Complications of Nasal SARS-CoV-2 Testing: A Review

Clark, James H.; Pang, Sharon; Naclerio, Robert M.; Kashima, Matthew L.

doi:10.1136/jim-2021-001962

Cited by 17 publications

(43 citation statements)

References 22 publications

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“…The nasopharyngeal swab and rapid antigen detection test or reverse transcription-polymerase chain reaction (RT-PCR) have been performed more than average of 600,000 and 3,000,000 times daily in South Korea 1 and USA, 2 respectively to detect both symptomatic and asymptomatic patients with coronavirus disease 2019 (COVID-19). 3 4 5 6 The initial form of swab, Q-tip, was invented by a Polish-American Leo Gerstenzang to clean his child’s ears in 1923. 7 8 The swab gained popularity in the 1950s and is still widely being used in various modified forms from cleaning one’s ear in daily lives to COVID-19 testing in quarantine facilities.…”

Section: Introductionmentioning

confidence: 99%

“…The trans-nasal approach to obtain the respiratory tract secretions in the nasopharynx has been regarded as the gold standard for optimal specimen collection of COVID-19 testing with RT-PCR. 3 9 The examination can also be performed on the anterior nares, middle turbinate, and nasopharynx, but the sensitivity resulting from the specimen collected on the anterior nares and middle turbinates was significantly inferior compared with the results of the nasopharynx. 3 10 The sensitivity of the rapid antigen detection test using a nasopharyngeal swab was higher than that of the anterior nasal swab often used in the self-performing screening test.…”

Section: Introductionmentioning

confidence: 99%

“… 3 9 The examination can also be performed on the anterior nares, middle turbinate, and nasopharynx, but the sensitivity resulting from the specimen collected on the anterior nares and middle turbinates was significantly inferior compared with the results of the nasopharynx. 3 10 The sensitivity of the rapid antigen detection test using a nasopharyngeal swab was higher than that of the anterior nasal swab often used in the self-performing screening test. 6 Therefore, the robust trend to proceed with extensive nasopharyngeal COVID-19 testing is expected to continue considering the diagnostic accuracy and general perception that it is a safe and well-tolerated procedure.…”

Section: Introductionmentioning

confidence: 99%

“… 6 Therefore, the robust trend to proceed with extensive nasopharyngeal COVID-19 testing is expected to continue considering the diagnostic accuracy and general perception that it is a safe and well-tolerated procedure. 3 11 12 …”

Section: Introductionmentioning

confidence: 99%

“…However, numerous complications, from minor to even fatal ones, have been repetitively reported in the media 13 14 and literatures 3 11 12 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 although complications required further medical evaluation were rarely happened ranging from 0.0012% 24 to 0.026%. 20 In addition, excessive quarantine burden and stressful condition of the COVID-19 pandemic 37 38 occasionally causes uncomfortable testing by the examiner who may not fully understand the nasopharyngeal anatomy or clinically cautious events related to nasopharyngeal swabs.…”

Section: Introductionmentioning

confidence: 99%

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Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

Kim

Moon

et al. 2022

J Korean Med Sci

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Nasopharyngeal swabs have been widely to prevent the spread of coronavirus disease 2019 (COVID-19). Nasopharyngeal COVID-19 testing is a generally safe and well-tolerated procedure, but numerous complications have been reported in the media. Therefore, the present study aimed to review and document adverse events and suggest procedural references to minimize preventable but often underestimated risks. A total of 27 articles were selected for the review of 842 related documents in PubMed, Embase, and KoreaMed. The complications related to nasopharyngeal COVID-19 testing were reported to be rarely happened, ranging from 0.0012 to 0.026%. Frequently documented adverse events were retained swabs, epistaxis, and cerebrospinal fluid leakage, often associated with high-risk factors, including severe septal deviations, pre-existing skull base defects, and previous sinus or transsphenoidal pituitary surgery. Appropriate techniques based on sufficient anatomical knowledge are mandatory for clinicians to perform nasopharyngeal COVID-19 testing. The nasal floor can be predicted by the line between the nostril and external ear canal. For safe testing, the angle of swab insertion in the nasal passage should remain within 30° of the nasal floor. The swab was gently inserted along the nasal septum just above the nasal floor to the nasopharynx and remained on the nasopharynx for several seconds before removal. Forceful insertion should be attempted, and alternative examinations should be considered, especially in vulnerable patients. In conclusion, patients and clinicians should be aware of rare but possible complications and associated high-risk factors. The suggested procedural pearls enable more comfortable and safe nasopharyngeal COVID-19 testing for both clinicians and patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

