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Case Reports
. 2022 Jul 22:9:906469.
doi: 10.3389/fmed.2022.906469. eCollection 2022.

Mild reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant: First case report from Indonesia

Naniek Isnaini  1 , Yan Mardian  2 , Dewi Lokida  1   2 , Fajar Budiono  1 , Deni P Butar-Butar  2 , Dona Arlinda  2   3 , Gustiani Salim  2 , Herman Kosasih  2 , Wahyu Nawang Wulan  2 , Jacqueline Perodin  4 , Aaron Neal  5 , H Clifford Lane  5 , Muhammad Karyana  2   3
Affiliations
Case Reports

Mild reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant: First case report from Indonesia

Naniek Isnaini et al. Front Med (Lausanne). .

Abstract

Background: Reinfection with SARS-CoV-2 has been well documented, yet little is known about the degree of protection a previous infection provides against reinfection, especially against Variants of Concern (VOC).

Case presentation: Here we describe a case of an unvaccinated 49-year-old man who experienced two sequential SARS-CoV-2 infections with two different variants, as evidenced by genomic sequencing. The first episode was caused by the Pango lineage B.1.466.2 and resulted in severe COVID-19 with 5 days in an intensive care unit (ICU). The second episode occurred approximately 6 months later, during the Delta surge in Indonesia. Genomic analysis showed that the second infection was caused by the Delta variant (Pango lineage B.1.617.2) and resulted in mild disease that did not require hospitalization. No SARS-CoV-2 nucleic acid was detected between the two episodes, but both binding and neutralizing antibodies to SARS-CoV-2 were detected prior to the reinfection, with the second infection leading to an increase in the levels of antibody.

Conclusion: We confirmed that the patient experienced a reinfection instead of persistent viral shedding from the first infection based on epidemiological, clinical, serological, and genomic analyses. Our case supports the hypothesis that SARS-CoV-2 reinfection may occur once antibody titers decrease or following the emergence of a new variant. The milder presentation in the patient's second infection deserves further investigation to provide a clear picture of the role of post-infection immunity in altering the course of subsequent disease.

Keywords: COVID-19; Delta variant; Indonesia; case report; reinfection.

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Conflict of interest statement

JP was employed by Leidos Biomedical Research, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Timeline of reinfection case. Image was created with BioRender.com.
FIGURE 2
FIGURE 2
(A) Serial serology of SARS-CoV-2 IgG (blue) and neutralizing antibody (green). Image was created with GraphPad Prism 9.3.1 and BioRender.com, (B) phylogenetic analysis of SARS-CoV-2 genomes showing the relationship between the two distinct variants of two infection episodes. The tree was constructed by maximum likelihood method. Clade information as inferred by GISAID, Nextstrain, and Pangolin nomenclatures, are shown. The reference genome Wuhan-Hu-1 (GenBank accession number NC_045512.2) is used as the root of the tree.
See this image and copyright information in PMC

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