tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Jun 23;8(7)
fab329.
doi: 10.1093/ofid/ofab329. eCollection 2021 Jul.
Critical Presentation of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Report
Marta Massanella[SUP] 1 [/SUP], Anabel Martin-Urda[SUP] 2 [/SUP], Lourdes Mateu[SUP] 3 4 [/SUP], Toni Marín[SUP] 5 [/SUP], Irene Aldas[SUP] 5 [/SUP], Eva Riveira-Muñoz[SUP] 1 [/SUP], Athina Kipelainen[SUP] 1 [/SUP], Esther Jiménez-Moyano[SUP] 1 [/SUP], Maria Luisa Rodriguez de la Concepción[SUP] 1 [/SUP], Carlos Avila-Nieto[SUP] 1 [/SUP], Benjamin Trinité[SUP] 1 [/SUP], Edwards Pradenas[SUP] 1 [/SUP], Jordi Rodon[SUP] 6 [/SUP], Silvia Marfil[SUP] 1 [/SUP], Mariona Parera[SUP] 1 [/SUP], Jorge Carrillo[SUP] 1 [/SUP], Julià Blanco[SUP] 1 7 [/SUP], Julia G Prado[SUP] 1 [/SUP], Ester Ballana[SUP] 1 [/SUP], Júlia Vergara-Alert[SUP] 6 [/SUP], Joaquim Segalés[SUP] 6 8 [/SUP], Marc Noguera-Julian[SUP] 1 7 [/SUP], Àngels Masabeu[SUP] 2 [/SUP], Bonaventura Clotet[SUP] 1 3 7 [/SUP], Maria de la Roca Toda[SUP] 2 [/SUP], Roger Paredes[SUP] 1 3 7 [/SUP]
Affiliations
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords: 19; 2; CoV; SARS; immune responses; life; reinfection; secondary infection; threatening COVID.
. 2021 Jun 23;8(7)
fab329.doi: 10.1093/ofid/ofab329. eCollection 2021 Jul.
Critical Presentation of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Report
Marta Massanella[SUP] 1 [/SUP], Anabel Martin-Urda[SUP] 2 [/SUP], Lourdes Mateu[SUP] 3 4 [/SUP], Toni Marín[SUP] 5 [/SUP], Irene Aldas[SUP] 5 [/SUP], Eva Riveira-Muñoz[SUP] 1 [/SUP], Athina Kipelainen[SUP] 1 [/SUP], Esther Jiménez-Moyano[SUP] 1 [/SUP], Maria Luisa Rodriguez de la Concepción[SUP] 1 [/SUP], Carlos Avila-Nieto[SUP] 1 [/SUP], Benjamin Trinité[SUP] 1 [/SUP], Edwards Pradenas[SUP] 1 [/SUP], Jordi Rodon[SUP] 6 [/SUP], Silvia Marfil[SUP] 1 [/SUP], Mariona Parera[SUP] 1 [/SUP], Jorge Carrillo[SUP] 1 [/SUP], Julià Blanco[SUP] 1 7 [/SUP], Julia G Prado[SUP] 1 [/SUP], Ester Ballana[SUP] 1 [/SUP], Júlia Vergara-Alert[SUP] 6 [/SUP], Joaquim Segalés[SUP] 6 8 [/SUP], Marc Noguera-Julian[SUP] 1 7 [/SUP], Àngels Masabeu[SUP] 2 [/SUP], Bonaventura Clotet[SUP] 1 3 7 [/SUP], Maria de la Roca Toda[SUP] 2 [/SUP], Roger Paredes[SUP] 1 3 7 [/SUP]
Affiliations
- PMID: 34337095
- PMCID: PMC8320276
- DOI: 10.1093/ofid/ofab329
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords: 19; 2; CoV; SARS; immune responses; life; reinfection; secondary infection; threatening COVID.