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Alsayed AR, Ahmed SI, AL Shweiki AO, Al-Shajlawi M, Hakooz N. The laboratory parameters in predicting the severity and death of COVID-19 patients: Future pandemic readiness strategies. BIOMOLECULES & BIOMEDICINE 2024; 24:238-255. [PMID: 37712883 PMCID: PMC10950347 DOI: 10.17305/bb.2023.9540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/16/2023]
Abstract
The range of clinical manifestations associated with the infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) encompasses a broad spectrum, ranging from flu-like symptoms to the occurrence of multiple organ failure and death. The severity of the coronavirus disease 2019 (COVID-19) is categorized based on clinical presentation and is divided into three distinct levels of severity identified as non-severe, severe, and critical. Although individuals of all age groups are susceptible to SARS-CoV-2 infection, middle-aged and older adults are more frequently impacted, with the latter being more likely to develop severe illness. Various laboratory characteristics observed in hospitalized COVID-19 patients have been correlated with adverse outcomes. These include elevated levels of D-dimer, liver enzymes, lactate dehydrogenase, C-reactive protein, ferritin, prothrombin time, and troponin, as well as decreased lymphocyte and platelets counts. This review investigated the relationship between baseline clinical characteristics, initial laboratory parameters upon hospital admission, and the severity of illness and mortality rates among COVID-19 patients. Although the COVID-19 pandemic has concluded, understanding the laboratory predictors of virus severity and mortality remains crucial, and examining these predictors can have long-term effects. Such insights can help healthcare systems manage resources more effectively and deliver timely and appropriate care by identifying and targeting high-risk individuals. This knowledge can also help us better prepare for future pandemics. By examining these predictors, we can take steps to protect public health and mitigate the impact of future pandemics.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Syed Imran Ahmed
- College of Health and Science, School of Pharmacy, University of Lincoln, Lincoln, United Kingdom
| | - Anas Osama AL Shweiki
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Mustafa Al-Shajlawi
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Nancy Hakooz
- School of Pharmacy, The University of Jordan, Amman, Jordan
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2
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Hayden MK, Hanson KE, Englund JA, Lee MJ, Loeb M, Lee F, Morgan DJ, Patel R, El Mikati IK, Iqneibi S, Alabed F, Amarin JZ, Mansour R, Patel P, Falck-Ytter Y, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of Coronavirus Disease 2019 (COVID-19): Molecular Diagnostic Testing. Clin Infect Dis 2023:ciad646. [PMID: 38112284 DOI: 10.1093/cid/ciad646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Indexed: 12/21/2023] Open
Abstract
Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.
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Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robin Patel
- Division of Clinical Microbiology and Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shahad Iqneibi
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Farouk Alabed
- School of Medicine, The University of Kansas, Kansas City, Kansas, USA
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Adarsh Bhimraj
- Houston Methodist Hospital, Center of Excellence for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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3
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Heyne TF, Negishi K, Choi DS, Al Saud AA, Marinacci LX, Smithedajkul PY, Devaraj LR, Little BP, Mendoza DP, Flores EJ, Petranovic M, Toal SP, Shokoohi H, Liteplo AS, Geisler BP. Handheld Lung Ultrasound to Detect COVID-19 Pneumonia in Inpatients: A Prospective Cohort Study. POCUS JOURNAL 2023; 8:175-183. [PMID: 38099168 PMCID: PMC10721309 DOI: 10.24908/pocus.v8i2.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background: Chest imaging, including chest X-ray (CXR) and computed tomography (CT), can be a helpful adjunct to nucleic acid test (NAT) in the diagnosis and management of Coronavirus Disease 2019 (COVID-19). Lung point of care ultrasound (POCUS), particularly with handheld devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19 pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19 pneumonia. Purpose: To assess the diagnostic performance of a standardized lung POCUS protocol using a handheld POCUS device to detect patients with either a positive NAT or a COVID-19-typical pattern on CT scan. Methods: Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol. Patients were divided into low, intermediate, and high suspicion based on their POCUS score. Results: Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively. Conclusions: The proposed lung POCUS protocol with a handheld device showed reasonable diagnostic performance to detect inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-resource settings, POCUS with handheld devices may serve as a helpful adjunct for persons under investigation for COVID-19 pneumonia.
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Affiliation(s)
- Thomas F Heyne
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Department of Pediatrics, Massachusetts General HospitalBoston, MAUSA
| | - Kay Negishi
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Daniel S Choi
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Ahad A Al Saud
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
- Department of Emergency Medicine, King Saud University College of MedicineRiyadhSaudi Arabia
| | - Lucas X Marinacci
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical CenterBoston, MAUSA
| | | | - Lily R Devaraj
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Department of Pediatrics, Massachusetts General HospitalBoston, MAUSA
| | - Brent P Little
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Dexter P Mendoza
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Efren J Flores
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Steven P Toal
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Benjamin P Geisler
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian UniversityMunichGermany
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Callahan A, Ashley E, Datta S, Desai P, Ferris TA, Fries JA, Halaas M, Langlotz CP, Mackey S, Posada JD, Pfeffer MA, Shah NH. The Stanford Medicine data science ecosystem for clinical and translational research. JAMIA Open 2023; 6:ooad054. [PMID: 37545984 PMCID: PMC10397535 DOI: 10.1093/jamiaopen/ooad054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To describe the infrastructure, tools, and services developed at Stanford Medicine to maintain its data science ecosystem and research patient data repository for clinical and translational research. Materials and Methods The data science ecosystem, dubbed the Stanford Data Science Resources (SDSR), includes infrastructure and tools to create, search, retrieve, and analyze patient data, as well as services for data deidentification, linkage, and processing to extract high-value information from healthcare IT systems. Data are made available via self-service and concierge access, on HIPAA compliant secure computing infrastructure supported by in-depth user training. Results The Stanford Medicine Research Data Repository (STARR) functions as the SDSR data integration point, and includes electronic medical records, clinical images, text, bedside monitoring data and HL7 messages. SDSR tools include tools for electronic phenotyping, cohort building, and a search engine for patient timelines. The SDSR supports patient data collection, reproducible research, and teaching using healthcare data, and facilitates industry collaborations and large-scale observational studies. Discussion Research patient data repositories and their underlying data science infrastructure are essential to realizing a learning health system and advancing the mission of academic medical centers. Challenges to maintaining the SDSR include ensuring sufficient financial support while providing researchers and clinicians with maximal access to data and digital infrastructure, balancing tool development with user training, and supporting the diverse needs of users. Conclusion Our experience maintaining the SDSR offers a case study for academic medical centers developing data science and research informatics infrastructure.
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Affiliation(s)
- Alison Callahan
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Euan Ashley
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
- Department of Genetics, School of Medicine, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, USA
| | - Somalee Datta
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Priyamvada Desai
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Todd A Ferris
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Jason A Fries
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Michael Halaas
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Curtis P Langlotz
- Department of Radiology, School of Medicine, Stanford University, Stanford, California, USA
| | - Sean Mackey
- Department of Anesthesia, School of Medicine, Stanford University, Stanford, California, USA
| | - José D Posada
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Michael A Pfeffer
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, USA
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5
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Abstract
The continued emergence of SARS-CoV-2 variants is one of several factors that may cause false-negative viral PCR test results. Such tests are also susceptible to false-positive results due to trace contamination from high viral titer samples. Host immune response markers provide an orthogonal indication of infection that can mitigate these concerns when combined with direct viral detection. Here, we leverage nasopharyngeal swab RNA-seq data from patients with COVID-19, other viral acute respiratory illnesses, and nonviral conditions (n = 318) to develop support vector machine classifiers that rely on a parsimonious 2-gene host signature to diagnose COVID-19. We find that optimal classifiers include an interferon-stimulated gene that is strongly induced in COVID-19 compared with nonviral conditions, such as IFI6, and a second immune-response gene that is more strongly induced in other viral infections, such as GBP5. The IFI6+GBP5 classifier achieves an area under the receiver operating characteristic curve (AUC) greater than 0.9 when evaluated on an independent RNA-seq cohort (n = 553). We further provide proof-of-concept demonstration that the classifier can be implemented in a clinically relevant RT-qPCR assay. Finally, we show that its performance is robust across common SARS-CoV-2 variants and is unaffected by cross-contamination, demonstrating its utility for improved accuracy of COVID-19 diagnostics. IMPORTANCE In this work, we study upper respiratory tract gene expression to develop and validate a 2-gene host-based COVID-19 diagnostic classifier and then demonstrate its implementation in a clinically practical qPCR assay. We find that the host classifier has utility for mitigating false-negative results, for example due to SARS-CoV-2 variants harboring mutations at primer target sites, and for mitigating false-positive viral PCR results due to laboratory cross-contamination. Both types of error carry serious consequences of either unrecognized viral transmission or unnecessary isolation and contact tracing. This work is directly relevant to the ongoing COVID-19 pandemic given the continued emergence of viral variants and the continued challenges of false-positive PCR assays. It also suggests the feasibility of pan-respiratory virus host-based diagnostics that would have value in congregate settings, such as hospitals and nursing homes, where unrecognized respiratory viral transmission is of particular concern.
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6
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Linton NM, Akhmetzhanov AR, Nishiura H. Correlation between times to SARS-CoV-2 symptom onset and secondary transmission undermines epidemic control efforts. Epidemics 2022; 41:100655. [PMID: 36413921 PMCID: PMC9661582 DOI: 10.1016/j.epidem.2022.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/12/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) infections have been associated with substantial presymptomatic transmission, which occurs when the generation interval-the time between infection of an individual with a pathogen and transmission of the pathogen to another individual-is shorter than the incubation period-the time between infection and symptom onset. We collected a dataset of 257 SARS-CoV-2 transmission pairs in Japan during 2020 and jointly estimated the mean incubation period of infectors (4.8 days, 95 % CrI: 4.4-5.1 days), mean generation interval to when they infect others (4.3 days, 95 % credible interval [CrI]: 4.0-4.7 days), and the correlation (Kendall's tau: 0.5, 95 % CrI: 0.4-0.6) between these two epidemiological parameters. Our finding of a positive correlation and mean generation interval shorter than the mean infector incubation period indicates ample infectiousness before symptom onset and suggests that reliance on isolation of symptomatic COVID-19 cases as a focal point of control efforts is insufficient to address the challenges posed by SARS-CoV-2 transmission dynamics.
