Comparison of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 detection in 353 patients received tests with both specimens simultaneously

Xiong, Weihao; Tan, Li; Wang, Xu; Liu, Weiyong; Lu, Yanjun; Cheng, Liming; Sun, Ziyong

doi:10.1016/j.ijid.2020.04.023

Cited by 244 publications

(251 citation statements)

References 14 publications

(12 reference statements)

Supporting

Mentioning

229

Contrasting

Unclassified

Order By: Relevance

“…Methodologically, few rRT-PCR accuracy studies describe how research or clinical staff were trained to collect NP specimens, so fidelity and reproducibility remain in question. 55 Wang et al 56 provide videos describing NP and OP collection methods and note poor agreement between the two sampling methods (kappa = 0.31) and a higher yield with NP. Saliva can be collected outside the hospital without training, perhaps as part of a telemedicine evaluation for COVID-19.…”

Section: Clinical Examinationmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Clinical Examinationmentioning

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

View full text Add to dashboard Cite

show abstract

“…On chest X-ray or chest computed tomography, bilateral lung involvement was common [32,37]. Diagnosis of SARS-CoV-2 is currently performed with reverse transcription polymerase chain reaction (PCR-RT) testing for nucleic acid sequence homology in nasopharyngeal or throat swabs [38].…”

Section: Covid Pandemicmentioning

confidence: 99%

Olfactory Dysfunction in the COVID-19 Outbreak

Izquierdo-Domínguez¹,

Rojas-Lechuga²,

Mullol³

et al. 2020

J Investig Allergol Clin Immunol

View full text Add to dashboard Cite

The first cases of coronavirus 2019 (COVID-19) occurred in Wuhan, China, and rapidly become a public health emergency of international proportions. The disease may cause mild-to-severe acute respiratory syndrome (SARS) and is caused by a SARS-CoV-2 coronavirus infection. The clinical manifestations of COVID-19 include fever, dry cough, fatigue, sputum production, shortness of breath, sore throat, and headache. This article is a narrative review with the aim of analyzing the current literature on postviral olfactory dysfunction (OD) related to SARS-CoV-2 pandemics. Since the initial anecdotal reports from China, international reports on COVID-19 patients have been increasing, describing a 5% to 85% range of loss of smell. To date, the literature is widely heterogeneous regarding the loss of smell; therefore, we advise home isolation measures and/or social distancing, and to carry out diagnostic tests for SARS-CoV-2 when possible in those patients with sudden and severe loss of smell who cannot be promptly evaluated.neurons nor the olfactory bulb neurons express specific genes that are instead expressed in support cells, stem cells, and perivascular cells. These findings suggest that infection of non-neuronal cell types leads to anosmia and related disturbances in odour perception in patients [7,8]

show abstract

“…Globally, shortage of molecular laboratories for the diagnosis of SARS CoV-2, lack of trained human capital, lack of NA extraction, ampli cation and detection kits, and lack of accessory and supplementary consumables despite an increasing number of testing demands has become an issue of concern (8,9) and nationally in a relatively short period of time. To minimize work load, resources and costs, a pooling approach of NA extractions or ampli cation and detection might be considered.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Sample Pooling for Screening of SARS-CoV-2

Mulu

Alemayehu

Alemu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The coronavirus disease (COVID-19) pandemic has revealed the global public health importance of robust diagnostic testing. To overcome the challenge of nucleic acid (NA) extraction and testing kit availability efficient method is urgently needed.Objectives: To establish an efficient, time and resource-saving and cost-effective methods, and to propose an ad hoc pooling approach for mass screening of SARS-CoV-2 Methods: Direct clinical sample and NA pooling approach was used for the standard reverse transcriptase polymerase chain reaction (RT-PCR) test of the SARS CoV-2 targeting the envelop (E) and open reading frame (ORF1ab) genomic region of the virus. In this approach, experimental pools were created using SARS CoV-2 positive clinical samples spiked with up to 9 negative samples prior to NA extraction step to have a final extraction volume of 200μL (maximum dilution factor of 10). Viral NA was also subsequently extracted from each pool and tested using the SARS CoV-2 RT-PCR assay.Results: We found that a single positive sample can be amplified and detected in pools of up to 7 samples depending on the ct value of the original sample, corresponding to high, medium, and low SARS CoV-2 viral copies/reaction. However, to minimize false negativity of the assay with pooling strategies and with unknown false negativity rate of the assay under validation, we recommend poling of 4 in 1 using the standard protocols of the assay, reagents and equipment. The predictive algorithm indicated a pooling ratio of 4 in 1 was expected to retain accuracy of the test irrespective of the ct value (relative ribonucleic acid RNA copy number) of the sample spiked and result in a 237% increase in testing efficiency. Conclusions: The approaches showed its concept in easily customized and resource-saving manner and would allow expanding of current screening capacities and enable the expansion of detection in the community.

show abstract

Comparison of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 detection in 353 patients received tests with both specimens simultaneously

Cited by 244 publications

References 14 publications

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

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

Olfactory Dysfunction in the COVID-19 Outbreak

Evaluation of Sample Pooling for Screening of SARS-CoV-2

Contact Info

Product

Resources

About