Home » Pandemic: More than 50 mutations in 613 days – the mysterious case of a corona patient

Pandemic: More than 50 mutations in 613 days – the mysterious case of a corona patient

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Pandemic: More than 50 mutations in 613 days – the mysterious case of a corona patient

Health pandemic

The puzzling case of a man who was corona positive for 613 days

As of: 5:19 p.m. | Reading time: 4 minutes

Whether intensive care or home care is better is a question for each individual case

Quelle: Getty Images/Westend61

More than 50 mutations in 613 days – researchers report on a corona patient whose immune deficiency made him particularly susceptible to the viruses. They warn about highly mutated variants, but emphasize that it should be possible to care for seriously ill people at home.

Doctors from the Netherlands observed the course of an extremely long corona infection – and warn of the emergence of dangerous variants. In this particular case, it concerns a 72-year-old man who was immunocompromised due to previous illnesses and was admitted to a university clinic in Amsterdam in February 2022 with a Sars-CoV-2 infection.

Until his death in October 2023, he was continuously corona-positive – for 613 days with a high viral load, as a statement now states. Other cases of very long infections had previously been reported in people whose immune systems were unable to adequately fight the virus. This appears to be the longest duration so far.

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The case is interesting for researchers, among other things, because the coronavirus can change particularly significantly in such long-term infected people. This poses the risk of variants of the virus emerging that the immune systems of healthy people can overcome more easily. The team led by doctoral student Magda Vergouwe from the University of Amsterdam wants to present the results of the study at this year’s congress of the European Society for Clinical Microbiology and Infectious Diseases, ESCMID Global Congress, in Barcelona at the end of April.

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The medical team in Amsterdam repeatedly took samples from the man’s nose and throat to examine the genetic material of the coronavirus. In retrospect, they found a total of more than 50 mutations in the 27 samples compared to the omicron variant BA.1 that was circulating at the time. These also include those that allow the virus to evade the immune system, or those that influence how well the virus binds to the ACE-2 receptor in human cells. And just 21 days after the man received the corona drug sotrovimab via infusion, the virus showed typical signs of resistance to it.

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The man had received medication that weakens his immune system as a result of a previous stem cell transplant. And because a so-called lymphoma had developed, he was also treated with the cancer drug rituximab, which breaks down all existing B cells. Including those that normally produce the antibodies directed against Sars-CoV-2. He was treated with the therapeutic antibody sotrovimab directed against Sars-CoV-2, the anti-IL6 antibody sarilumab and dexamethasone – without any clinical response.

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According to the information, the patient was vaccinated against Sars-CoV-2 several times. However, when he came to the hospital, no measurable “SARS-CoV-2 IgG antibody reaction” could be detected. Further tests in the first month – on antibodies and T-cell activities – also suggested that the patient’s immune system was unable to eliminate the virus. The man ultimately died due to a relapse of one of his previous illnesses. As far as is known, he did not infect anyone with one of the multiple mutated variants of the coronavirus.

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A risk to the public?

“This case highlights the risk posed by ongoing Sars-CoV-2 infections in immunocompromised people,” explain the researchers. As the virus develops extensively in a single patient, unique variants could emerge. It is important to closely monitor the evolution of the coronavirus in immunocompromised people. There is a risk that variants will emerge and spread through society that are less likely to affect the immune systems of healthy people.

At the same time, Vergouwe and her colleagues emphasize in the communication that although strict surveillance is necessary, a balance must be found between protecting the public from potential new variants – and humane home care for seriously ill patients at the end of life.

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As a possible solution, they suggest, on the one hand, pointing out potential risks and, on the other hand, offering early diagnostic tests if known (family) contacts develop corresponding symptoms. This should also be combined with genetic surveillance of the virus variants to assess the potential threat to the general population together with public health experts.

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The team will continue this research and examine the courses of several immunocompromised patients whose corona infections lasted a long time: between one month and two years.

The reference to vaccination has been added.

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