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COVID Re-Infection or Something Else? A Case Report

Authors:

Joy Ekezie ,

Department of Pediatrics, BronxCare Health System, Bronx, New York, US
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Tanya Rogo

Department of Pediatrics, BronxCare Health System, Bronx, New York, US
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Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 100 million people so far globally with few cases of reinfection reported [1, 2]. Most people with coronavirus disease 2019 (COVID-19) develop antibodies after resolution of acute infection, however the exact duration of these antibodies and the extent to which it may indicate a protective immunity to SARS-CoV-2 in humans is unknown [2, 3]. We report an unusual case of probable asymptomatic reinfection with SARS-CoV-2 while still having antibodies present.

Case Presentation: A 39-year-old healthy female healthcare professional in New York City had severe myalgia, generalized body weakness, cough, and subjective fever (maximum axillary temperature 99.8F) in March of 2020. The patient was not tested for COVID-19 initially because there was no documentation of fever ≥100F and restriction of testing due to limited availability. Conservative management with analgesics and hydration was done and symptoms subsided after 7 days. One week later (April 2020), multiple family members became sick with COVID-like symptoms and tested positive to SARS-CoV-2 by polymerase chain reaction (PCR). Patient was then screened with SARS-CoV-2 RT-PCR (Roche Cobas 6800) due to close household contact and was positive. Routine COVID-19 antibody testing (Roche Cobas Elecsys) offered to hospital staff on a voluntary basis a month later and again 4 months later (September 2020) during annual employee health screening were both positive. In January 2021, the patient was tested due to mandatory return-to-work screening after out-of-state travel and was found to be positive by both PCR and antibody (Table 1). At that time, patient was completely asymptomatic but was required to quarantine. Six days later, she repeated both tests in an urgent care facility at which time SARSCoV-2 RNA PCR (Roche Cobas) was negative while the IgG antibodies (Abbott Alinity i) remained positive. A respiratory viral panel for SARS-CoV-2 RNA PCR and influenza A and B (Roche Cobas) done three weeks later as part of the prerequisites for clinical rotation in a different hospital was also negative.

Conclusion:The asymptomatic index case had antibodies at the time she re-tested positive to SARS-CoV-2 10 months after first testing positive. This may be a case of re-infection in which the presence of antibodies kept the patient symptom-free. Less likely, she may have been carrying viral particles in her nose for 10 months as there was no documented negative test in the interim. There are no published reports of such prolonged carriage of virus [4]. Furthermore, prolonged detection of viral particles does not translate to infectivity [4, 5]. The repeat positive test could also have been a false positive. Polymerase chain reaction cycle thresholds may prove helpful to clinicians to determine the significance of a positive PCR test.

How to Cite: Ekezie, J. and Rogo, T., 2021. COVID Re-Infection or Something Else? A Case Report. Journal of Scientific Innovation in Medicine, 4(2), p.13. DOI: http://doi.org/10.29024/jsim.111
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  Published on 25 May 2021
 Accepted on 04 May 2021            Submitted on 04 May 2021

Table 1

Timeline for SARS-CoV-2 testing.


DATE REASON FOR SARS-CoV-2 TESTING SARS-CoV-2 TESTING DONE

March 18, 2020 Severe myalgia, generalized body weakness, cough, and subjective fever. Testing not done because patient did not meet testing criteria at that time (fever <100F).

April 3, 2020 Multiple symptomatic family members tested positive for COVID-19. SARS-CoV-2 RNA RT-PCRa positive.

May 26, 2020 Voluntary SARS-CoV-2 antibody screening offered to hospital staff. SARS-CoV-2 IgGb positive.

September 11, 2020 Annual employee health screening. SARS-CoV-2 IgGb positive.

January 7, 2021 Mandatory return-to-work COVID testing after a week-long vacation out-of-state. SARS-CoV-2 RNA RT-PCRa positive.
SARS-CoV-2 IgGb positive.

January 13, 2021 COVID PCR and antibody testing done in an Urgent Care. SARS-CoV-2 RNA RT-PCRa negative.
SARS-CoV-2 IgGc positive.

February 9, 2021 Mandatory COVID screening for clinical rotation in another hospital. SARS-CoV-2 RNA and Influenza A and B Qual NAATd negative.

Legend: a. COBAS-6800 (Roche); b. Cobas Elecsys (Roche); c. Alinity i (Abbott); d. Cobas (Roche).

Competing Interests

The authors have no competing interests to declare.

References

  1. Wang C, Wang Z, Wang G, Lau JY, Zhang K, Li W. COVID-19 in early 2021: Current status and looking forward. Sig Transduct Target Ther. 2021; 6: 114. DOI: https://doi.org/10.1038/s41392-021-00527-1 

  2. Tillett RL, Sevinsky JR, Hartley PD, Kerwin H, Crawford N, Gorzalski A, et al. Genomic evidence for reinfection with SARS-CoV-2: A case study. The Lancet Infectious Diseases. 2021 Jan; 21(1): 52–58. DOI: https://doi.org/10.1016/S1473-3099(20)30764-7 

  3. Dan JM, Mateus J, Kato Y, Hastie KM, Faliti CE, Ramirez SI, et al. Immunological memory to SARS-CoV-2 assessed for greater than six months after infection. Science. 6 Jan 2021. DOI: https://doi.org/10.1126/science.abf4063 

  4. Henderson DK, Weber DJ, Babcock H, Hayden MK, Malani A, Wright SB, et al. The perplexing problem of persistently PCR-positive personnel. Infect Control Hosp Epidemiol. 2021 Feb; 42(2): 203–204. DOI: https://doi.org/10.1017/ice.2020.343 

  5. Wajnberg A, Mansour M, Leven E, Bouvier NM, Patel G, Firpo-Betancourt A, et al. Humoral response and PCR positivity in patients with COVID-19 in the New York city region, USA: An observational study. The Lancet Microbe. 2020 Nov; 1(7): e283–289. DOI: https://doi.org/10.1016/S2666-5247(20)30120-8 

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