Mechanically Ventilated Patients Shed High-Titer Live Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for Extended Periods From Both the Upper and Lower Respiratory Tract
Abstract Background SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is crit...
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| Veröffentlicht in: | Clinical infectious diseases 2022-08, Vol.75 (1), p.e82-e88 |
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| creator | Saud, Zack Ponsford, Mark Bentley, Kirsten Cole, Jade M Pandey, Manish Jolles, Stephen Fegan, Chris Humphreys, Ian Wise, Matt P Stanton, Richard |
| description | Abstract
Background
SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection-control measures both within healthcare settings and the public domain.
Methods
We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit (ICU) of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (subglottic aspirate), or lower respiratory tract (nondirected bronchoalveolar lavage [NBAL] or bronchoalveolar lavage [BAL]) and analyzed by both quantitative PCR (qPCR) and plaque assay.
Results
117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types; however, live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titers of live virus were higher in subglottic aspirates (4.5 × 107) than in saliva (2.2 × 106) or BAL/NBAL (8.5 × 106) and reached >108 PFU/mL in some samples. The longest duration of shedding was 98 days, while most patients (14/25) shed live virus for ≥20 days.
Conclusions
ICU patients infected with SARS-CoV-2 can shed high titers of virus both in the upper and lower respiratory tract and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of personal protective equipment, and undertaking potential aerosol-generating procedures.
Patients on intensive therapy infected with SARS-CoV-2 tend to be prolonged shedders, excreting virus for far beyond the time periods specified in current guidelines, and live virus titers can be extremely high in both the upper and lower respiratory tracts. |
| doi_str_mv | 10.1093/cid/ciac170 |
| format | Article |
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Background
SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection-control measures both within healthcare settings and the public domain.
Methods
We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit (ICU) of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (subglottic aspirate), or lower respiratory tract (nondirected bronchoalveolar lavage [NBAL] or bronchoalveolar lavage [BAL]) and analyzed by both quantitative PCR (qPCR) and plaque assay.
Results
117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types; however, live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titers of live virus were higher in subglottic aspirates (4.5 × 107) than in saliva (2.2 × 106) or BAL/NBAL (8.5 × 106) and reached >108 PFU/mL in some samples. The longest duration of shedding was 98 days, while most patients (14/25) shed live virus for ≥20 days.
Conclusions
ICU patients infected with SARS-CoV-2 can shed high titers of virus both in the upper and lower respiratory tract and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of personal protective equipment, and undertaking potential aerosol-generating procedures.
Patients on intensive therapy infected with SARS-CoV-2 tend to be prolonged shedders, excreting virus for far beyond the time periods specified in current guidelines, and live virus titers can be extremely high in both the upper and lower respiratory tracts.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciac170</identifier><identifier>PMID: 35231086</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>COVID-19 ; COVID-19 Testing ; Humans ; Major ; Respiration, Artificial ; Respiratory System ; SARS-CoV-2</subject><ispartof>Clinical infectious diseases, 2022-08, Vol.75 (1), p.e82-e88</ispartof><rights>The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-817d5c427c3785911cc1b12caaf998ddbe75b19fb2d436e0514d79f9e8fb60e43</citedby><cites>FETCH-LOGICAL-c412t-817d5c427c3785911cc1b12caaf998ddbe75b19fb2d436e0514d79f9e8fb60e43</cites><orcidid>0000-0002-6799-1182</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35231086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saud, Zack</creatorcontrib><creatorcontrib>Ponsford, Mark</creatorcontrib><creatorcontrib>Bentley, Kirsten</creatorcontrib><creatorcontrib>Cole, Jade M</creatorcontrib><creatorcontrib>Pandey, Manish</creatorcontrib><creatorcontrib>Jolles, Stephen</creatorcontrib><creatorcontrib>Fegan, Chris</creatorcontrib><creatorcontrib>Humphreys, Ian</creatorcontrib><creatorcontrib>Wise, Matt P</creatorcontrib><creatorcontrib>Stanton, Richard</creatorcontrib><title>Mechanically Ventilated Patients Shed High-Titer Live Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for Extended Periods From Both the Upper and Lower Respiratory Tract</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection-control measures both within healthcare settings and the public domain.
Methods
We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit (ICU) of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (subglottic aspirate), or lower respiratory tract (nondirected bronchoalveolar lavage [NBAL] or bronchoalveolar lavage [BAL]) and analyzed by both quantitative PCR (qPCR) and plaque assay.
Results
117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types; however, live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titers of live virus were higher in subglottic aspirates (4.5 × 107) than in saliva (2.2 × 106) or BAL/NBAL (8.5 × 106) and reached >108 PFU/mL in some samples. The longest duration of shedding was 98 days, while most patients (14/25) shed live virus for ≥20 days.
Conclusions
ICU patients infected with SARS-CoV-2 can shed high titers of virus both in the upper and lower respiratory tract and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of personal protective equipment, and undertaking potential aerosol-generating procedures.
