Case report: viral shedding for 120 days in an allergic child with Covid 19

Abstract

Since it was first detected in Dec 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread through the planet causing the novel coronavirus disease, Covid-19. Here, we report the case of a 9-year-old girl with persistent viral shedding based on RT-PCR detection. Her first positive (Ct=36) dated from March 4 2021, came in a preoperative physical examination (scheduled tonsillectomy), with no apparent symptoms. Her father fell ill and tested positive soon after that casual finding. Surgery was postponed. The patient came positive again on July 1 2021 (Ct=33) and on July 29 2021 (Ct=29). She had a persistent cough, which was also compatible with her allergic condition. Her surgery could not be postponed any longer and was operated on July 30 2021. Excised adenoids and tonsils were extensively rubbed with a swab to test whether the material detected resulted infectious or not, on Vero E6 cell cultures. Based on the absence of any cytopathic effect, we found it was not infective, even upon an intended amplification by a second passage. RT-PCR was negative when performed on the last supernatant. The histological pattern of her tonsillar and adenoid tissue was analyzed through H&E staining and immune cell populations were examined by FACS. Both aspects were compatible with her hyperplastic condition and also with a viral infection. We tested the anti-Spike specific response by ELISA on serum samples taken on Aug 6 2021 (IgM=1.34, cut off=0.584 and IgG=3.27, cut off=0.364). Finally, we determined the neutralizing antibodies titer on the same serum, using the wild type SARS-CoV-2 (titre=32, the mean of infected adults is 64). We concluded that, albeit the long period the genetic material of the virus was detected on her swabs, the patient does not seem to have a major immunological deficiency and could mount an appropriate immune response against the virus. Importantly, we demonstrated she was not able to transmit virus at the time of the surgery.