Prolonged viral shedding in an immunocompetent patient with
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Early data suggest that throat swab PCR may remain positive for 20 days, however there is increasing evidence that some patients shed for significantly longer periods, particularly in faeces. This is a case of a patient with no underlying immunosuppression due to illness or therapy, who remained throat swab positive after 61 days of symptoms.

A 78-year-old white woman was hospitalized for increasing breathlessness and purulent sputum from her tracheostomy site over the preceding 14 days. Her medical history included hypertension, type 2 diabetes mellitus, tracheostomy following complications of thyroidectomy 23 years ago, atrial fibrillation, peripheral vascular disease and myocardial infarction treated with coronary bypass graft. She does not drink alcohol and is an ex-smoker from 23 years ago. On admission her body mass index was 34.2.

On day 14 after symptom onset, the patient was admitted with a positive PCR test for SARS-CoV-2 on nasopharyngeal swab specimen. Her white cell count revealed a lymphopenia (0.7×109/L), normal C reactive protein and normal lactate and lactate dehydrogenase levels. Her thyroid function was within normal range. A chest radiograph revealed left-sided consolidation. She was given oral antibiotic therapy and treated on a further two occasions for hospital-acquired pneumonia although sputum, blood and urine cultures were negative throughout her admission.

Chest radiographs completed on days 5, 12, 21, 36 and 53 of admission all displayed bilateral basal air space shadowing. Supplemental oxygen to maintain adequate saturations was administered per tracheostomy mask and never exceeded 8?L/min, and she did not require positive pressure ventilation or intubation. She was treated with regular sodium chloride nebulisers and carbocisteine for tracheostomy secretion clearance. Antibiotic therapy during her admission did not appear to significantly improve her clinical picture. She obtained no immunomodulatory therapies or experimental/trial therapies. She was anticoagulated for her atrial fibrillation and did not receive heparin treatment.

On the sixty-first day after symptom onset she tested negative for SARS-CoV-2 and remained so on two repeat swabs. This allowed enhanced social contact with limited family visitation and coincided with marked improvement.

To the knowledge, this case is the longest reported duration of viral shedding in COVID-19 in an immunocompetent patient. There is a need to understand the risk of transmission in such patients, as this has significant implications on an individual’s mental health and the wider public health advice.