Critical Presentation of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection : A Case Report

Altres ajuts: Departament de Salut de la Generalitat de Catalunya (DSL0016), (DSL015) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections have been reported; however, most cases are milder than the primary infection. We report the first case of a life-threatening critical prese...

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Hauptverfasser:	Massanella, Marta, Martin-Urda, Anabel, Mateu, Lourdes, Marín, Toni, Aldas Criado, Irene, Riveira Muñoz, Eva, Kipelainen, Athina, Jiménez-Moyano, Esther, Rodriguez de la Concepción, Maria Luisa, Avila-Nieto, Carlos, Trinité, Benjamin, Pradenas, Edwards, Rodon, Jordi, Marfil, Sílvia, Parera, Mariona, Carrillo, Jorge, Blanco, Julià, Prado, Julia G, Ballana, Ester, Vergara-Alert, Júlia, Segalés Coma, Joaquim, Noguera-Julian, Marc, Masabeu, Àngels, Clotet Sala, Bonaventura, Toda, Maria de la Roca, Paredes, Roger, Universitat Autònoma de Barcelona. Departament de Medicina
Format:	Artikel
Sprache:	eng
Schlagworte:	Immune responses Life threatening COVID-19 Reinfection SARS-CoV-2 Secondary infection
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Zusammenfassung:	Altres ajuts: Departament de Salut de la Generalitat de Catalunya (DSL0016), (DSL015) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections have been reported; however, most cases are milder than the primary infection. We report the first case of a life-threatening critical presentation of a SARS-CoV-2 reinfection. A 62-year-old man from Palamós (Spain) suffered a first mild coronavirus disease 2019 (COVID-19) episode in March 2020, confirmed by 2 independent SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) assays and a normal radiograph. He recovered completely and tested negative on 2 consecutive PCRs. In August 2020, the patient developed a second SARS-CoV-2 infection with life-threatening bilateral pneumonia and Acute respiratory distress syndrome criteria, requiring COVID-19-specific treatment (remdesivir + dexamethasone) plus high-flow oxygen therapy. Nasopharyngeal swabs from the second episode were obtained for virus quantification by real-time PCR, for virus outgrowth and sequencing. In addition, plasma and peripheral blood mononuclear cells during the hospitalization period were used to determine SARS-CoV-2-specific humoral and T-cell responses. Genomic analysis of SARS-CoV-2 showed that the virus had probably originated shortly before symptom onset. When the reinfection occurred, the subject showed a weak immune response, with marginal humoral and specific T-cell responses against SARS-CoV-2. All antibody isotypes tested as well as SARS-CoV-2 neutralizing antibodies increased sharply after day 8 postsymptoms. A slight increase of T-cell responses was observed at day 19 after symptom onset. The reinfection was firmly documented and occurred in the absence of robust preexisting humoral and cellular immunity. SARS-CoV-2 immunity in some subjects is unprotective and/or short-lived; therefore, SARS-CoV-2 vaccine schedules inducing long-term immunity will be required to bring the pandemic under control.