Case report of a neonate with high viral SARSCoV-2 loads and long-term virus shedding

Monique A L J Slaats; Maud Versteylen; Karin B Gast; Bas B Oude Munnink; Suzan D Pas; Robbert G Bentvelsen; Ron van Beek

doi:10.1016/j.jiph.2020.10.013

Case report of a neonate with high viral SARSCoV-2 loads and long-term virus shedding

J Infect Public Health. 2020 Dec;13(12):1878-1884. doi: 10.1016/j.jiph.2020.10.013. Epub 2020 Oct 27.

Authors

Monique A L J Slaats¹, Maud Versteylen², Karin B Gast³, Bas B Oude Munnink⁴, Suzan D Pas³, Robbert G Bentvelsen³, Ron van Beek²

Affiliations

¹ Department of Pediatrics, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands. Electronic address: moniqueslaats@gmail.com.
² Department of Pediatrics, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
³ Microvida, Location Amphia, Molengracht 21, 4818 CK, Breda, The Netherlands.
⁴ Department of Viroscience, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Erasmus University Medical Center, Molewaterplein 50, 3015 CE, Rotterdam, The Netherlands.

Abstract

Background: SARS-CoV-2 has spread globally. Currently, literature of SARS-CoV-2 in neonates is scarce. We present a case of a neonate with a high viral load and prolonged virus shedding.

Methods: Epidemiology, clinical characteristics, treatment, laboratory data and follow-up information and the treatment of a neonate with COVID-19 were recorded.

Results: A 7-day-old boy was admitted to the hospital with fever, lethargy and apnoea. He was found SARS-CoV-2 RNA positive with an exceptionally high viral load in nasopharyngeal swab and stool. The father and two maternity nurses at home had detectable SARS-CoV-2 RNA as well. Sequencing showed all strains belonged to the same cluster. The father was asymptomatic and the maternity nurses developed symptoms after visiting. In the mother, no SARS-CoV-2 RNA could be found. Six days after admission, the neonate was discharged after clinical improvement with oral antibiotics because of a possible pyelonephritis. Monitoring the course of this infection showed that SARS-CoV-2 RNA was detectable in the nasopharynx until day 19 and in stool until day 42 after symptom onset.

Conclusions: This case shows that neonates can have a high viral load of SARS-CoV-2 and can shed the virus for over one month in stool. Despite the high viral load in the neonate, the mother and a sibling did not get infected.

Keywords: COVID19; Neonates; Novel coronavirus; SARS-CoV-2.

Publication types

Case Reports
Review

MeSH terms

COVID-19 / complications
COVID-19 / diagnosis*
COVID-19 / virology
Diagnosis, Differential
Fever / etiology
Humans
Infant, Newborn
Male
SARS-CoV-2*
Viral Load
Virus Shedding