A Systematic Review on the Recurrence of SARS-CoV-2 Virus: Frequency, Risk Factors, and Possible Explanations

Overview

Journal Infect Dis (Lond)

Publisher Informa Healthcare

Specialty Infectious Diseases

Date 2021 Jan 29

PMID 33508989

Citations 19

Authors

Seyed Mohammad Piri

Maryam Edalatfar

Sina Shool

Mohammad Naser Jalalian

Soheil Tavakolpour

Affiliations

Soon will be listed here.

Abstract

Background: Since late 2019, SARS-CoV-2 which leads to coronavirus disease 2019 (COVID-19), has caused thousands of deaths. There are some pieces of evidence that SARS-CoV-2 genome could be re-detectable in recovered patients.

Methods: We performed a systematic review in the PubMed/Medline database to address the risk of SARS-CoV-2 recurrence. The last update was for 20 November 2020. Among the 1178 initially found articles, 66 met the inclusion criteria and were considered.

Findings: In total, 1128 patients with at least one-time recurrence of SARS-CoV-2 were included. Recurrence rate has been reported between 2.3% and 21.4% in cohort studies, within a mean of 20 (ranged 1-98) days after discharge; younger patients are being affected more. Following the second course of disease, the disease severity decreased or remained unchanged in 97.3% while it increased in 2.6%. Anti-SARS-CoV-2 IgG and IgM were positive in 11-95% and 58.8-100%, respectively. Based on the literature, three possibilities include reactivation of previous disease, reinfection with the same virus, and false negative, which have been discussed in details.

Conclusion: There is a relatively notable risk of disease recurrence in previously recovered patients, even those who are immunised against the virus. More studies are required to clarify the underlying cause of this phenomenon.

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References

Yuan B, Liu H, Yang Z, Chen Y, Liu Z, Zhang K . Recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients during medical isolation observation. Sci Rep. 2020; 10(1):11887. PMC: 7368008. DOI: 10.1038/s41598-020-68782-w. View

Mardani M, Nadji S, Sarhangipor K, Sharifi-Razavi A, Baziboroun M . COVID-19 infection recurrence presenting with meningoencephalitis. New Microbes New Infect. 2020; 37:100732. PMC: 7376341. DOI: 10.1016/j.nmni.2020.100732. View

Zhang B, Liu S, Dong Y, Zhang L, Zhong Q, Zou Y . Positive rectal swabs in young patients recovered from coronavirus disease 2019 (COVID-19). J Infect. 2020; 81(2):e49-e52. PMC: 7177113. DOI: 10.1016/j.jinf.2020.04.023. View

Chen S, Xu H, Feng H, Sun J, Li X, Zhou L . Epidemiological and Clinical Findings of Short-Term Recurrence of Severe Acute Respiratory Syndrome Coronavirus 2 Ribonucleic Acid Polymerase Chain Reaction Positivity in 1282 Discharged Coronavirus Disease 2019 Cases: A Multicenter, Retrospective,.... Open Forum Infect Dis. 2020; 7(10):ofaa432. PMC: 7543527. DOI: 10.1093/ofid/ofaa432. View

Hu R, Jiang Z, Gao H, Huang D, Jiang D, Chen F . Recurrent Positive Reverse Transcriptase-Polymerase Chain Reaction Results for Coronavirus Disease 2019 in Patients Discharged From a Hospital in China. JAMA Netw Open. 2020; 3(5):e2010475. PMC: 7256666. DOI: 10.1001/jamanetworkopen.2020.10475. View

Robbiani D, Gaebler C, Muecksch F, Lorenzi J, Wang Z, Cho A . Convergent antibody responses to SARS-CoV-2 in convalescent individuals. Nature. 2020; 584(7821):437-442. PMC: 7442695. DOI: 10.1038/s41586-020-2456-9. View

