Post-acute COVID-19 associated with evidence of bystander T-cell activation and a recurring antibiotic-resistant bacterial pneumonia

• DOI: 10.7554/elife.63430
• Publication Date: 2020-12-17T13:47:45Z
• Authors: Michaela Gregorova; Daniel Morse; Tarcisio Brignoli; Joseph Steventon; Fergus Hamilton; Mahableshwar Albur; David Arnold; Matthew Thomas; Alice Halliday; Holly Baum; Christopher Rice; Matthew B Avison; Andrew D Davidson; Marianna Santopaolo; Elizabeth Oliver; Anu Goenka; Adam Finn; Linda Wooldridge; Borko Amulic; Rosemary J Boyton; Daniel M Altmann; David K Butler; Claire McMurray; Joanna Stockton; Sam Nicholls; Charles Cooper; Nicholas Loman; Michael J Cox; Laura Rivino; Ruth C Massey
• Keywords: Male; 0301 basic medicine; QH301-705.5; Science; T-Lymphocytes; 610; Lymphocyte Activation; 03 medical and health sciences; Recurrence; Drug Resistance, Multiple, Bacterial; 616; t-cells activation; Humans; Pseudomonas Infections; Biology (General); Lung; metagenomics; Microbiology and Infectious Disease; SARS-CoV-2; Q; R; COVID-19; Pneumonia, Ventilator-Associated; Meropenem; Middle Aged; Respiration, Artificial; Anti-Bacterial Agents; 3. Good health; /dk/atira/pure/core/keywords/uob_covid19; Piperacillin, Tazobactam Drug Combination; name=Covid19; Pseudomonas aeruginosa; Medicine; Metagenomics

Here, we describe the case of a COVID-19 patient who developed recurring ventilator-associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed the AMR genotype, while immunological analysis revealed massive and escalating levels of T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander activated, which may have contributed to this patient’s persistent symptoms and radiological changes.