key: cord-0979348-meatpn34
authors: Radhakrishnan, Venkatraman; Gangopadhyay, Devleena
title: Repeat‐positive SARS‐CoV‐2 in a child with cancer
date: 2020-10-03
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28744
sha: 81e66161cf088fd0107ae933daa9e2dfdc2c61d2
doc_id: 979348
cord_uid: meatpn34

nan

To the Editor:

We report a case of repeat positivity with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a child with cancer. after two negative RT-PCR tests of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2. His WBC count, ANC, and ALC at reinitiation of the ALL protocol were 5400, 1566, and 3200/mm 3 , respectively. We did not test the patient or the caregiver for antibodies to SARS-CoV-2.

It is our policy to screen the patient and the caregiver for SARS- Viral shedding up to 37 days (median 20 days) has been observed in adult patients infected with SARS-CoV-2, and patients with severe disease had prolonged viral shedding compared to patients who were asymptomatic or had mild disease. 7 Disease severity, corticosteroid therapy, fever (temperature >38.5 • C), and time from onset to hospitalization were associated with prolonged duration of SARS-Cov-2 viral shedding in adult patients in a study from Beijing, China. 8 Our patient or the caregiver did not have any of the risk factors mentioned in this study. 8 The median duration of viral shedding in the above study was 11 days (interquartile range 8-14.3 days). 8 A study from Korea on children with SARS-CoV-2 infection reported a mean duration of viral shedding in nasopharyngeal swabs of 17.6 days (standard deviation 6 days). 9 It has been observed that positive RT-PCR tests in patients with prolonged viral shedding or those who turn positive after a negative RT-PCR test is due to viral ribonucleic acid (RNA) in dead cells, and these viral particles are inactive and noninfective. 10, 11 Persistent SARS-CoV-2 positivity has been demonstrated in feces ranging from 1 to 33 days after a negative nasopharyngeal swab. 12 However, the transmission of SARS-CoV-2 through feces has not been documented. 12 A prior study reports that the majority of repeat-positive cases after a negative SARS-CoV-2 PCR occur within 30 days of the first positive test. 9 Our patient and caregiver became positive 65 days after their first positive report, and this is one of the longest periods reported for repeat-positive cases and the first case report of a pediatric cancer patient developing repeat positivity or prolonged viral shedding with 

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