Variability of Salivary and Nasal Specimens for SARS-CoV-2 Detection

Manabe, Yukari C.; Reuland, Carolyn; Yu, Tong; Azamfirei, Răzvan; Church, Taylor R.; Brown, Diane; Sewell, Thelio T; Hardick, Justin; Blair, Paul W; Heaney, Christopher D.; Pekosz, Andrew; Thomas, David L.

doi:10.1101/2020.10.07.20208520

Cited by 4 publications

(6 citation statements)

References 5 publications

(6 reference statements)

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“…Furthermore, viral cultures from patients with prolonged disease onset/ high RT-PCR Ct values failed to identify viable virus ( Laferl et al, 2021 , Manzulli et al, 2021 , van Kampen et al, 2021 ). In one study comparing saliva to NPS, all viral culture-positive samples had concordantly positive NPS and saliva samples, and no viable virus was isolated from saliva-negative, NPS-positive patients ( Manabe et al, 2020 ). In our study, saliva could detect patients who had lower Ct values (suggestive of higher viral loads) and likely higher risk of viral transmission.…”

Section: Discussionmentioning

confidence: 99%

“…Early reports have revealed that saliva can harbor SARS-CoV-2 and can be used to monitor viral loads ( To et al, 2020 ). Since then, several studies comparing saliva to NPS have been published, with the majority of results suggesting comparable saliva sensitivity to that of NPS ( Azzi et al, 2020 , Becker et al, 2020 , Caulley et al, 2020 , Hanson et al, 2020 , Jamal et al, 2020 , Manabe et al, 2020 , Pasomsub et al, 2020 , Riccò et al, 2020 , Sakanashi et al, 2021 , Skolimowska et al, 2020 , Sutjipto et al, 2020 , Vaz et al, 2020 ). In some studies, saliva outperformed NPS in terms of sensitivity, highlighting a limitation of the latter method to be considered as the standard of care ( Kojima et al, 2020 , Moreno-Contreras et al, 2020 , Wyllie et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

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The reliability of saliva for the detection of SARS-CoV-2 in symptomatic and asymptomatic patients: Insights on the diagnostic performance and utility for COVID-19 screening

Alkhateeb

Cahill

Ross

et al. 2021

Diagnostic Microbiology and Infectious Disease

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Current literature has focused on testing saliva in symptomatic patients, and little information is available regarding saliva performance in asymptomatic SARS-CoV-2 infection. We compared paired saliva and nasopharyngeal swabs (NPS) collected from 33 symptomatic and 12 asymptomatic known SARS-CoV-2-positive patients. Saliva had an overall sensitivity of 59%, a specificity of 95%, and a negative predictive value of 98%. Saliva demonstrated higher sensitivity in symptomatic (80%) vs. asymptomatic individuals (36%) (P=0.006), and in high-risk (symptomatic, febrile and/or with comorbidities) (82%) vs. low-risk (asymptomatic, afebrile and no comorbidities) (22%) patients (P=0.0002). Cycle threshold (Ct) values in NPS specimens were higher in saliva-negative vs. saliva-positive cases (P= 0.02 and <0.001). Overall, these findings show that despite saliva's low sensitivity in asymptomatic SARS-CoV-2 infections, it can detect infections with lower Ct values and a potentially higher chance of viral transmission. Additional studies are warranted to fully evaluate saliva as a screening test for COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The reliability of saliva for the detection of SARS-CoV-2 in symptomatic and asymptomatic patients: Insights on the diagnostic performance and utility for COVID-19 screening

Alkhateeb

Cahill

Ross

et al. 2021

Diagnostic Microbiology and Infectious Disease

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“…When rRT-PCR is used for SARS-CoV-2 testing, the reliability of saliva testing is reportedly equal to, or even higher than, NPS (5,10,13,14), although some studies report contradictory findings (i.e. saliva as less sensitive) (15). This discrepancy might depend on the salivary viral load kinetic, the highest load occurring in the first week of symptom onset, followed by a progressive decline during the course of the disease (3,9,14).…”

