Case Report on Reinfection case

Abstract

Background

The degree of protective immunity conferred by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently unknown. As such, the possibility of reinfection with SARS-CoV-2 is not well understood. We describe an investigation of two instances of SARS-CoV-2 infection in the same individual.

Methods

A 24-year-old man who was a resident of Harjah Governorate in the KSA, Region of Aseer presented to health authorities on two occasions with symptoms of viral infection, once at a community testing event in June, 2020, and a second time to the hospital in the September,2020 . Nasopharyngeal swabs were obtained from the patient at each presentation and Two Times during follow-up. Nucleic acid amplification testing was done to confirm SARS-CoV-2 infection. We did next-generation sequencing of SARS-CoV-2 extracted from nasopharyngeal swabs. Sequence data were assessed by two different bioinformatic methodologies. A short tandem repeat marker was used for fragment analysis to confirm that samples from both infections came from the same individual.

Findings

The patient had two positive tests for SARS-CoV-2, the first on June 24, 2020, and the second on September 19, 2020, separated by one negative test done during follow-up in July, 2020. Genomic analysis of SARS-CoV-2 showed genetically significant differences between each variant associated with each instance of infection. The second infection was symptomatically more severe than the first.

Interpretation

Genetic discordance of the two SARS-CoV-2 specimens was greater than could be accounted for by short-term in vivo evolution. These findings suggest that the patient was infected by SARS-CoV-2 on two separate occasions by a genetically distinct virus. Thus, previous exposure to SARS-CoV-2 might not guarantee total immunity in all cases. All individuals, whether previously diagnosed with COVID-19 or not, should take identical precautions to avoid infection with SARS-CoV-2. The implications of reinfections could be relevant for vaccine development and application.

Funding

AL-HARJAH GENERAL HOSPITAL- ASEER REGIONAL LABORATORY- KSA.