Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2026
Circulating SARS-CoV-2 RNA detection in acute COVID-19 disease and Post-COVID Condition.
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Rovito Roberta, Terracciano Laura, De Pinto Giuseppe, Acampora Claudia, Limonta Marta, Santoro Andrea, Sala Valentina, Augello Matteo, Tincati Camilla, Bravi Francesca, Marchetti Giulia Carla, Eucare study group
Аннотация
OBJECTIVES: To determine the clinical significance of circulating plasma SARS-CoV-2 RNA across acute COVID-19 and post-COVID condition (PCC) by investigating prevalence, determinants, and kinetics in a large longitudinal cohort, accounting for hospitalization and vaccination.
METHODS: We consecutively enrolled individuals with confirmed SARS-CoV-2 infection. Acute COVID-19 was classified as mild, severe, or critical per WHO criteria. PCC was assessed three months post-symptom onset, plasma SARS-CoV-2 RNA (RNAemia) was quantified during acute infection (T0) and at follow-up (T1) by RT-qPCR. Associations between RNAemia and acute disease severity or PCC were evaluated using multivariable logistic regression. RNAemia was analyzed as tertiles, binary detectability, and continuous levels.
RESULTS: 442 COVID-19 individuals were included, of whom 195 (44.1%) had mild disease, 161 (36.4%) severe, and 86 (19.5%) critical. At a median of 3.2 (IQR 2.7-3.9) months from symptoms onset, 184/442 subjects were followed up, and 144/184 (78.3%) reported at least one persistent symptom compatible with PCC, most commonly asthenia (22.9%), myalgic pain (26.4%), brain fog (19.4%), dyspnea (31.3%), and cough (42.4%). RNAemia was detected in 67.4% of participants at baseline and in 53.6% at follow-up. RNAemia in the II-III tertiles or any detectable RNAemia were associated with critical COVID-19. Neither baseline nor follow-up RNAemia, were associated with PCC, and results were unchanged in a sensitivity analysis excluding vaccinated individuals. RNAemia trajectories were not associated with PCC, PCC clusters, or upper respiratory tract viral clearance..
CONCLUSIONS: SARS-CoV-2 RNAemia was closely linked to acute COVID-19 severity but showed no association with PCC or PCC phenotype which were assessed at 3 months from symptoms onset in a cohort predominantly experiencing severe COVID-19 and hospitalization during acute infection. This dissociation may suggest that viral RNA in the peripheral blood is primarily involved in acute pathogenesis, whereas PCC likely arises from distinct biological mechanisms.
METHODS: We consecutively enrolled individuals with confirmed SARS-CoV-2 infection. Acute COVID-19 was classified as mild, severe, or critical per WHO criteria. PCC was assessed three months post-symptom onset, plasma SARS-CoV-2 RNA (RNAemia) was quantified during acute infection (T0) and at follow-up (T1) by RT-qPCR. Associations between RNAemia and acute disease severity or PCC were evaluated using multivariable logistic regression. RNAemia was analyzed as tertiles, binary detectability, and continuous levels.
RESULTS: 442 COVID-19 individuals were included, of whom 195 (44.1%) had mild disease, 161 (36.4%) severe, and 86 (19.5%) critical. At a median of 3.2 (IQR 2.7-3.9) months from symptoms onset, 184/442 subjects were followed up, and 144/184 (78.3%) reported at least one persistent symptom compatible with PCC, most commonly asthenia (22.9%), myalgic pain (26.4%), brain fog (19.4%), dyspnea (31.3%), and cough (42.4%). RNAemia was detected in 67.4% of participants at baseline and in 53.6% at follow-up. RNAemia in the II-III tertiles or any detectable RNAemia were associated with critical COVID-19. Neither baseline nor follow-up RNAemia, were associated with PCC, and results were unchanged in a sensitivity analysis excluding vaccinated individuals. RNAemia trajectories were not associated with PCC, PCC clusters, or upper respiratory tract viral clearance..
CONCLUSIONS: SARS-CoV-2 RNAemia was closely linked to acute COVID-19 severity but showed no association with PCC or PCC phenotype which were assessed at 3 months from symptoms onset in a cohort predominantly experiencing severe COVID-19 and hospitalization during acute infection. This dissociation may suggest that viral RNA in the peripheral blood is primarily involved in acute pathogenesis, whereas PCC likely arises from distinct biological mechanisms.