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Erschienen in: Wiener Medizinische Wochenschrift 3-4/2022

Open Access 08.02.2021 | letter to the editor

Emerging COVID-19 reinfection four months after primary SARS-CoV-2 infection

verfasst von: Helmut J. F. Salzer, MD, MPH, Matthias Neuböck, Sven Heldt, Isabella Haug, Christian Paar, Bernd Lamprecht

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 3-4/2022

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The original online version of this article was revised: The article was published with incomplete authorship.
An erratum to this article is available online at https://​doi.​org/​10.​1007/​s10354-021-00834-w.

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To the editor
In the last few months, several cases of ominous coronavirus disease 2019 (COVID-19) reinfections have been reported (Table 1). However, there is a scientific controversy whether reinfections can occur just a few months after the first infection and if so, what it means for the fight against the COVID-19 pandemic.
Table 1
Clinical characteristics of symptomatic COVID-19 reinfections having a negative SARS-CoV‑2 PCR between the first and the second infection and/or a phylogenetic analysis
Country
Sex
Age (years)
Comorbidities
1st infection
2nd infection
Interval between 1st and 2nd infection
Negative SARS-CoV-2 PCR between 1st and 2nd infection
Phylogenetic analysis
Reference
Israel
Female
20
None
Milda
Asymptomatic
112 days
Yes
No
[5]
Ecuador
Male
46
N/A
Mild
Mild
63 days
N/A
Yes
[6]
USA
Male
82
Parkinson’s disease, diabetes, chronic kidney disease, hypertension
Severeb
Severe
55 days
Yes
No
[7]
Hong-Kong
Male
33
N/A
Mild
Asymptomatic
142 days
Yes
Yes
[4]
USA
Male
25
None
Mild
Mild
48 days
Yes
Yes
[8]
Belgium
Female
51
Asthma (inhaled corticosteroids)
Mild
Mild
93 days
No
Yes
[9]
The Netherlands
Female
89
Waldenström’s macroglobulinemia
Mild
Moderatec
59 days
No
Yes
[10]
USA
N/A
N/A
Emphysema, home oxygen, hypertension
Moderate
Moderate
144 days
Yes
Yes
[11]
USA
Male
42
N/A
Mild
Mild
51 days
No
Yes
[12]
Brazil
1 × Female, 2 × Male
40, 67, 47
Asthma, ancylosing spondylitis, obesity, OSAS, none
Mild
Mild to severe
54, 56, 70 days
Yes
No
[13]
Austria
Male
95
Dementia, hypertension, total thyroidectomy
Mild
Severe
124 days
Yes
No
COVID-19 coronavirus disease 2019, SARS-CoV‑2 severe acute respiratory syndrome coronavirus 2, PCR polymerase chain reaction, N/A not available, OSAS obstructive sleep apnea syndrome
aSymptomatic with absence of hypoxia
bCritical ill requiring non-invasive or invasive ventilation and/or death related to COVID-19
cSymptomatic requiring additional oxygen
On October 27, 2020, a 95-year-old man was re-admitted from his retirement home to Kepler University Hospital in Linz, Austria with new onset dyspnea and fever. Four months before, he had been discharged after 2 weeks of hospitalization due to mild COVID-19 characterized by fever and leukopenia, but absence of viral pneumonia and hypoxia. For virological confirmation a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) was performed showing positive test results on June 27 with a cycle threshold (Ct) value of 32.2 and on July 2, 2020 with a Ct value of 37.7 (cobas 6800 SARS-CoV‑2 test, Roche, Molecular Systems, Branchburg, NJ, USA). Thereafter, the patient tested negative for SARS-CoV‑2 on several occasions including at discharge from hospitalization on July 6 and 7 as well as on September 25 and on October 1, 2020. The patient had a medical history of dementia, arterial hypertension and total thyroidectomy.
Referring to local COVID-19 infection precaution regulation the patient was directly isolated in the emergency room and he was again tested for SARS-CoV‑2 on October 27, 2020. Meanwhile vital parameters were taken showing a reduced oxygen saturation of 89% on room air and an elevated body temperature of 38.4 °C. Auscultation of the lung revealed no pathological abnormalities, while laboratory test results showed mild leukopenia with 3.18 G/L (reference value 3.9–8.8 G/L) with a decreased lymphocyte count of 0.64 G/L (reference value 1.00–4.00 G/L) and a thrombocytopenia with 126 G/L (reference value 151–400 G/L), respectively. Other laboratory values and urine test results were unremarkable.
Two hours later the patient was again tested positive for SARS-CoV‑2 with a Ct value of 12.8 in the RT-PCR (Cepheid Xpert Xpress SARS-CoV-2 point-of-care test, Sunnyvale, CA, USA). Another oropharyngeal swab was taken confirming the positive SARS-CoV‑2 RT-PCR test result with a Ct value of 14.5 using a different platform (cobas 6800 SARS-CoV‑2 test, Roche, Molecular Systems, Branchburg, NJ, USA).
Despite primary SARS-CoV‑2 infection the patient this time required additional oxygen and had viral pneumonia on chest X‑ray. Furthermore, the patient received low molecular weight heparin with enoxaparin 4000 I.E. subcutaneously once daily for prophylaxis of venous thromboembolism and paracetamol 1000 mg intravenously as antipyretic treatment. Antiviral treatment was not administered due to drug shortage of remdesivir in Upper Austria at this time. We did not give dexamethasone at admission because the patient was not critically ill, he had no laboratory findings of hyperinflammation and was in the early phase of viral infection. Over the next few days the patients’ respiratory condition deteriorated continuously consistent with a severe course of COVID-19. Finally, the patient deceased 6 days after admission.
Taken this together a COVID-19 reinfection seems to be plausible in our patient 124 days after primary SARS-CoV‑2 infection, although a recently published clinical meta-analysis including 15 single or cumulative case reports did not find any clinical reinfection after a 70-day period following first infection [1]. These findings are supported by animal studies demonstrating protection against reinfection in rhesus macaques after primary exposure to SARS-CoV‑2 [2, 3].
Nevertheless, the first and the second COVID-19 episode in our patient were characterized by clinical symptoms, typical laboratory findings including leukopenia and thrombocytopenia as well as repeated virological confirmation of SARS-CoV‑2 infection, while he had no symptoms and he tested negative on several occasions in between. To KK‑W et al. also reported a reinfection in a 33-year-old man 142 days after first infection. Whole genome sequencing confirmed that both COVID-19 episodes were caused by phylogenetically diverse SARS-CoV‑2 strains, which supports our clinical observation of reinfection instead of persistent viral shedding [4]. Questions remain, for example, why this patient acquired a COVID-19 reinfection, while immunity against the virus is probable, at least in the short term, since SARS-CoV‑2 reinfections are only reported occasionally despite the high COVID-19 prevalence worldwide. Explanations could be an infection with a different SARS-CoV‑2 strain or an age-related impaired immune response. Unfortunately we were not able to perform a comparison of whole genome sequencing data due to missing sample material of the first episode of infection.
We want to draw attention to this emerging aspect in the COVID-19 pandemic since reinfections will certainly influence our future scientific, clinical, social and economic response to COVID-19 pandemic. It will raise considerable questions on innate and adaptive immune response, on herd immunity and on vaccine development.

