key: cord-0766179-vpzaoi6a
authors: Yoo, Si Yoon; Lee, Youngseok; Lee, Ga Hee; Kim, Dong Hyun
title: Reactivation of SARS‐CoV‐2 after Recovery
date: 2020-05-18
journal: Pediatr Int
DOI: 10.1111/ped.14312
sha: 85a77c6c223a505c4ab9901ef5c3b63c1de1074a
doc_id: 766179
cord_uid: vpzaoi6a

Coronavirus disease 2019 (COVID‐19) has now spread worldwide as a global pandemic.(1) We report on an 8‐year‐old boy who might be a patient with reactivation of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a family cluster.

year-old boy who might be a patient with reactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a family cluster.

We retrospectively reviewed medical records including symptoms and signs, laboratory examination, sequential cycle threshold values of real-time reverse transcription polymerase chain reaction (qRT-PCR) tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), radiologic findings, and management. The transmission route to SARS-CoV-2 was described based on the report by the epidemiological investigation service officer and the history taken from the parents. qRT-PCR tests for SARS-CoV-2 were performed using samples collected serially from the upper airway (nasopharyngeal swab), lower airway (sputum), urine, stool, saliva, and serum. Viral RNA was detected by using Allplex™2019-nCoV Assay (Seegene Inc., Seoul, Korea) for amplification of the RNA-dependent RNA polymerase (RdRP), N genes specific for SARS-CoV-2, and E gene for all of Sarbecovirus including SARS-CoV-2.

The cycle threshold (Ct) values from the qRT-PCR were measured; Ct value <35 was reported as positive, and Ct values between 35 and less than 40 are considered indeterminate.

On March 3, 2020, the 8-year-old boy presented a 3-day history of intermittent cough and was diagnosed as COVID-19 after having been in contact with his father, who was confirmed SARS-CoV-2 positive three days before.

He was previously healthy and had no travel history within two weeks. Once the father had tested positive, the family members had gone into self-quarantine at home. They had all been tested for COVID-19 on February 29 and were negative and had continued to self-isolation. Other family members were also tested but were found to be negative. He was then hospitalized to the nationally designated negative pressure room together with his mother. In order to protect her, she was provided with Level D personal protective equipment.

This article is protected by copyright. All rights reserved Upon admission, his initial blood tests were within reference ranges. Chest x-rays were performed during admission showed no active lesions. However, chest computed tomography (CT) revealed non-specific ground glassopacity nodule in the subpleural area of the left lower lobe, suggesting a viral pneumonia. Supportive care was given to the boy without antiviral medication.

On day 3 of admission, his cough gradually improved and resolved on day 15, following which symptomatic medication was discontinued. The results of the qRT-PCR tests from both the upper and lower respiratory tracts were positive until day 8 of admission, becoming negative on day 14 and subsequent qRT-PCR performed after 24 hours ( Table 1 ). The patient was discharged on day 17.

The patient stayed at home without contact with other people after discharge. However, his cough reoccurred and he developed a poor appetite 4 days after discharge. Therefore, the qRT-PCR test for SARS-CoV-2 was conducted again the following day and the results were negative. However, the cough was continued and deteriorated, and therefore a follow-up test was performed 14 days after discharge. On Apr 4, the test for SARS-CoV-2 was positive and so the patient was admitted again (Table 1) . Laboratory and imaging studies showed no remarkable abnormalities.

Even though he had a mild fever of 37.7℃, the patient's general condition was very good. Other multiplex PCR test was also performed to assess for various respiratory pathogens and was negative. On Apr 7, 2020, 4 days after readmission, his fever subsided and did not rise further above 37.5℃ after 48 hours. Until the 7th day, the qRT-PCR test at upper airway confirmed that it was positive. However, it was confirmed as negative by two tests conducted at 24 hour intervals from the 9th day to 10th day ( Table 1 ). The patient was then subsequently discharged on Apr 13, the 11st day of hospitalization. Fortunately, his mother has not been transmitted since he was first diagnosed.

Recent report on adults with reactivation of COVID-19 has been published, 5 (9%) of all 55 patients who discharged from hospital presented with SARS-CoV-2 reactivation. 2 As the prevalence of COVID-19 in children has been even lower than adults, 3,4 our study could be provided as a basis for future studies. Even though detection of viral RNA does not necessarily mean that infectious viruses are shedding, further research is needed to understand its significances in transmission-based precautions. 

COVID-19) Pandemic

Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation

Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children

This article is protected by copyright. All rights reserved