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A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2.
Am J Case Rep. 2020 Dec 01; 21:e927154.AJ

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) has radically changed the world, and promising vaccine trials are currently underway. The immune responses in asymptomatic and symptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still under investigation, and data are evolving. While it is known that humoral and cell-mediated immune responses against SARS-CoV-2 are elicited, it is uncertain whether these responses protect against reinfection or that they provide definitive evidence of viral clearance. Very few cases have been reported in the literature regarding reinfection with SARS-CoV-2. CASE REPORT We present a case of a middle-aged man with asymptomatic SARS-CoV-2 infection who later developed mild symptomatic COVID-19 after a period of 3 months. The source of reinfection was likely from the community, which had a soaring burden of infection with the highest number of COVID-19 cases per million in the world at that time. The patient had 2 negative COVID-19 polymerase chain reaction (PCR) tests 2 weeks after the initial infection. During the second infection, a nasopharyngeal reverse-transcription PCR test and tests for the presence of COVID-19 immunoglobulin (Ig)M and IgG antibodies were all positive.

CONCLUSIONS

Reinfection with SARS-CoV-2 is a strong possibility. This case raises concerns that asymptomatic infections may not provide long-term protective immunity to all patients, which could make them susceptible to reinfection. Possible explanations for reinfection include an interval decrease in protective antibodies titers after SARS-CoV-2 infection that may be more prevalent in patients who had an asymptomatic infection. Other possibilities include viral reactivation after a prolonged carriage of the virus or delayed immune response.

Authors+Show Affiliations

Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.Department of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

33257644

Citation

Sharma, Rohit, et al. "A Patient With Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later With COVID-19 Pneumonia Possibly Due to Reinfection With SARS-CoV-2." The American Journal of Case Reports, vol. 21, 2020, pp. e927154.
Sharma R, Sardar S, Mohammad Arshad A, et al. A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2. Am J Case Rep. 2020;21:e927154.
Sharma, R., Sardar, S., Mohammad Arshad, A., Ata, F., Zara, S., & Munir, W. (2020). A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2. The American Journal of Case Reports, 21, e927154. https://doi.org/10.12659/AJCR.927154
Sharma R, et al. A Patient With Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later With COVID-19 Pneumonia Possibly Due to Reinfection With SARS-CoV-2. Am J Case Rep. 2020 Dec 1;21:e927154. PubMed PMID: 33257644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Patient with Asymptomatic SARS-CoV-2 Infection Who Presented 86 Days Later with COVID-19 Pneumonia Possibly Due to Reinfection with SARS-CoV-2. AU - Sharma,Rohit, AU - Sardar,Sundus, AU - Mohammad Arshad,Abdullah, AU - Ata,Fateen, AU - Zara,Sabeen, AU - Munir,Waqar, Y1 - 2020/12/01/ PY - 2020/12/1/entrez PY - 2020/12/2/pubmed PY - 2020/12/18/medline SP - e927154 EP - e927154 JF - The American journal of case reports JO - Am J Case Rep VL - 21 N2 - BACKGROUND Coronavirus disease 2019 (COVID-19) has radically changed the world, and promising vaccine trials are currently underway. The immune responses in asymptomatic and symptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still under investigation, and data are evolving. While it is known that humoral and cell-mediated immune responses against SARS-CoV-2 are elicited, it is uncertain whether these responses protect against reinfection or that they provide definitive evidence of viral clearance. Very few cases have been reported in the literature regarding reinfection with SARS-CoV-2. CASE REPORT We present a case of a middle-aged man with asymptomatic SARS-CoV-2 infection who later developed mild symptomatic COVID-19 after a period of 3 months. The source of reinfection was likely from the community, which had a soaring burden of infection with the highest number of COVID-19 cases per million in the world at that time. The patient had 2 negative COVID-19 polymerase chain reaction (PCR) tests 2 weeks after the initial infection. During the second infection, a nasopharyngeal reverse-transcription PCR test and tests for the presence of COVID-19 immunoglobulin (Ig)M and IgG antibodies were all positive. CONCLUSIONS Reinfection with SARS-CoV-2 is a strong possibility. This case raises concerns that asymptomatic infections may not provide long-term protective immunity to all patients, which could make them susceptible to reinfection. Possible explanations for reinfection include an interval decrease in protective antibodies titers after SARS-CoV-2 infection that may be more prevalent in patients who had an asymptomatic infection. Other possibilities include viral reactivation after a prolonged carriage of the virus or delayed immune response. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/33257644/A_Patient_with_Asymptomatic_SARS_CoV_2_Infection_Who_Presented_86_Days_Later_with_COVID_19_Pneumonia_Possibly_Due_to_Reinfection_with_SARS_CoV_2_ L2 - https://www.amjcaserep.com/download/index/idArt/927154 DB - PRIME DP - Unbound Medicine ER -