Prolonged SARS-CoV-2 infection following rituximab treatment: clinical course and response to therapeutic interventions correlated with quantitative viral cultures and cycle threshold values

Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is completed through reverse transcriptase-PCR (RT-PCR) from either oropharyngeal or nasopharyngeal swabs, critically important for diagnostics but also from an infection control lens. Recent studies have suggested that CO...

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Bibliographic Details
Published in:	Antimicrobial resistance & infection control Vol. 11; no. 1; p. 28
Main Authors:	Thornton, Christina S, Huntley, Kevin, Berenger, Byron M, Bristow, Michael, Evans, David H, Fonseca, Kevin, Franko, Angela, Gillrie, Mark R, Lin, Yi-Chan, Povitz, Marcus, Shafey, Mona, Conly, John M, Tremblay, Alain
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 05-02-2022 BioMed Central BMC
Subjects:	Antiviral agents Bendamustine Bronchoscopy Case Report Case reports Coronaviruses COVID-19 COVID-19 - drug therapy COVID-19 - pathology COVID-19 - prevention & control COVID-19 vaccines COVID-19 Vaccines - administration & dosage Development and progression Disease control Disease transmission DNA polymerases DNA sequencing Drug resistance Genomes Genomics Health aspects Hospitals Humans Immunization Immunocompromised Host Immunocompromised patient Immunotherapy Infections Male Medical research Medicine, Experimental Middle Aged Monoclonal antibodies Mortality Nasopharynx Nucleotide sequencing Patients Pneumonia Prevention Risk factors Rituximab - pharmacology RNA SARS-CoV-2 SARS-CoV-2 - drug effects Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Steroids Therapeutics Tomography, X-Ray Computed Treatment Outcome Vaccination Viral infections Viral Load Viral shedding Virus Shedding - drug effects SARS-CoV-2 Viral shedding Immunocompromised patient Therapeutics
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Summary:	Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is completed through reverse transcriptase-PCR (RT-PCR) from either oropharyngeal or nasopharyngeal swabs, critically important for diagnostics but also from an infection control lens. Recent studies have suggested that COVID-19 patients can demonstrate prolonged viral shedding with immunosuppression as a key risk factor. We present a case of an immunocompromised patient with SARS-CoV-2 infection demonstrating prolonged infectious viral shedding for 189 days with virus cultivability and clinical relapse with an identical strain based on whole genome sequencing, requiring a multi-modal therapeutic approach. We correlated clinical parameters, PCR cycle thresholds and viral culture until eventual resolution. We successfully demonstrate resolution of viral shedding, administration of COVID-19 vaccination and maintenance of viral clearance. This case highlights implications in the immunosuppressed patient towards infection prevention and control that should consider those with prolonged viral shedding and may require ancillary testing to fully elucidate viral activity. Furthermore, this case raises several stimulating questions around complex COVID-19 patients around the role of steroids, effect of antiviral therapies in absence of B-cells, role for vaccination and the requirement of a multi-modal approach to eventually have successful clearance of the virus.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	2047-2994 2047-2994
DOI:	10.1186/s13756-022-01067-1