Patient and Immunological Factors Associated With Delayed Clearance of Mucosal Severe Acute Respiratory Syndrome Coronavirus 2 RNA and Symptom Persistence

• Published in: The Journal of infectious diseases Vol. 230; no. 2; pp. 357 - 362
• Main Authors: Stone, Mars, Spencer, Bryan R, Warden, Donald E, Fink, Rebecca V, Saa, Paula, Leddy, Jennifer, Mulach-Vannoy, Jackie, Townsend, Rebecca, Krysztof, David, Hughes, Alexandria N, Di Germanio, Clara, Kessler, Debra A, Kleinman, Steven, Busch, Michael P, Norris, Philip J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 16.08.2024
• Subjects: Adult; Aged; Antibodies, Viral - blood; Body mass index; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - immunology; Female; Humans; Immunoglobulin G; Immunoglobulin G - blood; Male; Middle Aged; Mucosa; Nucleocapsids; Reinfection - immunology; Reinfection - virology; RNA, Viral - blood; SARS-CoV-2 - immunology; Severe acute respiratory syndrome coronavirus 2; COVID-19; SARS-CoV-2; antibodies; long COVID; obesity
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiae132

Abstract Serial blood and mucosal samples were characterized for 102 participants enrolled a median of 7.0 days after coronavirus disease 2019 diagnosis. Mucosal RNA was detectable for a median of 31.5 (95% confidence interval [CI], 20.5–63.5) days, with persistence ≥1 month associated with obesity (body mass index [BMI] ≥30 kg/m2; odds ratio [OR], 3.9 [95% CI, 1.2–13.8]) but not age, sex, or chronic conditions. Fifteen participants had likely reinfection; lower serum anti-spike IgG levels were associated with reinfection risk. Nearly half of participants (47%) reported symptoms lasting ≥2–3 months; persistence ≥3 months was associated with BMI ≥30 kg/m2 (OR, 4.2 [95% CI, 1.1–12.8]) and peak anti-spike and anti-nucleocapsid antibody levels. Elevated body mass index is associated with mucosal viral persistence and prolonged symptoms after SARS-CoV-2 infection. Low serum anti-S IgG levels were associated with reinfection risk, and higher peak anti-S and anti-NC antibody levels were associated with persistent symptoms.