Massanella Marta, Martin-Urda Anabel, Mateu Lourdes, Marín Toni, Aldas Irene, Riveira-Muñoz Eva, Kipelainen Athina, Jiménez-Moyano Esther, Rodriguez de la Concepción Maria Luisa, Avila-Nieto Carlos, Trinité Benjamin, Pradenas Edwards, Rodon Jordi, Marfil Silvia, Parera Mariona, Carrillo Jorge, Blanco Julià, Prado Julia G, Ballana Ester, Vergara-Alert Júlia, Segalés Joaquim, Noguera-Julian Marc, Masabeu Àngels, Clotet Bonaventura, Toda Maria de la Roca, Paredes Roger
IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute, Badalona, Catalonia, Spain.
Internal Medicine Department, Hospital de Palamós, Palamós, Catalonia, Spain.
Open Forum Infect Dis. 2021 Jun 23;8(7):ofab329. doi: 10.1093/ofid/ofab329. eCollection 2021 Jul.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections have been reported; however, most cases are milder than the primary infection. We report the first case of a life-threatening critical presentation of a SARS-CoV-2 reinfection.
A 62-year-old man from Palamós (Spain) suffered a first mild coronavirus disease 2019 (COVID-19) episode in March 2020, confirmed by 2 independent SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) assays and a normal radiograph. He recovered completely and tested negative on 2 consecutive PCRs. In August 2020, the patient developed a second SARS-CoV-2 infection with life-threatening bilateral pneumonia and Acute respiratory distress syndrome criteria, requiring COVID-19-specific treatment (remdesivir + dexamethasone) plus high-flow oxygen therapy. Nasopharyngeal swabs from the second episode were obtained for virus quantification by real-time PCR, for virus outgrowth and sequencing. In addition, plasma and peripheral blood mononuclear cells during the hospitalization period were used to determine SARS-CoV-2-specific humoral and T-cell responses.
Genomic analysis of SARS-CoV-2 showed that the virus had probably originated shortly before symptom onset. When the reinfection occurred, the subject showed a weak immune response, with marginal humoral and specific T-cell responses against SARS-CoV-2. All antibody isotypes tested as well as SARS-CoV-2 neutralizing antibodies increased sharply after day 8 postsymptoms. A slight increase of T-cell responses was observed at day 19 after symptom onset.
The reinfection was firmly documented and occurred in the absence of robust preexisting humoral and cellular immunity. SARS-CoV-2 immunity in some subjects is unprotective and/or short-lived; therefore, SARS-CoV-2 vaccine schedules inducing long-term immunity will be required to bring the pandemic under control.
已有严重急性呼吸综合征冠状病毒2（SARS-CoV-2）再次感染的报道；然而，大多数病例比初次感染症状较轻。我们报告了首例SARS-CoV-2再次感染出现危及生命的严重表现的病例。
一名来自西班牙帕拉莫斯的62岁男性在2020年3月首次出现轻度冠状病毒病2019（COVID-19）发作，经2次独立的SARS-CoV-2鼻咽聚合酶链反应（PCR）检测确诊，胸部X光片正常。他完全康复，连续2次PCR检测均为阴性。2020年8月，该患者再次感染SARS-CoV-2，出现危及生命的双侧肺炎并符合急性呼吸窘迫综合征标准，需要接受COVID-19特异性治疗（瑞德西韦+地塞米松）加高频氧疗。采集第二次发作时的鼻咽拭子，通过实时PCR进行病毒定量、病毒培养及测序。此外，在住院期间采集血浆和外周血单个核细胞，以确定SARS-CoV-2特异性体液和T细胞反应。
SARS-CoV-2的基因组分析表明，该病毒可能在症状出现前不久出现。再次感染发生时，该患者免疫反应较弱，针对SARS-CoV-2的体液和特异性T细胞反应微弱。症状出现后第8天，所有检测的抗体亚型以及SARS-CoV-2中和抗体均急剧增加。症状出现后第19天，T细胞反应略有增加。
再次感染得到确切证实，且发生在缺乏强大的既有体液免疫和细胞免疫的情况下。部分个体的SARS-CoV-2免疫力无保护作用和/或持续时间短；因此，需要能诱导长期免疫的SARS-CoV-2疫苗接种计划来控制疫情。