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Affiliation(s)
- Natalie M. Linton
- Kyoto University School of Public Health, Yoshidakonoe-cho, Sakyo-ku, Kyoto city, 606-8501, Japan,Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
| | - Andrei R. Akhmetzhanov
- College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 10055, Taiwan
| | - Hiroshi Nishiura
- Kyoto University School of Public Health, Yoshidakonoe-cho, Sakyo-ku, Kyoto city, 606-8501, Japan,Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency, Saitama, Japan,Corresponding author at: Kyoto University School of Public Health, Yoshidakonoe-cho, Sakyo-ku, Kyoto city, 606-8501, Japan
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7
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Fistera D, Hoelscher T, Pabst D, Manegold R, Anastasiou OE, Dolff S, Kill C, Risse J. Evaluation of a new COVID-19 triage algorithm in the emergency department including combined antigen and PCR-testing: A case-control study. Medicine (Baltimore) 2022; 101:e31278. [PMID: 36281158 PMCID: PMC9592145 DOI: 10.1097/md.0000000000031278] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a major challenge for global healthcare systems. Early and safe triage in the emergency department (ED) is crucial for proper therapy. However, differential diagnosis remains challenging. Rapid antigen testing (RAT) may help to improve early triage and patient safety. We performed a retrospective study of 234 consecutive patients with suspected COVID-19 who presented to our ED in November 2020. All underwent SARS-CoV-2-nasopharyngeal swab testing using both RAT and reverse transcription polymerase chain reaction (RT-PCR). The inpatient treatment was established according to an empirically developed triage algorithm. The accuracy of the suggested algorithm was analyzed based on the rate of outpatients returning within 7 days and inpatients staying for less than 48 hours. COVID-19 inpatients and outpatients were compared for symptoms, vital signs, and C-reactive protein levels. Of the 221 included patients with suspected COVID-19 infection, the diagnosis could be confirmed in 120 patients (54.3%) by a positive RT-PCR result, whereas only 72% of those had a positive antigen test. Of the 56 COVID-19 outpatients, three returned within 7 days with the need for hospital treatment due to clinical deterioration. Among the 64 COVID-19 inpatients, 4 were discharged within 48 hours, whereas 60 stayed longer (mean duration 10.2 days). The suggested triage algorithm was safe and efficient in the first 234 consecutive patients. RAT can confirm a diagnosis in 72% of PCR proven COVID-19 patients and allows early cohort isolation as an important way to save hospital capacity.
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Affiliation(s)
- David Fistera
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
- * Correspondence: David Fistera, Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany (e-mail: )
| | - Tobias Hoelscher
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Dirk Pabst
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Randi Manegold
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Olympia E. Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- University Hospital Essen, Department of Infectious Diseases, West German Center of Infectious Diseases, University Duisburg-Essen, Essen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Essen, Germany
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8
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Breve FA. COVID-19 detection on Chest X-ray images: A comparison of CNN architectures and ensembles. EXPERT SYSTEMS WITH APPLICATIONS 2022; 204:117549. [PMID: 35615621 PMCID: PMC9122742 DOI: 10.1016/j.eswa.2022.117549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 06/01/2023]
Abstract
COVID-19 quickly became a global pandemic after only four months of its first detection. It is crucial to detect this disease as soon as possible to decrease its spread. The use of chest X-ray (CXR) images became an effective screening strategy, complementary to the reverse transcription-polymerase chain reaction (RT-PCR). Convolutional neural networks (CNNs) are often used for automatic image classification and they can be very useful in CXR diagnostics. In this paper, 21 different CNN architectures are tested and compared in the task of identifying COVID-19 in CXR images. They were applied to the COVIDx8B dataset, a large COVID-19 dataset with 16,352 CXR images coming from patients of at least 51 countries. Ensembles of CNNs were also employed and they showed better efficacy than individual instances. The best individual CNN instance results were achieved by DenseNet169, with an accuracy of 98.15% and an F1 score of 98.12%. These were further increased to 99.25% and 99.24%, respectively, through an ensemble with five instances of DenseNet169. These results are higher than those obtained in recent works using the same dataset.
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Affiliation(s)
- Fabricio Aparecido Breve
- Institute of Geosciences and Exact Sciences, São Paulo State University (UNESP) Júlio de Mesquita Filho, Rio Claro, SP, 13506-900, Brazil
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9
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Hilty MP, Favaron E, Wendel Garcia PD, Ahiska Y, Uz Z, Akin S, Flick M, Arbous S, Hofmaenner DA, Saugel B, Endeman H, Schuepbach RA, Ince C. Microcirculatory alterations in critically ill COVID-19 patients analyzed using artificial intelligence. Crit Care 2022; 26:311. [PMID: 36242010 PMCID: PMC9568900 DOI: 10.1186/s13054-022-04190-y] [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: 05/13/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sublingual microcirculation presumably exhibits disease-specific changes in function and morphology. Algorithm-based quantification of functional microcirculatory hemodynamic variables in handheld vital microscopy (HVM) has recently allowed identification of hemodynamic alterations in the microcirculation associated with COVID-19. In the present study we hypothesized that supervised deep machine learning could be used to identify previously unknown microcirculatory alterations, and combination with algorithmically quantified functional variables increases the model's performance to differentiate critically ill COVID-19 patients from healthy volunteers. METHODS Four international, multi-central cohorts of critically ill COVID-19 patients and healthy volunteers (n = 59/n = 40) were used for neuronal network training and internal validation, alongside quantification of functional microcirculatory hemodynamic variables. Independent verification of the models was performed in a second cohort (n = 25/n = 33). RESULTS Six thousand ninety-two image sequences in 157 individuals were included. Bootstrapped internal validation yielded AUROC(CI) for detection of COVID-19 status of 0.75 (0.69-0.79), 0.74 (0.69-0.79) and 0.84 (0.80-0.89) for the algorithm-based, deep learning-based and combined models. Individual model performance in external validation was 0.73 (0.71-0.76) and 0.61 (0.58-0.63). Combined neuronal network and algorithm-based identification yielded the highest externally validated AUROC of 0.75 (0.73-0.78) (P < 0.0001 versus internal validation and individual models). CONCLUSIONS We successfully trained a deep learning-based model to differentiate critically ill COVID-19 patients from heathy volunteers in sublingual HVM image sequences. Internally validated, deep learning was superior to the algorithmic approach. However, combining the deep learning method with an algorithm-based approach to quantify the functional state of the microcirculation markedly increased the sensitivity and specificity as compared to either approach alone, and enabled successful external validation of the identification of the presence of microcirculatory alterations associated with COVID-19 status.
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Affiliation(s)
- Matthias Peter Hilty
- grid.412004.30000 0004 0478 9977Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland ,grid.5645.2000000040459992XDepartment of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Emanuele Favaron
- grid.5645.2000000040459992XDepartment of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pedro David Wendel Garcia
- grid.412004.30000 0004 0478 9977Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | | | - Zuhre Uz
- grid.10419.3d0000000089452978Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sakir Akin
- grid.413591.b0000 0004 0568 6689Department of Intensive Care, Haga Hospital, The Hague, The Netherlands
| | - Moritz Flick
- grid.13648.380000 0001 2180 3484Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sesmu Arbous
- grid.10419.3d0000000089452978Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel A. Hofmaenner
- grid.412004.30000 0004 0478 9977Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bernd Saugel
- grid.13648.380000 0001 2180 3484Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Endeman
- grid.5645.2000000040459992XDepartment of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Reto Andreas Schuepbach
- grid.412004.30000 0004 0478 9977Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Can Ince
- grid.5645.2000000040459992XDepartment of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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10
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Atluri VL, Stalter RM, McGuffin SA, Johnson L, Healy B, Benesch HA, Lan K, Marsland P, Pottinger P, Patel RC. Patient characteristics associated with conversion from negative to positive severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test results: Implications for clinical false-negativity from a single-center: A case-control study. J Med Virol 2022; 94:4792-4802. [PMID: 35698816 PMCID: PMC9350093 DOI: 10.1002/jmv.27932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Accurate diagnosis of coronavirus disease 2019 is essential to limiting transmission within healthcare settings. The aim of this study was to identify patient demographic and clinical characteristics that could impact the clinical sensitivity of the nasopharyngeal severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) reverse transcription polymerase chain reaction (RT-PCR) test. METHODS We conducted a retrospective, matched case-control study of patients who underwent repeated nasopharyngeal SARS-CoV2 RT-PCR testing at a tertiary care academic medical center between March 1 and July 23, 2020. The primary endpoint was conversion from negative to positive PCR status within 14 days. We conducted conditional logistic regression modeling to assess the associations between demographic and clinical features and conversion to test positivity. RESULTS Of 51,116 patients with conclusive SARS-CoV2 nasopharyngeal RT-PCR results, 97 patients converted from negative to positive within 14 days. We matched those patients 1:2 to 194 controls by initial test date. In multivariate analysis, clinical suspicion for a respiratory infection (adjusted odds ratio [aOR] 20.9, 95% confidence interval [CI]: 3.1-141.2) and lack of pulmonary imaging (aOR 4.7, 95% CI: 1.03-21.8) were associated with conversion, while a lower burden of comorbidities trended toward an increased odds of conversion (aOR 2.2, 95% CI: 0.9-5.3). CONCLUSIONS Symptoms consistent with a respiratory infection, especially in relatively healthy individuals, should raise concerns about a clinical false-negative result. We have identified several characteristics that should be considered when creating institutional infection prevention guidelines in the absence of more definitive data and should be included in future studies.
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Affiliation(s)
- Vidya L. Atluri
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineVeterans Affairs Central California Healthcare SystemFresnoCaliforniaUSA
| | - Randy M. Stalter
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | | | - Luke Johnson
- School of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Bailey Healy
- School of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Kristine Lan
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Paula Marsland
- School of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Paul Pottinger
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Rena C. Patel
- Departments of Medicine and Global HealthUniversity of WashingtonSeattleWashingtonUSA
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11
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So MK, Chung HS, Lee DH, Lee M. How Significant Are Xpert Xpress SARS-CoV-2 Test Findings When Only an N2 Gene Is Detected? Diagnostics (Basel) 2022; 12:diagnostics12092133. [PMID: 36140534 PMCID: PMC9498257 DOI: 10.3390/diagnostics12092133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
The rapid identification of patients infected with COVID-19 during the SARS-CoV-2 pandemic is critical to operating emergency rooms effectively. Xpert Xpress SARS-CoV-2 (Xpert) assays are increasingly being used in the rapid screening of COVID-19. We evaluated the clinical performance of Xpert by comparing findings with those of qRT-PCR evaluations and included the clinical features of patients visiting the emergency department. Positive results with Xpert testing (n = 370) were compared with qRT-PCR findings, demonstrating a 91.9% intertest agreement. We reviewed the subsequent COVID-19 test results and SARS-CoV-2 infection histories for individuals showing discrepancies in Xpert and qRT-PCR testing and determined whether the findings were true-positive or false-positive. The true-positive rate for Xpert testing was 95.4% (353/370); the remaining 17 samples (4.6%) were false-positive. All false-positive data for Xpert testing showed N2 signals amplified to Ct values of ≥40 with no E gene signals. Rapid Xpert testing is highly sensitive and shows a good performance overall in challenging situations, such as an emergency room. However, we considered the possibility of false-positive Xpert results given an N2 gene signal only, especially given high Ct values. We recommend interpreting test data with caution and considering retesting over time.
