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Wang Y, Li X, Wang Y, Tu Z, Xu J, Pan J, Zhou Q. Comparison of the performance of two real-time fluorescent quantitative PCR kits for the detection of SARS-CoV-2 nucleic acid: a study based on large real clinical samples. Virol J 2022; 19:191. [PMID: 36401275 PMCID: PMC9675236 DOI: 10.1186/s12985-022-01922-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background The global pandemic of coronavirus disease 2019 (COVID-19) has led to the development of multiple detection kits by national manufacturers for severe acute respiratory syndrome coronavirus 2 viral nucleic acid testing. The purpose of this study is to evaluate the performance of different kits (i.e., Maccura kit and Sansure kit) in real clinical work using clinical samples, which will help with the optimization of the test kits. Method During the past three months (March–May 2022), 1399 pharyngeal swabs from suspected COVID-19 patients have been initially screened using the Maccura kit in Jilin, China, and the test results were verified using the Sansure kit. The cycle threshold (Ct) values generated by the two kits were compared at different viral load levels. Correlation and consistency of the Ct values were investigated using Spearman correlation, Deming regression, and Bland–Altman plots. The cut-off Ct values of the Maccura kit were recalculated by referencing the result of the Sansure kit as a standard. Furthermore, another 163 pharyngeal swabs from suspected COVID-19 patients were collected to verify the new cut-off values. Results As a result of the Maccura kit testing, 1192 positive cases and 207 suspected COVID-19 cases were verified. After re-examination by the Sansure kit, 1118 positive cases were confirmed. The difference between the Ct values provided by the two kits was statistically significant, except for the N gene at high viral load. The Ct values obtained from the two kits presented a linear positive correlation. The Maccura kit used new cut-off Ct values of 35.00 (ORF1ab gene) and 35.07 (N gene). Based on that, the validation pass rate for the new cut-off Ct values was 91.41%. Conclusion Since the Maccura kit is found to have false positives in actual clinical work, recalculation of the cut-off values can reduce this occurrence. In order to improve the accuracy of the testing, laboratories should use two kits for COVID-19 testing, and the adjusting and optimizing of the kits for their situation are needed.
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Grewal S, Syed Gurcoo M, Sudhan Sharma S. Comparative analysis of specificity and sensitivity between Cobas 6800 system and SARS-CoV-2 rRT-PCR to detect COVID-19 infection in clinical samples. Arch Microbiol 2022; 204:502. [PMID: 35852637 PMCID: PMC9295087 DOI: 10.1007/s00203-022-03118-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
Fast and reliable testing for the COVID 19 infection is the need of the hour for the development of effective and reliable tools and assays. However, it is difficult to find the performance relativity among all these tests which are poorly understood. In this study, we aimed to evaluate the two different platforms where we determine the difference of sensitivity and specificity between the fully automated analyzer (Roche Diagnostics Cobas 6800 SARS-CoV-2 test) under FDA Emergency Use Authorization (EUA) and the laboratory designed test (SARS-CoV-2 rRT-PCR) based on the protocol developed by ICMR (Indian Council for Medical Research). The study was conducted for individual samples. We performed our study with two different approaches, first with validation method consisting of 188 samples (2 batches) on cobas 6800 instrument (Roche Molecular Systems, Branchburg, NJ) soon after we received US FDA EUA on 1 June 2021, all these samples were tested earlier with laboratory designed tests on 25th and 26th May 2021. Over all agreement between the two tests is of 88% and the coefficient of agreement between the two testing platform Cohen’sκ coefficient was found to be 0.76 (95% CI, 2.5897–13.4103) suggesting the substantial agreement between the two platforms. However, in some of the cases, both tests have shown a little disagreement. An overall discordance rate between two systems was found 11.1%. The difference may be due to the limit of detection, variation in the sequences of the primer design or may be due to other factors depicting the importance of comparing the two platforms used in the testing for SARS-CoV-2. Second approach includes head to head evaluation which comprises 1631 samples showed overall agreement of 99% and kappa value of 0.98. These results showed that cobas is effective and reliable assay for the detection of SARS-CoV-2 infection.
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Affiliation(s)
- Simmi Grewal
- Department of Microbiology, Government Medical College, Jammu, 180001, Jammu and Kashmir, India
| | - Mehreen Syed Gurcoo
- Department of Microbiology, Government Medical College, Jammu, 180001, Jammu and Kashmir, India
| | - Shashi Sudhan Sharma
- Department of Microbiology, Government Medical College, Jammu, 180001, Jammu and Kashmir, India.
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A Review of SARS-CoV-2 Disease (COVID-19): Pandemic in Our Time. Pathogens 2022; 11:pathogens11030368. [PMID: 35335691 PMCID: PMC8951506 DOI: 10.3390/pathogens11030368] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Development and deployment of biosensors for the rapid detection of the 2019 novel severe acute respiratory syndrome—coronavirus 2 (SARS-CoV-2) are of utmost importance and urgency during this recent outbreak of coronavirus pneumonia (COVID-19) caused by SARS-CoV-2 infection, which spread rapidly around the world. Cases now confirmed in February 2022 indicate that more than 170 countries worldwide are affected. Recent evidence indicates over 430 million confirmed cases with over 5.92 million deaths scattered across the globe, with the United States having more than 78 million confirmed cases and over 920,000 deaths. The US now has many more cases than in China where coronavirus cases were first reported in late December 2019. During the initial outbreak in China, many leaders did not anticipate it could reach the whole world, spreading to many countries and posing severe threats to global health. The objective of this review is to summarize the origin of COVID-19, its biological nature, comparison with other coronaviruses, symptoms, prevention, treatment, potential, available methods for SARS-CoV-2 detection, and post-COVID-19 symptoms.
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Gwenzi W. Wastewater, waste, and water-based epidemiology (WWW-BE): A novel hypothesis and decision-support tool to unravel COVID-19 in low-income settings? THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 806:150680. [PMID: 34599955 PMCID: PMC8481624 DOI: 10.1016/j.scitotenv.2021.150680] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 05/02/2023]
Abstract
Traditional wastewater-based epidemiology (W-BE) relying on SARS-CoV-2 RNA detection in wastewater is attractive for understanding COVID-19. Yet traditional W-BE based on centralized wastewaters excludes putative SARS-CoV-2 reservoirs such as: (i) wastewaters from shared on-site sanitation facilities, (ii) solid waste including faecal sludge from non-flushing on-site sanitation systems, and COVID-19 personal protective equipment (PPE), (iii) raw/untreated water, and (iv) drinking water supply systems in low-income countries (LICs). A novel hypothesis and decision-support tool based on Wastewater (on-site sanitation, municipal sewer systems), solid Waste, and raw/untreated and drinking Water-based epidemiology (WWW-BE) is proposed for understanding COVID-19 in LICs. The WWW-BE conceptual framework, including components and principles is presented. Evidence on the presence of SARS-CoV-2 and its proxies in wastewaters, solid materials/waste (papers, metals, fabric, plastics), and raw/untreated surface water, groundwater and drinking water is discussed. Taken together, wastewaters from municipal sewer and on-site sanitation systems, solid waste such as faecal sludge and COVID-19 PPE, raw/untreated surface water and groundwater, and drinking water systems in LICs act as potential reservoirs that receive and harbour SARS-CoV-2, and then transmit it to humans. Hence, WWW-BE could serve a dual function in estimating the prevalence and potential transmission of COVID-19. Several applications of WWW-BE as a hypothesis and decision support tool in LICs are discussed. WWW-BE aggregates data from various infected persons in a spatial unit, hence, putatively requires less resources (analytical kits, personnel) than individual diagnostic testing, making it an ideal decision-support tool for LICs. The novelty, and a critique of WWW-BE versus traditional W-BE are presented. Potential challenges of WWW-BE include: (i) biohazards and biosafety risks, (ii) lack of expertise, analytical equipment, and accredited laboratories, and (iii) high uncertainties in estimates of COVID-19 cases. Future perspectives and research directions including key knowledge gaps and the application of novel and emerging technologies in WWW-BE are discussed.
