Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era.

Autor:	Götz, Veronika, Mathé, Philipp, Agarwal, Prerana, Hornuss, Daniel, Pfau, Stefanie, Panning, Marcus, Prager, Eric, Voll, Reinhard E., Engelhardt, Monika, Frye, Björn C., Bamberg, Fabian, Fuchs, Jonas, Müller, Matthias, Wagner, Dirk, Rieg, Siegbert
Předmět:	RESPIRATORY organ microbiology PHENOMENOLOGICAL biology VIROLOGY ACADEMIC medical centers VIRAL load TRANSPLANTATION of organs tissues etc. IMMUNOCOMPROMISED patients COMPUTED tomography SCIENTIFIC observation INFECTION SYMPTOMS RETROSPECTIVE studies FEVER TREATMENT duration CHRONIC diseases LONGITUDINAL method RNA ANTIVIRAL agents DRUG efficacy MEDICAL records ACQUISITION of data MICROBIOLOGY GENETIC mutation DYSPNEA COUGH COMPARATIVE studies PHENOTYPES SARS-CoV-2 COVID-19 B cells
Zdroj:	Infection; Jun2024, Vol. 52 Issue 3, p923-933, 11p
Abstrakt:	Purpose: This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication. Methods: We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included. Results: 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17). Conclusion: Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days. Trial registration number: DRKS 00027299. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
Externí odkaz:	Zobrazit plný text záznamu Full text from SpringerLink