Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts : a retrospective observational study in the Omicron era
© 2023. The Author(s)..
PURPOSE: This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication.
METHODS: We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included.
RESULTS: 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17).
CONCLUSION: Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days.
TRIAL REGISTRATION NUMBER: DRKS 00027299.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Infection - (2023) vom: 14. Dez. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Götz, Veronika [VerfasserIn] |
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| Links: |
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| Themen: |
Antiviral therapy |
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| Anmerkungen: |
Date Revised 14.12.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1007/s15010-023-02138-0 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM365864560 |
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| 100 | 1 | |a Götz, Veronika |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts |b a retrospective observational study in the Omicron era |
| 264 | 1 | |c 2023 | |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a PURPOSE: This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication | ||
| 520 | |a METHODS: We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included | ||
| 520 | |a RESULTS: 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17) | ||
| 520 | |a CONCLUSION: Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days | ||
| 520 | |a TRIAL REGISTRATION NUMBER: DRKS 00027299 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antiviral therapy | |
| 650 | 4 | |a Fibrotic-like lung changes | |
| 650 | 4 | |a Immunosuppression | |
| 650 | 4 | |a Lower respiratory tract | |
| 650 | 4 | |a Omicron | |
| 650 | 4 | |a SARS-CoV-2 | |
| 700 | 1 | |a Mathé, Philipp |e verfasserin |4 aut | |
| 700 | 1 | |a Agarwal, Prerana |e verfasserin |4 aut | |
| 700 | 1 | |a Hornuss, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Pfau, Stefanie |e verfasserin |4 aut | |
| 700 | 1 | |a Panning, Marcus |e verfasserin |4 aut | |
| 700 | 1 | |a Prager, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Voll, Reinhard E |e verfasserin |4 aut | |
| 700 | 1 | |a Engelhardt, Monika |e verfasserin |4 aut | |
| 700 | 1 | |a Frye, Björn C |e verfasserin |4 aut | |
| 700 | 1 | |a Bamberg, Fabian |e verfasserin |4 aut | |
| 700 | 1 | |a Fuchs, Jonas |e verfasserin |4 aut | |
| 700 | 1 | |a Müller, Matthias |e verfasserin |4 aut | |
| 700 | 1 | |a Wagner, Dirk |e verfasserin |4 aut | |
| 700 | 1 | |a Rieg, Siegbert |e verfasserin |4 aut | |
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