Kim

Moon

et al. 2022

J Korean Med Sci

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Orbital cellulitis complicated with subperiosteal abscess following post‐nasopharyngeal swab for COVID‐19: A case report

Abdul-Kadir

Rosli

2023

Clinical Case Reports

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Key Clinical Message The nasopharyngeal swab for COVID‐19 is associated with low risks of severe complications, but it is important to consider the patient's medical history and anatomy of the nasal cavity to ensure safety and accuracy of the test. Orbital complications can occur up to 85% secondary to acute sinusitis, and prompt treatments are crucial, particularly in the pediatric group. A conservative approach is effective for subperiosteal abscess if certain criteria are met, and it is not an absolute indication for immediate surgical intervention. However, timely management of orbital cellulitis is essential for better outcomes. Abstract Pre‐septal and orbital cellulitis are more commonly seen in children than in adults. The incidence of pediatric orbital cellulitis is 1.6 in 100,000. The impact of COVID‐19 has led to the increasing practice of nasopharyngeal swab surveillance. We presented a case of rare pediatric orbital cellulitis complicated with subperiosteal abscess secondary to severe acute sinusitis following a nasopharyngeal swab. A 4‐year‐old boy was brought in by his mother with increasing painful left eye swelling and redness. Three days prior, the patient developed a fever and mild rhinitis with loss of appetite which raised concerns about COVID‐19. He had a nasopharyngeal swab on that same day and tested negative. Clinically, there was marked erythematous and tender periorbital and facial oedema involving the left nasal bridge, maxilla extended to the left upper lip with a deviation of the left nasal tip contralaterally. Computed tomography confirmed left orbital cellulitis with left eye proptosis, fullness of left maxillary and ethmoidal sinuses and left subperiosteal abscess. The patient received empirical antibiotics and surgical intervention promptly and recovered well with improvements in ocular symptoms. The nasal swabbing techniques may vary among practitioners, and it is associated with extremely low risks of severe complications from 0.001% to 0.16%. Whether the swab had aggravated the underlying rhinitis or traumatized the turbinates leading to sinus drainage obstruction; a nasal swab may impose the risk of severe orbital infection in a susceptible pediatric patient. Any health practitioner conducting the nasal swab should be vigilant about this potential complication.

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Evaluation of a new “all in one” SARS‐CoV‐2 antigen‐detecting rapid diagnostic test and self‐test: Diagnostic performance and usability in child and adult populations

Prazuck

Gravier

Pires‐Roteira

et al. 2022

Journal of Medical Virology

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The control of the COVID‐19 epidemics has been one global health priorities for the last two years. To that end, more reliable and easy‐to‐use, regardless of age, diagnostic tests are necessary. Considering that, we evaluated an innovative two‐step self‐test, the AAZ COVID‐VIRO ALL IN®, switching from the classic nasal swab to a nasal sponge. We performed a multicentre study, on 124 adults and children, in a point‐of‐care setting. Sensitivity, specificity and overall acceptance of the COVID‐VIRO ALL IN® self‐test compared to RT‐PCR on nasopharyngeal samples were of 93.0%, 100% and 97.5%, respectively. We then performed a multicentre, usability study to evaluate the ease of use of COVID‐VIRO ALL IN® on 68 laypersons adults. A vast majority of participants correctly executed and interpreted the test. The usability was then specifically investigated on 40 children and teenagers, comparing COVID‐VIRO® first generation to the new COVID‐VIRO ALL IN®. They all found COVID‐VIRO ALL IN® more comfortable and easier to use. For young children, the new self‐test seems safer (less risk of trauma, no liquid exposure), and faster than saliva‐based RT‐PCR. Moreover, the COVID‐VIRO ALL IN® can easily be adapted as a multiplex self‐test for other respiratory viruses, opening new perspectives of simultaneous, rapid and massive detection of respiratory infections, especially among vulnerable populations like children and elderly people. This article is protected by copyright. All rights reserved.

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Complications of Nasal SARS-CoV-2 Testing: A Review

Cited by 17 publications

References 22 publications

Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

Orbital cellulitis complicated with subperiosteal abscess following post‐nasopharyngeal swab for COVID‐19: A case report

Evaluation of a new “all in one” SARS‐CoV‐2 antigen‐detecting rapid diagnostic test and self‐test: Diagnostic performance and usability in child and adult populations

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