key: cord-0745630-qu10w742
authors: Jung, Jiwon; Oh, Dong Kyu; An, Ji- Hwan; Hong, Sang-Bum; Sung, Heungsup; Kim, Mi-Na; Kim, Sung-Han
title: Re: Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-19
date: 2020-05-08
journal: J Infect
DOI: 10.1016/j.jinf.2020.05.004
sha: f30116f9cb0a61d0157e9168b8508b0fdf4ec1c8
doc_id: 745630
cord_uid: qu10w742

nan

We have read the article by Fang X, et al. 1 with great interest. The authors low dose steroid therapy did not associated with delaying viral clearance in 55 and 23 patients with general and severe coronavirus disease 2019 (COVID-19). We report a case of viral shedding more than 6 weeks in the nasopharyngeal swab in a critically ill patient with COVID-19 who received low-dose corticosteroid therapy and extracorporeal membrane oxygenation (ECMO). Studies showed that the median duration of viral shedding in patients with COVID-19 after symptom onset is approximately 3 weeks. 1-3 In this context, our patient exhibited a relatively prolonged viral shedding duration, especially from the upper respiratory tract. Corticosteroid therapy is a double-edged sword that can suppress inflammation while hindering pathogen clearance. In cases with MERS-CoV infection, corticosteroid therapy was not associated with decreased mortality but was associated with delayed viral clearance. 4 In SARS, corticosteroid therapy was also associated with delayed clearance of viral RNA from the blood. 5 Therefore, the exceptionally long duration of viral shedding in our patient may be due to long-term use of corticosteroid therapy, and further targeted study is needed to elucidate this issue.

In South Korea, the criteria for the release of patients with CO VID-19 from isolation is clinical improvement with two consecutive negative PCR results from specimens collected at least 24 hours apart. 6 As for the CDC, the criteria for discontinuation of transmission-based precaution is the resolution of fever without the use of anti-pyretic, improvement of respiratory symptoms, and negative results for SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected at least 24 hours apart. 7 We observed that even after 4 consecutive negative results, nasopharyngeal swabs may revert back to producing positive results; therefore, two consecutive negative PCR results may not be sufficient to guarantee persistent negative results. This is in line with the recent study about 15% of patients with COVID-19 who discharged had positive PCR results during the followup. 8 Several news media also reported on recurrent SARS-CoV-2 positive results due to relapse, remnant RNA detection, or reinfection. 9,10 Sharing the details of various experiences with persistent intermittent positive PCR results such as our current case would be valuable in tackling the issue of patients with recurrence of SARS-CoV-2.

In conclusion, a critically ill patient with COVID-19 continued to show positive PCR results for SARS-CoV-2 from her nasopharynx for at least 6 weeks after symptom onset. Further well-designed studies about the effect of low dose steroid use on the viral shedding kinetics are needed. 

Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-1

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Prolonged presence of SARS-CoV-2 viral RNA in faecal samples

Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome

Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients

Korea Centers for Disease Control and Prevention. Management guidelines for coronavirus disease-19

Korea Centers for Diseases Control & Prevention, c2020

Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance

KBS World Radio. Patient Released from Hospital Rediagnosed with COVID-19