Doctors report the case of a 72-year-old patient in the Netherlands who suffered from the novel coronavirus infection for 613 days, marking the longest SARS-CoV-2 infection duration to date.
They discovered extended evolution of the virus in the patient with compromised immunity in whom a highly mutated variant of SARS-CoV-2 evolved. While healthy patients infected with the coronavirus tend to clear it within a period of days to weeks, immunocompromised individuals may develop a persistent infection with prolonged viral replication and evolution. The latest findings highlight the importance of close genomic surveillance of the virus in this subpopulation of patients.
“The duration of SARS-CoV-2 infection in this described case is extreme, but prolonged infections in immunocompromised patients are much more common compared to the general community,” doctors wrote.
In the new research, they describe the case of a 72-year-old immunocompromised male patient who was admitted to Amsterdam University Medical Center in February 2022 with a SARS-CoV-2 infection. The patient underwent stem cell transplantation to treat a pre-existing condition and a further complication he developed was treated with the drug rituximab which depletes all available antibody-producing B-cells of the immune system. He was then treated with the anti-SARS-CoV-2 directed antibody sotrovimab, the anti-IL6 antibody sarilumab, and the drug dexamethasone – which did not lead to his recovery from infection. Further tests suggested that the patient’s immune system was not capable of clearing the virus.
Doctors found that prolonged infection led to the emergence of a novel immune-evasive variant in the patient due to the extensive evolution of the virus.
In the end patient died from a relapse of his pre-existing condition while remaining SARS-CoV-2 positive with high loads of the virus. However, there has been no documented transmission of the highly mutated virus variant to other people in the community. “This case underscores the risk of persistent SARS-CoV-2 infections in immunocompromised individuals as unique SARS-CoV-2 viral variants may emerge due to extensive intra-host evolution,” doctors noted. “We emphasise the importance of continuing genomic surveillance of SARS-CoV-2 evolution in immunocompromised individuals with persistent infections given the potential public health threat of possibly introducing viral escape variants into the community,” they added.
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