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Proper assignation of reactivation in a COVID-19 recurrence initially interpreted as a reinfection
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  • laura Pérez-Lago,
  • helena Martínez,
  • Jose Antonio pajares,
  • Arantxa Diaz Gomez,
  • Marina machado,
  • Pedro Sola-Campoy,
  • Marta Herranz,
  • Maricela valerio,
  • Maria Olmedo,
  • Cristina Andres Zayas,
  • Iñaki Comas,
  • fernando Gonzalez Candelas,
  • Rafael Bañares,
  • Pilar Catalán,
  • Patricia Muñoz,
  • Darío García de Viedma
laura Pérez-Lago
Instituto de Investigación Sanitaria Gregorio Marañón
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helena Martínez
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Jose Antonio pajares
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Arantxa Diaz Gomez
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Marina machado
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Pedro Sola-Campoy
Instituto de Investigación Sanitaria Gregorio Marañón
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Marta Herranz
Hospital General Universitario Gregorio Marañón
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Maricela valerio
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Maria Olmedo
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Cristina Andres Zayas
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Iñaki Comas
Instituto de Biomedicina de Valencia (IBV-CSIC)
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fernando Gonzalez Candelas
University of Valencia
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Rafael Bañares
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Pilar Catalán
Hospital General Universitario Gregorio Marañón
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Patricia Muñoz
Hospital General Universitario Gregorio Marañón
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Darío García de Viedma

Corresponding Author:dgviedma2@gmail.com

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Abstract

A 77-year-old male (Case R) who had had a previous diagnosis of mild COVID-19 episode, with fever without developing pneumonia or other complications, was hospitalized 57 days later, due to an acute cholangitis. He had a prolonged hospital stay with severe biliary and infectious complications. On Day 23 post-admission, the patient developed a second COVID-19 episode, now severe, with bilateral pneumonia, multiorgan failure, and finally died. Initially, Case R COVID-19 recurrence was interpreted as a reinfection due to the exposure to a patient with whom he had shared the hospital room, who also had a subsequent positive SARS-CoV-2 RT-PCR. However, whole genome sequencing data indicated that both cases were infected by different strains and clarified that case R recurrence corresponded to a reactivation of the strain involved in his first episode. Case R reactivation had major consequences, not only leading to a much more severe second episode, but causing a subsequent transmission to another two hospitalized patients, one of them with fatal resolution.