Prolonged shedding of infectious viruses with haplotype switches of SARS-CoV-2 in an immunocompromised patient

Kosuke Shoji, Akira Suzuki, Michiko Okamoto, Emmanuel Kagning Tsinda, Naoko Sugawara, Mie Sasaki, Yoshihiko Nogami, Michio Kobayashi, Hitoshi Oshitani, Masaru Yanai

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


A concern has been raised that the persistent COVID-19 infection in an immunocompromised host can be the source of the SARS-CoV-2 variants. This is the case of a 61-year-old man in complete remission of a follicular lymphoma after six cycles of rituximab and bendamustine with additional two cycles of rituximab completed eight months prior to the episode of COVID-19 pneumonia. The patient's respiratory failure was long-lasting, and required mechanical ventilation until day 75. Acquired immunity tested negative throughout the observational period. The viral RNA was detectable until day 100 while the infectious virus was isolated until day 79. Seven haplotypes were identified and the non-synonymous mutations accumulated in the spike gene which included E484Q and S494P. In the management of COVID-19 cases with suppressed immune statuses, initial evaluation of existing immunity and monitoring for infectiousness throughout the clinical course including the convalescent stage may be necessary.

Original languageEnglish
Pages (from-to)1001-1004
Number of pages4
JournalJournal of Infection and Chemotherapy
Issue number7
Publication statusPublished - 2022 Jul
Externally publishedYes


  • COVID-19
  • Haplotype
  • Immunocompromised host
  • Infectivity
  • Viral kinetic

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases


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