A 72-year-old dies after almost two years of Covid (613 days of uninterrupted positivity): this is the clinical case reported at the Congress of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in Barcelona by Magda Vergouwe of the Amsterdam University Medical Center. Experts explained that the persistence of the infection has led to the onset of a new, highly genetically modified variant (with 50 mutations).
It is the longest case of SARS-CoV-2 ever reported and involved a patient with low immune defenses, an immunocompromised individual. The patient was admitted to Amsterdam University Medical Center in February 2022 with a SARS-CoV-2 infection. The patient was taking immunosuppressants as part of treatment for blood cancer, and was therefore immunocompromised. In particular, he had taken a drug that eliminates B lymphocytes (white blood cells), including those that normally produce antibodies directed against SARS-CoV-2.
Despite multiple vaccinations against SARS-CoV-2, the patient did not have SARS-CoV-2-specific IgG antibodies upon admission. Routine genomic surveillance showed infection with the Omicron SARS-CoV-2 BA.1.17 variant. The patient’s immune system was unable to eliminate the virus. The man received treatment with the anti-SARS-CoV-2 antibody sotrovimab, the anti-IL6 antibody sarilumab and deksamethasone without success. Ultimately, the patient died from a relapse of his hematological condition after remaining positive for SARS-CoV-2 with high viral loads for a total of 613 days, with multiple symptomatic episodes, requiring hospitalization. The persistent infection led the patient to prolonged periods of isolation during hospitalization and the intensive use of personal protective materials, significantly reducing his quality of life.
The virus isolated from the patient was found to be resistant to sotrovimab as early as 21 days after receiving the treatment infusion. Prolonged infection led to the emergence of a new variant. In fact, the genome map of the virus isolated from the patient revealed over 50 mutations, confirming that persistent infections are a hotbed for the evolution and development of new variants.
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