Post-COVID-19 syndrome. SARS-CoV-2 RNA detection in plasma, stool, and urine in patients with persistent symptoms after COVID-19
Francisco Tejerina, Pilar Catalán, Cristina Rodríguez‐Grande, J. A. Carrillo Adán, Carmen Rodríguez, Patricia Muñóz, Teresa Aldámiz, Cristina Díez, Leire Pérez, Chiara Fanciulli, Darı́o Garcı́a de Viedma, Gregorio Marañon Microbiology ID COVID 19 Study Group, Luís Alcalá, Roberto Alonso, Beatriz Álvarez, Ana Álvarez‐Uría, Alexi Arias, Luis Antonio Arroyo, Juan Berenguer, Elena Bermúdez, Emilio Bouza, Almudena Burillo, Ana Candela, Raquel Carrillo, Emilia Cercenado, Alejandro Cobos, Pilar Escribano, Agustín Estévez, Silvia Fernandez, Alicia Galar, María Dolores García García, Paloma Gijón, Adolfo González, Helmuth Guillén, Jesús Guinea, Laura Vanessa Haces, Martha Kestler, Juan Carlos López, Carmen Narcisa Losada, Marina Machado, Mercedes Marín, Pablo Fernando Martin, Paloma Martín, Pedro Montilla, Zaira Moure, Patricia Muñóz, María Olmedo, Belén Padilla, M.J. Palomo, F Parras, María Jesús Pérez-Granda, Laura Pérez‐Lago, Paula Pescador, Elena Reigadas, Cristina Rincón, Belén Rodríguez, Sara Rodríguez, Adriana Rojas, María Jesús Ruiz‐Serrano, Carlos Sánchez, M. Cantero Sanchez, Julia Serrano, Maricela Valerio, Ma Cristina Veintimilla, Lara Vesperinas, Teresa Vicente, Sofía de la Villa
Abstract
BACKGROUND: There is a paucity of knowledge on the long-term outcome in patients diagnosed with COVID-19. We describe a cohort of patients with a constellation of symptoms occurring four weeks after diagnosis causing different degrees of reduced functional capacity. Although different hypothesis have been proposed to explain this condition like persistent immune activation or immunological dysfunction, to date, no physiopathological mechanism has been identified. Consequently, there are no therapeutic options besides symptomatic treatment and rehabilitation. METHODS: We evaluated patients with symptoms that persisted for at least 4 weeks after COVID-19. Epidemiological and clinical data were collected. Blood tests, including inflammatory markers, were conducted, and imaging studies made if deemed necessary. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) in plasma, stool, and urine were performed. Patients were offered antiviral treatment (compassionate use). RESULTS: We evaluated 29 patients who reported fatigue, muscle pain, dyspnea, inappropriate tachycardia, and low-grade fever. Median number of days from COVID-19 to positive RT-PCR in extra-respiratory samples was 55 (39-67). Previous COVID-19 was mild in 55% of the cases. Thirteen patients (45%) had positive plasma RT-PCR results and 51% were positive in at least one RT-PCR sample (plasma, urine, or stool). Functional status was severely reduced in 48% of the subjects. Eighteen patients (62%) received antiviral treatment. Improvement was seen in most patients (p = 0.000) and patients in the treatment group achieved better outcomes with significant differences (p = 0.01). CONCLUSIONS: In a cohort of COVID-19 patients with persistent symptoms, 45% of them have detectable plasma SARS-CoV-2 RNA. Our results indicate possible systemic viral persistence in these patients, who may benefit of antiviral treatment strategies.