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COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital

The novel, highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a pandemic of acute respiratory illness worldwide and remains a huge threat to the healthcare system’s capacity to respond to COVID-19. Elderly and immunocompromised patients are at increased r...

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Autores principales: Wünsch, Korbinian, Anastasiou, Olympia E., Alt, Mira, Brochhagen, Leonie, Cherneha, Maxim, Thümmler, Laura, van Baal, Lukas, Madel, Rabea J., Lindemann, Monika, Taube, Christian, Witzke, Oliver, Rohn, Hana, Krawczyk, Adalbert, Jansen, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024512/
https://www.ncbi.nlm.nih.gov/pubmed/35458476
http://dx.doi.org/10.3390/v14040746
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author Wünsch, Korbinian
Anastasiou, Olympia E.
Alt, Mira
Brochhagen, Leonie
Cherneha, Maxim
Thümmler, Laura
van Baal, Lukas
Madel, Rabea J.
Lindemann, Monika
Taube, Christian
Witzke, Oliver
Rohn, Hana
Krawczyk, Adalbert
Jansen, Sarah
author_facet Wünsch, Korbinian
Anastasiou, Olympia E.
Alt, Mira
Brochhagen, Leonie
Cherneha, Maxim
Thümmler, Laura
van Baal, Lukas
Madel, Rabea J.
Lindemann, Monika
Taube, Christian
Witzke, Oliver
Rohn, Hana
Krawczyk, Adalbert
Jansen, Sarah
author_sort Wünsch, Korbinian
collection PubMed
description The novel, highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a pandemic of acute respiratory illness worldwide and remains a huge threat to the healthcare system’s capacity to respond to COVID-19. Elderly and immunocompromised patients are at increased risk for a severe course of COVID-19. These high-risk groups have been identified as developing diminished humoral and cellular immune responses. Notably, SARS-CoV-2 RNA remains detectable in nasopharyngeal swabs of these patients for a prolonged period of time. These factors complicate the clinical management of these vulnerable patient groups. To date, there are no well-defined guidelines for an appropriate duration of isolation for elderly and immunocompromised patients, especially in hospitals or nursing homes. The aim of the present study was to characterize at-risk patient cohorts capable of producing a replication-competent virus over an extended period after symptomatic COVID-19, and to investigate the humoral and cellular immune responses and infectivity to provide a better basis for future clinical management. In our cohort, the rate of positive viral cultures and the sensitivity of SARS-CoV-2 antigen tests correlated with higher viral loads. Elderly patients and patients with diabetes mellitus had adequate cellular and humoral immune responses to SARS-CoV-2 infection, while immunocompromised patients had reduced humoral and cellular immune responses. Our patient cohort was hospitalized for longer compared with previously published cohorts. Longer hospitalization was associated with a high number of nosocomial infections, representing a potential hazard for additional complications to patients. Most importantly, regardless of positive SARS-CoV-2 RNA detection, no virus was culturable beyond a cycle threshold (ct) value of 33 in the majority of samples. Our data clearly indicate that elderly and diabetic patients develop a robust immune response to SARS-CoV-2 and may be safely de-isolated at a ct value of more than 35.
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spelling pubmed-90245122022-04-23 COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital Wünsch, Korbinian Anastasiou, Olympia E. Alt, Mira Brochhagen, Leonie Cherneha, Maxim Thümmler, Laura van Baal, Lukas Madel, Rabea J. Lindemann, Monika Taube, Christian Witzke, Oliver Rohn, Hana Krawczyk, Adalbert Jansen, Sarah Viruses Article The novel, highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a pandemic of acute respiratory illness worldwide and remains a huge threat to the healthcare system’s capacity to respond to COVID-19. Elderly and immunocompromised patients are at increased risk for a severe course of COVID-19. These high-risk groups have been identified as developing diminished humoral and cellular immune responses. Notably, SARS-CoV-2 RNA remains detectable in nasopharyngeal swabs of these patients for a prolonged period of time. These factors complicate the clinical management of these vulnerable patient groups. To date, there are no well-defined guidelines for an appropriate duration of isolation for elderly and immunocompromised patients, especially in hospitals or nursing homes. The aim of the present study was to characterize at-risk patient cohorts capable of producing a replication-competent virus over an extended period after symptomatic COVID-19, and to investigate the humoral and cellular immune responses and infectivity to provide a better basis for future clinical management. In our cohort, the rate of positive viral cultures and the sensitivity of SARS-CoV-2 antigen tests correlated with higher viral loads. Elderly patients and patients with diabetes mellitus had adequate cellular and humoral immune responses to SARS-CoV-2 infection, while immunocompromised patients had reduced humoral and cellular immune responses. Our patient cohort was hospitalized for longer compared with previously published cohorts. Longer hospitalization was associated with a high number of nosocomial infections, representing a potential hazard for additional complications to patients. Most importantly, regardless of positive SARS-CoV-2 RNA detection, no virus was culturable beyond a cycle threshold (ct) value of 33 in the majority of samples. Our data clearly indicate that elderly and diabetic patients develop a robust immune response to SARS-CoV-2 and may be safely de-isolated at a ct value of more than 35. MDPI 2022-04-01 /pmc/articles/PMC9024512/ /pubmed/35458476 http://dx.doi.org/10.3390/v14040746 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wünsch, Korbinian
Anastasiou, Olympia E.
Alt, Mira
Brochhagen, Leonie
Cherneha, Maxim
Thümmler, Laura
van Baal, Lukas
Madel, Rabea J.
Lindemann, Monika
Taube, Christian
Witzke, Oliver
Rohn, Hana
Krawczyk, Adalbert
Jansen, Sarah
COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital
title COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital
title_full COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital
title_fullStr COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital
title_full_unstemmed COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital
title_short COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital
title_sort covid-19 in elderly, immunocompromised or diabetic patients—from immune monitoring to clinical management in the hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024512/
https://www.ncbi.nlm.nih.gov/pubmed/35458476
http://dx.doi.org/10.3390/v14040746
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