Infectious Illnesses and Tropical Medicine, Necker-Enfants Malades Hospital, Help Publique-H itaux de Paris, Paris, France INSERM U970, PARCC, H ital Europ n Georges Pompidou, Facultde M ecine, Universitde Paris, Paris, FranceCorrespondence Nathalie Chavarot, Service de N hrologie et Transplantation R ale Adulte, H ital Necker-Enfants Malades, 149, Rue de S res, 75015 Paris, France. E-mail: [email protected] patients may perhaps knowledge prolonged viral shedding just after their initial SARS-CoV-2 infection, however, symptomatic relapses following remission at present stay rare. We herein describe a severe COVID-19 relapse case of a kidney transplant recipient (KTR) following rituximab therapy, 3 months right after a moderate COVID-19 infection, regardless of viral clearance immediately after recovery with the first episode. For the duration of the clinical relapse, the diagnosis was established on a broncho-alveolar lavage specimen (BAL) by RT-PCR. The infectivity of the BAL sample was confirmed on a cell culture assay. Complete genome sequencing confirmed the presence of an identical stain (Clade 20A). However, it had an acquired G142D mutation along with a larger deletion of 3-amino-acids at position 14345. These mutations situated inside the N-terminal domain are recommended to play a part in viral entry. The diagnosis of a COVID-19 relapse must be regarded as in the setting of unexplained persistent fever and/or respiratoryAbbreviations: ATG, antithymocyte globulin; AU, arbitrary units; CNI, calcineurin inhibitors; Ct, cycle threshold; eGFR, estimated glomerular filtration rate; IQR, interquartile range; KT, kidney transplantation; KTR, kidney transplant recipient; MPA, mycophenolic acid; mTOR, mammalian target of rapamycin; RT-PCR, reverse transcriptase-polymerase chain reaction; S Protein, spike protein; SARS- CoV-2, serious acute respiratory syndrome coronavirus 2; SCr, serum creatinine.Cytidine-5′-triphosphate Biological Activity Antoine Morel and Sandrine Imbeaud contributed equally to this short article.27-Hydroxycholesterol Cancer Nathalie Chavarot and David Veyer contributed equally to this short article.PMID:24423657 2022 The American Society of Transplantation plus the American Society of Transplant Surgeons. Am J Transplant. 2022;22:2099103. amjtransplant||AJTMOREL Et aL.symptoms in KTRs (in particular for those right after rituximab therapy), even in patients with previous damaging naso-pharyngeal SARS-CoV-2 PCR.KEYWORDSclinical research/practice, infection and infectious agents–viral, infectious illness, kidney transplantation/nephrology, lung illness: infectious, translational research/science1 | I NTRO D U C TI O NImmunocompromised patients, including kidney transplant recipients (KTRs), may possibly experience prolonged viral shedding for weeks soon after initial COVID-19 infection.1,and had hypoxemia (oxygen want = 4L/min). SARS-CoV-2 RT-PCR was constructive whilst bacteriological and mycological cultures remained damaging. The multiplex PCR assay (BioFireRespiratory two.1 Panel, Biom ieux) which makes it possible for detection of 16 viruses and four intracellular bacteria, was performed around the BAL, and no other virus was amplified (Supplemental Material 1). In vitro culture in the BAL with SARS-CoV-2 susceptible cells revealed a higher titer of infectious virus (1686 IU/ml). Complete genome sequencing was performed on each the first good nasal swab and the BAL specimen. Sequencing proved that the two stains were identical (Clade 20A), confirming the clinical relapse. Moreover, a comparison with local circulating strains at the time of sampling ruled out re-infection (Figure 1 and Table S1).
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