Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature
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REVIEW
Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature Anna Gidari 1 & Marco Nofri 1 & Luca Saccarelli 2 & Sabrina Bastianelli 1 & Samuele Sabbatini 3 & Silvia Bozza 3 & Barbara Camilloni 3 & Igino Fusco-Moffa 4 & Claudia Monari 3 & Edoardo De Robertis 2 & Antonella Mencacci 3 & Daniela Francisci 1 Received: 24 July 2020 / Accepted: 30 September 2020 # The Author(s) 2020
Abstract Can a patient diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) be infected again? This question is still unsolved. We tried to analyze local and literature cases with a positive respiratory swab after recovery. We collected data from symptomatic patients diagnosed with SARS-CoV-2 infection in the Italian Umbria Region that, after recovery, were again positive for SARS-CoV-2 in respiratory tract specimens. Samples were also assessed for infectivity in vitro. A systematic review of similar cases reported in the literature was performed. The study population was composed of 9 patients during a 4-month study period. Among the new positive samples, six were inoculated in Vero-E6 cells and showed no growth and negative molecular test in culture supernatants. All patients were positive for IgG against SARS-CoV-2 nucleoprotein and/or S protein. Conducting a review of the literature, 1350 similar cases have been found. The presumptive reactivation occurred in 34.5 days on average (standard deviation, SD, 18.7 days) after COVID-19 onset, when the 5.6% of patients presented fever and the 27.6% symptoms. The outcome was favorable in 96.7% of patients, while the 1.1% of them were still hospitalized at the time of data collection and the 2.1% died. Several hypotheses have been formulated to explain new positive respiratory samples after confirmed negativity. According to this study, the phenomenon seems to be due to the prolonged detection of SARS-CoV-2 RNA traces in respiratory samples of recovered patients. The failure of the virus to replicate in vitro suggests its inability to replicate in vivo. Keywords COVID-19 . SARS-CoV-2 . Recurrence . Reactivation . Re-infection
Introduction
Anna Gidari and Marco Nofri contributed equally to this work. * Anna Gidari [email protected] 1
Department of Medicine, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, Perugia, Italy
2
Department of Anesthesiology, Intensive Care and Pain therapy Center, “Santa Maria della Misericordia” Hospital, University of Perugia, Perugia, Italy
3
Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
4
Department of Prevention, Local Health Unit Umbria 1, Travel Medicine Unit, Perugia, Italy
Severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) is the etiologic agent of coronavirus disease 2019 (COVID-19) that has been declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 was discovered in December 2019, in Wuhan City (the capital of Hubei prov
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