Case report: change of dominant strain during dual SARS-CoV-2 infection
Open Access
- 16 September 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 21 (1), 1-8
- https://doi.org/10.1186/s12879-021-06664-w
Abstract
The dual infection with SARS-CoV-2 is poorly described and is currently under discussion. We present a study of two strains of SARS-CoV-2 detected in the same patient during the same disease presentation. A patient in their 90 s was hospitalised with fever. Oropharyngeal swab obtained on the next day (sample 1) tested positive for SARS-CoV-2. Five days later, the patient was transferred to the ICU (intensive care unit) of the hospital specialising in the treatment of COVID-19 patients, where the patient's condition progressively worsened and continuous oxygen insufflation was required. Repeated oropharyngeal swab (sample 2), which was taken eight days after the first one, also tested positive for SARS-CoV-2. After 5 days of ICU treatment, the patient died. The cause of death was a coronavirus infection, which progressed unfavourably due to premorbid status. We have performed sequencing of full SARS-CoV-2 genomes from oropharyngeal swabs obtained eight days apart. Genomic analysis revealed the presence of two genetically distant SARS-CoV-2 strains in both swabs. Detected strains belong to different phylogenetic clades (GH and GR) and differ in seven nucleotide positions. The relative abundance of strains was 70% (GH) and 30% (GR) in the first swab, and 3% (GH) and 97% (GR) in the second swab. Our findings suggest that the patient was infected by two genetically distinct SARS-CoV-2 strains at the same time. One of the possible explanations is that the second infection was hospital-acquired. Change of the dominant strain ratio during disease manifestation could be explained by the advantage or higher virulence of the GR clade strain.This publication has 50 references indexed in Scilit:
- Specific mutations in SARS-CoV2 RNA dependent RNA polymerase and helicase alter protein structure, dynamics and thus function: Effect on viral RNA replicationPublished by Cold Spring Harbor Laboratory ,2020
- Updated understanding of the outbreak of 2019 novel coronavirus (2019‐nCoV) in Wuhan, ChinaJournal of Medical Virology, 2020
- Update on HIV-1 and HIV-2 Dual InfectionPublished by Springer Science and Business Media LLC ,2013
- Improving the limit of detection for Sanger sequencing: A comparison of methodologies for KRAS variant detectionBioTechniques, 2012
- Dual Infection of Novel Influenza Viruses A/H1N1 and A/H3N2 in a Cluster of Cambodian PatientsThe American Journal of Tropical Medicine and Hygiene, 2011
- Identifying HIV-1 dual infectionsRetrovirology, 2007
- Dual Infections of the Central Nervous System with Epstein‐Barr VirusThe Journal of Infectious Diseases, 2005
- SARS-Associated Coronavirus Quasispecies in Individual PatientsThe New England Journal of Medicine, 2004
- Small-for-Gestational-Age Infants and Risk of Fetal Death in Subsequent PregnanciesThe New England Journal of Medicine, 2004
- Dual HIV-1 infection associated with rapid disease progressionThe Lancet, 2004