Brazilian man remained with coronavirus in his organism for 218 days

RIO DE JANEIRO, BRAZIL – Last November, the case of a 45-year-old man attracted the attention of the scientific community. This patient, who was treated in a Boston hospital, had Sars-CoV-2 in his body for 154 days – and the virus suffered 66 mutations in his body.

Now, a group of researchers from USP, Sírio-Libanês and Nove de Julho hospitals, Imperial College London, and Oxford University reported a similar case, but with an even longer infection: a Brazilian man about 40 years old who had the coronavirus for 218 days.

Like the American patient, the Brazilian had a compromised immune system – because he had undergone treatment for lymphoma (cancer of the lymphatic system). The Brazilian researchers wrote a scientific article describing the case.

In September 2020, six months after cancer treatment, the patient has a fever, headache, and aching limbs. He visits a doctor and tests positive for Sars-CoV-2. He receives two antibiotics (used to control secondary bacterial pneumonia, manifest in lungs damaged by coronavirus) and goes home. However, his symptoms worsen, and he seeks hospitalization. At this point, his blood oxygen rate is only 87%.

The man improves and is discharged from the hospital at the end of the month. But a few days later, he has symptoms again – fatigue, chest pain, and difficulty breathing – and is hospitalized again. His condition worsened, and he was even intubated. Nevertheless, he recovers and is discharged from the hospital after three months.

A few days later, the symptoms return (fever and shortness of breath), and he is readmitted. By this time, the patient’s bout with Covid-19 is over four months old. The disease is on day 134, with coronavirus tests (performed on days 6, 77, and 128) always coming back positive. The case is followed with even greater attention – and the man undergoes Sars-CoV-2 tests on days 134, 141, 148, 155, 162, 169, 196, and 218. All indicate the presence of the virus. The man did not develop antibodies to the virus at any time.

The scientists genetically analyzed the samples of days 6, 77, 134, 168, and 196, all belonging to the lineage B.1.128, widely distributed in Brazil. Still, the virus accumulates mutations during the course of the disease: There are 13, of which 4 are “synonymous” (do not change the structure of the virus) and 9 are “nonsynonymous” (mutations that alter or eliminate amino acids of the virus, changing its structure and function).

The result is a unique variant that has arisen in the patient’s body. This phenomenon can pose an epidemiological risk: if the person transmits the virus to others (including doctors or nurses when they are in the hospital), they can introduce a new variant into society. However, in the case of the Brazilian patient, there is no evidence that this has happened.

Since the first mutations of Sars-CoV-2 appeared last year, patients with immunological impairments have been considered possible foci of the new variants. This is because the body cannot eliminate the virus in them, as it replicates over a long time, allowing mutations to accumulate.