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Affiliation(s)
- Min-Kyung So
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul 07985, Korea
| | - Hae-Sun Chung
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul 07985, Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul 07985, Korea
| | - Miae Lee
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul 07985, Korea
- Correspondence: ; Tel.: +82-2-2650-5222
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12
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Li J, Frenette C, Loo VG. Diagnostic yield of serial SARS-CoV-2 testing in hospitalized patients. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:181-185. [PMID: 36337610 PMCID: PMC9629723 DOI: 10.3138/jammi-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The detection rate of SARS-CoV-2 by polymerase chain reaction (PCR) varies depending on the time since exposure and is highest around the time of symptom onset. It is conceivable that patients who are incubating SARS-CoV-2 may screen negative at admission and develop transmissible but undetected asymptomatic or pre-symptomatic disease while in hospital. The incidence of COVID-19 in Montreal, Canada started to increase in December 2020. In anticipation of a much larger rise after the holiday period, the McGill University Health Centre implemented serial SARS-CoV-2 testing for all admitted patients on day 5 and 10 after admission, to evaluate the clinical utility of serial SARS-CoV-2 testing among patients who test negative on admission screening. METHODS We retrospectively analyzed the diagnostic yield of SARS-CoV-2 serial testing for patients admitted between January 4, 2021 and April 30, 2021. RESULTS A total of 1,505 patients underwent serial testing at day 5 and 841 patients underwent serial testing at day 10. Only 10 patients were positive on serial testing at day 5 and only 12 patients were positive on serial testing at day 10, for a yield at day 5 and day 10 of 0.7% and 1.4%, respectively. CONCLUSIONS The yield of serial SARS-CoV-2 testing was 0.7% at day 5 and 1.4% at day 10. We found that the yield of serial testing was higher when the community incidence was higher and could be considered in this situation. Policies which target repeat testing towards symptomatic or exposed individuals appear to be effective in identifying those with a positive test while admitted but testing negative upon admission.
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Affiliation(s)
- Jeremy Li
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Charles Frenette
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Vivian G Loo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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13
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Park S, Hong D, Gatchalian KK, Oh HY. Follow-up COVID-19 PCR result up to day 5 with clinical features predicts positivity for inconclusive results. JOURNAL OF CLINICAL VIROLOGY PLUS 2022; 2:100100. [PMID: 35909945 PMCID: PMC9308491 DOI: 10.1016/j.jcvp.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/10/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction False-positive inconclusive polymerase chain reaction (PCR) results against severe acute respiratory syndrome coronavirus 2 were not low and have potentially harmful effects. We aimed to find parameters to differentiate positive cases from false-positive ones, and suggest an optimal scheme and follow-up period for inconclusive results. Methods Cases with inconclusive PCR tests among healthcare personnel from February 2020 to June 2021 were classified as confirmed positive, clinically positive, and clinically negative groups, which were compared. The diagnostic accuracy of follow-up tests and composites of clinical and laboratory data were analyzed. Results Symptoms, contact history, and lower cycle threshold of the N gene were more common in the COVID-19 positive group. The scoring schemes combining symptom and contact history with follow-up PCR results had higher sensitivities than the PCR tests only modality. Follow-up tests up to 5 days combined with symptoms and contact history could discriminate between positive and negative cases. Conclusion A follow-up PCR test up to day 5 with clinical features might predict positivity and shorten the quarantine period in most healthcare personnel.
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14
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Kobayashi R, Suzuki E, Murai R, Tanaka M, Fujiya Y, Takahashi S. Performance analysis among multiple fully automated anti-SARS-CoV-2 antibody measurement reagents: A potential indicator for the correlation of protection in the antibody titer. J Infect Chemother 2022; 28:1295-1303. [PMID: 35667939 PMCID: PMC9149151 DOI: 10.1016/j.jiac.2022.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
Background To evaluate the performance of various reagents in automated analyzers for antibody detection against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods Using 100 serum samples from 100 individual patients diagnosed with SARS-CoV-2 infection, the precision, linearity, determination agreement, and correlation of five qualitative reagents (Elecsys Anti-SARS-CoV-2, ARCHITECT SARS-CoV-2 IgG, ARCHITECT SARS-CoV-2 IgM, Access SARS-CoV-2 IgM, and SARS-CoV-2 IgM) and four quantitative reagents (Elecsys Anti-SARS-CoV-2 S, ARCHITECT SARS-CoV-2 IgG II, Access SARS-CoV-2 IgG 1st IS, and SARS-COV-2 IgG S) were analyzed. A surrogate virus-neutralizing test (sVNT) kit was used to evaluate the measurement value of each quantitative reagent corresponding to the amount of neutralizing antibody, similar to that of patients in the late stage of infection. Results Precision and linearity were found to be sufficient for clinical use. Five discrepant samples were observed in the positive and negative judgments of the qualitative reagents for IgG, and one discrepant sample was observed in the qualitative reagent for IgM. Although the measurement values of the quantitative reagents were different, they were correlated with each reagent. The reference values inferred from the sVNT were Elecsys Anti-SARS-CoV-2: 71.8 U/L, ARCHITECT SARS-CoV-2 IgGⅡ: 2976.3 AU/mL, Access SARS-CoV-2 IgG 1st IS: 689.6 IU/mL, and SARS-CoV-2 IgG S: 19.3 U/L. Conclusions The performance observed for each anti-SARS-CoV-2 antibody detection reagent was sufficient. The reference values based on the inhibition rate of sVNT have potential as indicators of the correlation of protection and are expected to be leveraged in automated antibody tests.
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Affiliation(s)
- Ryo Kobayashi
- Division of Laboratory Medicine, Sapporo Medical University Hospital, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ema Suzuki
- Division of Laboratory Medicine, Sapporo Medical University Hospital, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryosei Murai
- Division of Laboratory Medicine, Sapporo Medical University Hospital, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Makito Tanaka
- Division of Laboratory Medicine, Sapporo Medical University Hospital, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Yoshihiro Fujiya
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Satoshi Takahashi
- Division of Laboratory Medicine, Sapporo Medical University Hospital, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan; Division of Infection Control, Sapporo Medical University Hospital, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, 060-8543, Japan.
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15
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc Res 2022; 118:1385-1412. [PMID: 34864874 PMCID: PMC8690255 DOI: 10.1093/cvr/cvab342] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Affiliation(s)
- Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Hospital Clínic
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- ECGen, the Cardiogenetics Focus Group of EHRA
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
- Yale University School of Medicine, New Haven, CT, USA
| | - Elijah R Behr
- ECGen, the Cardiogenetics Focus Group of EHRA
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Sergio Berti
- U.O.C. Cardiologia Diagnostica e Interventistica, Dipartimento Cardiotoracico, Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS Gruppo MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION study group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France
- INSERM, UMR1062, Nutrition, Obesity and Risk of Thrombosis, Marseille, France
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Hypertension Research Center, Federico II University Hospital, Naples, Italy
| | - Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Ravenna, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arif Elvan
- Isala Heart Center, Zwolle, The Netherlands
| | - José R González-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mauro Gori
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Diederick Grobbee
- Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, Jagiellonian University College of Medicine, Kraków, Poland
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Gerhard Hindricks
- Department of Internal Medicine/Cardiology/Electrophysiology, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Borja Ibanez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, Paris, France
- European Hospital Georges Pompidou, Paris, France
| | - Hugo Katus
- Department of Internal Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Fredrikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ulf Landmesser
- Department of Cardiology, Charite University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Sergio Leonardi
- University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | | | - Josepa Mauri
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche e De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milan, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, University of Pisa, Ospedale Cisanello, Pisa, Italy
| | - Marija M Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Intensive Arrhythmia Care, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susanna Price
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College, London, UK
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Oriol Rodríguez-Leor
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Francesco R Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luccia Torracca
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Arthur A Wilde
- ECGen, the Cardiogenetics Focus Group of EHRA
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
- Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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16
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Takahashi H, Ichinose N, Okada Y. False-negative rate of SARS-CoV-2 RT-PCR tests and its relationship to test timing and illness severity: A case series. IDCases 2022; 28:e01496. [PMID: 35402162 PMCID: PMC8982474 DOI: 10.1016/j.idcr.2022.e01496] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the false-negative rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) test results, and to describe the characteristics of coronavirus disease 2019 (COVID-19) patients with false-negative results. Methods We validated SARS-CoV-2-positive RT-PCR test results performed in hospitalized patients between February 1 and August 31, 2020 and classified the patients according to disease severity. Results In total, 2038 SARS-CoV-2 RT-PCR tests were performed on 1890 patients. Of these, 145 patients had positive results and were diagnosed with COVID-19. Among the 145 patients with COVID-19, the initial RT-PCR tests were negative in five patients. Of these, three had moderate illness and were initially tested in the early stage of disease, and two had severe illness and were initially tested in the late stage of disease, when RT-PCR testing has lower sensitivity due to viral clearance. Conclusions These findings suggest that false-negative results can be caused by both observer errors and by low viral RNA levels in the later stages of disease, after the infection has cleared. Clinicians should be aware that patients with COVID-19 can have negative RT-PCR test results in the later stages of infection. All SARS-CoV-2 RT-PCR test results of hospitalized COVID-19 patients were reviewed. Of 145 confirmed COVID-19 cases, 5 (3.45%) had a negative first RT-PCR test result. Of the 5 patients, 3 with moderate disease first tested soon after symptom onset. The initial testing was delayed in 2 patients with severe/critical disease. False-negative results can occur in deteriorating patients who have delayed testing.
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Affiliation(s)
- Hidenori Takahashi
- Department of Infection Control and Prevention, Showa General Hospital, Kodaira, Japan
| | - Naoki Ichinose
- Department of Infection Control and Prevention, Showa General Hospital, Kodaira, Japan
| | - Yasusei Okada
- Department of Critical Care and Emergency Medicine, Showa General Hospital, Kodaira, Japan
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17
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Anagoni S, Mudhigeti N, Alladi M, Anju V, Am P, Kalawat U. Effect of delay in processing and storage temperature on diagnosis of SARS-CoV-2 by RTPCR testing. Indian J Med Microbiol 2022; 40:427-432. [PMID: 35393127 PMCID: PMC8979488 DOI: 10.1016/j.ijmmb.2022.03.005] [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: 11/20/2021] [Revised: 02/19/2022] [Accepted: 03/20/2022] [Indexed: 11/20/2022]
Abstract
Purpose A large number of new molecular or virology laboratories have been established to increase the testing capacity for SARS-CoV-2. Due to heavy workload, there is delay in testing of samples. In order to avoid the negative effect of delayed testing on RTPCR results guidelines are issued from WHO and CDC to transport samples in cold chain. However, in pandemic situations the recommended guidelines for transport and storage conditions are often compromised. This study was conducted to evaluate the effect of sample storage conditions at different temperatures on the results of RT PCR test. Methods Total 275 samples were included in this study, among these 126 samples tested positive and 149 samples tested negative. All samples were aliquoted into two and the aliquotes stored in duplicate at 4 °C and room temperature. All aliquots stored at both the temperatures were tested by RTPCR every 24 hours up to 5 days. Results Diagnostic accuracy decreased from day1 to day 5 at both the storage temperatures i,e 4 °C and room temperature in comparison to the initial day results. Positivity decreased on an average of 9.02% at 4 °C and at 9.27% at room temperature per day. Among total 126 positive samples on an average false negative and failure of internal control at 4 °C and room temperature was 8.86%, 8.22% and 3.64%, and 4.12%, respectively. All the samples with CT value < 30 remained positive at both temperatures up to 5 days. Few samples with >30 CT value showed variable results i.e. positive, negative or internal control failure from day 1 (2nd day after sample collection) onwards. Conclusions There was no significant difference between RT PCR results of samples stored at 4 °C and room temperature up to 5 days of collection. However internal control failure was more in samples stored at room temperature. Therefore, samples received without cold chain also may be processed by RTPCR and should not be rejected.
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Affiliation(s)
- Srikar Anagoni
- Department of Microbiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - Nagaraja Mudhigeti
- State Level Virology Laboratory, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - Mohan Alladi
- Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - Verma Anju
- Department of Microbiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - Padmalatha Am
- State Level Virology Laboratory, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
| | - Usha Kalawat
- Department of Clinical Virology, Sri Venkateswara Institute of Medical Sciences, 517501, Tirupati, Andhra Pradesh, India.