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Affiliation(s)
- Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Agricultural and Biosystems Engineering, Faculty of Agriculture, Environment and Food Systems, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe.
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Hasan T, Lim HL, Case J, Hueston L, Bag S, Dwyer DE, O'Sullivan MV. The utility of SARS-CoV-2-specific serology in COVID-19 diagnosis. Aust N Z J Public Health 2021; 45:616-621. [PMID: 34761846 PMCID: PMC8652559 DOI: 10.1111/1753-6405.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION In May 2020, The Communicable Diseases Network of Australia (CDNA) case definition introduced serological criteria to support the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present findings that support the utility of SARS-CoV-2-specific serology for public health investigations. METHODS From 24 January to 31 July 2020, the following information was collected from individuals with positive SARS-CoV-2-specific immunofluorescence antibody tests: history of contact with COVID-19 cases; recent travel; symptoms consistent with COVID-19; and SARS-CoV-2 nucleic acid testing (NAT) results. Individuals were classified as confirmed or probable by CDNA criteria or additionally as possible (SARS-CoV-2-specific IgG positive with compatible symptoms or epidemiologic risk) or indeterminate (SARS-CoV-2-specific IgA/IgM positive only) cases. RESULTS A total of 10,595 individuals were tested in the six-month period. Of these, 9.8% (1,037) individuals had positive SARS-CoV-2-specific serology of which 566 (53.6%) were NAT-confirmed COVID-19 cases and 286 (27.6%) were part of a cruise ship outbreak sero-survey. The remaining 185 individuals (NAT negative) were individually classified as serologically confirmed (4, 0.4%), probable (72, 6.9%) possible (66, 6.4%) and indeterminate (38, 3.7%) cases. Maternal antibody transfer was inferred in one infant and four were unclassified. CONCLUSION SARS-CoV-2-specific serology is a key diagnostic tool for retrospective identification of COVID-19 infection. Implications for public health: SARS-CoV-2 specific serology can enhance the ability to find cases, link missing cases in clusters of infection and identify the epidemiological extent of SARS-CoV-2 outbreaks. A combination of epidemiological criteria, clinical criteria and a quantitative serological test can be used as an adjunct to classify SARS-CoV-2 cases. Our study confirms the low level of community transmission in NSW during the first year of the COVID-19 pandemic.
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Affiliation(s)
- Tasnim Hasan
- NSW Health Pathology, ICPMR – Westmead, Westmead Hospital, New South Wales,Correspondence to: Dr Tasnim Hasan, NSW Health Pathology, ICPMR – Westmead, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145
| | - H. Ling Lim
- NSW Health Pathology, ICPMR – Westmead, Westmead Hospital, New South Wales
| | | | - Linda Hueston
- NSW Health Pathology, ICPMR – Westmead, Westmead Hospital, New South Wales
| | - Shopna Bag
- Centre for Population Health, Western Sydney Local Health District, New South Wales
| | - Dominic E. Dwyer
- NSW Health Pathology, ICPMR – Westmead, Westmead Hospital, New South Wales
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Stessel B, Callebaut I, Polus F, Geebelen L, Evers S, Ory JP, Magerman K, Souverijns G, Braeken G, Ramaekers D, Cox J. Evaluation of a comprehensive pre-procedural screening protocol for COVID-19 in times of a high SARS CoV-2 prevalence: a prospective cross-sectional study. Ann Med 2021; 53:337-344. [PMID: 33583292 PMCID: PMC7889170 DOI: 10.1080/07853890.2021.1878272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To minimise the risk of COVID-19 transmission, an ambulant screening protocol for COVID-19 in patients before admission to the hospital was implemented, combining the SARS CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) on a nasopharyngeal swab, a chest computed tomography (CT) and assessment of clinical symptoms. The aim of this study was to evaluatethe diagnostic yield and the proportionality of this pre-procedural screeningprotocol. METHODS In this mono-centre, prospective, cross-sectional study, all patients admitted to the hospital between 22nd April 2020 until 14th May 2020 for semi-urgent surgery, haematological or oncological treatment, or electrophysiological investigationunderwent a COVID-19 screening 2 days before their procedure. At a 2-week follow-up, the presence of clinical symptoms was evaluated by telephone as a post-hoc evaluation of the screening approach.Combined positive RT-PCR assay and/or positive chest CT was used as gold standard. Post-procedural outcomes of all patients diagnosed positive for COVID-19 were assessed. RESULTS In total,528 patients were included of which 20 (3.8%) were diagnosed as COVID-19 positive and 508 (96.2%) as COVID-19 negative. 11 (55.0%) of COVID-19 positive patients had only a positive RT-PCR assay, 3 (15.0%) had only a positive chest CT and 6 (30%) had both a positive RT-PCR assay and chest CT. 10 out of 20 (50.0%) COVID-19 positive patients reported no single clinical symptom at the screening. At 2 week follow-up, 50% of these patients were still asymptomatic. 37.5% of all COVID-19 negative patients were symptomatic at screening. In the COVID-19 negative group without symptoms at screening, 78 (29.3%) patients developed clinical symptoms at a 2-week follow-up. CONCLUSION This study suggests that routine chest CT and assessment of self-reported symptoms have limited value in the preprocedural COVID-19 screening due to low sensitivity and/or specificity.
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Affiliation(s)
- Björn Stessel
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Ina Callebaut
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Fréderic Polus
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Laurien Geebelen
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Stefan Evers
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jean-Paul Ory
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Koen Magerman
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
- Clinical Laboratory, Jessa Hospital, Hasselt, Belgium
| | | | - Geert Braeken
- Department of Intensive Care and Anaesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Dirk Ramaekers
- Jessa Hospital, Hasselt, Belgium
- Leuven Institute for Healthcare Policy (LIHP), University of Leuven, Leuven, Belgium
| | - Janneke Cox
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
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Alsheikh SH, Ibrahim K, AlFaraj D. The Impact of False Positive COVID-19 Result. Cureus 2021; 13:e20375. [PMID: 35036208 PMCID: PMC8752407 DOI: 10.7759/cureus.20375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/22/2022] Open
Abstract
The novel Coronavirus disease 2019 (COVID-19) pandemic has resulted in many adverse outcomes and challenges, and a false-positive result is one of them. Despite that this issue has a substantial impact, there is a scarcity in the literature of its prevalence or impact, and more knowledge is needed. This case report will present the case of a 54-years-old female who was misdiagnosed as COVID-19. The misleading COVID-19 diagnosis can result in significant consequences such as delaying surgeries, unnecessary quarantine and treatments, transplant lists omission, and unnecessary sick leaves. Moreover, as seen in our case, it delayed the other investigations and admitted a healthy patient to a COVID-19 isolation ward. Therefore, physicians should consider the possibility of false-positive results and utilize other investigation tools to further diagnose suspicious cases.
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Affiliation(s)
- Shahad H Alsheikh
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Khaled Ibrahim
- Emergency Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Dunya AlFaraj
- Emergency Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Zhang K, Li J, Fan Z, Li H, Xu JJ. "Covalent biosensing" enables a one-step, reagent-less, low-cost and highly robust assay of SARS-CoV-2. Chem Commun (Camb) 2021; 57:10771-10774. [PMID: 34585685 DOI: 10.1039/d1cc03686f] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We have established a new protocol for detecting severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) using a peptidomimetic to covalently detect a viral marker protease.
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Affiliation(s)
- Kai Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China.,State Key Laboratory of Analytical Chemistry for Life Science and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, China.
| | - Jinlong Li
- Department of Laboratory Medicine, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, P. R. China
| | - Zhenqiang Fan
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China
| | - Hao Li
- School of Biological Science and Technology, University of Jinan, No. 106 Jiwei Road, Jinan, Shandong 250022, China.
| | - Jing-Juan Xu
- State Key Laboratory of Analytical Chemistry for Life Science and Collaborative Innovation Center of Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, China.
