








key: cord-289364-p31gt533
authors: AlFehaidi, Alanoud; Ahmed, Syed Ali; Hamed, Ehab
title: A case of SARS-CoV-2 re-infection
date: 2020-10-25
journal: J Infect
DOI: 10.1016/j.jinf.2020.10.019
sha: 
doc_id: 289364
cord_uid: p31gt533

nan

We read with interest the study of Gousseff et al 1 . The study reported a second acute COVID-19 episode in 11 patients. A novel coronavirus (SARS-CoV-2) caused a pandemic end of 2019. Common signs of SARS-CoV-2 include fever, cough and shortness of breath with no definitive treatment to date 2 . Reverse transcriptase polymerase chain reaction (RT-PCR)-based assays are the current reference diagnostic test 3 . Positive result does not necessitate the presence of infection and viral RNA shedding declines following the resolution of symptoms. Viral nucleic acid could be detectable in throat swabs up to 6 weeks after symptom onset 2 . Different reports have proposed the reactivation of SARS-CoV-2 infection, with 2 RT-PCR positive results following resolving symptoms and interim RT-PCR negative results [4] [5] [6] [7] [8] [9] [10] [11] . Early studies reported patients with negative results having positive results within one week of discharge. Later, reports used 3 weeks (21 days) as the cut-off point, following which another positive RT-PCR result with symptoms would support the possibility of reinfection 4 . A recent report confirmed the possibility of reinfection with genetically distinct SARS-CoV-2 infection in 2 different cases 12 . Here we describe a case with 2 positive RT-PCR results in a symptomatic female with 84 days apart, patient had a complete resolution of symptoms and interim negative swab results on day 13.

A 46-year-old female attended primary healthcare settings in Qatar with a history of SARS-CoV-2 contact and sore throat on the 23 rd of May, 2020. The patient SARS-CoV-2 RT-PCR results swab result was positive. Her vital signs, blood investigations and chest X-ray were normal. The patient had a past medical history of mild asthma, which was controlled with only occasional use of salbutamol inhaler. The patient was admitted to a quarantine facility for observation. The patient PCR swab result was negative on the 5 th of June and she was discharged on the 6 th June.

On the 11 th of August she presented with fever, sore throat and body pain following a second contact with SARS-CoV-2 positive case. SARS-CoV-2 RT-PCR results swab result was inconclusive on 13 th August. The patient also reported chest pain, cough, and mild dyspnea. Her vital signs were normal, but blood investigations showed leucocytes of 1.7 ×10 9 cells per L and lymphocytes 0.9 ×10 9 cells per L. A repeat COVID-19 PCR swab was positive on the 15 th of August with CT value of 25.49. chest X-ray was normal and patient progression to recovery was unremarkable. She was discharged home on the 29 th of August, 2020. During both events, the patient received only symptomatic treatment.

Early studies reported that re-detectable positive virus nucleic acid among patients with SARS-CoV-2 with an average duration of 15 days from discharge to a re-positive results 13 . Patients in those early reports did not show signs of infection with the second positive results and had negative swab results within one week later. Researchers have suggested the persistence of viral RNA with no recurrence of infection.

The COCOREC (Collaborative study COvid RECurrences) study suggested that recurrence of infection is likely if the patient has two confirmed SARS-CoV-2 RT-PCR positive results over 15 days apart with one major clinical sign and no other cause to explain the symptoms. The study identified 11 patients similar to our case. The longest time to second positive test results in this cohort of patients was 49 days 4 .

Our case presented with symptoms, positive contact history and positive swab results with a timeline significantly longer than any reported case. The persistence of positive RT-PCR for SARS-CoV-2 is reported only up to 6 weeks 4 . A re-infection or to the least a re-activation following long-lasting carriage seems more likely in this patient report. Reports of such occurrences are rare to date in view of the number of worldwide reporting of the infection rates which is reassuring. This case report adds to current evidence of possibility of reinfection and provides a basis for future cohort studies. Detection of viral RNA in symptom 1 atic patients following complete remission of symptoms and full recovery should be considered as reinfection or recurrence at the least.

The patient gave consent for the material to appear in BMJ publication

The case report received ethical approval from Primary Health Care corporation (PHCC) research committee. The patient consented to publication and reporting is fully anonymized.

Clinical recurrences of COVID-19 symptoms after recovery: Viral relapse, reinfection or inflammatory rebound?

Transmission, Diagnosis, and Treatment of Coronavirus Disease

Diagnostic Testing for Severe Acute Respiratory Syndrome-Related Coronavirus 2: A Narrative Review

Clinical recurrences of COVID-19 symptoms after recovery: Viral relapse, reinfection or inflammatory rebound?

Cause analysis and treatment strategies of "recurrence" with novel coronavirus pneumonia (COVID-19) patients after discharge from hospital

Zhonghua Jie He He Hu Xi Za Zhi

Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation

Recurrence of COVID-19 after recovery: a case report from Italy

Reactivation of SARS-CoV-2 after recovery

Recurrence of positive SARS-CoV-2 RNA in COVID-19: A case report

Recurrent PCR positivity after hospital discharge of people with coronavirus disease

Seven discharged patients turning positive again for SARS-CoV-2 on quantitative RT-PCR

Asymptomatic reinfection in two healthcare workers from India with genetically distinct SARS-CoV-2

A systematic review of re-detectable positive virus nucleic acid among COVID-19 patients in recovery phase

We acknowledge the support we receive from Primary Health Care Corporation (PHCC) research committee.

