Unlike immunocompetent hosts, the duration of viral persistence after infection with severe acute respiratory syndrome coronavirus 2 can be prolonged in immunosuppressed patients. Here, we present a case of viral persistence for over 19 weeks in a patient with a history of solid organ transplant and explore the clinical, virologic, and immunologic course. Our patient still demonstrated viral persistence at 138 days with low polymerase chain reaction cycle threshold values and evidence of continuing viral sequence evolution indicative of ongoing virus replication. These findings have important implications for infection prevention and control recommendations in immunosuppressed patients. Immune response, including neutralizing antibody titers, T cell activity, and cytokine levels, peaked around days 44–72 after diagnosis. Anti-S trimer antibodies were low at all time points, and T cell response was attenuated by day 119. As immune response waned and viral load increased, increased genetic diversity emerged, suggesting a mechanism for the development of viral variants.

中文翻译：

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严重急性呼吸系统综合症冠状病毒 2 在实体器官移植患者中的长期持续存在、免疫反应减弱和病毒进化

与免疫功能正常的宿主不同，免疫抑制患者感染严重急性呼吸系统综合症冠状病毒 2 后病毒持续存在的时间可能会延长。在此，我们介绍了一名有实体器官移植病史的患者病毒持续存在超过 19 周的病例，并探讨了临床、病毒学和免疫学过程。我们的患者在 138 天时仍表现出病毒持续存在，聚合酶链反应循环阈值较低，并且病毒序列持续进化的证据表明病毒正在进行复制。这些发现对免疫抑制患者的感染预防和控制建议具有重要意义。免疫反应，包括中和抗体滴度、T 细胞活性和细胞因子水平，在诊断后 44-72 天左右达到峰值。