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Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients.
Ling, Yun; Xu, Shui-Bao; Lin, Yi-Xiao; Tian, Di; Zhu, Zhao-Qin; Dai, Fa-Hui; Wu, Fan; Song, Zhi-Gang; Huang, Wei; Chen, Jun; Hu, Bi-Jie; Wang, Sheng; Mao, En-Qiang; Zhu, Lei; Zhang, Wen-Hong; Lu, Hong-Zhou.
  • Ling Y; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Xu SB; Department of Infectious Disease and Immunology, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Lin YX; Department of Hepatology, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Tian D; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Zhu ZQ; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Dai FH; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Wu F; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Song ZG; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Huang W; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Chen J; Department of Infectious Disease and Immunology, Shanghai Public Health Clinical Center, Shanghai 201508, China.
  • Hu BJ; Department of Infectious Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
  • Wang S; Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
  • Mao EQ; Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
  • Zhu L; Department of Pulmonology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
  • Zhang WH; Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai 200041, China.
  • Lu HZ; Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China.
Chin Med J (Engl) ; 133(9): 1039-1043, 2020 May 05.
Article in English | MEDLINE | ID: covidwho-1722619
Semantic information from SemMedBD (by NLM)
1. Persistence PROCESS_OF Patients
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PROCESS_OF
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2. COVID-19 PROCESS_OF Patients
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4. Symptoms PROCESS_OF Patients
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5. 2019 novel coronavirus NEG_PROCESS_OF Patients
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2019 novel coronavirus
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6. Urine - SpecimenType LOCATION_OF Nucleic Acids
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7. Feces LOCATION_OF Duration
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8. Detection TREATS Treatment Group
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10. Glucocorticoids NEG_TREATS Disease
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18. Detection TREATS Treatment Group
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ABSTRACT

BACKGROUND:

A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.

METHODS:

The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.

RESULTS:

In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (F = 2.669, P = 0.044, and adjusted R = 0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t = -2.699, P = 0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; t = 2.550, P = 0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; t = 4.631, P < 0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P > 0.05).

CONCLUSIONS:

In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / RNA, Viral / Coronavirus Infections / Betacoronavirus Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Chin Med J (Engl) Year: 2020 Document Type: Article Affiliation country: CM9.0000000000000774

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / RNA, Viral / Coronavirus Infections / Betacoronavirus Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Chin Med J (Engl) Year: 2020 Document Type: Article Affiliation country: CM9.0000000000000774