Conflict of interest

H. Salzer, M. Neuböck, S. Heldt, I. Haug, C. Paar and B. Lamprecht declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Literatur
2.
Zurück zum Zitat Deng W, Bao L, Liu J, et al. Primary exposure to SARS-CoV‑2 protects against reinfection in rhesus macaques. Science. 2020;369(6505):818–23.CrossRef Deng W, Bao L, Liu J, et al. Primary exposure to SARS-CoV‑2 protects against reinfection in rhesus macaques. Science. 2020;369(6505):818–23.CrossRef
3.
Zurück zum Zitat Chandrashekar A, Liu J, Martinot AJ, et al. SARS-CoV‑2 infection protects against rechallenge in rhesus macaques. Science. 2020;369(6505):812–7.CrossRef Chandrashekar A, Liu J, Martinot AJ, et al. SARS-CoV‑2 infection protects against rechallenge in rhesus macaques. Science. 2020;369(6505):812–7.CrossRef
5.
Zurück zum Zitat Nachmias V, Fusman R, Mann S, et al. The first case of documented Covid-19 reinfection in Israel. IDCases. 2020;22:e970.CrossRef Nachmias V, Fusman R, Mann S, et al. The first case of documented Covid-19 reinfection in Israel. IDCases. 2020;22:e970.CrossRef
8.
Zurück zum Zitat Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. 2020. Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. 2020.
9.
Zurück zum Zitat Van Elslande J, Vermeersch P, Vandervoort K, et al. Symptomatic SARS-CoV‑2 reinfection by a phylogenetically distinct strain. Clin Infect Dis. 2020. Van Elslande J, Vermeersch P, Vandervoort K, et al. Symptomatic SARS-CoV‑2 reinfection by a phylogenetically distinct strain. Clin Infect Dis. 2020.
10.
Zurück zum Zitat Mulder M, van der Vegt DSJM, Oude Munnink BB, et al. Reinfection of SARS-CoV‑2 in an immunocompromised patient: a case report. Clin Infect Dis. 2020. Mulder M, van der Vegt DSJM, Oude Munnink BB, et al. Reinfection of SARS-CoV‑2 in an immunocompromised patient: a case report. Clin Infect Dis. 2020.
12.
Zurück zum Zitat Larson D, Brodniak SL, Voegtly LJ, et al. A Case of Early Re-infection with SARS-CoV‑2. Clin Infect Dis. 2020. Larson D, Brodniak SL, Voegtly LJ, et al. A Case of Early Re-infection with SARS-CoV‑2. Clin Infect Dis. 2020.
13.
Zurück zum Zitat Fernandes Valente Takeda C, Moura de Almeida M, Gonçalves de Aguiar Gomes R, et al. Case report: recurrent clinical symptoms of COVID-19 in healthcare professionals: a series of cases from Brazil. Am J Trop Med Hyg. 2020. Fernandes Valente Takeda C, Moura de Almeida M, Gonçalves de Aguiar Gomes R, et al. Case report: recurrent clinical symptoms of COVID-19 in healthcare professionals: a series of cases from Brazil. Am J Trop Med Hyg. 2020.
Metadaten
Titel
Emerging COVID-19 reinfection four months after primary SARS-CoV-2 infection
verfasst von
Helmut J. F. Salzer, MD, MPH
Matthias Neuböck
Sven Heldt
Isabella Haug
Christian Paar
Bernd Lamprecht
Publikationsdatum
08.02.2021
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 3-4/2022
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-021-00813-1

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