An American woman had been infected with COVID-19 for a year.This is what the doctor learned

Christy Somos, CTV News.ca Writer

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Toronto, Canada (CTV network) —American women who had previously defeated cancer had been infected with COVID-19 for a year, doctors say. The case study hopes to help scientists understand how immunocompromised people are affected by the virus.

A preprint report on medRxiv that has not yet been peer-reviewed, entitled “One Year of COVID-19 Infection Reveals Intrahost Evolution of SARS-CoV-2 in B-Cell Depleted Patients,” with researchers Doctors treated patients at the National Institutes of Health (NIH) in Maryland.

A 47-year-old woman who successfully treated lymphoma with cell therapy three years ago was hospitalized with COVID-19 in early 2020. In the months that followed, she became a patient of Dr. Veronic, an infectious disease expert. NIH’s Nussenblatt.

“It took me a while to be able to diagnose her,” Nussenblatt said in a telephone interview. CTVNews.ca On Friday, the medical team outlined how they noticed that their patients presented a unique case.

According to Nussenblatt, the initial test for SARS-CoV-2 virus was negative despite the patient’s symptoms, followed by a bronchoscopy to take a lower respiratory tract sample and a positive result. I’m back.

“She continued to have symptoms appearing and disappearing after she was discharged,” said Nussenblatt. “When we test her, her test returns to positive, but the positives are very low. Some people who had previously been infected with SARS-CoV-2 at the time of the pandemic have since I knew that I could get a positive test for a while. Patients with infections, especially immunodeficiencies. “

Due to past cancer treatments, patients have few “B cells,” a type of immune cell that produces antibodies that help fight infection and function the immune system.

Nussenblatt said that it has been so long since the patient was first diagnosed with COVID-19 that over time her team was initially looking for something other than a persistent coronavirus infection.

“We were trying to rule out other infections she might have,” she explained, telling the patient after developing COVID-19, known as “idiopathic organizing pneumonia.” He added that he had the type of pneumonia seen. “

To that end, the team treated the patient with steroids, noticed her symptoms, and her CT scan improved moderately, but “there was no major change,” said Nussenblatt.

“At that point, it wasn’t on our radar yet that he could be COVID-19 for the first time in a while,” she said.

The situation changed in March 2021.

“When her test returned positive, we realized something was wrong with our thinking. [in March] But the higher the positive, the higher the result. It suggested to me that she still had COVID-19, but it was becoming more active or she was newly infected with SARS-CoV-2. “

At that point, Nussenblatt said he had the help of his colleague Dr. Elodie Ghedin, a molecular virologist who works at NIH to study the genome of the SARS-CoV-2 virus.

Ghedin and Nussenblatt found a surprise when they performed a subgenome PCR test on samples from patients.

“Subgenome PCR looks for genetic material that should only be present if the virus is alive, so it turns out that she is actually actively infected with SARS-CoV-2. Is it original or new, “Nussenblatt said. “Dr. Geddin helped determine it, sequenced the virus and realized that it was actually the same virus all the time.”

The patient was infected with one of the first versions of SARS-CoV-2 in North America in 2020, but by early 2021, it had stopped circulating, the report said.

In addition, sequencing revealed two new mutations in the peaplomer in patient cells. This report emphasizes the importance of analyzing the evolution of viruses in long-term SARS-CoV-2 infection, especially in immunosuppressed hosts, and the effects of these mutations. The emergence of viral variants. . “

Other viruses are known to infect immunocompromised people for long periods of time, but “respiratory viruses tend not to see them,” she said.

In the case of Nussenblatt’s patient, she eventually recovered and had multiple negative COVID-19 tests since the NIH team gave her a second treatment.

“She’s not 100%, but she’s much better. She’s completely oxygen-free,” said Nussenblatt, who spoke to the patient last week. “All markers of active infections are gone and she is no longer symptomatic. Her tests are all negative and inflammatory markers in the blood are normal.”

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

Although rare, according to Nussenblatt, doctors and scientists learn how the virus affects people with immunodeficiency and what resources are needed to collect data on the phenomenon. It is said to be useful for people to understand.

“That was a big lesson, that immunocompromised patients can actually be infected with SARS-CoV-2 for a long time,” she said. “You know that it has a huge impact on their treatment and infection control … I was fortunate to have access to subgenome PCR tests. Not everyone has easy access. There is a virus there. “

Nussenblatt said he hoped the case study would “provide the potential for this to happen to other people’s radar.”

“We are still learning a lot,” she said. “COVID-19 is actually testing our knowledge of how to treat patients and the assumptions we make in clinical care.”

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