key: cord-1045371-4kaz3wn1 authors: Grossi, Enzo; Terruzzi, Vittorio title: Exceptionally high COVID-19 viral load and very long duration of shedding in a young pauci-symptomatic child with autism resident in an Italian nursing home date: 2020-08-22 journal: J Infect DOI: 10.1016/j.jinf.2020.08.026 sha: bfa53604c7eba0f81b2c0fd4de680460deeaff96 doc_id: 1045371 cord_uid: 4kaz3wn1 nan Exceptionally high COVID-19 viral load and very long duration of shedding in a young pauci-symptomatic child with autism resident in an Italian nursing home. Villa Santa Maria Foundation, Tavernerio, Italy Few studies so far have focused on the duration of COVID-19 detection in asymptomatic or paucisymptomatic subjects (1)(2). In asymptomatic adults, the median time from the first positive test to the first of two consecutive negative tests ranges between 7 to 23 days. Only two case-report studies have concerned children, with a detectable virus for 10 days (3) and for 17 days (4). There are multiple reports of prolonged viral shedding in people infected with SARS-CoV-2 but the presence of viral RNA on a test does not necessarily correlate with infectivity (5-8). The duration of quarantine required after clinical recovery to definitively prevent transmission is therefore uncertain. We report a case of exceptionally high viral load and extremely slow SARS-CoV-2 RNA shedding in a toddler resident in Villa Santa Maria rehabilitation Institute, a well-known Nursing Home in the Lombardy region. An Italian child with autism and severe intellectual disability, nine years old, resident in our Institute from 2018, on April 20th developed a cough and nasal discharge. On the evening of April 21st, a moderate fever (38.3 C°) was registered, disappearing on the morning of 22nd. All symptoms vanished from the 22nd afternoon. At the objective examination, no clinical signs of lung involvement were noticed. The child underwent nosepharyngeal swab for COVID-19 virus detection on April 24 th . Quantitative RT-PCR indicated a viral load corresponding to a Cycle Threshold(CT) value = 6 (10.5 log10 copies/mL). After this first swab other five repeated tests performed approximatively every two-three week confirmed the detection of COVID RNA with CT values of 29,30,36,26, 34 along the following twelve weeks (figure1), till July 15 th , date of the last positive swab. The subject was maintained in isolation for all this period considering viral load levels potentially related to infectivity as those registered. The first negative swab was registered on August 4 th followed by a second negative swab on August 6 th . At this latter date a high specific IgG response was registered with S/CO titers (Log 2 ) >10. Throughout this period the subject remained asymptomatic. Blood examination tests revealed the presence of marked neutropenia (neutrophil count = 930/ml) and a low percentage of CD4 helper lymphocytes (25%). This case suggests that in pauci-symptomatic children exceptionally high viral load can be detected and consequently the virus shedding can take a long duration, 82 days precisely. Careful monitoring with repeated tests at regular intervals checking CT values is important to establish the duration of the infectivity, which, as suggested by recent studies (9) (10) can be considered absent only with CT values above 34. SARS-CoV-2 detection, viral load and infectivity over the course of an infection On Behalf Of Inmi And The Italian Army Covid-Study Groups. Coronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study Epidemiologic and clinical characteristics of 10 children with coronavirus disease 2019 in Changsha Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea Epub ahead of print Virus shedding dynamics in asymptomatic and mildly symptomatic patients infected with SARS-CoV-2 Prolonged persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals Epidemiological features and viral shedding in children with SARS-CoV-2 infection Epub ahead of print Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards Virological assessment of hospitalized patients with COVID-2019 We thank Dr. Lucy Costantino, dr. Fulvio Ferrara and all the staff of the Oncological and Prenatal Genetics Department of Centro Diagnostico Italiano for technical support in processing swab samples, and performing laboratory analyses.