RT Journal Article
SR Electronic
T1 Dynamics of SARS-CoV-2 shedding in the respiratory tract depends on the severity of disease in COVID-19 patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2002724
DO 10.1183/13993003.02724-2020
A1 Dieter Munker
A1 Andreas Osterman
A1 Hans Stubbe
A1 Maximilian Muenchhoff
A1 Tobias Veit
A1 Tobias Weinberger
A1 Michaela Barnikel
A1 Jan-Niclas Mumm
A1 Katrin Milger
A1 Elham Khatamzas
A1 Sarah Klauss
A1 Clemens Scherer
A1 Johannes C. Hellmuth
A1 Clemens Giessen-Jung
A1 Michael Zoller
A1 Tobias Herold
A1 Enrico N. de Toni
A1 Christian Schulz
A1 Nikolaus Kneidinger
A1 Oliver T. Keppler
A1 Jürgen Behr
A1 Julia Mayerle
A1 Stefan Munker
YR 2021
UL http://erj.ersjournals.com/content/early/2021/02/18/13993003.02724-2020.abstract
AB A fraction of COVID-19 patients progress to a severe disease manifestation with respiratory failure and the necessity of mechanical ventilation. Identifying patients at risk is critical for optimized care and early therapeutic interventions. We investigated the dynamics of SARS-CoV-2 shedding relative to disease severity.We analyzed nasopharyngeal and tracheal shedding of SARS-CoV-2 in 92 patients with diagnosed COVID-19. Upon admission, standardized nasopharyngeal swabs or sputum were collected. If patients were mechanically ventilated, tracheal aspirates were additionally obtained. Viral shedding was quantified by real-time PCR detection of SARS-CoV-2 RNA.45% (41 of 92) of COVID-19 had a severe disease course with the need for mechanical ventilation (severe group). At week 1, the initial viral shedding determined from nasopharyngeal swabs showed no significant difference between non-severe and severe cases. At week 2, a difference could be observed as the viral shedding remained elevated in severely ill patients. A time course of C-reactive-Protein (CRP), Interleukin-6 (Il-6), and Procalcitonin (PCT) revealed an even more protracted inflammatory response following the delayed drop of virus shedding load in severely ill patients. A significant proportion (47.8%) of patients showed evidence of prolonged viral shedding (>17 days), which was associated with severe disease courses (73.2%).We report that viral shedding does not differ significantly between severe and non-severe cases upon admission to the hospital. Elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between second and third week and prolonged viral shedding are associated with a more severe disease course.We report that elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between second and third week and prolonged viral shedding are associated with a more severe disease course.