Patients on intensive therapy infected with SARS-CoV-2 tend to be prolonged shedders, excreting virus for far beyond the time periods specified in current guidelines, and live virus titers can be extremely high in both the upper and lower respiratory tracts.</description><subject>COVID-19</subject><subject>COVID-19 Testing</subject><subject>Humans</subject><subject>Major</subject><subject>Respiration, Artificial</subject><subject>Respiratory System</subject><subject>SARS-CoV-2</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUtv1DAUhS1ERUthxR55hYpQwHYedjZIw6gPpEGgZtqt5dg3jVEmDrYzML-Mv4erGaqyYWH5XvnzOVf3IPSKkveU1PkHbU06SlNOnqATWuY8q8qaPk01KUVWiFwco-chfCeEUkHKZ-g4L1lOiahO0O8voHs1Wq2GYYdvYYx2UBEM_qaiTV3ATZ-6K3vXZ2sbweOV3QJuYAse8ELPEfA1hMl6FZ3f4WY3Gu82gJfOu1FtrZ8DZvisWVw32dLdZuwt7pzH578ijObeB7x1JuCL9At_crHHsQd8M03JSo0Gr9zPVD22WHul4wt01KkhwMvDfYpuLs7Xy6ts9fXy83KxynRBWcwE5abUBeM65yIthWpNW8q0Ul1dC2Na4GVL665lpsgrICUtDK-7GkTXVgSK_BR93OtOc7sBo9NKvBrk5O1G-Z10ysp_X0bbyzu3lTVlya5KAmcHAe9-zBCi3NigYRjUCG4OklUpjCLnJU_ouz2qvQvBQ_dgQ4m8j1qmqOUh6kS_fjzZA_s32wS82QNunv6r9Af0DrX2</recordid><startdate>20220824</startdate><enddate>20220824</enddate><creator>Saud, Zack</creator><creator>Ponsford, Mark</creator><creator>Bentley, Kirsten</creator><creator>Cole, Jade M</creator><creator>Pandey, Manish</creator><creator>Jolles, Stephen</creator><creator>Fegan, Chris</creator><creator>Humphreys, Ian</creator><creator>Wise, Matt P</creator><creator>Stanton, Richard</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6799-1182</orcidid></search><sort><creationdate>20220824</creationdate><title>Mechanically Ventilated Patients Shed High-Titer Live Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for Extended Periods From Both the Upper and Lower Respiratory Tract</title><author>Saud, Zack ; Ponsford, Mark ; Bentley, Kirsten ; Cole, Jade M ; Pandey, Manish ; Jolles, Stephen ; Fegan, Chris ; Humphreys, Ian ; Wise, Matt P ; Stanton, Richard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-817d5c427c3785911cc1b12caaf998ddbe75b19fb2d436e0514d79f9e8fb60e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>COVID-19</topic><topic>COVID-19 Testing</topic><topic>Humans</topic><topic>Major</topic><topic>Respiration, Artificial</topic><topic>Respiratory System</topic><topic>SARS-CoV-2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saud, Zack</creatorcontrib><creatorcontrib>Ponsford, Mark</creatorcontrib><creatorcontrib>Bentley, Kirsten</creatorcontrib><creatorcontrib>Cole, Jade M</creatorcontrib><creatorcontrib>Pandey, Manish</creatorcontrib><creatorcontrib>Jolles, Stephen</creatorcontrib><creatorcontrib>Fegan, Chris</creatorcontrib><creatorcontrib>Humphreys, Ian</creatorcontrib><creatorcontrib>Wise, Matt P</creatorcontrib><creatorcontrib>Stanton, Richard</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saud, Zack</au><au>Ponsford, Mark</au><au>Bentley, Kirsten</au><au>Cole, Jade M</au><au>Pandey, Manish</au><au>Jolles, Stephen</au><au>Fegan, Chris</au><au>Humphreys, Ian</au><au>Wise, Matt P</au><au>Stanton, Richard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mechanically Ventilated Patients Shed High-Titer Live Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for Extended Periods From Both the Upper and Lower Respiratory Tract</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2022-08-24</date><risdate>2022</risdate><volume>75</volume><issue>1</issue><spage>e82</spage><epage>e88</epage><pages>e82-e88</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection-control measures both within healthcare settings and the public domain.
Methods
We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit (ICU) of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (subglottic aspirate), or lower respiratory tract (nondirected bronchoalveolar lavage [NBAL] or bronchoalveolar lavage [BAL]) and analyzed by both quantitative PCR (qPCR) and plaque assay.
Results
117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types; however, live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titers of live virus were higher in subglottic aspirates (4.5 × 107) than in saliva (2.2 × 106) or BAL/NBAL (8.5 × 106) and reached >108 PFU/mL in some samples. The longest duration of shedding was 98 days, while most patients (14/25) shed live virus for ≥20 days.
Conclusions
ICU patients infected with SARS-CoV-2 can shed high titers of virus both in the upper and lower respiratory tract and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of personal protective equipment, and undertaking potential aerosol-generating procedures.
Patients on intensive therapy infected with SARS-CoV-2 tend to be prolonged shedders, excreting virus for far beyond the time periods specified in current guidelines, and live virus titers can be extremely high in both the upper and lower respiratory tracts.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>35231086</pmid><doi>10.1093/cid/ciac170</doi><orcidid>https://orcid.org/0000-0002-6799-1182</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2022-08, Vol.75 (1), p.e82-e88 |
| issn | 1058-4838 1537-6591 |
| language | eng |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | COVID-19 COVID-19 Testing Humans Major Respiration, Artificial Respiratory System SARS-CoV-2 |
| title | Mechanically Ventilated Patients Shed High-Titer Live Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for Extended Periods From Both the Upper and Lower Respiratory Tract |
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