PDF(Pubmed)
Abstract：
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections have been reported; however, most cases are milder than the primary infection. We report the first case of a life-threatening critical presentation of a SARS-CoV-2 reinfection.
METHODS: A 62-year-old man from Palamós (Spain) suffered a first mild coronavirus disease 2019 (COVID-19) episode in March 2020, confirmed by 2 independent SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) assays and a normal radiograph. He recovered completely and tested negative on 2 consecutive PCRs. In August 2020, the patient developed a second SARS-CoV-2 infection with life-threatening bilateral pneumonia and Acute respiratory distress syndrome criteria, requiring COVID-19-specific treatment (remdesivir + dexamethasone) plus high-flow oxygen therapy. Nasopharyngeal swabs from the second episode were obtained for virus quantification by real-time PCR, for virus outgrowth and sequencing. In addition, plasma and peripheral blood mononuclear cells during the hospitalization period were used to determine SARS-CoV-2-specific humoral and T-cell responses.
RESULTS: Genomic analysis of SARS-CoV-2 showed that the virus had probably originated shortly before symptom onset. When the reinfection occurred, the subject showed a weak immune response, with marginal humoral and specific T-cell responses against SARS-CoV-2. All antibody isotypes tested as well as SARS-CoV-2 neutralizing antibodies increased sharply after day 8 postsymptoms. A slight increase of T-cell responses was observed at day 19 after symptom onset.
CONCLUSIONS: The reinfection was firmly documented and occurred in the absence of robust preexisting humoral and cellular immunity. SARS-CoV-2 immunity in some subjects is unprotective and/or short-lived; therefore, SARS-CoV-2 vaccine schedules inducing long-term immunity will be required to bring the pandemic under control.
METHODS: A 62-year-old man from Palamós (Spain) suffered a first mild coronavirus disease 2019 (COVID-19) episode in March 2020, confirmed by 2 independent SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) assays and a normal radiograph. He recovered completely and tested negative on 2 consecutive PCRs. In August 2020, the patient developed a second SARS-CoV-2 infection with life-threatening bilateral pneumonia and Acute respiratory distress syndrome criteria, requiring COVID-19-specific treatment (remdesivir + dexamethasone) plus high-flow oxygen therapy. Nasopharyngeal swabs from the second episode were obtained for virus quantification by real-time PCR, for virus outgrowth and sequencing. In addition, plasma and peripheral blood mononuclear cells during the hospitalization period were used to determine SARS-CoV-2-specific humoral and T-cell responses.
RESULTS: Genomic analysis of SARS-CoV-2 showed that the virus had probably originated shortly before symptom onset. When the reinfection occurred, the subject showed a weak immune response, with marginal humoral and specific T-cell responses against SARS-CoV-2. All antibody isotypes tested as well as SARS-CoV-2 neutralizing antibodies increased sharply after day 8 postsymptoms. A slight increase of T-cell responses was observed at day 19 after symptom onset.
CONCLUSIONS: The reinfection was firmly documented and occurred in the absence of robust preexisting humoral and cellular immunity. SARS-CoV-2 immunity in some subjects is unprotective and/or short-lived; therefore, SARS-CoV-2 vaccine schedules inducing long-term immunity will be required to bring the pandemic under control.
摘要：
■已经报道了严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）再感染；但是，大多数病例比原发性感染温和。我们报告了首例威胁生命的SARS-CoV-2再感染的关键表现。
■来自帕拉莫斯（西班牙）的一名62岁男子于2020年3月首次出现2019年轻度冠状病毒病（COVID-19）发作，经2项独立的SARS-CoV-2鼻咽聚合酶链反应（PCR）检测和正常的X光片证实。他完全康复，连续2次PCR检测呈阴性。2020年8月，患者出现第二次SARS-CoV-2感染，伴有危及生命的双侧肺炎和急性呼吸窘迫综合征标准，需要COVID-19特异性治疗（雷米西韦+地塞米松）加高流量氧疗。通过实时PCR获得第二次发作的鼻咽拭子用于病毒定量，用于病毒生长和测序。此外,住院期间血浆和外周血单核细胞用于确定SARS-CoV-2特异性体液和T细胞反应.
SARS-CoV-2的基因组分析表明，该病毒可能是在症状发作前不久就开始的。当再次感染发生时，受试者表现出微弱的免疫反应，具有针对SARS-CoV-2的边际体液和特异性T细胞反应。所有测试的抗体同种型以及SARS-CoV-2中和抗体在症状后第8天后急剧增加。在症状发作后第19天观察到T细胞应答的轻微增加。
■再次感染有明确的记录，并且在缺乏强大的预先存在的体液和细胞免疫的情况下发生。某些受试者的SARS-CoV-2免疫是无保护和/或短暂的；因此，需要诱导长期免疫的SARS-CoV-2疫苗时间表来控制大流行。
■来自帕拉莫斯（西班牙）的一名62岁男子于2020年3月首次出现2019年轻度冠状病毒病（COVID-19）发作，经2项独立的SARS-CoV-2鼻咽聚合酶链反应（PCR）检测和正常的X光片证实。他完全康复，连续2次PCR检测呈阴性。2020年8月，患者出现第二次SARS-CoV-2感染，伴有危及生命的双侧肺炎和急性呼吸窘迫综合征标准，需要COVID-19特异性治疗（雷米西韦+地塞米松）加高流量氧疗。通过实时PCR获得第二次发作的鼻咽拭子用于病毒定量，用于病毒生长和测序。此外,住院期间血浆和外周血单核细胞用于确定SARS-CoV-2特异性体液和T细胞反应.
SARS-CoV-2的基因组分析表明，该病毒可能是在症状发作前不久就开始的。当再次感染发生时，受试者表现出微弱的免疫反应，具有针对SARS-CoV-2的边际体液和特异性T细胞反应。所有测试的抗体同种型以及SARS-CoV-2中和抗体在症状后第8天后急剧增加。在症状发作后第19天观察到T细胞应答的轻微增加。
■再次感染有明确的记录，并且在缺乏强大的预先存在的体液和细胞免疫的情况下发生。某些受试者的SARS-CoV-2免疫是无保护和/或短暂的；因此，需要诱导长期免疫的SARS-CoV-2疫苗时间表来控制大流行。
