The longest chronic Sars-CoV-2 infection known to experts? It lasted 613 days. A new record in the Covid field identified by the experts of the Cemm (Centre for Experimental and Molecular Medicine) of the University Medical Center (umc) of Amsterdam. Magda Vergouwe and colleagues from the Dutch institute described the case of a 72-year-old immunocompromised man who lived with the Covid pandemic virus for approximately 1 year and 8 months.
And in the long time in which the pathogen has inhabited his organism it has had the opportunity to change a lot. So much so that experts highlight the risk that in 'eternal positives' conditions are created (persistent infections in defenseless patients) which make them 'engine' for the development of new potentially immunoevasive Sars-CoV-2 variants. The study illustrating the 'Guinness Book of Records' positivity will be presented at the Escmid Global Congress in Barcelona (27-30 April).
Although rare, these particular infections could lead to an increase in the number of mutations in the virus' genome, the authors argue, highlighting the need for greater risk awareness, close genomic surveillance and early diagnostic testing for symptomatic contacts as part of clinical management. of these patients.
The research describes the extensive viral evolution observed in this case which, to their knowledge, qualifies for “the longest Sars-CoV-2 infection duration to date” recorded, although several cases of hundreds have previously been recorded of days (the last 505). To give an idea of the relevance of the topic, it is recalled that the Omicron variant is also believed to have originated in an immunocompromised person.
The 72-year-old protagonist of the study did not have time to win his battle with the virus and died from a relapse of his haematological disease after remaining positive for Sars-CoV-2 with a high viral load for 613 days. He was hospitalized with the infection in the Amsterdam center in February 2022, and defined as immunocompromised due to a history of allogeneic stem cell transplant as treatment of myelodysplastic and myeloproliferative overlap syndrome. Situation complicated by post-transplant lymphoma for which he received rituximab, a drug that depletes all available B cells, including those that normally produce antibodies directed against Sars-CoV-2.
The man had previously received multiple Covid vaccinations without a measurable antibody response upon admission to hospital. Tests detected the presence of an Omicron BA.1.17 variant infection. And the patient received various treatments including monoclonals without obtaining a clinical response. Sequencing of the virus in the follow-up phase showed that already 21 days later a mutation resistant to the antibody with which the patient was treated had developed. In the following weeks, his immune system proved to be unable to eliminate the virus and the prolonged infection and the extensive viral evolution that was possible in his body led to the emergence of a new immunoevasive variant. Fortunately, there has been no documented transmission of the highly mutated variant in the community, so no secondary cases.
The man faced multiple hospitalizations and persistent Sars-CoV-2 infection forced him into prolonged periods of isolation during hospitalization and increased use of personal protection, impacting his quality of life, experts report. Comprehensive virus sequencing was performed on 27 nasopharyngeal samples, collected from February 2022 to September 2023. The analysis revealed over 50 nucleotide mutations compared to contemporary BA.1 variants circulating globally. Additionally, several additional changes indicative of immune escape have developed.
“This case highlights the risk linked to persistent Sars-CoV-2 infections in immunocompromised people”, conclude the authors, however, pointing out that “although there may be an increased risk of developing new variants, not all” of those that emerge in these patients “will develop into a new variant of concern (VOC) for the community. The mechanisms underlying the emergence of a VOC are much more complex and also depend on factors in the population surrounding the patient”, including immunity.
“The durations of Sars-CoV-2 infection in this case described are extreme, but these are much more common in the immunocompromised than in the general community. Further work by our team has described a cohort of these patients with durations of infection included in a range from 1 month to 2 years”.
#Covid #recordbreaking #positive #died #days #virus