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18
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MacKenzie EL, Hareza DA, Collison MW, Czapar AE, Kraft AK, Waxse BJ, Friedman EE, Ridgway JP. Clinical characteristics of hospitalized patients with false-negative severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test results. Infect Control Hosp Epidemiol 2022; 43:467-473. [PMID: 33867000 PMCID: PMC8111179 DOI: 10.1017/ice.2021.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine clinical characteristics associated with false-negative severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test results to help inform coronavirus disease 2019 (COVID-19) testing practices in the inpatient setting. DESIGN A retrospective observational cohort study. SETTING Tertiary-care facility. PATIENTS All patients 2 years of age and older tested for SARS-CoV-2 between March 14, 2020, and April 30, 2020, who had at least 2 SARS-CoV-2 reverse-transcriptase polymerase chain reaction tests within 7 days. METHODS The primary outcome measure was a false-negative testing episode, which we defined as an initial negative test followed by a positive test within the subsequent 7 days. Data collected included symptoms, demographics, comorbidities, vital signs, labs, and imaging studies. Logistic regression was used to model associations between clinical variables and false-negative SARS-CoV-2 test results. RESULTS Of the 1,009 SARS-CoV-2 test results included in the analysis, 4.0% were false-negative results. In multivariable regression analysis, compared with true-negative test results, false-negative test results were associated with anosmia or ageusia (adjusted odds ratio [aOR], 8.4; 95% confidence interval [CI], 1.4-50.5; P = .02), having had a COVID-19-positive contact (aOR, 10.5; 95% CI, 4.3-25.4; P < .0001), and having an elevated lactate dehydrogenase level (aOR, 3.3; 95% CI, 1.2-9.3; P = .03). Demographics, symptom duration, other laboratory values, and abnormal chest imaging were not significantly associated with false-negative test results in our multivariable analysis. CONCLUSIONS Clinical features can help predict which patients are more likely to have false-negative SARS-CoV-2 test results.
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Affiliation(s)
- Erica L. MacKenzie
- Section of Infectious Diseases & Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Dariusz A. Hareza
- Section of Internal Medicine, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Maggie W. Collison
- Section of Infectious Diseases & Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Anna E. Czapar
- Section of Internal Medicine, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Antigone K. Kraft
- Department of Pediatrics, The University of Chicago Medicine, Chicago, Illinois
| | - Bennett J. Waxse
- Section of Internal Medicine, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Eleanor E. Friedman
- Section of Infectious Diseases & Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Jessica P. Ridgway
- Section of Infectious Diseases & Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
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19
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J 2022; 43:1033-1058. [PMID: 34791157 PMCID: PMC8690026 DOI: 10.1093/eurheartj/ehab696] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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20
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Scotta MC, David CND, Varela FH, Sartor ITS, Polese-Bonatto M, Fernandes IR, Zavaglia GO, Ferreira CF, Kern LB, Santos AP, Krauzer JRM, Pitrez PM, Almeida WAFD, Porto VBG, Stein RT. Low performance of a SARS-CoV-2 point-of-care lateral flow immunoassay in symptomatic children during the pandemic. J Pediatr (Rio J) 2022; 98:136-141. [PMID: 34153236 PMCID: PMC8173459 DOI: 10.1016/j.jped.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE to evaluate the accuracy of an antibody point-of-care lateral flow immunoassay (LFI - Wondfo Biotech Co., Guangzhou, China) in a pediatric population. METHODS children and adolescents (2 months to 18 years) with signs and symptoms suggestive of acute SARS-CoV-2 infection were prospectively investigated with nasopharyngeal RT-PCR and LFI at the emergency room. RT-PCR was performed at baseline, and LFI at the same time or scheduled for those with less than 7 days of the clinical picture. Overall accuracy, sensitivity and specificity were assessed, as well as according to the onset of symptoms (7-13 or ≥14 days) at the time of the LFI test. RESULTS In 175 children included, RT-PCR and LFI were positive in 51 (29.14%) and 36 (20.57%), respectively. The overall sensitivity, specificity, positive and negative predictive value was 70.6% (95%CI 56.2-82.5), 96.8% (95%CI 91.9-99.1), 90.0% (95%CI 77.2-96.0), and 88.9% (95%CI 83.9-92.5), respectively. At 7-13 and ≥14 days after the onset of symptoms, sensitivity was 60.0% (95%CI 26.2-87.8) and 73.2% (95%CI 57.1-85.8) and specificity was 97.9% (95%CI 88.7-99.9) and 96.1% (95%CI 89.0-99.2), respectively. CONCLUSION Despite its high specificity, in the present study the sensitivity of LFI in children was lower (around 70%) than most reports in adults. Although a positive result is informative, a negative LFI test cannot rule out COVID-19 in children.
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Affiliation(s)
- Marcelo Comerlato Scotta
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre, RS, Brazil.
| | | | - Fernanda Hammes Varela
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre, RS, Brazil.
| | | | - Márcia Polese-Bonatto
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil
| | | | | | | | - Luciane Beatriz Kern
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil
| | - Amanda Paz Santos
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil
| | | | - Paulo Márcio Pitrez
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil
| | | | | | - Renato T Stein
- Hospital Moinhos de Vento, Responsabilidade Social - PROADI-SUS, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre, RS, Brazil
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21
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Gabriele S, Minervini S, Schepisi R, Peroni M, Dall’Alda M, Broch D, Recchi D, Longo D, Camin M, Girardello R. Radiographic pulmonary description of bilateral multifocal patchy with ground-glass opacifications needs careful evaluation in the Era of SARS-CoV-2. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Multiplex real-time RT-PCR method for the diagnosis of SARS-CoV-2 by targeting viral N, RdRP and human RP genes. Sci Rep 2022; 12:2853. [PMID: 35181721 PMCID: PMC8857243 DOI: 10.1038/s41598-022-06977-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Corona Virus Disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This pandemic has brought the world to a standstill and threatened human lives. Many methods are known to date to detect this virus. Due to their relative sensitivity, polymerase chain reaction (PCR)-based assays are the most frequently applied and considered the gold standard. However, due to the rapid mutation rate of the viral genome and the emergence of new variants, existing protocols need to be updated and improved. Designing a fast and accurate PCR-based assay is of great importance for the early detection of this virus and more efficient control of the spread of this disease. This study describes a fast, reliable, easy-to-use, and high-throughput multiplex SARS-CoV-2 RT-PCR detection method. The assay was designed to detect two viral genes (N and RdRP) and a human gene (RP) simultaneously. The performance and the sensitivity of the assay were tested in 28 SARS-CoV-2 positive samples and compared with commercial kits, which showed 100% positive percent agreement with a limit of detection (LOD) value of 1.40 and 0.81 copies/µL or 35.13 and 20.31 copies/reaction for RdRP and N genes, respectively. The current assay is found accurate, reliable, simple, sensitive, and specific. It can be used as an optimized SARS-CoV-2 diagnostic assay in hospitals, medical centers, and diagnostic laboratories as well as for research purposes.
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23
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Zhou JQ, Liu GX, Huang XL, Gan HT. The importance of fecal nucleic acid detection in patients with coronavirus disease(COVID-19):a systematic review and meta-analysis. J Med Virol 2022; 94:2317-2330. [PMID: 35174515 PMCID: PMC9088624 DOI: 10.1002/jmv.27652] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 02/05/2023]
Abstract
Pooled data from 2352 hospitalized coronavirus disease 2019 (COVID‐19) patients with viral RNA in feces across 46 studies were analyzed and the pooled prevalence of fecal RNA was 46.8% (95% confidence interval [CI]: 0.383–0.554). The pooled analysis showed that the occurrence of total gastrointestinal (GI) symptoms was 28.5% (95% CI: 0.125–0.44) in COVID‐19 patients with fecal RNA, that of both respiratory and GI symptoms was 21.9% (95% CI: 0.09–0.346), that of only GI symptoms was 19.8% (95% CI: 0.107–0.288), and that of only respiratory symptoms was 50.5%(95% CI: 0.267–0.744). The pooled data showed no significant difference in positive fecal RNA between severe and nonsevere cases (odds ratio = 2.009, p = 0.079, 95% CI: 0.922–4.378). During hospital admission, after samples from the respiratory system tested negative for viral RNA, 55.4% (95% CI: 0.418–0.669) of the patients with positive fecal RNA had persistent shedding of fecal RNA and pooled results from the other 4 studies including 848 discharged patients with nucleic acid‐negative stool samples indicated that the occurrence of repositive stool swabs was 18.1% (95% CI: 0.028–0.335), that of repositive respiratory swabs was 22.8% (95% CI: 0.003–0.452), that of both repositive stool and respiratory swabs was 19.1% (95% CI: 0.019–0.363), and that of only repositive stool swabs was 9.6% (95% CI: 0.010–0.203). The digestive tract may be an important organ involved in COVID‐19 infection and in the excretion of the virus. Because of the potential risk of fecal–oral transmission, giving emphasis on stool swab tests can help increase the detection rate of asymptomatic carriers and reduce missed diagnoses.
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Affiliation(s)
- Jin-Qiu Zhou
- Department of Geriatrics Medicine and the Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Geriatrics Medicine and the Center of Inflammatory Bowel Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gong-Xiang Liu
- Department of Geriatrics Medicine and the Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Geriatrics Medicine and the Center of Inflammatory Bowel Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Li Huang
- Department of Geriatrics Medicine and the Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua-Tian Gan
- Department of Geriatrics Medicine and the Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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24
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Li Q, Jiang MT, Yuan SE. Clinical Characteristics of Coronavirus Disease 2019 (COVID-19): A Comparison Between Laboratory-Confirmed and Clinically Suspected Patients. IRANIAN JOURNAL OF SCIENCE AND TECHNOLOGY, TRANSACTIONS A: SCIENCE 2022; 46:81-89. [PMID: 34803335 PMCID: PMC8590879 DOI: 10.1007/s40995-021-01244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 11/02/2021] [Indexed: 11/09/2022]
Abstract
To investigate the characteristic findings between laboratory-confirmed and clinically suspected patients with COVID-19. In this retrospective study, we included patients admitted to the Xiangya Hospital from Jan 24 to Feb 10, 2020. Two researchers separately collected and sorted out the patients’ epidemiological, demographic, clinical, laboratory, and radiologic findings. SPSS was performed to analyze the collected data. 241 patients were admitted, including 28 (45.5; IQR, 34.0–52.5) confirmed and 213 (42.0; IQR, 30.0–57.0) suspected patients. The prevalence of COVID-19 disease in males was significantly higher than in females (64.3% vs. 35.7%, P = 0.033). Before admission of the confirmed and suspected undiagnosed cases, the onset of symptoms is often manifested as respiratory symptoms such as fever (35.7% vs. 27.7%) and cough (30.7% vs. 32.1%). Twenty patients (71.4%) had an exposure history to high-risk areas, and 14 patients (50.0%) traveled or lived in a high-risk area in the confirmed group, which was significantly different from the suspected group. The pulmonary imaging of the patients in the confirmed group was primarily manifested as ground-glass opacity (89.3%). A total of 499 nucleic acid testing (NAT) was performed to determine the 28 COVID-19 positive throat swabs among the 241 patients. Whether there is a history of high-risk area exposure in the epidemiological investigation is essential in distinguishing the suspected patients from the confirmed patients. Multiple nucleic acid tests were used as the basis for the diagnosis of COVID-19, and during CT examination, ground-glass opacity was used as a COVID-19 indicator. Trail registration Trail registration number. 202012195, Date of registration: 2020.12.22 “retrospectively registered”.
