Probable causes and risk factors for positive SARS-CoV-2 test in recovered patients: Evidence from Brunei Darussalam
Probable causes and risk factors for positive SARS-CoV-2 test in recovered patients: Evidence from Brunei Darussalam
复制标题
DOI：
10.1002/jmv.26199
复制
发表时间：
2020-07-06
影响因子：
12.7
通讯作者：
Naing, Lin
中科院分区：
文献类型：
--
作者：
Wong, Justin;Koh, Wee Chian;Naing, Lin
2019冠状病毒病（COVID-19）患者出院后再次报告逆转录-聚合酶链反应阳性（以下简称“再阳性”）的病例报告并不能充分描述这一问题的严重性和重要性。为了确定再阳性率（比例）并审查可能的原因和结果，我们对文莱达鲁萨兰国截至4月23日的所有119名出院患者进行了回顾性研究。出院的患者需要在家自我隔离14天，并在出院后进行鼻咽标本采集。出院后发现再阳性的患者再次入院。我们回顾了所有出院患者的临床和流行病学记录，并应用对数二项式模型获得再阳性状态的风险比。五分之一的康复患者随后再次检测出严重急性呼吸系统综合征冠状病毒2阳性-60岁及以上的人的风险高出六倍以上。再阳性患者出院前平均Ct值低于再入院时的Ct值。在接受检测的111名密切接触者中，没有发现因接触再阳性患者而呈阳性的病例。我们的研究结果支持长期但间歇性的病毒脱落是这种现象的可能原因。我们在这些患者中未观察到潜在感染性。
Case reports of patients with coronavirus disease-2019 (COVID-19) who have been discharged and subsequently report positive reverse transcription-polymerase chain reaction again (hereafter referred as "re-positive") do not fully describe the magnitude and significance of this issue. To determine the re-positive rate (proportion) and review probable causes and outcomes, we conduct a retrospective study of all 119 discharged patients in Brunei Darussalam up till April 23. Patients who were discharged are required to self-isolate at home for 14 days and undergo nasopharyngeal specimen collection postdischarge. Discharged patients found to be re-positive were readmitted. We reviewed the clinical and epidemiological records of all discharged patients and apply log-binomial models to obtain risk ratios for re-positive status. One in five recovered patients subsequently test positive again for severe acute respiratory syndrome coronavirus 2-this risk is more than six times higher in persons aged 60 years and above. The average Ct value of re-positive patients was lower predischarge compared with their readmission Ct value. Out of 111 close contacts tested, none were found to be positive as a result of exposure to a re-positive patient. Our findings support prolonged but intermittent viral shedding as the probable cause for this phenomenon. We did not observe infectivity potential in these patients.