Clinical features of atypical 2019 novel coronavirus pneumonia with an initially negative RT-PCR assay

Hao, Wendong; Li, Manxiang

doi:10.1016/j.jinf.2020.02.008

Cited by 29 publications

(24 citation statements)

References 3 publications

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“…Patients with real-time polymerase chain reaction (RT-PCR) revealed positive detection of COVID-19 in throat swabs or lower respiratory tract of patients were admitted to Shanghai Public Health Center for further treatment [7,11]. False-negative COVID-19 cases were reported in recent investigations [12,13]. In our center, RT-PCR was performed the first three times in one case of 13 confirmed patients with COVID-19, revealing a negative detection of COVID-19.…”

Section: Introductionmentioning

confidence: 87%

Characteristic CT findings distinguishing 2019 novel coronavirus disease (COVID-19) from influenza pneumonia

et al. 2020

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Section: Introductionmentioning

confidence: 87%

Characteristic CT findings distinguishing 2019 novel coronavirus disease (COVID-19) from influenza pneumonia

et al. 2020

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“…83 Multiple studies report COVID-19 identified by CT after one or more negative rRT-PCR tests. [84][85][86][87] When the COVID-19 epidemic erupted in China, clinicians lacked access to rRT-PCR kits and then as rRT-PCR became available, low rRT-PCR sensitivity reinforced belief in the additive value of CT for many. 88 These observations and scenarios prompted some to advocate for CT as a first-line supplement to the diagnostic evaluation for COVID-19, combining rRT-PCR with CT. 89,90 If CT alone or in combination with rRT-PCR reduced false-negative rates, the positive public health implications for case identification and control of disease transmission could be substantial.…”

Section: Antigen Testsmentioning

confidence: 99%

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Carpenter

Mudd

West

et al. 2020

Academic Emergency Medicine

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Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.

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“…Hao reported a clinically suspected COVID-19 patient with an abnormal chest CT. The patient was not diagnosed until the fourth RT-PCR test was positive [25]. We suggest that RT-PCR tests should be repeated, especially for patients with a high clinical suspicion of COVID-19.…”

Section: Discussionmentioning

confidence: 94%

How to evaluate the value of chest CT in COVID-19: case reports and literature review

Huang

Yao

et al. 2020

Chin J Acad Radiol

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The coronavirus disease 2019 (COVID-19) that occurred in Wuhan, Hubei Province, China, has been declared a public health emergency of international concern and a pandemic by the World Health Organization. The Chinese government has temporarily taken strong response measures and effective procedures to stop the further expansion and development of the epidemic. It is important for clinicians to screen, diagnose, and monitor COVID-19.

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Clinical features of atypical 2019 novel coronavirus pneumonia with an initially negative RT-PCR assay

Cited by 29 publications

References 3 publications

Characteristic CT findings distinguishing 2019 novel coronavirus disease (COVID-19) from influenza pneumonia

Characteristic CT findings distinguishing 2019 novel coronavirus disease (COVID-19) from influenza pneumonia

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

How to evaluate the value of chest CT in COVID-19: case reports and literature review

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