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25
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Pecoraro V, Negro A, Pirotti T, Trenti T. Estimate false-negative RT-PCR rates for SARS-CoV-2. A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13706. [PMID: 34741305 PMCID: PMC8646643 DOI: 10.1111/eci.13706] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Molecular-based tests used to identify symptomatic or asymptomatic patients infected by SARS-CoV-2 are characterized by high specificity but scarce sensitivity, generating false-negative results. We aimed to estimate, through a systematic review of the literature, the rate of RT-PCR false negatives at initial testing for COVID-19. METHODS We systematically searched Pubmed, Embase and CENTRAL as well as a list of reference literature. We included observational studies that collected samples from respiratory tract to detect SARS-CoV-2 RNA using RT-PCR, reporting the number of false-negative subjects and the number of final patients with a COVID-19 diagnosis. Reported rates of false negatives were pooled in a meta-analysis as appropriate. We assessed the risk of bias of included studies and graded the quality of evidence according to the GRADE method. All information in this article is current up to February 2021. RESULTS We included 32 studies, enrolling more than 18,000 patients infected by SARS-CoV-2. The overall false-negative rate was 0.12 (95%CI from 0.10 to 0.14) with very low certainty of evidence. The impact of misdiagnoses was estimated according to disease prevalence; a range between 2 and 58/1,000 subjects could be misdiagnosed with a disease prevalence of 10%, increasing to 290/1,000 misdiagnosed subjects with a disease prevalence of 50%. CONCLUSIONS This systematic review showed that up to 58% of COVID-19 patients may have initial false-negative RT-PCR results, suggesting the need to implement a correct diagnostic strategy to correctly identify suspected cases, thereby reducing false-negative results and decreasing the disease burden among the population.
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Affiliation(s)
- Valentina Pecoraro
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | - Antonella Negro
- Health and Social Regional Agency of Emilia-Romagna Region, Bologna, Italy
| | - Tommaso Pirotti
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
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26
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Rapid screening for severe acute respiratory syndrome coronavirus 2 infection with a combined point-of-care antigen test and an immunoglobulin G antibody test. PLoS One 2022; 17:e0263327. [PMID: 35104281 PMCID: PMC8806068 DOI: 10.1371/journal.pone.0263327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Rapid screening and diagnosis of coronavirus disease 2019 in the emergency department is important for controlling infections. When polymerase chain reaction tests cannot be rapidly performed, rapid antigen testing is often used, albeit with insufficient sensitivity. Therefore, we evaluated the diagnostic accuracy of combining rapid antigen and antibody test results. This was a retrospective review of patients who visited our emergency department between February and May 2021 and underwent rapid antigen, immunoglobulin G antibody, and reverse transcription–polymerase chain reaction tests. The study included 1,070 patients, of whom 56 (5.2%) tested positive on reverse transcription–polymerase chain reaction. The sensitivity, specificity, and area under the curve of rapid antigen testing were 73.7%, 100.0%, and 0.87, respectively. The combined rapid antigen and antibody test result had improved diagnostic accuracy, with 91.2% sensitivity, 97.9% specificity, and an area under the curve of 0.95. The results of the rapid antigen and antibody tests could be combined as a reliable alternative to reverse transcription–polymerase chain reaction.
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27
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David CND, Varela FH, Sartor ITS, Polese-Bonatto M, Fernandes IR, Zavaglia GO, Kern LB, Ferreira CF, Bastos GAN, Pitrez PM, Almeida WAFD, Porto VBG, Zavascki AP, Stein RT, Scotta MC. Diagnostic accuracy of a SARS-CoV-2 rapid test and optimal time for seropositivity according to the onset of symptoms. CAD SAUDE PUBLICA 2022; 38:e00069921. [DOI: 10.1590/0102-311x00069921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Abstract
Point-of-care serological tests for SARS-CoV-2 have been used for COVID-19 diagnosis. However, their accuracy over time regarding the onset of symptoms is not fully understood. We aimed to assess the accuracy of a point-of-care lateral flow immunoassay (LFI). Subjects, aged over 18 years, presenting clinical symptoms suggestive of acute SARS-CoV-2 infection were tested once by both nasopharyngeal and oropharyngeal RT-PCR and LFI. The accuracy of LFI was assessed in periodic intervals of three days in relation to the onset of symptoms. The optimal cut-off point was defined as the number of days required to achieve the best sensitivity and specificity. This cut-off point was also used to compare LFI accuracy according to participants’ status: outpatient or hospitalized. In total, 959 patients were included, 379 (39.52%) tested positive for SARS-CoV-2 with RT-PCR, and 272 (28.36%) tested positive with LFI. LFI best performance was achieved after 10 days of the onset of symptoms, with sensitivity and specificity of 84.9% (95%CI: 79.8-89.1) and 94.4% (95%CI: 91.0-96.8), respectively. Although the specificity was similar (94.6% vs. 88.9%, p = 0.051), the sensitivity was higher in hospitalized patients than in outpatients (91.7% vs. 82.1%, p = 0.032) after 10 days of the onset of symptoms. Best sensitivity of point-of-care LFI was found 10 days after the onset of symptoms which may limit its use in acute care. Specificity remained high regardless of the number of days since the onset of symptoms.
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Affiliation(s)
| | - Fernanda Hammes Varela
- Hospital Moinhos de Vento, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marcelo Comerlato Scotta
- Hospital Moinhos de Vento, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
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28
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Navarro-Carrera P, Roces-Álvarez P, Ramos-Ramos JC, Montero D, Losantos I, Díaz-Pollán B, García Bujalance S. Characteristics of patients with suspected COVID-19 pneumonia and repeatedly negative RT-PCR. Access Microbiol 2021; 3:000279. [PMID: 35024549 PMCID: PMC8749149 DOI: 10.1099/acmi.0.000279] [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: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Challenges remain and there are still a sufficient number of cases with epidemiological, clinical features and radiological data suggestive of COVID-19 pneumonia that persist negative in their RT-PCR results. The aim of the study was to define the distinguishing characteristics between patients developing a serological response to SARS-CoV-2 and those who did not. Methods RT-PCR tests used were TaqPath 2019-nCoV Assay Kit v1 (ORF-1ab, N and S genes) from Thermo Fisher Diagnostics and SARS-COV-2 Kit (N and E genes) from Vircell. Serological response was tested using the rapid SARS-CoV2 IgG/IgM Test Cassette from T and D Diagnostics Canada and CMC Medical Devices and Drugs, S.L, CE. Results In this cross-sectional study, we included a cohort of 52 patients recruited from 31 March 2020 to 23 April 2020. Patients with positive serology had an older average age (73.29) compared to those who were negative (54.82) (P<0.05). Sat02 in 27 of 34 patients with positive serology were below 94% (P<0.05). There was a frequency of 1.5% negative SARS-CoV-2 RT-PCRs during the study period concurring with 36.7% of positivity. Conclusion Clinical features and other biomarkers in a context of a positive serology can be considered crucial for diagnosis.
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Affiliation(s)
- Paula Navarro-Carrera
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Patricia Roces-Álvarez
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Juan Carlos Ramos-Ramos
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Dolores Montero
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Itsaso Losantos
- Section of Biostatistics- IdiPAZ, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Beatriz Díaz-Pollán
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Silvia García Bujalance
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
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Marateb HR, Ziaie Nezhad F, Mohebian MR, Sami R, Haghjooy Javanmard S, Dehghan Niri F, Akafzadeh-Savari M, Mansourian M, Mañanas MA, Wolkewitz M, Binder H. Automatic Classification Between COVID-19 and Non-COVID-19 Pneumonia Using Symptoms, Comorbidities, and Laboratory Findings: The Khorshid COVID Cohort Study. Front Med (Lausanne) 2021; 8:768467. [PMID: 34869483 PMCID: PMC8640954 DOI: 10.3389/fmed.2021.768467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/06/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease-2019, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was a disaster in 2020. Accurate and early diagnosis of coronavirus disease-2019 (COVID-19) is still essential for health policymaking. Reverse transcriptase-polymerase chain reaction (RT-PCR) has been performed as the operational gold standard for COVID-19 diagnosis. We aimed to design and implement a reliable COVID-19 diagnosis method to provide the risk of infection using demographics, symptoms and signs, blood markers, and family history of diseases to have excellent agreement with the results obtained by the RT-PCR and CT-scan. Our study primarily used sample data from a 1-year hospital-based prospective COVID-19 open-cohort, the Khorshid COVID Cohort (KCC) study. A sample of 634 patients with COVID-19 and 118 patients with pneumonia with similar characteristics whose RT-PCR and chest CT scan were negative (as the control group) (dataset 1) was used to design the system and for internal validation. Two other online datasets, namely, some symptoms (dataset 2) and blood tests (dataset 3), were also analyzed. A combination of one-hot encoding, stability feature selection, over-sampling, and an ensemble classifier was used. Ten-fold stratified cross-validation was performed. In addition to gender and symptom duration, signs and symptoms, blood biomarkers, and comorbidities were selected. Performance indices of the cross-validated confusion matrix for dataset 1 were as follows: sensitivity of 96% [confidence interval, CI, 95%: 94–98], specificity of 95% [90–99], positive predictive value (PPV) of 99% [98–100], negative predictive value (NPV) of 82% [76–89], diagnostic odds ratio (DOR) of 496 [198–1,245], area under the ROC (AUC) of 0.96 [0.94–0.97], Matthews Correlation Coefficient (MCC) of 0.87 [0.85–0.88], accuracy of 96% [94–98], and Cohen's Kappa of 0.86 [0.81–0.91]. The proposed algorithm showed excellent diagnosis accuracy and class-labeling agreement, and fair discriminant power. The AUC on the datasets 2 and 3 was 0.97 [0.96–0.98] and 0.92 [0.91–0.94], respectively. The most important feature was white blood cell count, shortness of breath, and C-reactive protein for datasets 1, 2, and 3, respectively. The proposed algorithm is, thus, a promising COVID-19 diagnosis method, which could be an amendment to simple blood tests and screening of symptoms. However, the RT-PCR and chest CT-scan, performed as the gold standard, are not 100% accurate.
