A case of imported COVID-19 diagnosed by PCR-positive lower respiratory specimen but with PCR-negative throat swabs

Hase, Ryota; Kurita, Takashi; Muranaka, Emiri; Sasazawa, Hiroki; Mito, Haruki; Yano, Yudai

doi:10.1080/23744235.2020.1744711

Cited by 58 publications

(56 citation statements)

References 5 publications

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“…Until now, only some case reports have described the clinical characteristics of patients with persistent negative PCR results from pharyngeal swabs. All of these cases had fever, and patients with nausea also had diarrhea, which was consistent with our ndings that fever was common and nausea was highly correlated with diarrhea [14,[24][25]. In addition, our study also found that patients with both symptoms of dyspnea and chest pain were more common in serology-con rmed cases, possibly due to hypercoagulation status, cardiac injury and involvement of the pleura, as these patients had higher levels of D-dimer and troponin as well as a higher proportion of pleural lesions.…”

Section: Discussionsupporting

confidence: 91%

“…However, false negative results were always the most concerning issue, leading to a rapid growth of invention and evaluation of other diagnostic tools such as computed tomography and serum antibody assay [15,18]. In addition, repeated PCR tests of pharyngeal swabs and further specimen collection from the lower respiratory tract were also useful ways to minimize the false negative rate [7,24]. Nevertheless, in our clinical practice and previous case reports [14,[24][25], some symptomatic patients with CT abnormalities were continuously PCR negative for pharyngeal swabs, even with more than three tests, which was enough to detect the majority of PCR-diagnosed patients [26].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, repeated PCR tests of pharyngeal swabs and further specimen collection from the lower respiratory tract were also useful ways to minimize the false negative rate [7,24]. Nevertheless, in our clinical practice and previous case reports [14,[24][25], some symptomatic patients with CT abnormalities were continuously PCR negative for pharyngeal swabs, even with more than three tests, which was enough to detect the majority of PCR-diagnosed patients [26]. Therefore, in our study, characteristics of these patients were described, and we found that serology-con rmed patients with continuously negative PCR results were older, more severe, tending to have both symptoms of dyspnea and chest pain, and likely to have pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

More severe hypercoagulation status, cytokine storm, and disease progression in coronavirus disease 2019 with persistent RT-PCR negative results: a multicenter prospective study

Shi

Zhou

et al. 2020

Preprint

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Purpose: Persistent negative results (at least 3 times) of reverse transcription–polymerase chain reaction (RT-PCR) from pharyngeal swabs are not rare in coronavirus disease 2019 (COVID-19) patients, but their characteristics have not yet been well studied.Methods: PCR confirmed, serum antibody confirmed with persistent negative PCR results, and clinically diagnosed patients hospitalized in two medical centers during February and March 2020 were included. Differences in clinical, imaging and laboratory characteristics as well as factors affecting their prognosis were analyzed.Results: There were 114 PCR confirmed, 17 serology confirmed and 21 clinically diagnosed patients included. Time from onset of disease to the first PCR and admission were similar among the groups. Compared with PCR-confirmed patients, serology-confirmed patients were older and likely to have hypertension, vomiting, or symptoms of chest pain and dyspnea. Regarding imaging manifestations, serology-confirmed patients were more prone to pleural effusion. In addition, higher levels of C-reactive protein, neutrophil-to-lymphocyte ratio, total bilirubin, D-dimer, fibrinogen, troponin, interleukin-6 and IL-8 were also found. Although with similar mortality, serology confirmed patients were more likely to have disease progression. High levels of D-dimer and IL-6 were possibly the underlying factors leading to their worse prognosis. On the other hand, clinically diagnosed patients were more similar to PCR-confirmed patients.Conclusion: Serology confirmed COVID-19 patients with at least three negative PCR results had different clinical characteristics and were likely to have disease progression, possibly due to more severe hypercoagulation status and cytokine storm.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

More severe hypercoagulation status, cytokine storm, and disease progression in coronavirus disease 2019 with persistent RT-PCR negative results: a multicenter prospective study