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Alvarez FJ, Perez-Cardenas M, Gudiño M, Tellkamp MP. Tips for a reduction of false positives in manual RT-PCR diagnostics of SARS-CoV-2. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.03.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RT-PCR is the standard gold technique for testing the presence of RNA of the coronavirus causing Severe Acute Respiratory Syndrome (SARS-CoV-2) due to its high specificity and sensitivity. Despite its general use and reliability, no lab in the world is immune to the generation of false positives. These errors cause a loss of confidence in the technique's power and damage the image of laboratories. More importantly, they can take a toll on tested individuals and have economic, psychological, and health-associated effects. Most false positives are caused during a manual operation inside the laboratory. However, not much has been published about the errors associated with particular laboratory techniques used to detect the virus since the beginning of the actual pandemic. This work precisely reflects on events that occur during manual RT-PCR diagnostics in a COVID-19 laboratory, providing tips for reducing false-positive results.
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Affiliation(s)
- Francisco J. Alvarez
- Yachay Tech University, School of Biological Sciences and Engineering, Hda. San José s/n y Proyecto Yachay, 100119, Urcuquí, Ecuador
| | - Mariela Perez-Cardenas
- Yachay Tech University, School of Biological Sciences and Engineering, Hda. San José s/n y Proyecto Yachay, 100119, Urcuquí, Ecuador
| | - Marco Gudiño
- Yachay Tech University, School of Biological Sciences and Engineering, Hda. San José s/n y Proyecto Yachay, 100119, Urcuquí, Ecuador
| | - Markus P. Tellkamp
- Yachay Tech University, School of Biological Sciences and Engineering, Hda. San José s/n y Proyecto Yachay, 100119, Urcuquí, Ecuador
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Jagtap S, K R, Valloly P, Sharma R, Maurya S, Gaigore A, Ardhya C, Biligi DS, Desiraju BK, Natchu UCM, Saini DK, Roy R. Evaluation of spike protein antigens for SARS-CoV-2 serology. J Virol Methods 2021; 296:114222. [PMID: 34197839 PMCID: PMC8239204 DOI: 10.1016/j.jviromet.2021.114222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spike protein domains are being used in various serology-based assays to detect prior exposure to SARS-CoV-2 virus. However, there has been limited comparison of antibody titers against various spike protein antigens among COVID-19 infected patients. METHODS We compared four spike proteins (RBD, S1, S2 and a stabilized spike trimer (ST)) representing commonly used antigens for their reactivity to human IgG antibodies using indirect ELISA in serum from COVID-19 patients and pre-2020 samples. ST ELISA was also compared against the EUROIMMUN IgG ELISA test. Further, we estimated time appropriate IgG and IgA seropositivity rates in COVID-19 patients using a panel of sera samples collected longitudinally from the day of onset of symptoms (DOS). RESULTS Among the four spike antigens tested, the ST demonstrated the highest sensitivity (86.2 %; 95 % CI: 77.8-91.7 %), while all four antigens showed high specificity to COVID-19 sera (94.7-96.8 %). 13.8 % (13/94) of the samples did not show seroconversion in any of the four antigen-based assays. In a double-blinded head-to-head comparison, ST based IgG ELISA displayed a better sensitivity (87.5 %, 95 % CI: 76.4-93.8 %) than the EUROIMMUN IgG ELISA (67.9 %, 95 % CI: 54.8-78.6 %). Further, in ST-based assays, we found 48 % and 50 % seroconversion in the first six days (from DOS) for IgG and IgA antibodies, respectively, which increased to 84 % (IgG) and 85 % (IgA) for samples collected ≥22 days from DOS. CONCLUSIONS Comparison of spike antigens demonstrates that spike trimer protein is a superior option as an ELISA antigen for COVID-19 serology.
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Affiliation(s)
- Suraj Jagtap
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, 560012, India
| | - Ratnasri K
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore, 560012, India
| | - Priyanka Valloly
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, 560012, India
| | - Rakhi Sharma
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, 560012, India
| | - Satyaghosh Maurya
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, 560012, India
| | - Anushree Gaigore
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, 560012, India
| | - Chitra Ardhya
- Department of Pathology, Bangalore Medical College and Research Institute, Bangalore, 560002, India
| | - Dayananda S Biligi
- Department of Pathology, Bangalore Medical College and Research Institute, Bangalore, 560002, India
| | - Bapu Koundinya Desiraju
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India
| | | | - Deepak Kumar Saini
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore, 560012, India; Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore, 560012, India
| | - Rahul Roy
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, 560012, India; Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore, 560012, India.
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11
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Gededzha MP, Mampeule N, Jugwanth S, Zwane N, David A, Burgers WA, Blackburn JM, Grove JS, George JA, Sanne I, Scott L, Stevens W, Mayne ES. Performance of the EUROIMMUN Anti-SARS-CoV-2 ELISA Assay for detection of IgA and IgG antibodies in South Africa. PLoS One 2021; 16:e0252317. [PMID: 34161348 PMCID: PMC8221517 DOI: 10.1371/journal.pone.0252317] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) has been identified as the causative agent for causing the clinical syndrome of COVID -19. Accurate detection of SARS-CoV-2 infection is not only important for management of infected individuals but also to break the chain of transmission. South Africa is the current epicenter of SARS-CoV-2 infection in Africa. To optimize the diagnostic algorithm for SARS-CoV-2 in the South African setting, the study aims to evaluate the diagnostic performance of the EUROIMMUN Anti-SARS-CoV-2 assays. This study reported the performance of EUROIMMUN enzyme-linked immunosorbent assay (ELISA) for semi-quantitative detection of IgA and IgG antibodies in serum and plasma samples targeting the recombinant S1 domain of the SARS-CoV-2 spike protein as antigen. Samples were collected from 391 individuals who had tested positive for SARS-CoV-2 and 139 SARS CoV-2 negative controls. Samples were stratified by number of days’ post-PCR diagnosis and symptoms. The sensitivity of EUROIMMUN IgG was 64.1% (95% CI: 59.1–69.0%) and 74.3% (95% CI: 69.6–78.6%) for IgA and the specificity was lower for IgA [84.2% (95% CI: 77–89.2%)] than IgG [95.2% (95% CI: 90.8–98.4%)]. The EUROIMMUN Anti-SARS-CoV-2 ELISA Assay sensitivity was higher for IgA but low for IgG and improved for both assays in symptomatic individuals and at later timepoints post PCR diagnosis.
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Affiliation(s)
- Maemu P Gededzha
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Nakampe Mampeule
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Sarika Jugwanth
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Nontobeko Zwane
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anura David
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Wendy A Burgers
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jonathan M Blackburn
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Divisions of Chemical and System Biology, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jurette S Grove
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Scott
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Wendy Stevens
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Elizabeth S Mayne
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
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12
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Bi C, Ramos-Mandujano G, Tian Y, Hala S, Xu J, Mfarrej S, Esteban CR, Delicado EN, Alofi FS, Khogeer A, Hashem AM, Almontashiri NAM, Pain A, Izpisua Belmonte JC, Li M. Simultaneous detection and mutation surveillance of SARS-CoV-2 and multiple respiratory viruses by rapid field-deployable sequencing. MED 2021; 2:689-700.e4. [PMID: 33821249 PMCID: PMC8011639 DOI: 10.1016/j.medj.2021.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Strategies for monitoring the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are crucial for combating the pandemic. Detection and mutation surveillance of SARS-CoV-2 and other respiratory viruses require separate and complex workflows that rely on highly specialized facilities, personnel, and reagents. To date, no method can rapidly diagnose multiple viral infections and determine variants in a high-throughput manner. METHODS We describe a method for multiplex isothermal amplification-based sequencing and real-time analysis of multiple viral genomes, termed nanopore sequencing of isothermal rapid viral amplification for near real-time analysis (NIRVANA). It can simultaneously detect SARS-CoV-2, influenza A, human adenovirus, and human coronavirus and monitor mutations for up to 96 samples in real time. FINDINGS NIRVANA showed high sensitivity and specificity for SARS-CoV-2 in 70 clinical samples with a detection limit of 20 viral RNA copies per μL of extracted nucleic acid. It also detected the influenza A co-infection in two samples. The variant analysis results of SARS-CoV-2-positive samples mirror the epidemiology of coronavirus disease 2019 (COVID-19). Additionally, NIRVANA could simultaneously detect SARS-CoV-2 and pepper mild mottle virus (PMMoV) (an omnipresent virus and water-quality indicator) in municipal wastewater samples. CONCLUSIONS NIRVANA provides high-confidence detection of both SARS-CoV-2 and other respiratory viruses and mutation surveillance of SARS-CoV-2 on the fly. We expect it to offer a promising solution for rapid field-deployable detection and mutational surveillance of pandemic viruses. FUNDING M.L. is supported by KAUST Office of Sponsored Research (BAS/1/1080-01). This work is supported by KAUST Competitive Research Grant (URF/1/3412-01-01; M.L. and J.C.I.B.) and Universidad Catolica San Antonio de Murcia (J.C.I.B.). A.M.H. is supported by Saudi Ministry of Education (project 436).