He F, Luo Q, Lei M, Fan L, Shao X, Hu K . Successful recovery of recurrence of positive SARS-CoV-2 RNA in COVID-19 patient with systemic lupus erythematosus: a case report and review. Clin Rheumatol. 2020; 39(9):2803-2810. PMC: 7385201. DOI: 10.1007/s10067-020-05230-0. View

Ota M . Will we see protection or reinfection in COVID-19?. Nat Rev Immunol. 2020; 20(6):351. PMC: 7186928. DOI: 10.1038/s41577-020-0316-3. View

Gyorfi A, Kopp M, May M, Vetter M, Uder M, Kremer A . Glucocorticoid-induced relapse of COVID-19 in a patient with sarcoidosis. Ann Rheum Dis. 2020; 80(6):e87. DOI: 10.1136/annrheumdis-2020-218258. View

10.

Tillett R, Sevinsky J, Hartley P, Kerwin H, Crawford N, Gorzalski A . Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. 2020; 21(1):52-58. PMC: 7550103. DOI: 10.1016/S1473-3099(20)30764-7. View

11.

van Beek N, Schumacher N, Rose C, Schmidt E, Zillikens D . [Modern diagnostics of autoimmune bullous diseases]. Pathologe. 2020; 41(4):317-325. DOI: 10.1007/s00292-020-00795-8. View

12.

Kaur N, Gupta I, Singh H, Karia R, Ashraf A, Habib A . Epidemiological and Clinical Characteristics of 6635 COVID-19 Patients: a Pooled Analysis. SN Compr Clin Med. 2020; 2(8):1048-1052. PMC: 7343407. DOI: 10.1007/s42399-020-00393-y. View

13.

Jiang M, Li Y, Han M, Wang Z, Zhang Y, Du X . Recurrent PCR positivity after hospital discharge of people with coronavirus disease 2019 (COVID-19). J Infect. 2020; 81(1):147-178. PMC: 7151420. DOI: 10.1016/j.jinf.2020.03.024. View

14.

Galanti M, Shaman J . Direct Observation of Repeated Infections With Endemic Coronaviruses. J Infect Dis. 2020; 223(3):409-415. PMC: 7454749. DOI: 10.1093/infdis/jiaa392. View

15.

Zheng J, Zhou R, Chen F, Tang G, Wu K, Li F . Incidence, clinical course and risk factor for recurrent PCR positivity in discharged COVID-19 patients in Guangzhou, China: A prospective cohort study. PLoS Negl Trop Dis. 2020; 14(8):e0008648. PMC: 7505432. DOI: 10.1371/journal.pntd.0008648. View

16.

Bongiovanni M, Basile F . Re-infection by COVID-19: a real threat for the future management of pandemia?. Infect Dis (Lond). 2020; 52(8):581-582. DOI: 10.1080/23744235.2020.1769177. View

17.

Alfehaidi A, Ahmad S, Hamed E . SARS-CoV-2 re-infection: a case report from Qatar. J Infect. 2020; 82(3):414-451. PMC: 7585726. DOI: 10.1016/j.jinf.2020.10.019. View

18.

Du H, Chen J, Pan X, Chen X, Yixian-Zhang , Fang S . Prevalence and outcomes of re-positive nucleic acid tests in discharged COVID-19 patients. Eur J Clin Microbiol Infect Dis. 2020; 40(2):413-417. PMC: 7456660. DOI: 10.1007/s10096-020-04024-1. View

19.

Chen D, Xu W, Lei Z, Huang Z, Liu J, Gao Z . Recurrence of positive SARS-CoV-2 RNA in COVID-19: A case report. Int J Infect Dis. 2020; 93:297-299. PMC: 7129213. DOI: 10.1016/j.ijid.2020.03.003. View

20.

Fenner J, Min M, Liu S, Silverberg N . A case of neonatal pemphigus vulgaris with co-existing BP180 autoantibodies. Pediatr Dermatol. 2019; 37(1):241-243. DOI: 10.1111/pde.14059. View