Re-infection with a different SARS-CoV-2 clade and prolonged viral shedding in a hematopoietic stem cell transplantation patient

Abeer N Alshukairi; Sherif A El-Kafrawy; Ashraf Dada; Muhammad Yasir; Amani H Yamani; Mohammed F Saeedi; Ahmed Aljohaney; Naif I AlJohani; Husam A Bahaudden; Intikhab Alam; Takashi Gojobori; Aleksandar Radovanovic; Thamir A Alandijany; Norah A Othman; Tagreed L Alsubhi; Ahmed M Hassan; Ahmed M Tolah; Jaffar A Al-Tawfiq; Alimuddin Zumla; Esam I Azhar

doi:10.1016/j.ijid.2021.07.036

Re-infection with a different SARS-CoV-2 clade and prolonged viral shedding in a hematopoietic stem cell transplantation patient

Int J Infect Dis. 2021 Sep:110:267-271. doi: 10.1016/j.ijid.2021.07.036. Epub 2021 Jul 18.

Authors

Abeer N Alshukairi¹, Sherif A El-Kafrawy², Ashraf Dada³, Muhammad Yasir², Amani H Yamani¹, Mohammed F Saeedi¹, Ahmed Aljohaney⁴, Naif I AlJohani⁵, Husam A Bahaudden⁶, Intikhab Alam⁷, Takashi Gojobori⁷, Aleksandar Radovanovic⁷, Thamir A Alandijany², Norah A Othman⁸, Tagreed L Alsubhi⁸, Ahmed M Hassan⁸, Ahmed M Tolah⁸, Jaffar A Al-Tawfiq⁹, Alimuddin Zumla¹⁰, Esam I Azhar¹¹

Affiliations

¹ Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
² Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
³ Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
⁴ Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
⁵ Adult Hematology and Bone Marrow Transplant Section, Oncology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
⁶ Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
⁷ Computational Bioscience Research Centre, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia.
⁸ Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
⁹ Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁰ Division of Infection and Immunity, Centre for Clinical Microbiology, University College London Royal Free Campus, London, UK; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
¹¹ Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: eazhar@kau.edu.sa.

Abstract

Immunocompromised patients who have a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection pose many clinical and public health challenges. We describe the case of a hematopoietic stem cell transplantation patient with lymphoma who had a protracted illness requiring three consecutive hospital admissions. Whole genome sequencing confirmed two different SARS-CoV-2 clades. Clinical management issues and the unanswered questions arising from this case are discussed.

Keywords: COVID-19; Hematological stem cell transplant; Immunocompromised; Prolonged viral shedding; Re-infection; SARS-CoV-2.

Publication types

Case Reports

MeSH terms

COVID-19*
Hematopoietic Stem Cell Transplantation*
Humans
Reinfection
SARS-CoV-2
Virus Shedding