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Affiliation(s)
- Chongwei Bi
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Gerardo Ramos-Mandujano
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Yeteng Tian
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Sharif Hala
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Jeddah, Makkah, Saudi Arabia
| | - Jinna Xu
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Sara Mfarrej
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Concepcion Rodriguez Esteban
- Gene Expression Laboratory, Salk Institute for Biological Studies, 10010 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Estrella Nuñez Delicado
- Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, No. 135 12, Guadalupe 30107, Spain
| | - Fadwa S Alofi
- Infectious Diseases Department, King Fahad Hospital, Madinah, Saudi Arabia
| | - Asim Khogeer
- Plan and Research Department, General Directorate of Health Affairs Makkah Region, MOH, Saudi Arabia
| | - Anwar M Hashem
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naif A M Almontashiri
- College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
- Center for Genetics and Inherited Diseases, Taibah University, Madinah, Saudi Arabia
| | - Arnab Pain
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Juan Carlos Izpisua Belmonte
- Gene Expression Laboratory, Salk Institute for Biological Studies, 10010 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Mo Li
- Biological and Environmental Science and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
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13
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Combination of rRT-PCR and Anti-Nucleocapsid/Anti-Spike Antibodies to Characterize Specimens with Very Low Viral SARs-CoV-2 Load: A Real-Life Experience. Microorganisms 2021; 9:microorganisms9061263. [PMID: 34200837 PMCID: PMC8230444 DOI: 10.3390/microorganisms9061263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of the present study was to evaluate the true positivity among people, whose results of initial testing of nasopharyngeal swabs (NPS) showed a very low viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Seventy-seven people detected with low viral loads of SARs-CoV-2 in nasopharyngeal samples (Ct ≥ 35) were enrolled in the study. For this purpose, a second NPS was collected for rRT-PCR (real-time reverse transcription polymerase chain reaction) combined with a pair of serum samples for detection of anti-nucleocapsid (anti-N) and anti-spike (anti-S) antibodies. In 8 people, subsequent examinations indicated an increase in viral loads, thereafter, followed by an increase of anti-N and anti-S antibodies, findings compatible with an early stage of COVID-19 infection. In 9 people, who already had increased anti-N antibodies, subsequent examination showed a decrease or absence of viral load and an increase in antibodies, indicative of a late stage of COVID-19 infection. In 60 people, subsequent examination showed absence of infection (as indicated by absence of viral load and antibodies). We propose that the combination of a second NPS and one serum-specimen, both taken three days after the first NPS, helps significantly to avoid false-positive results.
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14
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Sullivan A, Alfego D, Poirier B, Williams J, Adcock D, Letovsky S. Follow-Up SARS-CoV-2 PCR Testing Outcomes From a Large Reference Lab in the US. Front Public Health 2021; 9:679012. [PMID: 34136460 PMCID: PMC8200821 DOI: 10.3389/fpubh.2021.679012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
By analyzing COVID-19 sequential COVID-19 test results of patients across the United States, we herein attempt to quantify some of the observations we've made around long-term infection (and false-positive rates), as well as provide observations on the uncertainty of sampling variability and other dynamics of COVID-19 infection in the United States. Retrospective cohort study of a registry of RT-PCR testing results for all patients tested at any of the reference labs operated by Labcorp® including both positive, negative, and inconclusive results, from March 1, 2020 to January 28, 2021, including patients from all 50 states and outlying US territories. The study included 22 million patients with RT-PCR qualitative test results for SARS-CoV-2, of which 3.9 million had more than one test at Labcorp. We observed a minuscule <0.1% basal positive rate for follow up tests >115 days, which could account for false positives, long-haulers, and/or reinfection but is indistinguishable in the data. In observing repeat-testing, for patients who have a second test after a first RT-PCR, 30% across the cohort tested negative on the second test. For patients who test positive first and subsequently negative within 96 h (40% of positive test results), 18% of tests will subsequently test positive within another 96-h span. For those who first test negative and then positive within 96 h (2.3% of negative tests), 56% will test negative after a third and subsequent 96-h period. The sudden changes in RT-PCR test results for SARS-CoV-2 from this large cohort study suggest that negative test results during active infection or exposure can change rapidly within just days or hours. We also demonstrate that there does not appear to be a basal false positive rate among patients who test positive >115 days after their first RT-PCR positive test while failing to observe any evidence of widespread reinfection.
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Affiliation(s)
- Adam Sullivan
- Labcorp Holdings of America, Inc., Burlington, NC, United States
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15
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Moreno-Pérez O, Merino E, Chico-Sánchez P, Gras-Valentí P, Sánchez-Payá J. Effectiveness of a SARS-CoV-2 infection prevention model in elective surgery patients - a prospective study: does universal screening make sense? J Hosp Infect 2021; 115:27-31. [PMID: 33992743 PMCID: PMC8118710 DOI: 10.1016/j.jhin.2021.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/26/2022]
Abstract
This observational study included patients who underwent pre-operative coronavirus disease 2019 (COVID-19) screening in order to preserve patient safety. Reverse transcriptase polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus-2 was performed in 2292 of 8740 surgical procedures, and the incidence of a positive PCR result was 0.0022%. No healthcare-associated infections were detected. There was no difference in overall mortality or length of hospital stay compared with the same period from the previous year. A selective screening strategy to identify patients for PCR testing, based on isolation measures, presurgical clinical-epidemiological assessment and selected major surgeries susceptible to a poor COVID-19-related outcome, is effective and safe for patients and healthcare workers.
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Affiliation(s)
- O Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research, Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - E Merino
- Unit of Infectious Diseases, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - P Chico-Sánchez
- Preventive Department Epidemiology Unit, Preventive Medicine Department, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - P Gras-Valentí
- Preventive Department Epidemiology Unit, Preventive Medicine Department, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - J Sánchez-Payá
- Preventive Department Epidemiology Unit, Preventive Medicine Department, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research, Alicante, Spain.
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16
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Abstract
This article reviews the many and varied mass spectrometry based responses to the SARS-CoV2 coronavirus amidst a continuing global healthcare crisis. Although RT-PCR is the most prevalent molecular based surveillance approach, improvements in the detection sensitivities with mass spectrometry coupled to the rapid nature of analysis, the high molecular precision of measurements, opportunities for high sample throughput, and the potential for in-field testing, offer advantages for characterising the virus and studying the molecular pathways by which it infects host cells. The detection of biomarkers by MALDI-TOF mass spectrometry, studies of viral peptides using proteotyping strategies, targeted LC-MS analyses to identify abundant peptides in clinical specimens, the analysis of viral protein glycoforms, proteomics approaches to understand impacts of infection on host cells, and examinations of point-of-care breath analysis have all been explored. This review organises and illustrates these applications with reference to the many studies that have appeared in the literature since the outbreak. In this respect, those studies in which mass spectrometry has a major role are the focus, and only those which have peer-reviewed have been cited.
