchester Medical Center/New York Medical College, Valhalla, NY, United States.
EBioMedicine. 2021 May;67:103355. doi: 10.1016/j.ebiom.2021.103355. Epub 2021 Apr 26.
There is increasing concern that persistent infection of SARS-CoV-2 within immunocompromised hosts could serve as a reservoir for mutation accumulation and subsequent emergence of novel strains with the potential to evade immune responses.
We describe three patients with acute lymphoblastic leukemia who were persistently positive for SARS-CoV-2 by real-time polymerase chain reaction. Viral viability from longitudinally-collected specimens was assessed. Whole-genome sequencing and serological studies were performed to measure viral evolution and evidence of immune escape.
We found compelling evidence of ongoing replication and infectivity for up to 162 days from initial positive by subgenomic RNA, single-stranded RNA, and viral culture analysis. Our results reveal a broad spectrum of infectivity, host immune responses, and accumulation of mutations, some with the potential for immune escape.
Our results highlight the potential need to reassess infection control precautions in the management and care of immunocompromised patients. Routine surveillance of mutations and evaluation of their potential impact on viral transmission and immune escape should be considered.
人们越来越担心，在免疫功能低下的宿主中，SARS-CoV-2 的持续感染可能成为突变积累的储库，并随后出现有可能逃避免疫反应的新型菌株。
我们描述了 3 例通过实时聚合酶链反应持续检测到 SARS-CoV-2 呈阳性的急性淋巴细胞白血病患者。对从纵向采集的标本进行了病毒存活能力评估。进行了全基因组测序和血清学研究，以测量病毒进化和免疫逃逸的证据。
我们发现了令人信服的证据，表明通过亚基因组 RNA、单链 RNA 和病毒培养分析，从最初的阳性结果开始，持续复制和感染长达 162 天。我们的结果揭示了广泛的感染性、宿主免疫反应和突变积累，其中一些具有免疫逃逸的潜力。
我们的研究结果强调了在免疫功能低下患者的管理和护理中重新评估感染控制预防措施的潜在需要。应考虑常规监测突变及其对病毒传播和免疫逃逸的潜在影响的评估。
