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Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients

BACKGROUND: Prolonged shedding/relapse of COVID-19 infection has been reported, particularly in patients who received anti-CD20 agents (eg. rituximab). However, cases of occult COVID-19, in which SARS-CoV-2 persistence in lung parenchyma is diagnosed despite clearance from nasopharyngeal (NP) specim...

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Autores principales: Wee, Liang En, Tan, Jing Yuan, Ko, Karrie Kwan-Ki, Wan, Wei Yee, Lai, Deborah Chooi Mun, Oon, Lynette Lin Ean, Tan-Garcia, Alfonso, Yeong, Joe Poh Sheng, Pena, Angela Maria Takano, Lim, Tony Kiat Hon, Conceicao, Edwin Philip, Venkatachalam, Indumathi, Wijaya, Limin, Tan, Thuan Tong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9395297/
https://www.ncbi.nlm.nih.gov/pubmed/36032521
http://dx.doi.org/10.1016/j.idcr.2022.e01611
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author Wee, Liang En
Tan, Jing Yuan
Ko, Karrie Kwan-Ki
Wan, Wei Yee
Lai, Deborah Chooi Mun
Oon, Lynette Lin Ean
Tan-Garcia, Alfonso
Yeong, Joe Poh Sheng
Pena, Angela Maria Takano
Lim, Tony Kiat Hon
Conceicao, Edwin Philip
Venkatachalam, Indumathi
Wijaya, Limin
Tan, Thuan Tong
author_facet Wee, Liang En
Tan, Jing Yuan
Ko, Karrie Kwan-Ki
Wan, Wei Yee
Lai, Deborah Chooi Mun
Oon, Lynette Lin Ean
Tan-Garcia, Alfonso
Yeong, Joe Poh Sheng
Pena, Angela Maria Takano
Lim, Tony Kiat Hon
Conceicao, Edwin Philip
Venkatachalam, Indumathi
Wijaya, Limin
Tan, Thuan Tong
author_sort Wee, Liang En
collection PubMed
description BACKGROUND: Prolonged shedding/relapse of COVID-19 infection has been reported, particularly in patients who received anti-CD20 agents (eg. rituximab). However, cases of occult COVID-19, in which SARS-CoV-2 persistence in lung parenchyma is diagnosed despite clearance from nasopharyngeal (NP) specimens, are uncommon. CASE SUMMARY: We describe two cases of occult COVID-19 in immunocompromised patients. Both patients had received rituximab previously. Both cases initially presented as ground-glass infiltrates on lung imaging; the diagnosis was originally not suspected due to repeated demonstration of negative SARS-CoV-2 from NP specimens, and alternative etiologies were originally considered. Persistence of SARS-CoV-2 in lung parenchyma, however, was demonstrated on bronchoalveolar lavage (BAL) specimens; additionally, isolation of viable SARS-CoV-2 virus and detection of SARS-CoV-2 nucleocapsid and spike-protein antigen in lung tissue on immunohistochemistry close to 3-months from primary infection strongly suggested ongoing viral persistence and replication as a driver of the lung parenchymal changes, which resolved after antiviral treatment. DISCUSSION: Occult COVID-19 can be a cause of unexplained ground-glass infiltrates on lung imaging; negative NP samples do not rule out SARS-CoV-2 persistence and invasive sampling must be considered. The unsuspected presence of viable virus on BAL, however, highlights that procedurists perfoming aerosol-generating-procedures during an ongoing pandemic wave must also practise appropriate infection-prevention precautions to limit potential exposure.
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spelling pubmed-93952972022-08-23 Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients Wee, Liang En Tan, Jing Yuan Ko, Karrie Kwan-Ki Wan, Wei Yee Lai, Deborah Chooi Mun Oon, Lynette Lin Ean Tan-Garcia, Alfonso Yeong, Joe Poh Sheng Pena, Angela Maria Takano Lim, Tony Kiat Hon Conceicao, Edwin Philip Venkatachalam, Indumathi Wijaya, Limin Tan, Thuan Tong IDCases Case Report BACKGROUND: Prolonged shedding/relapse of COVID-19 infection has been reported, particularly in patients who received anti-CD20 agents (eg. rituximab). However, cases of occult COVID-19, in which SARS-CoV-2 persistence in lung parenchyma is diagnosed despite clearance from nasopharyngeal (NP) specimens, are uncommon. CASE SUMMARY: We describe two cases of occult COVID-19 in immunocompromised patients. Both patients had received rituximab previously. Both cases initially presented as ground-glass infiltrates on lung imaging; the diagnosis was originally not suspected due to repeated demonstration of negative SARS-CoV-2 from NP specimens, and alternative etiologies were originally considered. Persistence of SARS-CoV-2 in lung parenchyma, however, was demonstrated on bronchoalveolar lavage (BAL) specimens; additionally, isolation of viable SARS-CoV-2 virus and detection of SARS-CoV-2 nucleocapsid and spike-protein antigen in lung tissue on immunohistochemistry close to 3-months from primary infection strongly suggested ongoing viral persistence and replication as a driver of the lung parenchymal changes, which resolved after antiviral treatment. DISCUSSION: Occult COVID-19 can be a cause of unexplained ground-glass infiltrates on lung imaging; negative NP samples do not rule out SARS-CoV-2 persistence and invasive sampling must be considered. The unsuspected presence of viable virus on BAL, however, highlights that procedurists perfoming aerosol-generating-procedures during an ongoing pandemic wave must also practise appropriate infection-prevention precautions to limit potential exposure. Elsevier 2022-08-23 /pmc/articles/PMC9395297/ /pubmed/36032521 http://dx.doi.org/10.1016/j.idcr.2022.e01611 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Wee, Liang En
Tan, Jing Yuan
Ko, Karrie Kwan-Ki
Wan, Wei Yee
Lai, Deborah Chooi Mun
Oon, Lynette Lin Ean
Tan-Garcia, Alfonso
Yeong, Joe Poh Sheng
Pena, Angela Maria Takano
Lim, Tony Kiat Hon
Conceicao, Edwin Philip
Venkatachalam, Indumathi
Wijaya, Limin
Tan, Thuan Tong
Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
title Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
title_full Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
title_fullStr Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
title_full_unstemmed Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
title_short Detection of viable SARS-CoV-2 in deep respiratory specimens despite negative nasopharyngeal SARS-CoV-2 RT-PCR: Occult COVID-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
title_sort detection of viable sars-cov-2 in deep respiratory specimens despite negative nasopharyngeal sars-cov-2 rt-pcr: occult covid-19 as an unsuspected cause of pulmonary infiltrates in immunocompromised patients
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9395297/
https://www.ncbi.nlm.nih.gov/pubmed/36032521
http://dx.doi.org/10.1016/j.idcr.2022.e01611
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