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Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab

Background. Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed. Methods. We describe the viral evolution, immunologic response and clinical course of a patient with...

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Autores principales: Van der Moeren, Nathalie, Selhorst, Philippe, Ha, My, Heireman, Laura, Van Gaal, Pieter-Jan, Breems, Dimitri, Meysman, Pieter, Laukens, Kris, Verstrepen, Walter, Van Gasse, Natasja, Ogunjimi, Benson, Arien, Kevin K., Naesens, Reinout
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032773/
https://www.ncbi.nlm.nih.gov/pubmed/35458482
http://dx.doi.org/10.3390/v14040752
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author Van der Moeren, Nathalie
Selhorst, Philippe
Ha, My
Heireman, Laura
Van Gaal, Pieter-Jan
Breems, Dimitri
Meysman, Pieter
Laukens, Kris
Verstrepen, Walter
Van Gasse, Natasja
Ogunjimi, Benson
Arien, Kevin K.
Naesens, Reinout
author_facet Van der Moeren, Nathalie
Selhorst, Philippe
Ha, My
Heireman, Laura
Van Gaal, Pieter-Jan
Breems, Dimitri
Meysman, Pieter
Laukens, Kris
Verstrepen, Walter
Van Gasse, Natasja
Ogunjimi, Benson
Arien, Kevin K.
Naesens, Reinout
author_sort Van der Moeren, Nathalie
collection PubMed
description Background. Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed. Methods. We describe the viral evolution, immunologic response and clinical course of a patient with a lymphoma in complete remission who had received therapy with rituximab and remained SARS-CoV-2 RT-qPCR positive for 161 days. Results. The patient remained hospitalised for 10 days, after which he fully recovered and remained asymptomatic. A progressive increase in Ct-value, coinciding with a progressive rise in lymphocyte count, was seen from day 137 onward. Culture of a nasopharyngeal swab on day 67 showed growth of SARS-CoV-2. Whole genome sequencing (WGS) demonstrated that the virus belonged to the wildtype SARS-CoV-2 clade 20B/GR, but rapidly accumulated a high number of mutations as well as deletions in the N-terminal domain of its spike protein. Conclusion. SARS-CoV-2 persistence in immunocompromised individuals has important clinical implications, but halting immunosuppressive therapy might result in a favourable clinical course. The long-term shedding of viable virus necessitates customized infection prevention measures in these individuals. The observed accelerated accumulation of mutations of the SARS-CoV-2 genome in these patients might facilitate the origin of new VOCs that might subsequently spread in the general community.
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spelling pubmed-90327732022-04-23 Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab Van der Moeren, Nathalie Selhorst, Philippe Ha, My Heireman, Laura Van Gaal, Pieter-Jan Breems, Dimitri Meysman, Pieter Laukens, Kris Verstrepen, Walter Van Gasse, Natasja Ogunjimi, Benson Arien, Kevin K. Naesens, Reinout Viruses Case Report Background. Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed. Methods. We describe the viral evolution, immunologic response and clinical course of a patient with a lymphoma in complete remission who had received therapy with rituximab and remained SARS-CoV-2 RT-qPCR positive for 161 days. Results. The patient remained hospitalised for 10 days, after which he fully recovered and remained asymptomatic. A progressive increase in Ct-value, coinciding with a progressive rise in lymphocyte count, was seen from day 137 onward. Culture of a nasopharyngeal swab on day 67 showed growth of SARS-CoV-2. Whole genome sequencing (WGS) demonstrated that the virus belonged to the wildtype SARS-CoV-2 clade 20B/GR, but rapidly accumulated a high number of mutations as well as deletions in the N-terminal domain of its spike protein. Conclusion. SARS-CoV-2 persistence in immunocompromised individuals has important clinical implications, but halting immunosuppressive therapy might result in a favourable clinical course. The long-term shedding of viable virus necessitates customized infection prevention measures in these individuals. The observed accelerated accumulation of mutations of the SARS-CoV-2 genome in these patients might facilitate the origin of new VOCs that might subsequently spread in the general community. MDPI 2022-04-03 /pmc/articles/PMC9032773/ /pubmed/35458482 http://dx.doi.org/10.3390/v14040752 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 Case Report
Van der Moeren, Nathalie
Selhorst, Philippe
Ha, My
Heireman, Laura
Van Gaal, Pieter-Jan
Breems, Dimitri
Meysman, Pieter
Laukens, Kris
Verstrepen, Walter
Van Gasse, Natasja
Ogunjimi, Benson
Arien, Kevin K.
Naesens, Reinout
Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab
title Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab
title_full Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab
title_fullStr Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab
title_full_unstemmed Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab
title_short Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab
title_sort viral evolution and immunology of sars-cov-2 in a persistent infection after treatment with rituximab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032773/
https://www.ncbi.nlm.nih.gov/pubmed/35458482
http://dx.doi.org/10.3390/v14040752
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