[HTML][HTML] Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19

I Thevarajan, THO Nguyen, M Koutsakos, J Druce… - Nature medicine, 2020 - nature.com
I Thevarajan, THO Nguyen, M Koutsakos, J Druce, L Caly, CE van De Sandt, X Jia…
Nature medicine, 2020nature.com
To the Editor—We report the kinetics of immune responses in relation to clinical and
virological features of a patient with mild-to-moderate coronavirus disease 2019 (COVID-19)
that required hospitalization. Increased antibody-secreting cells (ASCs), follicular helper T
cells (T FH cells), activated CD4+ T cells and CD8+ T cells and immunoglobulin M (IgM) and
IgG antibodies that bound the COVID-19-causing coronavirus SARS-CoV-2 were detected
in blood before symptomatic recovery. These immunological changes persisted for at least 7 …
To the Editor—We report the kinetics of immune responses in relation to clinical and virological features of a patient with mild-to-moderate coronavirus disease 2019 (COVID-19) that required hospitalization. Increased antibody-secreting cells (ASCs), follicular helper T cells (T FH cells), activated CD4+ T cells and CD8+ T cells and immunoglobulin M (IgM) and IgG antibodies that bound the COVID-19-causing coronavirus SARS-CoV-2 were detected in blood before symptomatic recovery. These immunological changes persisted for at least 7 d following full resolution of symptoms.
A 47-year-old woman from Wuhan, Hubei province, China, presented to an emergency department in Melbourne, Australia. Her symptoms commenced 4 d earlier with lethargy, sore throat, dry cough, pleuritic chest pain, mild dyspnea and subjective fevers (Fig. 1a). She traveled from Wuhan to Australia 11 d before presentation. She had no contact with the Huanan seafood market or with known COVID-19 cases. She was otherwise healthy and was a non-smoker taking no medications. Clinical examination revealed a temperature of 38.5 C, a pulse rate of 120 beats per minute, a blood pressure of 140/80 mm Hg, a respiratory rate of 22 breaths per minute, and oxygen saturation 98% while breathing ambient air. Lung auscultation revealed bi-basal rhonchi. At presentation on day 4, SARS-CoV-2 was detected in a nasopharyngeal swab specimen by real-time reverse-transcriptase PCR. SARS-CoV-2 was again detected at days 5–6 in nasopharyngeal, sputum and fecal samples, but was undetectable from day 7 (Fig. 1a). Blood C-reactive protein was elevated at 83.2, with normal counts of lymphocytes (4.3× 10 9 cells per liter (range, 4.0× 10 9 to 12.0× 10 9 cells per liter)) and neutrophils (6.3× 10 9 cells per liter (range, 2.0× 10 9 to 8.0× 10 9× 10 9 cells per liter)). No other respiratory pathogens were detected. Her management was intravenous fluid rehydration without supplemental oxygenation. No antibiotics, steroids or antiviral agents were administered. Chest radiography demonstrated bi-basal infiltrates at day 5 that cleared on day 10 (Fig. 1b). She was discharged to home isolation on day 11. Her symptoms resolved completely by day 13, and she remained well at day 20, with progressive increases in plasma SARS-CoV-2-binding IgM and IgG antibodies from day 7 until day 20 (Fig. 1c and Extended Data Fig. 1). The patient was enrolled through the Sentinel Travelers Research Preparedness Platform for Emerging Infectious Diseases novel coronavirus substudy (SETREP-ID-coV) and provided written informed consent before the study. Patient care and research were conducted in compliance with the Case Report guidelines and the Declaration of Helsinki. Experiments were performed with ethics approvals HREC/17/MH/53, HREC/15/MonH/64/2016.196 and UoM# 1442952.1/# 1443389.4.
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