Section: Introductionmentioning

confidence: 99%

Salivary SARS-CoV-2 antigen rapid detection: a prospective cohort study

Basso

Aita

Padoan

et al. 2020

Preprint

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BackgroundSARS-CoV-2 quick testing and reporting are now considered relevant for the containment of new pandemic waves. Antigen testing in self-collected saliva might be useful. We compared the diagnostic performance of salivary and naso-pharyngeal swab (NPS) SARS-CoV-2 antigen detection by a rapid chemiluminescent assay (CLEIA) and two different point-of-care (POC) immunochromatographic assays, with that of molecular testing.Methods234 patients were prospectively enrolled. Paired self-collected saliva (Salivette) and NPS were obtained to perform rRT-PCR, chemiluminescent (Lumipulse G) and POC (NPS: Fujirebio and Abbott; saliva: Fujirebio) for SARS-CoV-2 antigen detection.ResultsThe overall agreement between NPS and saliva rRT-PCR was 78.7%, reaching 91.7% at the first week from symptoms onset. SARS-CoV-2 CLEIA antigen was highly accurate in distinguishing between positive and negative NPS (ROC-AUC=0.939, 95%CI:0.903-0.977), with 81.6% sensitivity and 93.8% specificity. This assay on saliva had an overall good accuracy (ROC-AUC=0.805, 95%CI:0.740-0.870), reaching the optimal value within 7 days from symptom onset (Sensitivity: 72%; Specificity: 97%). POC antigen in saliva had a very limited sensitivity (13%), performing better in NPS (Sensitivity: 48% and 66%; Specificity: 100% and 99% for Espline and Abbott respectively), depending on viral loads.ConclusionsSelf-collected saliva is a valid alternative to NPS for SARS-CoV-2 detection not only by molecular, but also by CLEIA antigen testing, for which the highest diagnostic accuracy was achieved in the first week from symptom onset. Saliva is not suitable for POC, although the accuracy of these tests appears satisfactory for NPS with high viral load.

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“…Viruslasten an verschiedenen Abstrichorten werden in Studien oft unterschiedlich ermittelt [5,6,10,19,22].…”

Section: Viruslastenunclassified

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Gelegentlich wird auch die Empfehlung gegeben, mit einem Tupfer Abstriche aus der Nase und dem Pharynx zu nehmen, wobei die Reihenfolge unterschiedlich ausgeübt wird [5,12,15,18,22]. Deitmer T et al Der Nasen-oder… Laryngo-Rhino-Otol | © 2021.

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Der Nasen- oder Rachenabstrich in der COVID-19-Pandemie – Aspekte für den HNO-Arzt/die HNO-Ärztin – SARS-CoV-2, Coronavirus, Nasenabstrich, Rachenabstrich, Komplikationen

Deitmer

Dietz

Chaberny

et al. 2021

Laryngorhinootologie

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ZusammenfassungSeit Beginn der SARS-CoV-2-Pandemie werden zunehmend Abstriche oder andere Beprobungen aus dem oberen Aerodigestivtrakt genommen, da hier vor allen Dingen in frühen Erkrankungsstadien hohe Viruslasten bestehen. Als diagnostische Möglichkeiten sind Abstriche aus der vorderen Nase, dem Nasopharynx oder dem Oropharynx sowie die Gewinnung von Rachenspülwasser oder Speichel möglich. Als Labormethoden stehen in einigen Minuten ablesbare Antigentests oder langwierigere RT-PCR-Methoden zur Verfügung. Abstriche werden von ärztlichem Personal, medizinischem Fachpersonal, Laien und im Eigentest, jeweils nach Instruktionen, durchgeführt. Auf die Aussagekraft und die Sensitivität des gesamten diagnostischen Prozesses haben somit viele dieser Faktoren einen Einfluss. Die PCR-Labormethode ist sensitiver als die Antigenmethode; der Abstrich aus dem Nasopharynx wird als der valideste Abstrichort angesehen. Eine korrekte Durchführung eines Tests kann auch bei nicht professionellen Personen mit guten Instruktionen erreicht werden. Komplikationen werden bei solchen Abstrichen, gemessen an der anzunehmenden Anzahl durchgeführter Prozeduren, sehr selten berichtet. Kurzfristiges Nasenbluten bei traumatischen Abstrichen ist anzunehmen, ohne dass darüber Publikationen aufgefunden werden konnten. Abgebrochene Abstrichträger mussten HNO-ärztlich entfernt werden. Verletzungen der Schädelbasis mit Liquorrhö wurden bisher sehr vereinzelt berichtet, davon 2-mal bei Anomalien wie Meningozelen. Die Wahl eines geeigneten diagnostischen Mediums hängt von vielen Parametern, wie Verfügbarkeit, zeitlicher Ablauf bis zum Ergebnis, Abstrich durch kundiges Personal oder Eigentest und etlichen anderen praktischen Erwägungen, ab.

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Variability of Salivary and Nasal Specimens for SARS-CoV-2 Detection

Cited by 4 publications

References 5 publications

The reliability of saliva for the detection of SARS-CoV-2 in symptomatic and asymptomatic patients: Insights on the diagnostic performance and utility for COVID-19 screening

The reliability of saliva for the detection of SARS-CoV-2 in symptomatic and asymptomatic patients: Insights on the diagnostic performance and utility for COVID-19 screening

Salivary SARS-CoV-2 antigen rapid detection: a prospective cohort study

Der Nasen- oder Rachenabstrich in der COVID-19-Pandemie – Aspekte für den HNO-Arzt/die HNO-Ärztin – SARS-CoV-2, Coronavirus, Nasenabstrich, Rachenabstrich, Komplikationen

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