Mendel Arielle, Colmegna Ines, Bourque Guillaume, Rajda Ewa, Lee Todd C, Gálvez José Héctor, Vinet Évelyne, Cheng Matthew P
Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
Canadian Centre for Computational Genomics, McGill University, Montreal, Quebec, Canada.
J Assoc Med Microbiol Infect Dis Can. 2022 Jun 3;7(2):131-134. doi: 10.3138/jammi-2021-0033. eCollection 2022 Jun.
Few reports exist on the characteristics and outcomes of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immunocompromised hosts.
A 49-year-old patient with granulomatosis with polyangiitis (GPA) and a renal transplant experienced multiple hospitalizations for coronavirus disease 2019 (COVID-19) pneumonia and relapses between October 2020 and February 2021. Careful chart review of medical history, hospitalizations, and microbiological testing including SARS-CoV-2 cycle threshold values, therapies, and imaging was undertaken. SARS-CoV-2 genome sequencing was performed in five viral samples to distinguish persistent infection from re-infection with a different strain.
Sequencing confirmed that all samples tested were from the same viral lineage, indicating a long-term, persistent infection rather than re-infection with a new strain. The patient ultimately stabilized after two courses of remdesivir plus dexamethasone, replacement intravenous immunoglobulin, and bamlanivimab. Rituximab maintenance therapy for vasculitis remains on hold.
SARS-CoV-2 may persist for several months in immunocompromised hosts and may go unrecognized as an ongoing active infection. More studies are needed to determine how to optimize COVID-19 treatment in this vulnerable population.
关于免疫功能低下宿主中持续性严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的特征和结局的报告较少。
一名49岁患有肉芽肿性多血管炎（GPA）且接受了肾移植的患者在2020年10月至2021年2月期间因2019冠状病毒病（COVID-19）肺炎多次住院并复发。对病史、住院情况以及包括SARS-CoV-2循环阈值、治疗方法和影像学检查在内的微生物检测进行了仔细的病历审查。对五个病毒样本进行了SARS-CoV-2基因组测序，以区分持续性感染与不同毒株的再次感染。
测序证实所有检测样本均来自同一病毒谱系，表明是长期的持续性感染而非新毒株的再次感染。该患者在接受了两个疗程的瑞德西韦加地塞米松、补充静脉注射免疫球蛋白和巴瑞替尼治疗后最终病情稳定。用于血管炎的利妥昔单抗维持治疗暂停。
SARS-CoV-2可能在免疫功能低下宿主中持续数月，并且可能未被识别为正在进行的活动性感染。需要更多研究来确定如何在这一脆弱人群中优化COVID-19治疗。
