ABSTRACT
The reports on coronavirus disease 2019 (COVID-19) describe the pandemic in waves. Similar to the ocean's waves, the frequency and amplitude of the number of new cases and the number of deaths were globally quite regular; nevertheless, they showed important regional irregularities and the direction of spread has been generally rather unpredictable for COVID-19. One of the major reasons for the repeated outbreaks is the mutating capacity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that allows the virus to infect persons who have natural immunity or have been vaccinated. Vaccination began in vast campaigns from the second year of the pandemic that was supposed to decrease the magnitude of the waves. Although it reduced the complications, the expected attenuation of the disease expansion has not yet been met. This paper provides a short overview of the most recent data on the rate of reinfection in vaccinated and non-vaccinated individuals. It points out that testing positive for a second time for SARS-CoV-2 does not necessarily mean a reinfection; it can also be interpreted as recontamination. The symptom free outcome as well as the rapid reconversion of the polymerase chain reaction test may help to determine the difference between reinfection and recontamination. Awareness of this phenomenon may be valuable in times of human resource difficulties. The available evidence may suggest that the protective value of a prior infection could be better considered for vaccine distribution in the future.
ABSTRACT
Összefoglaló. A COVID-19 mortalitását a súlyos társbetegségek, közöttük bizonyos daganatos betegségek is növelik. Immunszuppresszív hatásuk miatt felmerülhet a citotoxikus kezelések rizikónövelo hatása is. Ugyanakkor az onkológiai terápia megszakítása vagy halasztása, különösen az agresszívebb, kiterjedtebb és fiatalkorban jelentkezo daganatok esetében ronthatja a kórjóslatot. Egy 39 éves nobeteg esetét ismertetjük. A járvány során késlekedve felismert, lokoregionálisan kiterjedt emlodaganat miatt primer szisztémás kemoterápiában részesült. A kezelés 5. ciklusa során enyhe légúti tünetek kapcsán, az onkológiai ambulancián SARS-CoV-2-fertozése igazolódott. Kemoterápiás kezelését felfüggesztettük. A diagnózistól számított 3. napon tünetmentessé vált, ám SARS-CoV-2-PCR-pozitivitása még a 43. napon is fennállt. A 19. napon hormongátló kezelést indítottunk. Az 51. napon mastectomia és axillaris block dissectio történt. A 82. napon a megszakított kemoterápiát a hormongátló kezelés leállítását követoen G-CSF-profilaxis mellett újraindítottuk. A kezelés során fertozéses szövodményt nem észleltünk. Kemoterápia és mutét SARS-CoV-2-fertozött, tünetmentes daganatos betegnél szövodménymentesen végezheto elhúzódó virológiai pozitivitás esetén, felszabadító vizsgálat nélkül is. A daganatos betegek koronavírus-fertozése esetén az onkológiai protokolltól történo eltérés egyénre szabott optimalizálásával és a multidiszciplináris team szorosabb együttmuködésével az infektológiai és az onkológiai kockázat együttes alacsonyan tartása is megvalósítható. Orv Hetil. 2021; 162(16): 611-614. Summary. Mortality of COVID-19 is increased when certain co-morbidities, among others advanced malignancies are present. Deleterious effect of cytotoxic therapy, related to its immunosuppressive effect, may also be hypothesised. However, postponing or cancelling oncologic treatment, especially in younger patients with advanced and more aggressive tumors may worsen the prognosis. The case of a 39-year-old female patient is presented, who was diagnosed with loco-regionally advanced breast cancer during the pandemic. Primary systemic chemotherapy was started. The patient presented with acute respiratory tract symptoms during the fifth cycle and subsequently SARS-CoV-2 infection was diagnosed. Chemotherapy was cancelled. Symptoms resolved in three days after diagnosis. SARS-CoV-2 PCR remained positive up to day 43. Antihormonal therapy was introduced on day 19 and she underwent mastectomy with axillary lymph node dissection on day 51. Chemotherapy was reset postoperatively on day 82 with prophylactic G-CSF protection. No adverse event was observed throughout the treatment. Cytotoxic chemotherapy and surgery can be successfully delivered in breast cancer patients with prolonged asymptomatic SARS-CoV-2 PCR positivity, even without negative swab result. Individual optimisation of the therapy may require deviations from standard protocols. Closer multidisciplinary cooperation may contribute to the minimisation of both oncologic and infectious risks. Orv Hetil. 2021; 162(16): 611-614.