ArticleOpen forum infectious diseases2021
The Longest Persistence of Viable SARS-CoV-2 With Recurrence of Viremia and Relapsing Symptomatic COVID-19 in an Immunocompromised Patient-A Case Study.
Article in Open forum infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 4 of them syntheses that pooled it.
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Who cites it
68 citing papers in PubMed, 4 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Serial cycle threshold to assess the infectious potential of SARS-CoV-2: A systematic review.Epidemiology and infection · 2026Pooled it
- COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis.JAMA network open · 2023Pooled it
- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Sequence Characteristics of Coronavirus Disease 2019 (COVID-19) Persistence and Reinfection.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Pooled it
- Analysis of Immune Escape Variants from Antibody-Based Therapeutics against COVID-19: A Systematic Review.International journal of molecular sciences · 2021Pooled it
- Large-scale genomic surveillance reveals immunosuppression drives mutation dynamics in persistent SARS-CoV-2 infections.Nature communications · 2026Article
- Recurrent Cytopathic Effects and Prolonged Viral Shedding in an Immunocompromised Patient With Malignant Lymphoma Treated With Rituximab and Bendamustine: A Case of Coronavirus Disease 2019 Relapse.Clinical case reports · 2026Article
- Molecular Characterization of Persistent SARS-CoV-2 Infections in Immunocompromised Patients.Viruses · 2026Article
- Genomic and epidemiologic characteristics of SARS-CoV-2 persistent infections in California, January 2021 - July 2023.PLoS pathogens · 2025Article
- Characterisation of a persistent SARS-CoV-2 infection lasting more than 750 days in a person living with HIV: a genomic analysis.The Lancet. Microbe · 2025Article
- Immune signatures of SARS-CoV-2 infection resolution in human lung tissues.PLoS pathogens · 2025Article
- The consequences of SARS-CoV-2 within-host persistence.Nature reviews. Microbiology · 2025Review
- Management of SARS-CoV-2 Infection-Clinical Practice Guidelines of the Polish Association of Epidemiologists and Infectiologists, for 2025.Journal of clinical medicine · 2025Review
- Chronic Systemic SARS-CoV-2 Infection Without Respiratory Involvement in an Immunocompromised Patient.Viruses · 2025Article
- Severe and/or prolonged COVID-19 in hematologic diseases: clinical implications before and during the omicron era.Frontiers in oncology · 2025Article
- COVID-19 convalescent plasma for B-cell depleted patients: a systematic review and individual patient data meta-analysis.Frontiers in medicine · 2025Article
- Long-Term Outcomes of COVID-19 and Risk Factors for Prolonged or Persistent COVID-19 in Lymphoma Patients: A Multicenter, Retrospective Cohort Study.Journal of Korean medical science · 2024Article
- The winding road: Infectious disease considerations for CAR-T and other novel adoptive cellular therapies in the era of COVID-19.Seminars in hematology · 2024Review
- Factors Associated with Prolonged SARS-CoV-2 Viral Positivity in an Italian Cohort of Hospitalized Patients.Diseases (Basel, Switzerland) · 2024Article
- Prolonged viral pneumonia and high mortality in COVID-19 patients on anti-CD20 monoclonal antibody therapy.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2024Article
- Properties and Mechanisms of Deletions, Insertions, and Substitutions in the Evolutionary History of SARS-CoV-2.International journal of molecular sciences · 2024Review
8 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundImmunocompromised patients show prolonged shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal swabs. We report a case of prolonged persistence of viable SARS-CoV-2 associated with clinical relapses of coronavirus disease 2019 (COVID-19) in a patient with mantle cell lymphoma who underwent treatment with rituximab, bendamustine, cytarabine with consequent lymphopenia and hypogammaglobulinemia.
methodsNasopharyngeal swabs and blood samples were tested for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR). On 5 positive nasopharyngeal swabs, we performed viral culture and next-generation sequencing. We analyzed the patient's adaptive and innate immunity to characterize T- and NK-cell subsets.
resultsSARS-CoV-2 RT-PCR on nasopharyngeal swabs samples remained positive for 268 days. All 5 performed viral cultures were positive, and genomic analysis confirmed a persistent infection with the same strain. Viremia resulted positive in 3 out of 4 COVID-19 clinical relapses and cleared each time after remdesivir treatment. The T- and NK-cell dynamic was different in aviremic and viremic samples, and no SARS-CoV-2-specific antibodies were detected throughout the disease course.
conclusionsIn our patient, SARS-CoV-2 persisted with proven infectivity for >8 months. Viremia was associated with COVID-19 relapses, and remdesivir treatment was effective in viremia clearance and symptom remission, although it was unable to clear the virus from the upper respiratory airways. During the viremic phase, we observed a low frequency of terminal effector CD8+ T lymphocytes in peripheral blood; these are probably recruited in inflammatory tissue for viral eradication. In addition, we found a high level of NK-cell repertoire perturbation with relevant involvement during SARS-CoV-2 viremia.
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