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Long-Term Evolution of SARS-CoV-2 in an Immunocompromised Patient with Non-Hodgkin Lymphoma

2021; American Society for Microbiology; Volume: 6; Issue: 4 Linguagem: Inglês

10.1128/msphere.00244-21

2379-5042

Vítor Borges, Joana Isidro, Mário Cunha, Daniela Cochicho, Luís Martins, Luís Banha, Margarida Figueiredo, Leonor Rebelo, Maria Céu Trindade, Sílvia Duarte, Luı́s Vieira, Maria João Alves, Inês Costa, Raquel Guiomar, Madalena Santos, Rita Côrte‐Real, André Dias, Diana Póvoas, J. F. González Cabo, Carlos Figueiredo, Maria José Manata, Fernando Maltêz, María Gomes da Silva, João Paulo Gomes,

Long-Term Effects of COVID-19

Recent studies have shown that persistent SARS-CoV-2 infections in immunocompromised patients can trigger the accumulation of an unusual high number of mutations with potential relevance at both biological and epidemiological levels. Here, we report a case of an immunocompromised patient (non-Hodgkin lymphoma patient under immunosuppressive therapy) with a persistent SARS-CoV-2 infection (marked by intermittent positivity) over at least 6 months. Viral genome sequencing was performed at days 1, 164, and 171 to evaluate SARS-CoV-2 evolution. Among the 15 single-nucleotide polymorphisms (SNPs) (11 leading to amino acid alterations) and 3 deletions accumulated during this long-term infection, four amino acid changes (V3G, S50L, N87S, and A222V) and two deletions (18-30del and 141-144del) occurred in the virus Spike protein. Although no convalescent plasma therapy was administered, some of the detected mutations have been independently reported in other chronically infected individuals, which supports a scenario of convergent adaptive evolution. This study shows that it is of the utmost relevance to monitor the SARS-CoV-2 evolution in immunocompromised individuals, not only to identify novel potentially adaptive mutations, but also to mitigate the risk of introducing "hyper-evolved" variants in the community.