tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2024 Jan 9;11(2)
fae012.
doi: 10.1093/ofid/ofae012. eCollection 2024 Feb. Increased Risk of Invasive Aspergillosis in Immunocompromised Patients With Persistent SARS-CoV-2 Viral Shedding >8 Weeks, Retrospective Case-control Study
Cléa Melenotte[SUP] 1 [/SUP], Nathalie Chavarot[SUP] 2 3 4 [/SUP], Anne-Sophie L'Honneur[SUP] 3 5 [/SUP], Sylvain Bodard[SUP] 3 6 [/SUP], Morgane Cheminant[SUP] 3 7 [/SUP], Adrien Flahault[SUP] 4 [/SUP], Yann Nguyen[SUP] 8 [/SUP], Marianne Burgard[SUP] 9 [/SUP], Eric Dannaoui[SUP] 3 10 [/SUP], Marie-Elisabeth Bougnoux[SUP] 3 10 [/SUP], Perrine Parize[SUP] 1 [/SUP], Claire Rouzaud[SUP] 1 [/SUP], Anne Scemla[SUP] 2 [/SUP], Etienne Canouï[SUP] 11 [/SUP], Emmanuel Lafont[SUP] 12 [/SUP], Damien Vimpere[SUP] 13 [/SUP], Julien Zuber[SUP] 2 3 [/SUP], Caroline Charlier[SUP] 3 11 [/SUP], Felipe Suarez[SUP] 3 7 [/SUP], Dany Anglicheau[SUP] 2 3 [/SUP], Olivier Hermine[SUP] 3 7 [/SUP], Fanny Lanternier[SUP] 1 3 [/SUP], Luc Mouthon[SUP] 3 8 [/SUP], Olivier Lortholary[SUP] 1 3 14 [/SUP]
Affiliations
Background: Immunocompromised patients now represent the population most at risk for severe coronavirus disease 2019. Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral shedding was reported in these patients ranging from several weeks up to 9 months. We conducted a bicentric retrospective case-control study to identify risk and prognostic factors associated with persistent viral shedding in immunocompromised patients.
Material and methods: Symptomatic immunocompromised adults with persistent SARS-CoV-2 viral shedding >8 weeks were retrospectively included between 1 March 2020 and 24 April 2022 at 2 university hospitals in Paris, France, and matched with a control group consisting of symptomatic immunocompromised patients without persistent viral shedding.
Results: Twenty-nine immunocompromised patients with persistent viral shedding were compared with 40 controls. In multivariate analysis, fever and lymphocytopenia (<0.5 G/L) were associated with an increased risk of persistent viral shedding (odds ratio [OR]: 3.3; 95% confidence interval [CI], 1.01-11.09) P = .048 and OR: 4.3; 95% CI, 1.2-14.7; P = .019, respectively). Unvaccinated patients had a 6-fold increased risk of persistent viral shedding (OR, 6.6; 95% CI, 1.7-25.1; P = .006). Patients with persistent viral shedding were at risk of hospitalization (OR: 4.8; 95 CI, 1.5-15.6; P = .008), invasive aspergillosis (OR: 10.17; 95 CI, 1.15-89.8; P = .037) and death (log-rank test <0.01).
Conclusions: Vaccine coverage was protective against SARS-CoV-2 persistent viral shedding in immunocompromised patients. This new group of immunocompromised patients with SARS-CoV-2 persistent viral shedding is at risk of developing invasive aspergillosis and death and should therefore be systematically screened for this fungal infection for as long as the viral shedding persists.
Keywords: COVID-19; SARS-CoV-2; death; hematological diseases; immunocompromised host; invasive aspergillosis; persistent viral shedding; solid organ transplant recipients.
. 2024 Jan 9;11(2)
fae012.doi: 10.1093/ofid/ofae012. eCollection 2024 Feb. Increased Risk of Invasive Aspergillosis in Immunocompromised Patients With Persistent SARS-CoV-2 Viral Shedding >8 Weeks, Retrospective Case-control Study
Cléa Melenotte[SUP] 1 [/SUP], Nathalie Chavarot[SUP] 2 3 4 [/SUP], Anne-Sophie L'Honneur[SUP] 3 5 [/SUP], Sylvain Bodard[SUP] 3 6 [/SUP], Morgane Cheminant[SUP] 3 7 [/SUP], Adrien Flahault[SUP] 4 [/SUP], Yann Nguyen[SUP] 8 [/SUP], Marianne Burgard[SUP] 9 [/SUP], Eric Dannaoui[SUP] 3 10 [/SUP], Marie-Elisabeth Bougnoux[SUP] 3 10 [/SUP], Perrine Parize[SUP] 1 [/SUP], Claire Rouzaud[SUP] 1 [/SUP], Anne Scemla[SUP] 2 [/SUP], Etienne Canouï[SUP] 11 [/SUP], Emmanuel Lafont[SUP] 12 [/SUP], Damien Vimpere[SUP] 13 [/SUP], Julien Zuber[SUP] 2 3 [/SUP], Caroline Charlier[SUP] 3 11 [/SUP], Felipe Suarez[SUP] 3 7 [/SUP], Dany Anglicheau[SUP] 2 3 [/SUP], Olivier Hermine[SUP] 3 7 [/SUP], Fanny Lanternier[SUP] 1 3 [/SUP], Luc Mouthon[SUP] 3 8 [/SUP], Olivier Lortholary[SUP] 1 3 14 [/SUP]
Affiliations
- PMID: 38390457
- PMCID: PMC10883287
- DOI: 10.1093/ofid/ofae012
Background: Immunocompromised patients now represent the population most at risk for severe coronavirus disease 2019. Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral shedding was reported in these patients ranging from several weeks up to 9 months. We conducted a bicentric retrospective case-control study to identify risk and prognostic factors associated with persistent viral shedding in immunocompromised patients.
Material and methods: Symptomatic immunocompromised adults with persistent SARS-CoV-2 viral shedding >8 weeks were retrospectively included between 1 March 2020 and 24 April 2022 at 2 university hospitals in Paris, France, and matched with a control group consisting of symptomatic immunocompromised patients without persistent viral shedding.
Results: Twenty-nine immunocompromised patients with persistent viral shedding were compared with 40 controls. In multivariate analysis, fever and lymphocytopenia (<0.5 G/L) were associated with an increased risk of persistent viral shedding (odds ratio [OR]: 3.3; 95% confidence interval [CI], 1.01-11.09) P = .048 and OR: 4.3; 95% CI, 1.2-14.7; P = .019, respectively). Unvaccinated patients had a 6-fold increased risk of persistent viral shedding (OR, 6.6; 95% CI, 1.7-25.1; P = .006). Patients with persistent viral shedding were at risk of hospitalization (OR: 4.8; 95 CI, 1.5-15.6; P = .008), invasive aspergillosis (OR: 10.17; 95 CI, 1.15-89.8; P = .037) and death (log-rank test <0.01).
Conclusions: Vaccine coverage was protective against SARS-CoV-2 persistent viral shedding in immunocompromised patients. This new group of immunocompromised patients with SARS-CoV-2 persistent viral shedding is at risk of developing invasive aspergillosis and death and should therefore be systematically screened for this fungal infection for as long as the viral shedding persists.
Keywords: COVID-19; SARS-CoV-2; death; hematological diseases; immunocompromised host; invasive aspergillosis; persistent viral shedding; solid organ transplant recipients.