Cell
Volume 183, Issue 7, 23 December 2020, Pages 1901-1912.e9
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Article
Case Study: Prolonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer

https://doi.org/10.1016/j.cell.2020.10.049Get rights and content
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Highlights

  • 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

Summary

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.

Keywords

SARS-CoV-2
COVID-19
immunocompromised
asymptometic
long-term shedding
infectious virus
within host evolution
convalescent plasma
chronic lymphocytic leukemia

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