Coronavirus disease 2019 re-infection: first report from Turkey

There are concerns about the possibility of SARS-CoV-2 reinfection and recently, a patient with SARS-CoV-2 re-infection (or COVID-19) confirmed by epidemiological, clinical, serological and genomic analyses have been published. We have noticed another patient with SARS-CoV-2 re-infection based on clinical and laboratory studies: A 23-year-old woman presented to her hospital with fever (39°C), chills, fatigue, cough, headache, sore throat, muscle and joint pain on April 9, 2020. On examination, oropharynx was mildly hyperemic, and chest auscultation was normal. SARS-CoV-2 PCR from nasopharyngeal specimen was ordered. She was given isotonic saline and acetaminophen and prescribed azithromycin and acetaminophen and sent home for isolation. SARS-CoV-2 PCR was reported positive and she was given hydroxychloroquine for five days. She improved in 10 days and PCR studies on April 22, and April 27 remained negative. On 4 August 2020, she was re-admitted with fever (38.7°C), chills, fatigue, loss of appetite, taste and smell loss, muscle and joint pain. On examination, oropharynx and chest auscultation were normal. SARS-CoV-2 PCR was reported positive and she was prescribed hydroxychloroquine, acetaminophen and sent home for isolation again. She improved in one week (taste-smell loss improved in 10 days) and on follow-up visit after 14 days, she was doing well. PCR was negative on 17 August 2020. Her anti-SARS-CoV-2 antibodies were negative on 17 August 2020 and slightly positive (2.14 signal-to-cutoff) on 29 August 2020. Previous report from To et al. [Clin Infect Dis. 2020;ciaa1275. doi:10.1093/cid/ciaa1275] showed that viral genomes from first and second episodes belonged to different clades/lineages. They described second episode of asymptomatic infection occurred 142 day after the first symptomatic one. Our patient is the first report, describing two symptomatic episodes 116 days apart. We conclude that as the patients recovered from COVID-19 increases, increased awareness may delineate the characteristics of re-infection.