Nucleocapsid Antigenemia Is a Marker of Acute SARS-CoV-2 Infection

Hans P Verkerke; Gregory L Damhorst; Daniel S Graciaa; Kaleb McLendon; William O'Sick; Chad Robichaux; Narayanaiah Cheedarla; Sindhu Potlapalli; Shang-Chuen Wu; Kristin R V Harrington; Andrew Webster; Colleen Kraft; Christina A Rostad; Jesse J Waggoner; Neel R Gandhi; Jeannette Guarner; Sara C Auld; Andrew Neish; John D Roback; Wilbur A Lam; N Sarita Shah; Sean R Stowell

doi:10.1093/infdis/jiac225

Nucleocapsid Antigenemia Is a Marker of Acute SARS-CoV-2 Infection

J Infect Dis. 2022 Nov 1;226(9):1577-1587. doi: 10.1093/infdis/jiac225.

Authors

Hans P Verkerke^{1

2}, Gregory L Damhorst^{3

4}, Daniel S Graciaa³, Kaleb McLendon¹, William O'Sick¹, Chad Robichaux⁵, Narayanaiah Cheedarla¹, Sindhu Potlapalli¹, Shang-Chuen Wu², Kristin R V Harrington⁶, Andrew Webster³, Colleen Kraft³, Christina A Rostad⁷, Jesse J Waggoner^{3

4

5

7}, Neel R Gandhi^{3

6}, Jeannette Guarner¹, Sara C Auld^{6

8}, Andrew Neish¹, John D Roback¹, Wilbur A Lam^{4

7

9

10}, N Sarita Shah^{3

6}, Sean R Stowell²

Affiliations

¹ Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
² Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
⁴ The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA.
⁵ Emory Healthcare, Atlanta, Georgia, USA.
⁶ Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
⁷ Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁸ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
⁹ Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
¹⁰ Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.

Abstract

Detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is essential for diagnosis, treatment, and infection control. Polymerase chain reaction (PCR) fails to distinguish acute from resolved infections, as RNA is frequently detected after infectiousness. We hypothesized that nucleocapsid in blood marks acute infection with the potential to enhance isolation and treatment strategies. In a retrospective serosurvey of inpatient and outpatient encounters, we categorized samples along an infection timeline using timing of SARS-CoV-2 testing and symptomatology. Among 1860 specimens from 1607 patients, the highest levels and frequency of antigenemia were observed in samples from acute SARS-CoV-2 infection. Antigenemia was higher in seronegative individuals and in those with severe disease. In our analysis, antigenemia exhibited 85.8% sensitivity and 98.6% specificity as a biomarker for acute coronavirus disease 2019 (COVID-19). Thus, antigenemia sensitively and specifically marks acute SARS-CoV-2 infection. Further study is warranted to determine whether antigenemia may aid individualized assessment of active COVID-19.

Keywords: COVID-19; SARS-CoV-2; antigenemia; nucleocapsid.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Biomarkers
COVID-19 Testing
COVID-19*
Humans
Nucleocapsid
Retrospective Studies
SARS-CoV-2
Sensitivity and Specificity

Substances

Biomarkers

Abstract

Publication types

MeSH terms

Substances

Grants and funding