Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol

Clercq, Jozefien De; Malfait, Thomas; Malfait, Simon; Boelens, Jerina; Coorevits, Liselotte; Padalko, Elizaveta; Vandendriessche, Stien; Verhasselt, Bruno; Morbée, Lieve; Bauters, F; Hertegonne, Katrien; Stevens, Dieter; Weygaerde, Yannick Vande; Vermaelen, Karim; Biesen, Wim Van; Vanommeslaeghe, Floris; Verbeke, Francis; Piers, R.; Noortgate, Nele Van Den; Desmet, Tania; Vermassen, Frank; Vandekerckhove, L.; Braeckel, Eva Van

doi:10.1080/17843286.2021.1883362

Cited by 7 publications

(9 citation statements)

References 30 publications

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“…By performing a random effects analysis, the pooled estimated prevalence of RVCI in COVID‐19 was 5.01% (95% CI 3.43%–7.27%, n = 16,643, 59 studies, I 2 = 95%) (Figure 2 ). The prevalence of co‐infection in the included studies ranged from 0% 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 to 56.25%. 26 …”

Section: Resultsmentioning

confidence: 99%

Respiratory viral co‐infections in patients with COVID‐19 and associated outcomes: A systematic review and meta‐analysis

Krumbein

Kümmel

Fragkou

et al. 2022

Reviews in Medical Virology

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The aim of this systematic review and meta‐analysis was to critically assess the published literature related to community‐acquired viral co‐infections and COVID‐19 and to evaluate the prevalence, most identified co‐pathogens, and relevant risk factors. Furthermore, we aimed to examine the clinical features and outcomes of co‐infected compared to mono‐infected COVID‐19 patients. We systematically searched PubMed, Web of Science, Embase, Scopus, and The Cochrane Library for studies published from 1 November 2019 to 13 August 2021. We included patients of all ages and any COVID‐19 severity who were screened for respiratory viral co‐infection within 48 h of COVID‐19 diagnosis. The main outcome was the proportion of patients with a respiratory viral co‐infection. The systematic review was registered to PROSPERO (CRD42021272235). Out of 6053 initially retrieved studies, 59 studies with a total of 16,643 SARS‐CoV‐2 positive patients were included. The global pooled prevalence was 5.01% (95% CI 3.34%–7.27%; I 2 = 95%) based on a random‐effects model, with Influenza Viruses (1.54%) and Enteroviruses (1.32%) being the most prevalent pathogens. Subgroup analyses showed that co‐infection was significantly higher in paediatric (9.39%) than adult (3.51%) patients ( p ‐value = 0.02). Furthermore, co‐infected patients were more likely to be dyspnoeic and the odds of fatality (OR = 1.66) were increased. Although a relatively low proportion of COVID‐19 patients have a respiratory viral co‐infection, our findings show that multiplex viral panel testing may be advisable in patients with compatible symptoms. Indeed, respiratory virus co‐infections may be associated with adverse clinical outcomes and therefore have therapeutic and prognostic implications.

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Section: Resultsmentioning

confidence: 99%

Respiratory viral co‐infections in patients with COVID‐19 and associated outcomes: A systematic review and meta‐analysis

Krumbein

Kümmel

Fragkou

et al. 2022

Reviews in Medical Virology

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“… Overall proportion of SARS-CoV-2 positivity in BAL fluid [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. …”

Section: Figurementioning

confidence: 99%

“… Graphical display of the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) results, according to risk of bias and applicability concerns [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. …”

Section: Figurementioning

confidence: 99%

Diagnostic Role of Bronchoalveolar Lavage in Patients with Suspected SARS-CoV-2 Pneumonia and Negative Upper Respiratory Tract Swab: A Systematic Review and Meta-Analysis

Mei

Rota

Bonifazi

et al. 2022

JCM

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The added role of bronchoalveolar lavage (BAL) in SARS-CoV-2 detection in hospitalized patients with suspected COVID-19 pneumonia and at least one negative nasopharyngeal swab (NPS) has yet to be definitively established. We aimed to provide a systematic review and meta-analysis to summarize data from the literature on the diagnostic yield of BAL in this context. We searched Medline and Embase for all studies reporting outcomes of interest published up to October 2021. Two authors reviewed all titles/abstracts and retrieved the selected full texts according to predefined selection criteria. The summary estimate was derived using the random-effects model. Thirteen original studies, involving 868 patients, were included. The summary estimate of proportions of SARS-CoV-2 positivity in BAL fluid in patients with at least one previous negative NPS was 20% (95% confidence interval [CI]; 11–30%). Moreover, microbiological tests of BAL fluid led to the identification of other pathogens, mainly bacteria, in up to two-thirds of cases. BAL plays a crucial role in the diagnostic work-up of patients with clinical suspicion of COVID-19 and previous negative NPS, as it allowed to detect the infection in a significant proportion of subjects, who would have been otherwise misclassified, with relevant implications in the prevention of disease spread, especially in hospital settings.

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“…22 During the first COVID-19 wave (March-April 2020), De Clercq et al conducted a retrospective monocentre study in Belgium aimed to evaluate the feasibility of their local diagnostic protocol that included BAL in patients' diagnostic workup. 23 They performed 27 BAL in non-critically ill patients with HCRT changes suspected for COVID-19 and two negative NP swabs and found 26% (7/27) positive BAL for SARS-Cov-2. They also identified one coinfection in SARS-Cov-2 positive (E cloacae) and 63% of other pathogens in negative BAL for SARS-Cov-2 including Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Pneumocysitis jirovecii , and other viruses.…”

Section: Bal In Suspected Covid-19 Non-critically Ill Patientsmentioning

confidence: 99%

Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium.

Tomassetti

Ciani

Luzzi

et al. 2022

Preprint

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Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or in supporting alternative diagnosis, and can change management decisions in up to two-third of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for the understanding of the microenvironment and interaction between epithelial cells and immunity revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and health care workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management and with great potential for research.

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Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol

Cited by 7 publications

References 30 publications

Respiratory viral co‐infections in patients with COVID‐19 and associated outcomes: A systematic review and meta‐analysis

Respiratory viral co‐infections in patients with COVID‐19 and associated outcomes: A systematic review and meta‐analysis

Diagnostic Role of Bronchoalveolar Lavage in Patients with Suspected SARS-CoV-2 Pneumonia and Negative Upper Respiratory Tract Swab: A Systematic Review and Meta-Analysis

Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium.

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