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Test-based de-isolation in COVID-19 immunocompromised patients: Cycle threshold value versus SARS-CoV-2 viral culture
Journal article   Open access   Peer reviewed

Test-based de-isolation in COVID-19 immunocompromised patients: Cycle threshold value versus SARS-CoV-2 viral culture

Abeer N Alshukairi, Ahmed M Tolah, Ashraf Dada, Jaffar A Al-Tawfiq, Reem S Almagharbi, Mohammed F Saeedi, Mohammed A Al-Hamzi, Sherif A El-Kafrawy, Husam A Bahaudden, Aiman El-Saed, …
International journal of infectious diseases, Vol.108, pp.112-115
07/2021
DOI: 10.1016/j.ijid.2021.05.027
PMCID: PMC8123529
PMID: 34004329
url
https://doi.org/10.1016/j.ijid.2021.05.027View
Published (Version of record) Open Access

Abstract

•The de-isolation of immunocompromised COVID-19 patients is challenging.•A test-based rather than symptom-based approach is suggested.•The mean Ct value for negative viral cultures was 20.5 in this case series.•A test-based approach could lead to prolonged quarantine of non-infectious patients.•The de-isolation of immunocompromised patients needs disease-specific studies. Immunocompromised patients with coronavirus disease 2019 (COVID-19) have prolonged infectious viral shedding for more than 20 days. A test-based approach is suggested for de-isolation of these patients. The strategy was evaluated by comparing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (cycle threshold (Ct) values) and viral culture at the time of hospital discharge in a series of 13 COVID-19 patients: six immunocompetent and seven immunocompromised (five solid organ transplant patients, one lymphoma patient, and one hepatocellular carcinoma patient). Three of the 13 (23%) patients had positive viral cultures: one patient with lymphoma (on day 16) and two immunocompetent patients (on day 7 and day 11). Eighty percent of the patients had negative viral cultures and had a mean Ct value of 20.5. None of the solid organ transplant recipients had positive viral cultures. The mean Ct value for negative viral cultures was 20.5 in this case series of immunocompromised patients. Unlike those with hematological malignancies, none of the solid organ transplant patients had positive viral cultures. Adopting the test-based approach for all immunocompromised patients may lead to prolonged quarantine. Large-scale studies in disease-specific populations are needed to determine whether a test-based approach versus a symptom-based approach or a combination is applicable for the de-isolation of various immunocompromised patients.
 Isolation Viral culture SARS-CoV-2 Immunocompromised patients

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