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Affiliation(s)
- Hamid Reza Marateb
- The Biomedical Engineering Department, Engineering Faculty, University of Isfahan, Isfahan, Iran
| | - Farzad Ziaie Nezhad
- The Biomedical Engineering Department, Engineering Faculty, University of Isfahan, Isfahan, Iran
| | - Mohammad Reza Mohebian
- Department of Electrical and Computer Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Department of Physiology, Applied Physiology Research Center, School of Medicine, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahsa Akafzadeh-Savari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Automatic Control Department (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain.,Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Miquel Angel Mañanas
- Automatic Control Department (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Martin Wolkewitz
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
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Shin Low S, Nong Lim C, Yew M, Siong Chai W, Low LE, Manickam S, Ti Tey B, Show PL. Recent ultrasound advancements for the manipulation of nanobiomaterials and nanoformulations for drug delivery. ULTRASONICS SONOCHEMISTRY 2021; 80:105805. [PMID: 34706321 PMCID: PMC8555278 DOI: 10.1016/j.ultsonch.2021.105805] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 05/04/2023]
Abstract
Recent advances in ultrasound (US) have shown its great potential in biomedical applications as diagnostic and therapeutic tools. The coupling of US-assisted drug delivery systems with nanobiomaterials possessing tailor-made functions has been shown to remove the limitations of conventional drug delivery systems. The low-frequency US has significantly enhanced the targeted drug delivery effect and efficacy, reducing limitations posed by conventional treatments such as a limited therapeutic window. The acoustic cavitation effect induced by the US-mediated microbubbles (MBs) has been reported to replace drugs in certain acute diseases such as ischemic stroke. This review briefly discusses the US principles, with particular attention to the recent advancements in drug delivery applications. Furthermore, US-assisted drug delivery coupled with nanobiomaterials to treat different diseases (cancer, neurodegenerative disease, diabetes, thrombosis, and COVID-19) are discussed in detail. Finally, this review covers the future perspectives and challenges on the applications of US-mediated nanobiomaterials.
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Affiliation(s)
- Sze Shin Low
- Continental-NTU Corporate Lab, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore; Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia
| | - Chang Nong Lim
- School of Engineering and Physical Sciences, Heriot-Watt University Malaysia, No. 1, Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Maxine Yew
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo 315100, Zhejiang, China
| | - Wai Siong Chai
- School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen, Shenzhen 518055, Guangdong, China
| | - Liang Ee Low
- Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
| | - Sivakumar Manickam
- Petroleum and Chemical Engineering, Faculty of Engineering, Universiti Teknologi Brunei, Jalan Tungku Link Gadong, Bandar Seri Begawan, BE1410, Brunei Darussalam.
| | - Beng Ti Tey
- Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Chemical Engineering Discipline, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia.
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Design of a population-based longitudinal cohort study of SARS-CoV-2 incidence and prevalence among adults in the San Francisco Bay Area. Ann Epidemiol 2021; 67:81-100. [PMID: 34800659 PMCID: PMC8596645 DOI: 10.1016/j.annepidem.2021.11.001] [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: 05/26/2021] [Revised: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Purpose We describe the design of a longitudinal cohort study to determine SARS-CoV-2 incidence and prevalence among a population-based sample of adults living in six San Francisco Bay Area counties. Methods Using an address-based sample, we stratified households by county and by census-tract risk. Risk strata were determined by using regression models to predict infections by geographic area using census-level sociodemographic and health characteristics. We disproportionately sampled high and medium risk strata, which had smaller population sizes, to improve precision of estimates, and calculated a desired sample size of 3400. Participants were primarily recruited by mail and were followed monthly with PCR testing of nasopharyngeal swabs, testing of venous blood samples for antibodies to SARS-CoV-2 spike and nucleocapsid antigens, and testing of the presence of neutralizing antibodies, with completion of questionnaires about socio-demographics and behavior. Estimates of incidence and prevalence will be weighted by county, risk strata and sociodemographic characteristics of non-responders, and will take into account laboratory test performance. Results We enrolled 3842 adults from August to December 2020, and completed follow-up March 31, 2021. We reached target sample sizes within most strata. Conclusions Our stratified random sampling design will allow us to recruit a robust general population cohort of adults to determine the incidence of SARS-CoV-2 infection. Identifying risk strata was unique to the design and will help ensure precise estimates, and high-performance testing for presence of virus and antibodies will enable accurate ascertainment of infections.
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Higo H, Taguchi Y, Suzaki N, Nagata T, Marukawa M. Indications for SARS-CoV-2 nucleic acid amplification test for areas with low endemicity. J Infect Chemother 2021; 28:238-241. [PMID: 34776347 PMCID: PMC8576171 DOI: 10.1016/j.jiac.2021.10.029] [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: 07/17/2021] [Revised: 10/11/2021] [Accepted: 10/30/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The optimal indication for the nucleic acid amplification test (NAAT) in areas with low endemicity for coronavirus disease 2019 (COVID-19) is unclear. This study aimed to identify patients who should undergo the NAAT for COVID-19 diagnosis. METHODS We retrospectively analyzed the clinical data of patients with suspected COVID-19 who underwent NAAT between October 5, 2020, and May 31, 2021 in our institution. RESULTS A total of 1238 patients were enrolled and NAAT positive results were observed in 40 patients (3.2%). The NAAT positivity rate was 34.3% (23/67) in patients with a history of close contact and 1.5% (17/1171) in patients without a history of close contact. Olfactory/gustatory dysfunction and a history of stay in other prefectures were independent risk factors of COVID-19 in patients without a history of close contact. On the other hand, the NAAT positivity rate was only 0.7% (8/1073) in patients without olfactory/gustatory dysfunction and a history of stay in other prefectures. Among them, the group without respiratory symptoms/sign had only one NAAT-positive case (0.1%: 1/1073). CONCLUSIONS This study revealed that a history of close contact, olfactory/gustatory dysfunction, and a history of stay in other prefectures are key eligibility criteria for NAAT in areas with relatively few patients with COVID-19. On the other hand, NAAT may not be necessary in cases without all of these factors and respiratory symptoms/sign.
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Affiliation(s)
- Hisao Higo
- Department of Internal Medicine, Kagawa Rosai Hospital, Kagawa, Japan.
| | - Yoshinori Taguchi
- Department of Internal Medicine, Kagawa Rosai Hospital, Kagawa, Japan
| | - Noriyuki Suzaki
- Department of Internal Medicine, Kagawa Rosai Hospital, Kagawa, Japan
| | - Takuya Nagata
- Department of Internal Medicine, Kagawa Rosai Hospital, Kagawa, Japan
| | - Masaomi Marukawa
- Department of Internal Medicine, Kagawa Rosai Hospital, Kagawa, Japan
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Development and prospective validation of COVID-19 chest X-ray screening model for patients attending emergency departments. Sci Rep 2021; 11:20384. [PMID: 34650190 PMCID: PMC8516957 DOI: 10.1038/s41598-021-99986-3] [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: 05/11/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
Chest X-rays (CXRs) are the first-line investigation in patients presenting to emergency departments (EDs) with dyspnoea and are a valuable adjunct to clinical management of COVID-19 associated lung disease. Artificial intelligence (AI) has the potential to facilitate rapid triage of CXRs for further patient testing and/or isolation. In this work we develop an AI algorithm, CovIx, to differentiate normal, abnormal, non-COVID-19 pneumonia, and COVID-19 CXRs using a multicentre cohort of 293,143 CXRs. The algorithm is prospectively validated in 3289 CXRs acquired from patients presenting to ED with symptoms of COVID-19 across four sites in NHS Greater Glasgow and Clyde. CovIx achieves area under receiver operating characteristic curve for COVID-19 of 0.86, with sensitivity and F1-score up to 0.83 and 0.71 respectively, and performs on-par with four board-certified radiologists. AI-based algorithms can identify CXRs with COVID-19 associated pneumonia, as well as distinguish non-COVID pneumonias in symptomatic patients presenting to ED. Pre-trained models and inference scripts are freely available at https://github.com/beringresearch/bravecx-covid.
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Muller ML, Logan LK, Kociolek LK, Guzman-Cottrill JA, Bartlett AH, Schaffzin JK, Ravin KA, Rubin LG, Lake J, Caughell C, Ramirez-Avila L. SHEA Pediatric Leadership Council commentary: Personal protective equipment during care of children with multisystem inflammatory syndrome in children (MIS-C). Infect Control Hosp Epidemiol 2021; 42:1108-1110. [PMID: 34121639 PMCID: PMC8207550 DOI: 10.1017/ice.2021.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Martha L. Muller
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Latania K. Logan
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, Illinois
| | - Larry K. Kociolek
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of MedicineChicago, Illinois
| | | | - Allison H. Bartlett
- Section of Pediatric Infectious Diseases, The University of Chicago Medicine Comer Children’s Hospital, Chicago, Illinois
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen A. Ravin
- Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lorry G. Rubin
- Department of Pediatrics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jason Lake
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Carolyn Caughell
- Hospital Epidemiology and Infection Prevention, Department of Quality, University of California San Francisco Health, San Francisco, California
| | - Lynn Ramirez-Avila
- Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California
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Gniazdowski V, Paul Morris C, Wohl S, Mehoke T, Ramakrishnan S, Thielen P, Powell H, Smith B, Armstrong DT, Herrera M, Reifsnyder C, Sevdali M, Carroll KC, Pekosz A, Mostafa HH. Repeated Coronavirus Disease 2019 Molecular Testing: Correlation of Severe Acute Respiratory Syndrome Coronavirus 2 Culture With Molecular Assays and Cycle Thresholds. Clin Infect Dis 2021; 73:e860-e869. [PMID: 33104776 PMCID: PMC7665437 DOI: 10.1093/cid/ciaa1616] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Repeated coronavirus disease 2019 (COVID-19) molecular testing can lead to positive test results after negative results and to multiple positive results over time. The association between positive test results and infectious virus is important to quantify. METHODS A 2-month cohort of retrospective data and consecutively collected specimens from patients with COVID-19 or patients under investigation were used to understand the correlation between prolonged viral RNA positive test results, cycle threshold (Ct) values and growth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in cell culture. Whole-genome sequencing was used to confirm virus genotype in patients with prolonged viral RNA detection. Droplet digital polymerase chain reaction was used to assess the rate of false-negative COVID-19 diagnostic test results. RESULTS In 2 months, 29 686 specimens were tested and 2194 patients underwent repeated testing. Virus recovery in cell culture was noted in specimens with a mean Ct value of 18.8 (3.4) for SARS-CoV-2 target genes. Prolonged viral RNA shedding was associated with positive virus growth in culture in specimens collected up to 21 days after the first positive result but mostly in individuals symptomatic at the time of sample collection. Whole-genome sequencing provided evidence the same virus was carried over time. Positive test results following negative results had Ct values >29.5 and were not associated with virus culture. Droplet digital polymerase chain reaction results were positive in 5.6% of negative specimens collected from patients with confirmed or clinically suspected COVID-19. CONCLUSIONS Low Ct values in SARS-CoV-2 diagnostic tests were associated with virus growth in cell culture. Symptomatic patients with prolonged viral RNA shedding can also be infectious.
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Affiliation(s)
- Victoria Gniazdowski
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Paul Morris
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- National Institutes of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Shirlee Wohl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland,USA
| | | | - Peter Thielen
- Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland,USA
| | | | | | - Derek T Armstrong
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Karen C Carroll
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ruling Out Coronavirus Disease 2019 in Patients with Pneumonia: The Role of Blood Cell Count and Lung Ultrasound. J Clin Med 2021; 10:jcm10163481. [PMID: 34441777 PMCID: PMC8397060 DOI: 10.3390/jcm10163481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a distinctive blood leucocyte pattern and B-lines on lung ultrasound (LUS) as marker of alveolar-interstitial syndrome. We aimed to evaluate the accuracy of blood leucocyte count alone or in combination with LUS for COVID-19 diagnosis. We retrospectively enrolled consecutive patients diagnosed with community acquired pneumonia (CAP) at hospital admission to derive and validate cutoff values for blood cell count that could be predictive of COVID-19 before confirmation by the nucleic acid amplification test (NAAT). Cutoff values, generated and confirmed in inception (41/115, positive/negative patients) and validation (100/180, positive/negative patients) cohorts, were ≤17 and ≤10 cells/mm3 for basophils and eosinophils, respectively. Basophils and/or eosinophils below cutoff were associated with sensitivity of 98% (95%CI, 94–100) and negative likelihood ratio of 0.04 (95%CI, 0.01–0.11). In a subgroup of 265 subjects, the sensitivity of B-line on LUS was 15% lower (p < 0.001) than that of basophils and/or eosinophils below cutoff. The combination of B-lines with basophils and eosinophils below cutoff was associated with a moderate increase of the positive likelihood ratio: 5.0 (95%CI, 3.2–7.7). In conclusion, basophil and eosinophil counts above the generated cutoff virtually rule out COVID-19 in patients with CAP. Our findings can help optimize patient triage pending the NAAT results.