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Affiliation(s)
- Justin H Griffin
- Infectious Disease Responses Laboratory, Prince of Wales Clinical Research Sciences, Sydney, Australia
| | - Kevin M Downard
- Infectious Disease Responses Laboratory, Prince of Wales Clinical Research Sciences, Sydney, Australia
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17
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Bentley P. Error rates in SARS-CoV-2 testing examined with Bayes' theorem. Heliyon 2021; 7:e06905. [PMID: 33937546 PMCID: PMC8080131 DOI: 10.1016/j.heliyon.2021.e06905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022] Open
Abstract
The SARS-CoV-2 pandemic has created a demand for large scale testing, as part of the effort to understand and control transmission. It is important to quantify the error rates of test equipment under field conditions, which might differ significantly from those obtained in the laboratory. A literature review on SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) is used to construct a clinical test confusion matrix. A simple correction method for bulk test results is then demonstrated with examples. The required sensitivity and specificity of a test are explored for societal needs and use cases, before a sequential analysis of common example scenarios is explored. The analysis suggests that many of the people with mild symptoms and positive test results are unlikely to be infected with SARS-CoV-2 in some regions. It is concluded that current and foreseen alternative tests can not be used to "clear" people as being non-infected. Recommendations are given that regional authorities must establish a programme to monitor operational test characteristics before launching large scale testing; and that large scale testing for tracing infection networks in some regions is not viable, but may be possible in a focused way that does not exceed the working capacity of the laboratories staffed by competent experts. RT-PCR tests can not be solely relied upon as the gold standard for SARS-CoV-2 diagnosis at scale, instead clinical assessment supported by a range of expert diagnostic tests should be used.
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Affiliation(s)
- P.M. Bentley
- European Spallation Source ESS ERIC, Box 176, SE-221 00 Lund, Sweden
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18
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Verma HK. Radiological and clinical spectrum of COVID-19: A major concern for public health. World J Radiol 2021; 13:53-63. [PMID: 33815683 PMCID: PMC8006056 DOI: 10.4329/wjr.v13.i3.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/07/2020] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
The pandemic of novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by +ve strand RNA virus (SARS-CoV-2, severe acute respiratory syndrome coronavirus 2) that belongs to the corona viridae family. In March, the World Health Organization declared the outbreak of novel coronavirus for the public health emergency. Although SARS-CoV-2 infection presents with respiratory symptoms, it affects other organs such as the kidneys, liver, heart and brain. Early-stage laboratory disease testing shows many false positive or negative outcomes such as less white blood cell count and a low number of lymphocyte count. However, radiological examination and diagnosis are among the main components of the diagnosis and treatment of COVID-19. In particular, for COVID-19, chest computed tomography developed vigorous initial diagnosis and disease progression assessment. However, the accuracy is limited. Although real-time reverse transcription-polymerase chain reaction is the gold standard method for the diagnosis of COVID-19, sometimes it may give false-negative results. Due to the consequences of the missing diagnosis. This resulted in a discrepancy between the two means of examination. Conversely, based on currently available evidence, we summarized the possible understanding of the various patho-physiology, radio diagnostic methods in severe COVID-19 patients. As the information on COVID-19 evolves rapidly, this review will provide vital information for scientists and clinicians to consider novel perceptions for the comprehensive knowledge of the diagnostic approaches based on current experience.
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Affiliation(s)
- Henu Kumar Verma
- Developmental and Stem Cell Biology Lab, Institute of Experimental Endocrinology and Oncology CNR, Naples 80131, Campania, Italy
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19
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Szigeti R, Kellermayer R. Natural unblinding of BCG vaccination trials. Vaccine 2021; 39:2017-2019. [PMID: 33744042 PMCID: PMC7969911 DOI: 10.1016/j.vaccine.2021.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 12/26/2022]
Abstract
There is significant public and clinical interest in the potential for Bacillus Calmette-Guérin (BCG) vaccination to protect against type 2 Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) induced COVID-19. This question could be best answered by blinded and placebo controlled clinical trials. However, a skin reaction occurs within days at the site of BCG injection, making it rather challenging to blind this vaccination. Here, we examined registered clinical trials in ClinicalTrials.gov on BCG against COVID-19 by October 9th 2020, and found that 94.7% of such trials were listed as placebo controlled (all with normal saline as placebo), and single to quadruple blinded. The mode of overcoming the natural unblinding by the BCG induced skin reaction was not clarified on the website in either of the trials. We conclude that detailed description of the strategy towards overcoming the BCG vaccination induced skin reaction associated unblinding hurdle will be important for the interpretation of the theoretically blinded COVID-19 directed clinical trials.
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Affiliation(s)
- Reka Szigeti
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Richard Kellermayer
- Section of Pediatric Gastroenterology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA; USDA/ARS Children's Nutrition Research Center, Houston, TX, USA.
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20
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Abueg M, Hinch R, Wu N, Liu L, Probert W, Wu A, Eastham P, Shafi Y, Rosencrantz M, Dikovsky M, Cheng Z, Nurtay A, Abeler-Dörner L, Bonsall D, McConnell MV, O'Banion S, Fraser C. Modeling the effect of exposure notification and non-pharmaceutical interventions on COVID-19 transmission in Washington state. NPJ Digit Med 2021; 4:49. [PMID: 33712693 PMCID: PMC7955120 DOI: 10.1038/s41746-021-00422-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
Contact tracing is increasingly used to combat COVID-19, and digital implementations are now being deployed, many based on Apple and Google's Exposure Notification System. These systems utilize non-traditional smartphone-based technology, presenting challenges in understanding possible outcomes. In this work, we create individual-based models of three Washington state counties to explore how digital exposure notifications combined with other non-pharmaceutical interventions influence COVID-19 disease spread under various adoption, compliance, and mobility scenarios. In a model with 15% participation, we found that exposure notification could reduce infections and deaths by approximately 8% and 6% and could effectively complement traditional contact tracing. We believe this can provide health authorities in Washington state and beyond with guidance on how exposure notification can complement traditional interventions to suppress the spread of COVID-19.
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Affiliation(s)
| | - Robert Hinch
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Neo Wu
- Google Research, Mountain View, CA, USA
| | | | - William Probert
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Austin Wu
- Google Research, Mountain View, CA, USA
| | | | | | | | | | | | - Anel Nurtay
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - David Bonsall
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael V McConnell
- Google Research, Mountain View, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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21
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Braunstein GD, Schwartz L, Hymel P, Fielding J. False Positive Results With SARS-CoV-2 RT-PCR Tests and How to Evaluate a RT-PCR-Positive Test for the Possibility of a False Positive Result. J Occup Environ Med 2021; 63:e159-e162. [PMID: 33405498 PMCID: PMC7934325 DOI: 10.1097/jom.0000000000002138] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Glenn D Braunstein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Jonathan Fielding
- The UCLA Fielding School of Public Health and The David Geffen School of Medicine at UCLA, Los Angeles, California
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22
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Yang S, Stanzione N, Uslan DZ, Garner OB, de St Maurice A. Clinical and Epidemiologic Evaluation of Inconclusive COVID-19 PCR Results Using a Quantitative Algorithm. Am J Clin Pathol 2021; 155:376-380. [PMID: 33274731 PMCID: PMC7799210 DOI: 10.1093/ajcp/aqaa251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives The inconclusive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result causes confusion and delay for infection prevention precautions and patient management. We aimed to develop a quantitative algorithm to assess and interpret these inconclusive results. Methods We created a score-based algorithm by combining laboratory, clinical, and epidemiologic data to evaluate 69 cases with inconclusive coronavirus disease 2019 (COVID-19) PCR results from the Centers for Disease Control and Prevention (CDC) assay (18 cases) and the TaqPath assay (51 cases). Results We determined 5 (28%) of 18 (CDC assay) and 20 (39%) of 51 (TaqPath assay) cases to be false positive. Lowering the cycle threshold cutoff from 40 to 37 in the TaqPath assay resulted in a dramatic reduction of the false-positive rate to 14%. We also showed testing of asymptomatic individuals is associated with a significantly higher probability of having a false-positive result. Conclusions A substantial percentage of inconclusive SARS-CoV-2 PCR results can be false positive, especially among asymptomatic patients. The quantitative algorithm we created was shown to be effective and could provide a useful tool for clinicians and hospital epidemiologists to interpret inconclusive COVID-19 PCR results and provide clinical guidance when additional PCR or antibody test results are available.
