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Volume 14
Issue 4
10.3390/v14040752
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Case Report

Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab

by
Nathalie Van der Moeren
1,*,
Philippe Selhorst
2,
My Ha
3,
Laura Heireman
1,
Pieter-Jan Van Gaal
4,
Dimitri Breems
5,
Pieter Meysman
3,
Kris Laukens
3,
Walter Verstrepen
1,
Natasja Van Gasse
1,
Benson Ogunjimi
3,
Kevin K. Arien
2 and
Reinout Naesens
1
1
Laboratory of Microbiology, Ziekenhuis Netwerk Antwerpen, 2050 Antwerp, Belgium
2
Department of Biomedical Sciences, Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium
3
Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Antwerp Centre for Translational Immunology and Virology (ACTIV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Department of Paediatrics, Antwerp University, 2610 Antwerp, Belgium
4
Departement of Nephrology, Ziekenhuis Netwerk Antwerpen, 2050 Antwerp, Belgium
5
Department of Haematology, Ziekenhuis Netwerk Antwerpen, 2050 Antwerp, Belgium
*
Author to whom correspondence should be addressed.
Viruses 2022, 14(4), 752; https://doi.org/10.3390/v14040752
Submission received: 20 January 2022 / Revised: 24 March 2022 / Accepted: 31 March 2022 / Published: 3 April 2022
(This article belongs to the Special Issue SARS-CoV-2 Research in Belgium)
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Abstract

Background. Prolonged shedding of SARS-CoV-2 in immunocompromised patients has been described. Furthermore, an accumulation of mutations of the SARS-CoV-2 genome in these patients has been observed. Methods. We describe the viral evolution, immunologic response and clinical course of a patient with a lymphoma in complete remission who had received therapy with rituximab and remained SARS-CoV-2 RT-qPCR positive for 161 days. Results. The patient remained hospitalised for 10 days, after which he fully recovered and remained asymptomatic. A progressive increase in Ct-value, coinciding with a progressive rise in lymphocyte count, was seen from day 137 onward. Culture of a nasopharyngeal swab on day 67 showed growth of SARS-CoV-2. Whole genome sequencing (WGS) demonstrated that the virus belonged to the wildtype SARS-CoV-2 clade 20B/GR, but rapidly accumulated a high number of mutations as well as deletions in the N-terminal domain of its spike protein. Conclusion. SARS-CoV-2 persistence in immunocompromised individuals has important clinical implications, but halting immunosuppressive therapy might result in a favourable clinical course. The long-term shedding of viable virus necessitates customized infection prevention measures in these individuals. The observed accelerated accumulation of mutations of the SARS-CoV-2 genome in these patients might facilitate the origin of new VOCs that might subsequently spread in the general community.
Keywords: SARS-CoV-2; persistent infection; immunocompromised host; variants of concern (voc); viral evolution SARS-CoV-2; persistent infection; immunocompromised host; variants of concern (voc); viral evolution

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MDPI and ACS Style

Van der Moeren, N.; Selhorst, P.; Ha, M.; Heireman, L.; Van Gaal, P.-J.; Breems, D.; Meysman, P.; Laukens, K.; Verstrepen, W.; Van Gasse, N.; et al. Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab. Viruses 2022, 14, 752. https://doi.org/10.3390/v14040752

AMA Style

Van der Moeren N, Selhorst P, Ha M, Heireman L, Van Gaal P-J, Breems D, Meysman P, Laukens K, Verstrepen W, Van Gasse N, et al. Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab. Viruses. 2022; 14(4):752. https://doi.org/10.3390/v14040752

Chicago/Turabian Style

Van der Moeren, Nathalie, Philippe Selhorst, My Ha, Laura Heireman, Pieter-Jan Van Gaal, Dimitri Breems, Pieter Meysman, Kris Laukens, Walter Verstrepen, Natasja Van Gasse, and et al. 2022. "Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab" Viruses 14, no. 4: 752. https://doi.org/10.3390/v14040752

APA Style

Van der Moeren, N., Selhorst, P., Ha, M., Heireman, L., Van Gaal, P.-J., Breems, D., Meysman, P., Laukens, K., Verstrepen, W., Van Gasse, N., Ogunjimi, B., Arien, K. K., & Naesens, R. (2022). Viral Evolution and Immunology of SARS-CoV-2 in a Persistent Infection after Treatment with Rituximab. Viruses, 14(4), 752. https://doi.org/10.3390/v14040752

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