Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised Patient

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Abstract

We describe a case of chronic coronavirus disease 2019 (COVID-19) in a patient with lymphoma and associated B-cell immunodeficiency. Viral cultures and sequence analysis demonstrate ongoing replication of infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for at least 119 days. The patient had 3 admissions related to COVID-19 over a 4-month period and was treated twice with remdesivir and convalescent plasma with resolution of symptoms. The patient’s lack of seroconversion and prolonged course illustrate the importance of humoral immunity in resolving SARS-CoV-2 infection. This case highlights challenges in managing immunocompromised hosts, who may act as persistent shedders and sources of transmission.

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  1. SciScore for 10.1101/2020.09.20.20196899: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: All experiments using SARS-CoV-2 were performed at the University of Michigan under Biosafety Level 3 (BSL3) protocols in compliance with containment procedures in laboratories approved for use by the University of Michigan Institutional Biosafety Committee (IBC) and Environment, Health & Safety (EHS).
    IRB: This study and the use of residual specimens from patients with COVID-19 have been approved by the University of Michigan Institutional Review Board (IRB).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    To detect viral-infected cells, anti-nucleocapsid protein (anti-N) SARS-CoV-2 antibody (Antibodies Online, Cat# ABIN6952432) was used as a primary antibody with an overnight staining at 4°C followed by staining with secondary antibody Alexa-647 (goat anti-mouse, Thermo Fisher,
    anti-nucleocapsid protein (anti-N) SARS-CoV-2
    suggested: None
    anti-mouse
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    The SARS-CoV-2 WA1 strain was obtained from BEI Resources and was propagated in Vero E6 cells.
    Vero E6
    suggested: RRID:CVCL_XD71)
    Huh-7 cells infected with SARS-CoV-2 WA1 at a multiplicity of infection (MOI) of 0.2 were used as positive control of infection.
    Huh-7
    suggested: CLS Cat# 300156/p7178_HuH7, RRID:CVCL_0336)
    Software and Algorithms
    SentencesResources
    Sequencing libraries were prepared using the NEBNext Ultra II kit and sequenced on an Illumina MiSeq with 2×250bp reads, V2 chemistry.
    MiSeq
    suggested: (A5-miseq, RRID:SCR_012148)
    Reads were aligned to the Wuhan-1 reference (GenBank: MN908947.3) with BWA-MEM version 0.7.15.
    BWA-MEM
    suggested: (Sniffles, RRID:SCR_017619)
    Sequencing adaptors were removed and the ARTIC primer were trimmed with iVar version 1.2.1.
    iVar
    suggested: None
    We determined the consensus sequences with samtools (version 1.5) mpileup and iVar consensus, excluding bases with a quality score below 20.
    samtools
    suggested: (SAMTOOLS, RRID:SCR_002105)
    Whole genome consensus sequences were aligned to the Wuhan-Hu-1 reference with MUSCLE (version 3.8.31) and the phylogeny constructed with IQ-TREE using a GTR model and 1000 ultrafast bootstrap replicates.
    MUSCLE
    suggested: (MUSCLE, RRID:SCR_011812)
    IQ-TREE
    suggested: (IQ-TREE, RRID:SCR_017254)
    To determine the frequency of case patient mutations in the larger global dataset of SARS-CoV-2, we downloaded all sequences >27000 bases in length from GISAID and aligned them with MAFFT within the nextstrain environment (Supplemental Table 3).
    MAFFT
    suggested: (MAFFT, RRID:SCR_011811)

    Results from OddPub: Thank you for sharing your code and data.


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A major limitation of our study is that it describes a single individual whose clinical course may not be broadly generalizable to other immunocompromised population. Nevertheless, we expect that additional cases such as the one described above will continue to elucidate important aspects of SARS-CoV-2 pathogenesis, evolution, and immunity.

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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