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Ünsaler S, Okan A, Tekin S, Hafız AM, Gökler O, Altuntaş O. Comparison of nasopharyngeal swab and nasopharyngeal aspiration in adults for SARS-CoV-2 identification using reverse transcription-polymerase chain reaction. J Med Virol 2021; 93:6693-6695. [PMID: 34331714 PMCID: PMC8426860 DOI: 10.1002/jmv.27250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
We aimed to compare reverse transcription‐polymerase chain reaction (RT‐PCR) results of nasopharyngeal aspiration (NA) and nasopharyngeal swab (NS) samples in the diagnosis of coronavirus disease 2019. NS was obtained with a dacron swab and NA was performed by aspiration cannula. The sampling was performed by an otolaryngologist to ensure standardized correct sampling from the nasopharynx. RT‐PCR was performed for the detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The level of agreement between the result of NA and NS samples for each patient was analyzed. The Ct values were compared. Thirty‐three patients were enrolled in the study with a mean age of 56.3 years. Thirteen subjects resulted negative with both NS and NA; 20 subjects resulted positive with NA and 18 subjects resulted positive with NS. The mean values of Ct for NA samples and NS samples were 24.6 ± 5.9 and 24 ± 6.7, respectively. There was no statistical difference between Ct values of NA and NS samples (p = 0.48). RT‐PCR for SARS‐Cov2 performed with NA sample and NS sample showed a strong correlation regarding the positivity/negativity and the Ct values. The results demonstrated that RT–PCR for SARS–Cov2 performed with NA sample and NS sample showed a strong correlation regarding the positivity and negativity and the Ct values. It is less likely to obtain an insufficient amount of material with NA than that with NS. Therefore, NA may be preferred for the second sampling, especially in patients who are difficult to be sampled with swab because of a septal deviation or patient incompatibility.
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Affiliation(s)
- Selin Ünsaler
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
| | - Ayşe Okan
- Department of Microbiology, Division of Molecular Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Süda Tekin
- Department of Clinical Microbiology and Infectious Diseases, Koç University School of Medicine, Istanbul, Turkey
| | - Ayşenur M Hafız
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
| | - Ozan Gökler
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
| | - Ozan Altuntaş
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
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Dong W, Gao R, Cai J, Yang S, Guo J, Zhao J, Wang Z, Cai L. Resumption of the treatment of non-COVID-19 gynecologic patients after lifting lockdown: Triage and infection prevention experiences from Wuhan. J Obstet Gynaecol Res 2021; 47:3297-3302. [PMID: 34322966 PMCID: PMC8457066 DOI: 10.1111/jog.14917] [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: 03/17/2021] [Revised: 05/29/2021] [Accepted: 06/06/2021] [Indexed: 01/08/2023]
Abstract
Aim To share our experiences of resuming the treatments for gynecologic patients after lifting the lockdown in a hotspot area for the Coronavirus Disease 2019 (COVID‐19) pandemic. Methods The triage process used to resume medical activities for gynecologic patients at the Wuhan Union Hospital after a 76‐day lockdown of the city is described, and its effectiveness in preventing COVID‐19 nosocomial transmission is shown. Results Nonemergency patients were pretriaged based on their contact history and body temperature at an outpatient clinic, and negative COVID‐19 screening test results were required for admission to the buffering rooms at the gynecologic department. The buffering lasted at least 3 days for symptom monitoring, and a second round of COVID‐19 testing was required before patients could be transferred to the regular gynecologic wards. For patients who needed emergency surgery, the first screening was completed at the isolation wards after surgery, followed by buffering at the gynecologic department. We received 19 298 outpatient visits, admitted 326 patients, and performed 223 operations in the first 2 months after the lockdown was lifted. No COVID‐19 cases occurred in the hospitalized patients, while the proportion of potentially high‐risk patients with cancer and severe anemia was increased in comparison to that observed during the same period in 2019 and the first 2 months of 2020 before the lockdown. Conclusions We provide an effective triage system with buffering at two levels to guarantee safe and timely treatment for non‐COVID‐19 gynecologic patients in the postlockdown phase.
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Affiliation(s)
- Weihong Dong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Gao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shouhua Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianfeng Guo
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiong Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Reich N, Lowe CF, Puddicombe D, Matic N, Greiner J, Simons J, Leung V, Chu T, Naik H, Myles N, Burns L, Romney MG, Ritchie G, Champagne S, Dooley K, Sekirov I, Stefanovic A. Repeat virological and serological profiles in hospitalized patients initially tested by nasopharyngeal RT-PCR for SARS-CoV-2. J Med Virol 2021; 93:6808-6812. [PMID: 34297350 PMCID: PMC8426995 DOI: 10.1002/jmv.27227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023]
Abstract
Real‐time polymerase chain reaction (PCR) for SARS‐CoV‐2 is the mainstay of COVID‐19 diagnosis, yet there are conflicting reports on its diagnostic performance. Wide ranges of false‐negative PCR tests have been reported depending on clinical presentation, the timing of testing, specimens tested, testing method, and reference standard used. We aimed to estimate the frequency of discordance between initial nasopharyngeal (NP) PCR and repeat NP sampling PCR and serology in acutely ill patients admitted to the hospital. Panel diagnosis of COVID‐19 infection is further utilized in discordance analysis. Included in the study were 160 patients initially tested by NP PCR with repeat NP sampling PCR and/or serology performed. The percent agreement between initial and repeat PCR was 96.7%, while the percent agreement between initial PCR and serology was 98.9%. There were 5 (3.1%) cases with discordance on repeat testing. After discordance analysis, 2 (1.4%) true cases tested negative on initial PCR. Using available diagnostic methods, discordance on repeat NP sampling PCR and/or serology is a rare occurrence.
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Affiliation(s)
- Noah Reich
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher F Lowe
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Puddicombe
- Perinatal Services BC, Provincial Health Service Authority, Vancouver, British Columbia, Canada
| | - Nancy Matic
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse Greiner
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victor Leung
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Chu
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hiten Naik
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Myles
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Burns
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc G Romney
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon Ritchie
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvie Champagne
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kent Dooley
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada, Life Labs, Vancouver, British Columbia, Canada
| | - Inna Sekirov
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
| | - Aleksandra Stefanovic
- Division of Medical Microbiology and Virology, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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40
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Zhou Y, O’Leary TJ. Relative sensitivity of anterior nares and nasopharyngeal swabs for initial detection of SARS-CoV-2 in ambulatory patients: Rapid review and meta-analysis. PLoS One 2021; 16:e0254559. [PMID: 34283845 PMCID: PMC8291630 DOI: 10.1371/journal.pone.0254559] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 01/22/2023] Open
Abstract
Nasopharyngeal (NP) swabs are considered "gold standard" for diagnosing SARS-CoV-2 infections, but anterior nares or mid-turbinate swabs (nasal swabs) are often used. We performed a meta-analysis comparing the sensitivity of nasal and nasopharyngeal swabs against a composite reference standard for the initial diagnosis of SARS-CoV-2 infection in ambulatory patients. The study is registered on PROSPERO (CRD42020221827). Data sources included studies appearing between January 1, 2020 and March 20, 2021, identified by searches of PubMed, medRxiv and bioRxiv. Studies included at least 20 subjects who simultaneously provided nasal and nasopharyngeal specimens for reverse transcription-polymerase chain reaction testing, and for which confusion matrices could be constructed. Authors individually assessed studies for inclusion and compared assessments. Each author independently extracted all data elements; differences were reconciled by review of initial data sources. Extracted data included specimen site, patient characteristics, collection site, and confusion matrices comparing results for nasal and nasopharyngeal swabs. Assessed against a composite reference standard, anterior nares swabs are less sensitive (82% - 88%) than nasopharyngeal swabs (98%). For populations with 10% specimen positivity, the negative predictive values of all swab types were greater than 98%. Mid-turbinate and anterior nares swabs seem to perform similarly. The lower sensitivity associated with nasal swab SARS-CoV-2 diagnosis is justified by the ability to screen more patients and reduced personal protective equipment requirements. Our conclusions are limited by the small number of studies and the significant heterogeneity of study designs and study outcomes.
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Affiliation(s)
- Yaolin Zhou
- Department of Pathology & Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Timothy J. O’Leary
- Office of Research and Development, Veterans Health Administration, Department of Veterans Affairs, Washington, District of Columbia, United States of America
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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41
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Peng B, Zhou W, Pettit RW, Yu P, Matos PG, Greninger AL, McCashin J, Amos CI. Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study. BMJ Open 2021; 11:e050473. [PMID: 34272225 PMCID: PMC8290949 DOI: 10.1136/bmjopen-2021-050473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of SARS-CoV-2 testing on shortening the duration of quarantines for COVID-19 and to identify the most effective choices of testing schedules. DESIGN We performed extensive simulations to evaluate the performance of quarantine strategies when one or more SARS-CoV-2 tests were administered during the quarantine. Simulations were based on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available testing methods. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the outcomes of optimal strategies. RESULTS We found that SARS-CoV-2 testing can effectively reduce the length of a quarantine without compromising safety. A single reverse transcription-PCR (RT-PCR) test performed before the end of quarantine can reduce quarantine duration to 10 days. Two tests can reduce the duration to 8 days, and three highly sensitive RT-PCR tests can justify a 6-day quarantine. More strategic testing schedules and longer quarantines are needed if tests are administered with less-sensitive RT-PCR tests or antigen tests. Shorter quarantines can be used for applications that tolerate a residual postquarantine transmission risk comparable to a 10-day quarantine. CONCLUSIONS Testing could substantially reduce the length of isolation, reducing the physical and mental stress caused by lengthy quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, test-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.
