A confirmed, severe case of re-infection with the coronavirus 2 (SARS-CoV-2) with severe acute respiratory syndrome with the new variant B.1.1.7 in a hospital in London was reported in Clinical Infectious Diseases. Reinfection occurred 8 months after an initial mild course of SARS-CoV-2 during the first wave of the pandemic in the UK.
The patient was a 78 year old male with a history of type 2 diabetes mellitus, diabetic nephropathy on hemodialysis, COPD, mixed central and obstructive sleep apnea, and ischemic heart disease. On April 2, he presented with a fever while on hemodialysis, subsequently tested positive for SARS-CoV-2, had a mild illness and an uneventful recovery.
It was tested on December 8, 2020 as part of routine SARS-CoV-2 tests in the hemodialysis clinic. The relative light unit (RLU) value of its sample was 1348. A replicate sample sent on December 14 using reverse transcription polymerase chain reaction (RT-PCR) had Ct values of 27.5 and 27.9.
The patient was taken to the emergency room and reported a three-day history of worsening dyspnoea. He had shortness of breath, difficulty speaking, and severe hypoxia. He was immediately intubated and taken to the intensive care unit.
In-house sequencing of the entire genome on the nasal and throat swabs of the patient showed that the sample from April 2nd belonged to line B.2 without mutations in the S region and the sample from December 8th belonged to line B.1.1.7 with 18 amino acid changes in the S region and 2 deletions in the spike region, corresponding to the new SARS-CoV-2 variant VOC-202012/01, which is spreading rapidly in the UK.
Although the new variant is associated with increased transferability, it has not been associated with increased pathogenicity. In the case of this patient, however, re-infection with the new variant caused a life-threatening illness.
Anti-SARS-CoV-2 antibodies were detected in the patient shortly before re-infection with no evidence of a decrease in the antibody, which “could raise some concerns about immune evasion from this new variant, which is a problem with the high number of mutations in the spike region is seen, ”the authors wrote. They added that the mutations in the spike region also raise concerns about vaccine evasion and the likelihood of re-infection.
The authors named regular PCR screening of their dialysis cohort and access to internal sequencing of the entire genome as key components in order to confirm reinfection with the new variant. They estimated that such a new infection is “drastically underreported” worldwide.
Harrington D., Kele B., Pereira S. et al. Confirmed reinfection with SARS-CoV-2 variant VOC-202012/01. Clin Infect Dis. Published online January 9, 2021. doi: 10.1093 / cid / ciab014
This article originally appeared on Infectious Disease Advisor