Shi

Zhou

et al. 2020

Preprint

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“…However, the diagnostic sensitivity of qRT-PCR assay is influenced significantly by the timing of specimen collection during the disease course, site of specimen collection, and skill required during specimen collection [ 6 , 7 ]. It is therefore plausible that a significant proportion of patients with COVID-19 failed to be diagnosed using qRT-PCR [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Multicenter evaluation of two chemiluminescence and three lateral flow immunoassays for the diagnosis of COVID-19 and assessment of antibody dynamic responses to SARS-CoV-2 in Taiwan

Chen

Lee

Lin

et al. 2020

Emerging Microbes & Infections

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This multicenter, retrospective study included 346 serum samples from 74 patients with coronavirus disease 2019 (COVID-19) and 194 serum samples from non-COVID-19 patients to evaluate the performance of five anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests, i.e. two chemiluminescence immunoassays (CLIAs): Roche Elecsys® Anti-SARS-CoV-2 Test (Roche Test) and Abbott SARS-CoV-2 IgG (Abbott Test), and three lateral flow immunoassays (LFIAs): Wondfo SARS-CoV-2 Antibody Test (Wondfo Test), ASK COVID-19 IgG/IgM Rapid Test (ASK Test), and Dynamiker 2019-nCoV IgG/IgM Rapid Test (Dynamiker Test). We found high diagnostic sensitivities (%, 95% confidence interval [CI]) for the Roche Test (97.4%, 93.4–99.0%), Abbott Test (94.0%, 89.1–96.8%), Wondfo Test (91.4%, 85.8–94.9%), ASK Test (97.4%, 93.4–99.0%), and Dynamiker Test (90.1%, 84.3–94.0%) after >21 days of symptom onset. Meanwhile, the diagnostic specificity was 99.0% (95% CI, 96.3–99.7%) for the Roche Test, 97.9% (95% CI, 94.8–99.2%) for the Abbott Test, and 100.0% (95% CI, 98.1–100.0%) for the three LFIAs. Cross-reactivity was observed in sera containing anti-cytomegalovirus (CMV) IgG/IgM antibodies and autoantibodies. No difference was observed in the time to seroconversion detection of the five serological tests. Specimens from patients with COVID-19 pneumonia demonstrated a shorter seroconversion time and higher chemiluminescent signal than those without pneumonia. Our data suggested that understanding the dynamic antibody response after COVID-19 infection and performance characteristics of different serological test are crucial for the appropriate interpretation of serological test result for the diagnosis and risk assessment of patient with COVID-19 infection.

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“…Hase. et al study reported that a COVID-19 case diagnosed by PCR-positive lower respiratory specimen, but with PCR-negative throat swabs [7]. Although the knowledge of viral loads in COVID-19 is limited, the high viral loads of lower respiratory tract specimens had been reported in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [8,9].…”

Section: Discussionmentioning

confidence: 99%

The unsynchronized changes of CT image and nucleic acid detection in COVID-19: reports the two cases from Gansu, China

Gao

Liu²,

Wen

et al. 2020

Respir Res

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The novel coronavirus disease outbreak started in December 2019 in Wuhan, China, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The CT image is used to assess the disease progress, whereas the continued two times of negative results from SARS-CoV-2 nucleic acid detection had been considered as a criterion for ending antiviral treatment. We compared the two COVID-19 cases with similar backgrounds and CT image repeated intervals under treatment. Our report highlighted the unsynchronized expression in the changes of CT image and nucleic acid detection in COVID-19, and lasting positive nucleic acid test result in patients recovered from pneumonia. It may be contributed to recognize the disease and improve prevention.

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A case of imported COVID-19 diagnosed by PCR-positive lower respiratory specimen but with PCR-negative throat swabs

Cited by 58 publications

References 5 publications

More severe hypercoagulation status, cytokine storm, and disease progression in coronavirus disease 2019 with persistent RT-PCR negative results: a multicenter prospective study

More severe hypercoagulation status, cytokine storm, and disease progression in coronavirus disease 2019 with persistent RT-PCR negative results: a multicenter prospective study

Multicenter evaluation of two chemiluminescence and three lateral flow immunoassays for the diagnosis of COVID-19 and assessment of antibody dynamic responses to SARS-CoV-2 in Taiwan

The unsynchronized changes of CT image and nucleic acid detection in COVID-19: reports the two cases from Gansu, China

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