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Affiliation(s)
| | | | - Daniel Z Uslan
- Department of Clinical Epidemiology and Infection Prevention
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine
| | | | - Annabelle de St Maurice
- Department of Clinical Epidemiology and Infection Prevention
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California Los Angeles
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23
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Agoti CN, Mutunga M, Lambisia AW, Kimani D, Cheruiyot R, Kiyuka P, Lewa C, Gicheru E, Tendwa M, Said Mohammed K, Osoti V, Makale J, Tawa B, Odundo C, Cheruiyot W, Nyamu W, Gumbi W, Mwacharo J, Nyamako L, Otieno E, Amadi D, Thoya J, Karani A, Mugo D, Musyoki J, Gumba H, Mwarumba S, M. Gichuki B, Njuguna S, Riako D, Mutua S, Gitonga JN, Sein Y, Bartilol B, Mwangi SJ, O. Omuoyo D, M. Morobe J, de Laurent ZR, Bejon P, Ochola-Oyier LI, Tsofa B. Pooled testing conserves SARS-CoV-2 laboratory resources and improves test turn-around time: experience on the Kenyan Coast. Wellcome Open Res 2021; 5:186. [PMID: 33134555 PMCID: PMC7590893 DOI: 10.12688/wellcomeopenres.16113.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background. International recommendations for the control of the coronavirus disease 2019 (COVID-19) pandemic emphasize the central role of laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent, at scale. The availability of testing reagents, laboratory equipment and qualified staff are important bottlenecks to achieving this. Elsewhere, pooled testing (i.e. combining multiple samples in the same reaction) has been suggested to increase testing capacities in the pandemic period. Methods. We discuss our experience with SARS-CoV-2 pooled testing using real-time reverse transcription polymerase chain reaction (RT-PCR) on the Kenyan Coast. Results. In mid-May, 2020, our RT-PCR testing capacity for SARS-CoV-2 was improved by ~100% as a result of adoption of a six-sample pooled testing strategy. This was accompanied with a concomitant saving of ~50% of SARS-CoV-2 laboratory test kits at both the RNA extraction and RT-PCR stages. However, pooled testing came with a slight decline of test sensitivity. The RT-PCR cycle threshold value (ΔCt) was ~1.59 higher for samples tested in pools compared to samples tested singly. Conclusions. Pooled testing is a useful strategy to increase SARS-CoV-2 laboratory testing capacity especially in low-income settings.
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Affiliation(s)
- Charles N. Agoti
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Department of Biomedical Sciences, Pwani University, Kilifi, Kenya
| | - Martin Mutunga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Arnold W. Lambisia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Domtila Kimani
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Robinson Cheruiyot
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Patience Kiyuka
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Clement Lewa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Elijah Gicheru
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Metrine Tendwa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Khadija Said Mohammed
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Victor Osoti
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Johnstone Makale
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Brian Tawa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Calleb Odundo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Wesley Cheruiyot
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Wilfred Nyamu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Wilson Gumbi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Jedidah Mwacharo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Lydia Nyamako
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Edward Otieno
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - David Amadi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Janet Thoya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Angela Karani
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Daisy Mugo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Jennifer Musyoki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Horace Gumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Salim Mwarumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Bonface M. Gichuki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Susan Njuguna
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Debra Riako
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Shadrack Mutua
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - John N. Gitonga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Yiakon Sein
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Brian Bartilol
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Shaban J. Mwangi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Donwilliams O. Omuoyo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - John M. Morobe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Zaydah R. de Laurent
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Lynette Isabella Ochola-Oyier
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Benjamin Tsofa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
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Sicsic I, Chacon AR, Zaw M, Ascher K, Abreu A, Chediak A. A case of SARS-CoV-2 reinfection in a patient with obstructive sleep apnea managed with telemedicine. BMJ Case Rep 2021; 14:e240496. [PMID: 33526540 PMCID: PMC7852971 DOI: 10.1136/bcr-2020-240496] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 12/26/2022] Open
Abstract
The novel coronavirus (SARS-CoV-2) has produced millions of infections and deaths worldwide. It is believed that adaptive immunity to the virus occurs although with variation in its pattern and duration. While uncommon, confirmed reinfection with the novel coronavirus has been reported. Telemedicine has emerged as a viable tool for the delivery of healthcare in lieu of in-person patient contact. The variable and occasionally rapid course of clinical disease raises safety concerns of using telemedicine in the clinical management of acute infection with the novel coronavirus. We present a case of novel coronavirus infection in an immunocompetent individual with obstructive sleep apnea (OSA) who failed to manifest an adaptive immune response to acute infection and was subsequently reinfected. The case highlights the use of telemedicine in managing novel coronavirus respiratory disease and the potential role of OSA as a disease facilitator.
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Affiliation(s)
- Isabelo Sicsic
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andres R Chacon
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Moe Zaw
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kori Ascher
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexandre Abreu
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alejandro Chediak
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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25
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Younes S, Al-Jighefee H, Shurrab F, Al-Sadeq DW, Younes N, Dargham SR, Al-Dewik N, Qotba H, Syed M, Alnuaimi A, Yassine HM, Tang P, Abu-Raddad LJ, Nasrallah GK. Diagnostic Efficiency of Three Fully Automated Serology Assays and Their Correlation with a Novel Surrogate Virus Neutralization Test in Symptomatic and Asymptomatic SARS-COV-2 Individuals. Microorganisms 2021; 9:245. [PMID: 33504067 PMCID: PMC7912688 DOI: 10.3390/microorganisms9020245] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
To support the deployment of serology assays for population screening during the COVID-19 pandemic, we compared the performance of three fully automated SARS-CoV-2 IgG assays: Mindray CL-900i® (target: spike [S] and nucleocapsid [N]), BioMérieux VIDAS®3 (target: receptor-binding domain [RBD]) and Diasorin LIAISON®XL (target: S1 and S2 subunits). A total of 111 SARS-CoV-2 RT-PCR- positive samples collected at ≥ 21 days post symptom onset, and 127 pre-pandemic control samples were included. Diagnostic performance was assessed in correlation to RT-PCR and a surrogate virus-neutralizing test (sVNT). Moreover, cross-reactivity with other viral antibodies was investigated. Compared to RT-PCR, LIAISON®XL showed the highest overall specificity (100%), followed by VIDAS®3 (98.4%) and CL-900i® (95.3%). The highest sensitivity was demonstrated by CL-900i® (90.1%), followed by VIDAS®3 (88.3%) and LIAISON®XL (85.6%). The sensitivity of all assays was higher in symptomatic patients (91.1-98.2%) compared to asymptomatic patients (78.4-80.4%). In correlation to sVNT, all assays showed excellent sensitivities (92.2-96.1%). In addition, VIDAS®3 demonstrated the best correlation (r = 0.75) with the sVNT. The present study provides insights on the performance of three fully automated assays, which could help diagnostic laboratories in the choice of a particular assay according to the intended use.
