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. 2022 Aug 17;9(8):ofac419.
doi: 10.1093/ofid/ofac419. eCollection 2022 Aug.

Nucleocapsid Antigenemia in Patients Receiving Anti-CD20 Therapy With Protracted COVID-19

Eli Wilber  1 , Anne Piantadosi  1   2 , Ahmed Babiker  1   2 , Kaleb McLendon  2 , William O'Sick  2 , Eric Fitts  2 , Andrew S Webster  1 , Hans Verkerke  2   3 , James S Kim  4 , Varun K Phadke  1 , Nadine Rouphael  1 , Boghuma K Titanji  1 , William T Blake  1 , Jessica Howard-Anderson  1 , John D Roback  2 , Wilbur A Lam  2   5   6   7 , Gregory L Damhorst  1   5
Affiliations

Nucleocapsid Antigenemia in Patients Receiving Anti-CD20 Therapy With Protracted COVID-19

Eli Wilber et al. Open Forum Infect Dis. .

Abstract

Immunocompromised patients with prolonged coronavirus disease 2019 symptoms present diagnostic and therapeutic challenges. We measured viral nucleocapsid antigenemia in 3 patients treated with anti-CD20 immunotherapy who acquired severe acute respiratory syndrome coronavirus 2 infection and experienced protracted symptoms. Our results support nucleocapsid antigenemia as a marker of persistent infection and therapeutic response.

Keywords: SARS-CoV-2; antigenemia; diagnostics; immunocompromised.

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Conflict of interest statement

Potential conflicts of interest. The authors: no reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
A, Approximate timelines for 3 patients with impaired humoral immunity, clinical evidence of protracted SARS-CoV-2 infection, and nucleocapsid antigenemia during hospitalizations weeks to a month after initial diagnosis. B, Serial blood plasma nucleocapsid measurements during hospitalization for Case 1 and Case 2 show a decline in antigen concentration during antiviral therapy and following treatment with convalescent plasma. Dotted lines represent the approximate duration from first dose to final dose of remdesivir treatment. Available samples for Case 3 demonstrated antigenemia during both the second and third hospitalizations despite receiving 10 days of remdesivir during the second hospitalization. Abbreviations: BAL, bronchoalveolar lavage; CTD-ILD, connective tissue disease–associated interstitial lung disease; NP, Nasopharyngeal; RDV, remdesivir; RT-PCR, reverse transcription polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; VATS, video-assisted thoracoscopic surgery.
See this image and copyright information in PMC

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