Case Study: Prolonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer.
Case Study: Prolonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer.
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DOI：
10.1016/j.cell.2020.10.049
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发表时间：
2020-12-23
期刊：
影响因子：
64.5
通讯作者：
Munster VJ
中科院分区：
文献类型：
--
作者：
Avanzato VA;Matson MJ;Seifert SN;Pryce R;Williamson BN;Anzick SL;Barbian K;Judson SD;Fischer ER;Martens C;Bowden TA;de Wit E;Riedo FX;Munster VJ
长期严重急性呼吸综合征冠状病毒2（SARS-CoV-2）脱落从上呼吸道的女性免疫功能低下的个人慢性淋巴细胞白血病和获得性低丙种球蛋白血症。在初步诊断后70天内观察到传染性SARS-CoV-2的脱落，基因组和亚基因组RNA的脱落长达105天。在第一次用恢复期血浆治疗后，感染没有被清除，这表明对该个体上呼吸道中SARS-CoV-2的影响有限。第二次恢复期血浆输注后数周，不再检测到SARS-CoV-2 RNA。我们观察到SARS-CoV-2的宿主内基因组进化显著，并伴随着显性病毒变体的持续更替。然而，在Vero E6细胞和原代人肺泡上皮组织中的复制动力学不受影响。我们的数据表明，某些免疫功能低下的个体可能比以前认识到的更长时间地传播传染性病毒。建议在持续SARS-CoV-2阳性个体中检测亚基因组RNA，作为感染性病毒脱落的替代。免疫功能低下的个体中持续的SARS-CoV-2感染和脱落诊断后70天内分离的传染性SARS-CoV-2观察到宿主内的遗传变异和病毒变异体的持续更新从个体分离的SARS-CoV-2不显示复制改变本病例研究描述了一名患有慢性淋巴细胞白血病和获得性低丙种球蛋白血症的女性免疫功能低下的个体，她持续感染SARS-二型冠状病毒虽然在整个感染过程中无症状，但她表现出感染性SARS-CoV-2病毒和RNA的长期脱落。这项研究表明，某些人可能会在很长一段时间内保持传染性，并强调需要进一步研究，以了解长期传染性SARS-CoV-2脱落的风险因素。
Long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding was observed from the upper respiratory tract of a female immunocompromised individual with chronic lymphocytic leukemia and acquired hypogammaglobulinemia. Shedding of infectious SARS-CoV-2 was observed up to 70 days, and of genomic and subgenomic RNA up to 105 days, after initial diagnosis. The infection was not cleared after the first treatment with convalescent plasma, suggesting a limited effect on SARS-CoV-2 in the upper respiratory tract of this individual. Several weeks after a second convalescent plasma transfusion, SARS-CoV-2 RNA was no longer detected. We observed marked within-host genomic evolution of SARS-CoV-2 with continuous turnover of dominant viral variants. However, replication kinetics in Vero E6 cells and primary human alveolar epithelial tissues were not affected. Our data indicate that certain immunocompromised individuals may shed infectious virus longer than previously recognized. Detection of subgenomic RNA is recommended in persistently SARS-CoV-2-positive individuals as a proxy for shedding of infectious virus. Persistent SARS-CoV-2 infection and shedding in immunocompromised individual Infectious SARS-CoV-2 isolated up to 70 days after diagnosis Observed within-host genetic variation with continuous turnover of viral variants SARS-CoV-2 isolates from the individual do not display altered replication This case study describes a female immunocompromised individual with chronic lymphocytic leukemia and acquired hypogammaglobulinemia who became persistently infected with SARS-CoV-2. Although asymptomatic throughout the course of infection, she demonstrated prolonged shedding of infectious SARS-CoV-2 virus and RNA. This study demonstrates that certain individuals may remain infectious for prolonged periods of time and highlights the need for further studies to understand risk factors for prolonged infectious SARS-CoV-2 shedding.
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