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The Persistence of COVID-19 Reinfections

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COVID-19 has posed numerous challenges since its emergence, and one area of concern has been the phenomenon of frequent reinfections.  In a recent study, based on UK's national COVID-19 Infection Survey, seven participants experienced COVID-19 reinfection five times.  Among these participants, identified as white females aged 21–50 years, three reported having a long-term health condition, and two were healthcare workers. The study also analyzed the variants, symptoms, and cycle threshold (Ct) values associated with these reinfections (see table) The study revealed that while reinfections increased after the emergence of Omicron variants, they were generally less severe than initial infections, associated with lower viral load and fewer reported symptoms compared to first infections. Several factors were identified as influencing the risk of reinfection. Age played a significant role, with individuals aged 30–45 years being at higher risk ( likely due to increased exposure ).  The

Chronic SARS-CoV-2 Shedding

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Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative. This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high viral loads and last for at least 60 da

Navigating the Tripledemic: JN.1, RSV, and Flu Update

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The respiratory viruses are out there.  Wastewater viral activity levels for COVID-19 , as reported by the Centers for Disease Control and Prevention, have reached the highest point since the Omicron surge in 2022. The levels are also high in Canada . The three primary respiratory illnesses continue to circulate at very high levels. But despite the triple threat of  SARS-Cov-2, respiratory syncytial virus ( RSV ) and the flu , there is a notable lack of community attention.   JN.1 (Pirola,  BA.2.86 ,  with additional L455S mutation, descending from a  de-escalated  variant of concern BA.2), initially detected on August 25 2023, has evolved from a variant under monitoring to a  variant of interest. Variants like Acrux (XBB.2.3, that began to spread worldwide soon after WHO declared the end of the pandemic) are  no longer relevant , but a few now less prevalent variants such as  Centaurus  (BA.2.75) and XBB, a hybrid of Centaurus with BA.2 lineage, that  gave rise to  Eris , its descend

G6PD Mutation & Vaccine Complications

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A 72-year-old patient presenting with an inguinal mass and a history of asthma and edema, received two doses of the COVID-19 vaccine in 2021. Approximately two weeks after the second dose, he developed a myriad of symptoms, including dyspnea, palpitations, and edema. Despite local clinic treatments, the symptoms worsened, eventually leading to a diagnosis of retroperitoneal dedifferentiated liposarcoma. The diagnostic journey involved chest CT scans, pleural punctures, and biopsies. The patient's unique case posed challenges, with initial treatments providing only temporary relief. The situation escalated, prompting further examinations and a switch to anlotinib treatment.  Three days after discharge, the patient faced a recurrence of symptoms, leading to a critical discovery — a severe G6PD deficiency. This revelation unfolded through whole exome sequencing, shedding light on a genetic predisposition that played a pivotal role in the patient's adverse reactions.  The authors h

Severe Breakthrough COVID-19 in CAR T-cell treated patient

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A 51-year-old woman, with anemia and rib fractures, diagnosed with IgG-kappa multiple myeloma (MM) in 2012, initially achieved complete remission. However, in 2020, she experienced a clinical relapse followed by a biochemical relapse. In 2021, she received two doses of the mRNA vaccine BNT162b2 against SARS-CoV-2, yielding no serological response. Subsequently, before undergoing CAR T-cell therapy, she received a third vaccine boost in March. Two months later, in July 2022, she contracted a SARS-CoV-2 infection, presenting with a dry cough and low-grade fever. Due to relapsed/refractory multiple myeloma (R/R MM), the patient underwent various treatments, including CAR T-cell therapy. Despite achieving minimal residual disease negativity post-infusion, she developed severe COVID-19 pneumonia, posing challenges to her clinical management.  Her prolonged hospitalization was marked by a complex interplay of factors: pulmonary embolism, immune deficiencies including B-cell aplasia and lymph

Pilomatricoma at COVID-19 Vaccination Sites

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Pilomatrixoma, pilomatricoma, or calcifying epithelioma of Malherbe, is a common benign tumor originating from hair follicles. It has been noted to develop at COVID-19 vaccination sites. Case 1: Pilomatricoma Post-First COVID-19 Vaccination  A 65-year-old man experienced a growing pilomatricoma on his left upper arm, coinciding with the site of his initial COVID-19 vaccine. The tumor, appearing three months after vaccination, was 3 cm in diameter, mobile, and infection-free. Surgical removal confirmed pilomatricoma, identified by basaloid cells and keratinization. No recurrence was noted three months following surgery. Case 2: Subcutaneous Tumor Following COVID-19 Vaccination In this instance, a 43-year-old Japanese woman developed a subcutaneous tumor at her COVID-19 vaccination site. The tumor, emerging immediately post-vaccination, grew over five months. Dermatological examination showed a distinct, multilocular tumor with redness, and ultrasound imaging revealed a hypoechoic mass.

COVID-19: November 2023 insights

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At a Congressional hearing on November 30, CDC Director Dr. Mandy Cohen highlighted a post-Thanksgiving rise in COVID-19 cases, a trend supported by wastewater monitoring.  The innovative  wastewater reporting dashboard , rolled out  in November ,  revamped by the CDC team "Poo's Clues," using SARS-CoV-2 viral RNA concentrations in wastewater, offer insights into the virus's spread, covering over 100 million people across 700+ sites.  A 12% increase in COVID-19 cases was observed from mid- to end of October, with regional variations. The Midwest and West saw significant surges, contrasting with the relative stability in the Northeast and South. By the end of November, West seemingly peaked but then continued upward, Northeast started catching up with Midwest, and numbers kept climbing nationwide  (another 11% increase by the end of November). ( Biobot data show even larger growth  in SARS Cov-2 number, ILInet also reports increasing levels of  influenza-like illness