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Affiliation(s)
- Salma Younes
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
| | - Hadeel Al-Jighefee
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Farah Shurrab
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
| | - Duaa W. Al-Sadeq
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
- College of Medicine, Member of QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Nadin Younes
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
| | - Soha R. Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation–Education City, Doha P.O. Box 24144, Qatar; (S.R.D.); (L.J.A.-R.)
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation–Education City, Doha, P.O. Box 24144, Qatar
| | - Nader Al-Dewik
- Clinical and Metabolic Genetics Section, Pediatrics Department, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
- Qatar Medical Genetic Center and Interim Translational Research Institute, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
- College of Health and Life Science, Hamad Bin Khalifa University, Doha P.O. Box 34110, Qatar
- Department of Pediatrics, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Hamda Qotba
- Department of Clinical Research, Primary Health Care Centers, Doha P.O. Box 26555, Qatar; (H.Q.); (M.S.); (A.A.)
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar;
| | - Mohamed Syed
- Department of Clinical Research, Primary Health Care Centers, Doha P.O. Box 26555, Qatar; (H.Q.); (M.S.); (A.A.)
| | - Ahmed Alnuaimi
- Department of Clinical Research, Primary Health Care Centers, Doha P.O. Box 26555, Qatar; (H.Q.); (M.S.); (A.A.)
| | - Hadi M. Yassine
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha P.O. Box 26999, Qatar;
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation–Education City, Doha P.O. Box 24144, Qatar; (S.R.D.); (L.J.A.-R.)
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation–Education City, Doha P.O. Box 24144, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY 10021, USA
| | - Gheyath K. Nasrallah
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar; (S.Y.); (H.A.-J.); (F.S.); (D.W.A.-S.); (N.Y.); (H.M.Y.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha P.O. Box 2713, Qatar
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26
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Roy S. Physicians' Dilemma of False-Positive RT-PCR for COVID-19: a Case Report. ACTA ACUST UNITED AC 2021; 3:255-258. [PMID: 33426468 PMCID: PMC7778390 DOI: 10.1007/s42399-020-00655-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has played havoc on this world's health and economics since its outbreak in December 2019. Reverse transcription-polymerase chain reaction (RT-PCR) has been the gold standard to diagnose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Still, few false-positive reports are emerging up that add to the physicians' dilemma and maintenance of health statistics.
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Affiliation(s)
- Sayak Roy
- Department of Internal Medicine, Medica Superspeciality Hospital, Kolkata, India
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Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: a narrative review. Eur J Clin Microbiol Infect Dis 2020; 40:13-25. [PMID: 33113040 PMCID: PMC7592450 DOI: 10.1007/s10096-020-04088-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Many studies have shown that re-positive tests for SARS-CoV-2 by RT-PCR in recovered COVID-19 patients are very common. We aim to conduct this review to summarize the clinical and epidemiological characteristics of these patients and discuss the potential explanations for recurrences, the contagiousness of re-detectable positive SARS-CoV-2 virus, and the management of COVID-19 patients after discharge from hospital. The proportion of re-positive tests in discharged COVID-19 patients varied from 2.4 to 69.2% and persisted from 1 to 38 days after discharge, depending on population size, age of patients, and type of specimens. Currently, several causes of re-positive tests for SARS-CoV-2 in recovered COVID-19 patients are suggested, including false-negative, false-positive RT-PCR tests; reactivation; and re-infection with SARS-CoV-2, but the mechanism leading to these re-positive cases is still unclear. The prevention of re-positive testing in discharged patients is a fundamental measure to control the spread of the pandemic. In order to reduce the percentage of false-negative tests prior to discharge, we recommend performing more than two tests, according to the standard sampling and microbiological assay protocol. In addition, specimens should be collected from multiple body parts if possible, to identify SARS-CoV-2 viral RNA before discharge. Further studies should be conducted to develop novel assays that target a crucial region of the RNA genome in order to improve its sensitivity and specificity.
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Cengel F, Gurkan O, Calik M, Demirkol MA, Sargin Altunok E, Kaya MF, Nacar Dogan S. Diagnosis of the coronavirus disease 2019 with chest computed tomography: A retrospective inter-observer agreement study between radiologists and clinicians. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920968648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Effective triage and early detection are very important for the control and treatment of coronavirus disease 2019. For this purpose, reverse transcription polymerase chain reaction and chest computed tomography are used in emergency departments. Objective: The aim of the study was to examine the diagnostic performance of computed tomography and to compare the inter-observer agreement among radiologists and between clinicians, in a coronavirus disease 2019 pneumonia high-prevalence area. Methods: After exclusions, 534 patients were retrospectively included in this study. Reverse transcription polymerase chain reaction was considered as gold standard for diagnosis. All computed tomography images were independently reviewed by two radiologists who were blinded to reverse transcription polymerase chain reaction results and other clinical information. Each computed tomography scan was scored in four categories as typical, intermediate, atypical, and negative, regarding coronavirus disease 2019 pneumonia according to Radiological Society of North America guideline. As for the evaluation of the diagnostic performance, typical and intermediate appearances were accepted as positive for coronavirus disease 2019. In addition, the computed tomography scans were scored by two clinicians as coronavirus disease 2019 positive and negative. Results: The study group included 534 patients after the exclusion criteria. As a result of the repeated reverse transcription polymerase chain reaction tests, 396 (74%) patients were diagnosed with coronavirus disease 2019, 138 (26%) patients had a negative result and were evaluated as a control group. When the reverse transcription polymerase chain reaction results were referenced as the gold standard; the accuracy rates of radiologists and clinicians (R1, R2, C1, and C2) in the diagnosis of coronavirus disease 2019 were 78%, 79%, 73%, and 71%, their sensitivity rates were 83%, 83%, 74%, and 75%, and the negative predictive values were 57%, 58%, 49%, and 46%, respectively. Inter-observer agreements among the reviewers ranged from good to excellent. Conclusions: Radiological Society of North America guideline related to coronavirus disease 2019 has excellent inter-observer agreement among chest radiologists. In this study, radiologists and clinicians have presented similar and good diagnostic performances in the evaluation of coronavirus disease 2019–suspected patients with chest computed tomography in high-epidemic area.
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Affiliation(s)
- Ferhat Cengel
- Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Okan Gurkan
- Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Calik
- Department of Emergency Medicine, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Asim Demirkol
- Department of Respiratory Diseases, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Elif Sargin Altunok
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Fatih Kaya
- Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Sebahat Nacar Dogan
- Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
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Affiliation(s)
- Michael Goggin
- University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Brendan Vote
- University of Tasmania, Hobart, Tasmania, Australia
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30
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Falasca F, Sciandra I, Di Carlo D, Gentile M, Deales A, Antonelli G, Turriziani O. Detection of SARS-COV N2 Gene: Very low amounts of viral RNA or false positive? J Clin Virol 2020; 133:104660. [PMID: 33126109 PMCID: PMC7553900 DOI: 10.1016/j.jcv.2020.104660] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The detection of a low amount of viral RNA is crucial to identify a SARS-CoV-2 positive individual harboring a low level of virus, especially during the convalescent period. However, the detection of one gene at high Cycle threshold (Ct) has to be interpreted with caution. In this study we address this specific issue and report our real-life experience. STUDY DESIGN A total of 1639 nasopharyngeal swabs (NPS) were analyzed with Xpert® Xpress SARS-CoV-2. Positive samples showing high Ct values (Ct>35) were concentrated by centrifugation and re-tested with Cepheid or other methods (RealStar SARS-CoV2 RT-PCR, Altona Diagnostics; GeneFinder COVID-19 Plus RealAmp Kit, Elitech). RESULTS 1599 (97.5%) negative samples, 36 (2.3%) positive samples and 4 (0.2%) presumptive positive samples were detected. In 17 out of 36 positive patients, very low viral RNA copies were suspected since positivity was detected at high Ct. We confirmed positivity for patients who showed both E and N genes detected and for patients with only N detected but with Ct <39. On the contrary, samples with only gene N detected with Ct values >39 were found negative. NPS taken 24 hours after the first collection confirmed the negativity of the 12 samples. Clinical data sustained these results since only 2 of these 12 patients showed COVID-19-like symptoms. CONCLUSIONS These data support our consideration that detection of the N2 gene at high Ct needs to be interpreted with caution, suggesting that collaboration between virologists and clinicians is important for better understanding of results.
