Woman had COVID-19 for a year – .

Woman had COVID-19 for a year – .

TORONTO – An American woman who has already beaten cancer has had COVID-19 for a year, doctors say, in a case study they hope will help scientists understand how immunocompromised people are affected by the virus.

In a pre-printed report on medRxiv that has not yet been peer reviewed titled “One-year-old COVID-19 infection reveals host evolution of SARS-CoV-2 in a patient with B-cell depletion, ”the researchers and physicians document their treatment results for the patient at the National Institutes of Health (NIH) in Maryland.

The patient, a 47-year-old woman who was successfully treated for lymphoma with cell therapy three years earlier, was hospitalized for COVID-19 in early 2020. In the months that followed, she became a patient of the infectious disease specialist Dr Véronique. Nussenblatt at NIH.

“It took a while to be able to diagnose it,” Nussenblatt said in a telephone interview with CTVNews.ca on Friday, describing how the medical team realized their patient had a unique case.

Nussenblatt said the first tests for the SARS-CoV-2 virus were negative, despite the patient showing symptoms, which then led them to do a bronchoscopy to take samples from the lower respiratory tract which came back positive.

“She continued to have symptoms after leaving the hospital,” Nussenblatt said. “When we tested her, her test would come back positive, but very weakly positive – at that time, during the pandemic, we knew that some people who had already been infected with SARS-CoV-2 might test positive for a period of time. some time after infection, especially in immunocompromised patients.

The patient, due to her previous cancer treatment, had very few “B cells,” a type of immune cell that creates antibodies to help fight infection and help the immune system function.

Nussenblatt said so much time had passed since the patient was first diagnosed with COVID-19 that over time her team were initially looking for things other than a persistent coronavirus infection.

“We were trying to rule out other infections that she might have,” she explained, adding that a current of thought was that the patient had a type of pneumonia that is seen in patients after having. contracted COVID-19, known as cryptogenic pneumonia. “

To that end, the team treated the patient with steroids and noted her symptoms and her CT scans improved slightly, “but without major changes,” Nussenblatt said.

“At that point, it was still not on our radar that hers could be COVID-19 after so long,” she said.

Things changed in March 2021.

“We realized something was wrong without thinking when his test came back positive [in March] but a higher positive, with higher results. It suggested to me that she still had COVID-19 but was getting more active or had a new SARS-CoV-2 infection. “

At this point, Nussenblatt said, she enlisted the help of her colleague, Dr. Elodie Ghedin, a molecular virologist who works at NIH and studies the genomes of the SARS-CoV-2 virus.

Ghedin and Nussenblatt performed a subgenomic PCR test on samples from the patient and found a surprise.

“The subgenomic PCR looks for genetic material that should only be present if the virus is alive, so that told me that she actually had an active SARS-CoV-2 infection, but I didn’t know. not whether it was the original one or a new one, “Nussenblatt said. “Dr. Ghedin helped determine this and sequenced the virus and found that it was actually the same virus all the time. “

The patient had been infected in 2020 with one of the first versions of SARS-CoV-2 in North America, which by early 2021 was no longer circulating, the report says.

In addition, the sequencing revealed two new mutations of the spike protein in the patient’s cells, which, according to the report, “underscore the importance of analyzing viral evolution in prolonged SARS-CoV infection. 2, in particular in immunocompromised hosts and the implication of these mutations in the emergence of viral variants.

While other viruses are known to infect immunocompromised people for longer periods of time, “we tend not to see that with respiratory viruses,” she said.

In the case of Nussenblatt’s patient, she eventually recovered and had several negative COVID-19 tests since the NIH team treated her for the second time.

“She’s not 100%, but she’s doing a lot better – she’s out of oxygen,” said Nussenblatt, who spoke with the patient last week. “All the markers of an active infection are gone and she is no longer having symptoms – all of her tests are negative and the inflammatory markers in her blood have returned to normal. “

And despite having COVID-19 for a year, Nussenblatt said that to his knowledge no one who was in close contact with the patient was affected.

Nussenblatt said the case, while rare, is helping doctors and scientists understand how the virus can affect people who are immunocompromised and what resources are needed to collect data on the phenomenon.

“It was a great lesson, that immunocompromised patients can actually be infected with SARS-CoV-2 for a long time,” she said. “You know this has major implications for their treatment and also for infection control… we have been fortunate to have access to subgenomic PCR tests, which not everyone has easy access to, because it really helped us determine whether or not there was a virus there.

Nussenblatt said she hopes this case study “puts the possibility of this happening on other people’s radar.”

“We are still learning so much,” she said. “COVID-19 is really testing our knowledge of how to treat patients and the assumptions we make about clinical care. ”


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