Critical illness in immunocompromised patients: insights into relapse or persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): case series report.

BACKGROUND

Upon the pandemic transitioning into a new phase, research into the immune pathophysiology of severe and critical coronavirus disease 2019 has become increasingly crucial. Such studies are pivotal in shaping advanced treatment strategies and driving the development of innovative therapeutics, including more effective vaccines targeting the virus. High-risk comorbidities and pre-existing immunocompromised states have been identified as significant factors contributing to increased susceptibility to severe coronavirus disease 2019. Moreover, cases of severe infections, particularly those characterized by relapses or viral persistence, provide invaluable insights into the evolving behavior and dynamics of this pathogen.

CASES SERIES PRESENTATION

We report three cases involving mixed-race Colombian female patients aged 58, 35, and 63 years who experienced multiple episodes of coronavirus disease 2019 infection, with the most recent episode progressing to critical illness. These cases were characterized by relapses or persistent infections, and genomic analyses consistently identified the Omicron severe acute respiratory syndrome coronavirus 2 lineage as the causative variant. Notably, individuals with underlying immunosuppressive conditions developed severe acute respiratory syndrome coronavirus 2 infections that were more severe, leading to fatal outcomes that included acute respiratory distress syndrome, multiorgan dysfunction, and death. In contrast, one vaccinated patient with significant comorbidities exhibited persistent critical coronavirus disease 2019 but responded positively to treatment with tocilizumab.

CONCLUSIONS

The key takeaway is the critical need for continued investigation into coronavirus disease 2019 among individuals with high-risk comorbidities and those undergoing immunosuppressive therapy. Recurrent episodes of infection, including cases marked by relapses or persistent viral presence in these populations, create conditions conducive to viral replication and adaptation. Such environments may potentially act as breeding grounds for the emergence of significant new viral mutations.