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Affiliation(s)
- Bo Peng
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Wen Zhou
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Rowland W Pettit
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Patrick Yu
- Corporate Medical Advisors, Houston, Texas, USA
| | | | - Alexander L Greninger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher I Amos
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA
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42
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Benoni R, Panunzi S, Campagna I, Moretti F, Lo Cascio G, Spiteri G, Porru S, Tardivo S. The Effect of Test Timing on the Probability of Positive SARS-CoV-2 Swab Test Results: Mixed Model Approach. JMIR Public Health Surveill 2021; 7:e27189. [PMID: 34003761 PMCID: PMC8176944 DOI: 10.2196/27189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/08/2021] [Accepted: 05/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, swab tests proved to be effective in containing the infection and served as a means for early diagnosis and contact tracing. However, little evidence exists regarding the correct timing for the execution of the swab test, especially for asymptomatic individuals and health care workers. OBJECTIVE The objective of this study was to analyze changes in the positive findings over time in individual SARS-CoV-2 swab tests during a health surveillance program. METHODS The study was conducted with 2071 health care workers at the University Hospital of Verona, with a known date of close contact with a patient with COVID-19, between February 29 and April 17, 2020. The health care workers underwent a health surveillance program with repeated swab tests to track their virological status. A generalized additive mixed model was used to investigate how the probability of a positive test result changes over time since the last known date of close contact, in an overall sample of individuals who tested positive for COVID-19 and in a subset of individuals with an initial negative swab test finding before being proven positive, to assess different surveillance time intervals. RESULTS Among the 2071 health care workers in this study, 191 (9.2%) tested positive for COVID-19, and 103 (54%) were asymptomatic with no differences based on sex or age. Among 49 (25.7%) cases, the initial swab test yielded negative findings after close contact with a patient with COVID-19. Sex, age, symptoms, and the time of sampling were not different between individuals with an initial negative swab test finding and those who initially tested positive after close contact. In the overall sample, the estimated probability of testing positive was 0.74 on day 1 after close contact, which increased to 0.77 between days 5 and 8. In the 3 different scenarios for scheduled repeated testing intervals (3, 5, and 7 days) in the subgroup of individuals with an initially negative swab test finding, the probability peaked on the sixth, ninth and tenth, and 13th and 14th days, respectively. CONCLUSIONS Swab tests can initially yield false-negative outcomes. The probability of testing positive increases from day 1, peaking between days 5 and 8 after close contact with a patient with COVID-19. Early testing, especially in this final time window, is recommended together with a health surveillance program scheduled in close intervals.
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Affiliation(s)
- Roberto Benoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Verona, Verona, Italy
| | - Silvia Panunzi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Irene Campagna
- Postgraduate School of Hygiene and Preventive Medicine, University of Verona, Verona, Italy
| | - Francesca Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Gianluca Spiteri
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stefano Porru
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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43
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021; 47:100. [PMID: 33846767 PMCID: PMC8043662 DOI: 10.3892/ijmm.2021.4933] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute-IRCCS 'Fondazione G. Pascale', I-80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
- Research Center for the Prevention, Diagnosis and Treatment of Tumors, University of Catania, I-95123 Catania, Italy
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44
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021. [PMID: 33846767 DOI: 10.3892/ijmm.2021.4933/html] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute‑IRCCS 'Fondazione G. Pascale', I‑80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
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45
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Williams E, Bond K, Williamson DA. Limited clinical value of early repeat RT-PCR testing for SARS-CoV-2. Med J Aust 2021; 215:42-43. [PMID: 34036589 PMCID: PMC8242732 DOI: 10.5694/mja2.51102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/07/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Deborah A Williamson
- Royal Melbourne Hospital, Melbourne, VIC.,Public Health Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
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46
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Ruhnke GW. Limiting Patient Autonomy: Mandatory COVID-19 Diagnostic Testing. J Hosp Med 2021; 16:313-315. [PMID: 33734984 DOI: 10.12788/jhm.3603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Gregory W Ruhnke
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
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47
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Khidir H, DeLuca M, Macias-Konstantopoulos WL, Samuels-Kalow M, Jasrasaria R, Risley K, Liburd K, Adjei V, Yun BJ. The Health and Social Needs of Patients Discharged From the Emergency Department With Suspected COVID-19. Public Health Rep 2021; 136:309-314. [PMID: 33593138 PMCID: PMC8580402 DOI: 10.1177/0033354920982579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Health-related social needs (HRSNs), such as food or housing insecurity, are important drivers of disparities in outcomes during public health emergencies. We describe the development of a telehealth follow-up program in Boston, Massachusetts, for patients discharged from the emergency department after coronavirus disease 2019 (COVID-19) testing to identify patients with worsening clinical symptoms, to screen for unmet HRSNs, and to deliver self-isolation counseling and risk-reduction strategies for socially vulnerable people. We prioritized telephone calls to patients with public health insurance and patients without primary care physicians. In the first 43 days of operation, March 30-May 12, 2020, our intervention reached 509 patients, with 209 (41.1%) patients reporting an HRSN, most commonly related to food, housing, or utilities. Thirty-one (6.1%) patients required assessment by a clinician for clinical worsening. This public health intervention may be useful for other institutions developing programs to address the social and health needs of patients discharged with suspected COVID-19.
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Affiliation(s)
- Hazar Khidir
- Harvard Affiliated Emergency Medicine Residency Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, MA, USA
| | - Michael DeLuca
- Harvard Affiliated Emergency Medicine Residency Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, MA, USA
| | - Wendy L. Macias-Konstantopoulos
- Center for Social Justice and Health Equity, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Rashmi Jasrasaria
- Department of Medicine, Chelsea HealthCare Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kristen Risley
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA
| | - Kendra Liburd
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA
| | - Vanessa Adjei
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA
| | - Brian J. Yun
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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48
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Brogna B, Brogna C, Petrillo M, Conte AM, Benincasa G, Montano L, Piscopo M. SARS-CoV-2 Detection in Fecal Sample from a Patient with Typical Findings of COVID-19 Pneumonia on CT but Negative to Multiple SARS-CoV-2 RT-PCR Tests on Oropharyngeal and Nasopharyngeal Swab Samples. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:290. [PMID: 33804646 PMCID: PMC8003654 DOI: 10.3390/medicina57030290] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Reverse transcriptase polymerase chain reaction (RT-PCR) negative results in the upper respiratory tract represent a major concern for the clinical management of coronavirus disease 2019 (COVID-19) patients. Herein, we report the case of a 43-years-old man with a strong clinical suspicion of COVID-19, who resulted in being negative to multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests performed on different oropharyngeal and nasopharyngeal swabs, despite serology having confirmed the presence of SARS-CoV-2 IgM. The patient underwent a chest computed tomography (CT) that showed typical imaging findings of COVID-19 pneumonia. The presence of viral SARS-CoV-2 was confirmed only by performing a SARS-CoV-2 RT-PCR test on stool. Performing of SARS-CoV-2 RT-PCR test on fecal samples can be a rapid and useful approach to confirm COVID-19 diagnosis in cases where there is an apparent discrepancy between COVID-19 clinical symptoms coupled with chest CT and SARS-CoV-2 RT-PCR tests' results on samples from the upper respiratory tract.
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Affiliation(s)
- Barbara Brogna
- Department of Radiology, Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy
| | - Carlo Brogna
- Specialist-Craniomed Laboratory Group srl, Viale degli Astronauti, 45, 83038 Montemiletto, Italy;
| | - Mauro Petrillo
- European Commission, Joint Research Centre (JRC), Ispra, 21027 Via Enrico Fermi, Italy;
| | - Adriana Modestina Conte
- Chief U.O. Emergency Unit-OBI P.O., Pineta Grande Hospital, Via Domitiana 3000, 81030 Castel Volturno, Italy;
| | - Giulio Benincasa
- Chief Anatomy Pathology Department, Pineta Grande Hospital, Via Domitiana 3000, 81030 Castel Volturno, Italy;
| | - Luigi Montano
- Specialist Andrology Unit, Service of Lifestyle Medicine in Uro-Andrology, Local Health Authority (ASL), 84121 Salerno, Italy;
| | - Marina Piscopo
- Department of Biology, University of Naples Federico II, 80138 Naples, Italy;
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49
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Raukar NP, Cooper LT. Implications of SARS-CoV-2-Associated Myocarditis in the Medical Evaluation of Athletes. Sports Health 2021; 13:145-148. [PMID: 33201768 PMCID: PMC8167355 DOI: 10.1177/1941738120974747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Myocarditis is a known cause of death in athletes. As we consider clearance of athletes to participate in sports during the COVID-19 pandemic, we offer a brief review of the myocardial effects of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) through the lens of what is known about myocarditis and exercise. All athletes should be queried about any recent illness suspicious for COVID-19 prior to sports participation. EVIDENCE ACQUISITION The PubMed database was evaluated through 2020, with the following keywords: myocarditis, COVID-19, SARS-CoV-2, cardiac, and athletes. Selected articles identified through the primary search, along with position statements from around the world, and the relevant references from those articles, were reviewed for pertinent clinical information regarding the identification, evaluation, risk stratification, and management of myocarditis in patients, including athletes, with and without SARS-CoV-2. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. RESULTS Since myocarditis can present with a variety of symptoms, and can be asymptomatic, the sports medicine physician needs to have a heightened awareness of athletes who may have had COVID-19 and be at risk for myocarditis and should have a low threshold to obtain further cardiovascular testing. Symptomatic athletes with SARS-CoV-2 may require cardiac evaluation including an electrocardiogram and possibly an echocardiogram. Athletes with cardiomyopathy may benefit from cardiac magnetic resonance imaging in the recovery phase and, rarely, endocardial biopsy. CONCLUSION Myocarditis is a known cause of sudden cardiac death in athletes. The currently reported rates of cardiac involvement of COVID-19 makes myocarditis a risk, and physicians who clear athletes for participation in sport as well as sideline personnel should be versed with the diagnosis, management, and clearance of athletes with suspected myocarditis. Given the potentially increased risk of arrhythmias, sideline personnel should practice their emergency action plans and be comfortable using an automated external defibrillator.
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Affiliation(s)
- Neha P. Raukar
- Department of Emergency Medicine,
Mayo Clinic, Rochester, Minnesota
| | - Leslie T. Cooper
- Department of Cardiovascular
Medicine, Mayo Clinic, Jacksonville, Florida
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A multidisciplinary evaluation of suspected, non-confirmed cases of COVID-19 including chest CT, as compared to World Health Organization recommendations. Clin Radiol 2021; 76:384-390. [PMID: 33691952 PMCID: PMC7901374 DOI: 10.1016/j.crad.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/11/2021] [Indexed: 12/18/2022]
Abstract
AIM To report an audit of the evaluation of suspected, unconfirmed cases of COVID-19 including chest computed tomography (CT), as compared to World Health Organization recommendations. METHODS A clinical audit was undertaken examining the evaluation of patients with suspected COVID-19 with negative SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) results, with comparison to WHO recommendations. A retrospective chart review was undertaken for 90 patients examining investigations, in particular CT, used to clarify the diagnosis. RESULTS Ninety patients underwent additional investigation. Seventy-five per cent adherence to WHO recommendations was observed. Fifty-two men (57.78%) and 38 (42.22%) women were investigated, with a median age of 69 years (range 20–96 years). Seventy-nine chest CT examinations demonstrated positive, indeterminate, and negative rates for COVID-19 of 3.79%, 24.1%, and 72.15% respectively. Three patients had discordant swab results with initially negative and subsequently positive results for SARS-CoV-2, resulting in false-negative rates of 5.1% for those retested. Combining discordant RT-PCR swab results, positive radiology, and patients treated as COVID-19-positive due to indeterminate radiology and highly consistent symptoms, resulted in a false-negative rate for initial SARS-CoV-2 RT-PCR swabs of 16.67%. CONCLUSION Seventy-five per cent compliance with relevant WHO guidance and a false-negative rate for initial swabs of 16.67% was demonstrated. Further evidence is needed to fully determine the utility of chest CT in the diagnosis of COVID-19 in the context of initial false-negative RT-PCR results.
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