Published August 25, 2021 | Version v1
Journal article Open

Symptomatic Reinfections in COVID-19 Patients: A Retrospective Study in the Pre-Vaccination Period

Creators

  • 1. Department of Medical Microbiology, Malatya Turgut Özal University Faculty of Medicine, Malatya, Turkey.
  • 2. Department of Medical Microbiology, Malatya Training and Research Hospital, Malatya, Turkey.
  • 3. Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey.

Description

Özet

Bu çalışmada COVID-19 (Coronavirus Disease 2019) hastalığına neden olan yeni koronavirus (SARS-CoV-2; Severe acute respiratory syndrome coronavirus-2) tanısı için yapılan gerçek zamanlı polimeraz zincir reaksiyonu (RT-PCR) testi pozitif olan hastalarda reenfeksiyon oranlarını ve bu enfeksiyonların özelliklerini irdelemek ve literatür bilgileriyle karşılaştırmak amaçlanmıştır. Çalışmada 01.03.2020 ile 31.12.2020 tarihleri arasında COVID-19 şüphesi ile hastanemize başvuran ve SARS-CoV-2 RT-PCR test sonucu pozitif çıkan 27.354 kişinin laboratuvar testi sonuçları ve hastalık bilgileri geriye dönük olarak tarandı. Hastaların ilk SARS-CoV-2 RT-PCR test pozitiflik tarihleri kaydedildi. Daha sonra ilk pozitifliği izleyen süreçte art arda en az birer hafta arayla yapılan iki kez test sonucu negatif çıkan olgular tespit edildi ve bu olgulardan tekrar test sonucu pozitif olanlar saptandı (%0.19; 36/18.726). İlk pozitiflik ile ikinci pozitiflik arasındaki sürenin en az 3 ay (90 gün) olduğu vakalar reenfeksiyon olguları olarak (18/18.726, %0.096) çalışmaya dahil edildi. Olguların 10’u (%55.6) kadın ve 8’i (%44.4) erkek hasta iken, yaş ortalaması 40.44 ±17.42 (18-74) idi. Birinci SARS-CoV-2 pozitifliği ile ikinci pozitiflik arasındaki ortalama süre 123.33 ±31.62 (90-190) gün olarak saptandı. Hastaların akciğer bilgisayarlı tomografi pozitiflik ve negatiflik oranları sırasıyla %16.7 (3/18) ve %83.3 (15/18) olarak tespit edildi. Kronik hastalığı olanların oranı %50 (9/18) iken, olmayanların oranı %50 (9/18) idi. Hastaların %11.1’i (2/18) sağlık çalışanı iken %88.9’u (16/18) sağlık çalışanı değildi. İlk ve ikinci enfeksiyonlar için laboratuvar bulguları karşılaştırıldığında laktat dehidrogenaz, C-reaktif protein, nötrofil, lenfosit, ferritin ve prokalsitonin değerleri için istatistiksel olarak anlamlı bir fark saptanmazken (p>0.05), lökosit sayıları (azalma) ve D-dimer değerlerinde (artış) anlamlı farklılıklar saptandı (sırasıyla p=0.043 ve p=0.035). Reenfeksiyon olgularının üçü %16.7 (3/18) ölümle sonuçlandı. Çalışmamız COVID-19 hastalığında iyileşme sonrası ilk 3-6 aylık dönemde reenfeksiyonların oldukça düşük oranda olduğunu, ancak kalıcı bir bağışıklık gelişmediğini göstermektedir. Prospektif ve çok merkezli çalışmaların yapılması reenfeksiyon oranlarının ve bu hastalarda klinik seyrin değerlendirilmesi için önemli olacaktır. Sunulan bu verilerin hastalığa yönelik tedavi süreçlerine ve koruyucu önlemlerin alınması için yapılacak planlamalara katkı sağlayacağı kanaatindeyiz.

Abstract

In this study, it was aimed to examine reinfection rates and the characteristics of these infections in patients with positive real-time polymerase chain reaction (RT-PCR) test performed for the diagnosis of new coronavirus (SARS-CoV-2; Severe acute respiratory syndrome coronavirus-2), which causes COVID-19 (Coronavirus Disease 2019), and compare with the literature. The study included 27,354 people who applied to our hospital due to suspected COVID-19 between 01.03.2020 and 31.12.2020 and had a positive SARS-CoV-2 RT-PCR test result. The laboratory test results and disease status of these people were investigated retrospectively. The first SARS-CoV-2 RT-PCR test positivity dates of the patients were recorded. Then, after the first positivity, the cases that were tested at least one week apart and the test results were negative twice were determined and positive retest results were detected (0.19%; 36/18.726) among these. Cases in which the time between the first positivity and the second positivity was at least 3 months (90 days) were included in the study as reinfection cases (18/18,726, %0.096). Ten (55.6%) of the cases were female and 8 (44.4%) were male and the mean age was 40.44 ±17.42 (18-74). The average time between the first and the second SARS-CoV-2 positivity was 123.33 ±31.62 (90-190) days. The number of patients with lung computed tomography positivity was 16.7% (3/18), and the negative was 83.3% (15/18). While the rate of those with chronic disease was 50% (9/18), the without chronic disease was 50% (9/18). While 11.1% (2/18) of the patients were healthcare workers, 88.9% (16/18) were not. When the laboratory findings of the first and second infection were compared, no statistically significant difference between the lactate dehydrogenase, C-reactive protein, neutrophil, lymphocyte, ferritin and procalcitonin values (p>0.05). Significant differences were found in leukocyte (decrease) and D-dimer (increase) values (p=0.043 and p=0.035, respectively). Three of the reinfection cases resulted in death of 16.7% (3/18). Our study shows that reinfection rate in COVID-19 disease is very low within the first 3-6 months after recovery, but does not develop a permanent immunity. Conducting prospective and multicenter studies will be more important in terms of evaluation of reinfection rates and the clinical course of these patients. We believe that the data presented will contribute to the treatment processes for the disease and the plans to be made for taking preventive measures.

Notes

COVID-19 Hastalarında Semptomatik Reenfeksiyonlar: Aşılama Öncesi Dönemde Retrospektif Bir Çalışma

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