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Affiliation(s)
| | - Ilaria Sciandra
- Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Daniele Di Carlo
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Massimo Gentile
- Department of Molecular Medicine, Sapienza University, Rome, Italy; Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Alberto Deales
- Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University, Rome, Italy; Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Ombretta Turriziani
- Department of Molecular Medicine, Sapienza University, Rome, Italy; Sapienza University Hospital "Policlinico Umberto I", Rome, Italy.
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31
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Hueston L, Kok J, Guibone A, McDonald D, Hone G, Goodwin J, Carter I, Basile K, Sandaradura I, Maddocks S, Sintchenko V, Gilroy N, Chen S, Dwyer DE, O’Sullivan MVN. The Antibody Response to SARS-CoV-2 Infection. Open Forum Infect Dis 2020; 7:ofaa387. [PMID: 32989419 PMCID: PMC7499696 DOI: 10.1093/ofid/ofaa387] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/22/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies has become an important tool, complementing nucleic acid tests (NATs) for diagnosis and for determining the prevalence of coronavirus disease 2019 (COVID-19) in population serosurveys. The magnitude and persistence of antibody responses are critical for assessing the duration of immunity. METHODS A SARS-CoV-2-specific immunofluorescent antibody (IFA) assay for immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) was developed and prospectively evaluated by comparison to the reference standard of NAT on respiratory tract samples from individuals with suspected COVID-19. Neutralizing antibody responses were measured in a subset of samples using a standard microneutralization assay. RESULTS A total of 2753 individuals were eligible for the study (126 NAT-positive; prevalence, 4.6%). The median "window period" from illness onset to appearance of antibodies (range) was 10.2 (5.8-14.4) days. The sensitivity and specificity of either SARS-CoV-2 IgG, IgA, or IgM when collected ≥14 days after symptom onset were 91.3% (95% CI, 84.9%-95.6%) and 98.9% (95% CI, 98.4%-99.3%), respectively. The negative predictive value was 99.6% (95% CI, 99.3%-99.8%). The positive predictive value of detecting any antibody class was 79.9% (95% CI, 73.3%-85.1%); this increased to 96.8% (95% CI, 90.7%-99.0%) for the combination of IgG and IgA. CONCLUSIONS Measurement of SARS-CoV-2-specific antibody by IFA is an accurate method to diagnose COVID-19. Serological testing should be incorporated into diagnostic algorithms for SARS-CoV-2 infection to identify additional cases where NAT was not performed and resolve cases where false-negative and false-positive NATs are suspected. The majority of individuals develop robust antibody responses following infection, but the duration of these responses and implications for immunity remain to be established.
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Affiliation(s)
- Linda Hueston
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - Jen Kok
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - Ayla Guibone
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - Damien McDonald
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - George Hone
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - James Goodwin
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - Ian Carter
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - Kerri Basile
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
| | - Indy Sandaradura
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
- Department of Infectious Diseases, Westmead Hospital, Westmead, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Susan Maddocks
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
- Department of Infectious Diseases, Westmead Hospital, Westmead, Australia
| | - Vitali Sintchenko
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Nicole Gilroy
- Department of Infectious Diseases, Westmead Hospital, Westmead, Australia
| | - Sharon Chen
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Dominic E Dwyer
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Matthew V N O’Sullivan
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead, Australia
- Department of Infectious Diseases, Westmead Hospital, Westmead, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
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Agoti CN, Mutunga M, Lambisia AW, Kimani D, Cheruiyot R, Kiyuka P, Lewa C, Gicheru E, Tendwa M, Said Mohammed K, Osoti V, Makale J, Tawa B, Odundo C, Cheruiyot W, Nyamu W, Gumbi W, Mwacharo J, Nyamako L, Otieno E, Amadi D, Thoya J, Karani A, Mugo D, Musyoki J, Gumba H, Mwarumba S, M. Gichuki B, Njuguna S, Riako D, Mutua S, Gitonga JN, Sein Y, Bartilol B, Mwangi SJ, O. Omuoyo D, M. Morobe J, de Laurent ZR, Bejon P, Ochola-Oyier LI, Tsofa B. Pooled testing conserves SARS-CoV-2 laboratory resources and improves test turn-around time: experience on the Kenyan Coast. Wellcome Open Res 2020; 5:186. [PMID: 33134555 PMCID: PMC7590893 DOI: 10.12688/wellcomeopenres.16113.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Background. International recommendations for the control of the coronavirus disease 2019 (COVID-19) pandemic emphasize the central role of laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent, at scale. The availability of testing reagents, laboratory equipment and qualified staff are important bottlenecks to achieving this. Elsewhere, pooled testing (i.e. combining multiple samples in the same reaction) has been suggested to increase testing capacities in the pandemic period. Methods. We discuss our experience with SARS-CoV-2 pooled testing using real-time reverse transcription polymerase chain reaction (RT-PCR) on the Kenyan Coast. Results. In mid-May, 2020, our RT-PCR testing capacity for SARS-CoV-2 was improved by ~100% as a result of adoption of a six-sample pooled testing strategy. This was accompanied with a concomitant saving of ~50% of SARS-CoV-2 laboratory test kits at both the RNA extraction and RT-PCR stages. However, pooled testing came with a slight decline of test sensitivity. The RT-PCR cycle threshold value (ΔCt) was ~1.59 higher for samples tested in pools compared to samples tested singly. Conclusions. Pooled testing is a useful strategy to increase SARS-CoV-2 laboratory testing capacity especially in low-income settings.
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Affiliation(s)
- Charles N. Agoti
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Department of Biomedical Sciences, Pwani University, Kilifi, Kenya
| | - Martin Mutunga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Arnold W. Lambisia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Domtila Kimani
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Robinson Cheruiyot
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Patience Kiyuka
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Clement Lewa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Elijah Gicheru
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Metrine Tendwa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Khadija Said Mohammed
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Victor Osoti
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Johnstone Makale
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Brian Tawa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Calleb Odundo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Wesley Cheruiyot
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Wilfred Nyamu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Wilson Gumbi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Jedidah Mwacharo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Lydia Nyamako
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Edward Otieno
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - David Amadi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Janet Thoya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Angela Karani
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Daisy Mugo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Jennifer Musyoki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Horace Gumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Salim Mwarumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Bonface M. Gichuki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Susan Njuguna
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Debra Riako
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Shadrack Mutua
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - John N. Gitonga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Yiakon Sein
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Brian Bartilol
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Shaban J. Mwangi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Donwilliams O. Omuoyo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - John M. Morobe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Zaydah R. de Laurent
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Lynette Isabella Ochola-Oyier
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Benjamin Tsofa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
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Katz AP, Civantos FJ, Sargi Z, Leibowitz JM, Nicolli EA, Weed D, Moskovitz AE, Civantos AM, Andrews DM, Martinez O, Thomas GR. False-positive reverse transcriptase polymerase chain reaction screening for SARS-CoV-2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications. Head Neck 2020; 42:1621-1628. [PMID: 32530131 PMCID: PMC7307014 DOI: 10.1002/hed.26317] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT‐PCR) for novel coronavirus in preoperative screening. Methods Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated. Results Forty‐three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT‐PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT‐PCR, clear chest imaging, and lack of subsequent symptoms represent the “gold standard,” RT‐PCR specificity was 0.97. Conclusions If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT‐PCR. Validated serum immunoglobulin testing may ultimately prove useful.
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Affiliation(s)
- Andrew P Katz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco J Civantos
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jason M Leibowitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth A Nicolli
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Alexander E Moskovitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alyssa M Civantos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Andrews
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Octavio Martinez
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovana R Thomas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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