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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 COVID-19: Molecular Diagnostic Testing (December 2023). Clin Infect Dis 2024; 78:e385-e415. [PMID: 38112284 DOI: 10.1093/cid/ciad646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Hartvigsen B, Jakobsen KK, Benfield T, Gredal NT, Ersbøll AK, Grønlund MW, Bundgaard H, Andersen MP, Steenhard N, von Buchwald C, Todsen T. Molecular Detection of SARS-CoV-2 From Throat Swabs Performed With or Without Specimen Collection From the Tonsils: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e47446. [PMID: 38865190 PMCID: PMC11208824 DOI: 10.2196/47446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Testing for SARS-CoV-2 is essential to provide early COVID-19 treatment for people at high risk of severe illness and to limit the spread of infection in society. Proper upper respiratory specimen collection is the most critical step in the diagnosis of the SARS-CoV-2 virus in public settings, and throat swabs were the preferred specimens used for mass testing in many countries during the COVID-19 pandemic. However, there is still a discussion about whether throat swabs have a high enough sensitivity for SARS-CoV-2 diagnostic testing, as previous studies have reported a large variability in the sensitivity from 52% to 100%. Many previous studies exploring the diagnostic accuracy of throat swabs lack a detailed description of the sampling technique, which makes it difficult to compare the different diagnostic accuracy results. Some studies perform a throat swab by only collecting specimens from the posterior oropharyngeal wall, while others also include a swab of the palatine tonsils for SARS-CoV-2 testing. However, studies suggest that the palatine tonsils could have a tissue tropism for SARS-CoV-2 that may improve the SARS-CoV-2 detection during sampling. This may explain the variation of sensitivity reported, but no clinical studies have yet explored the differences in sensitivity and patient discomfort whether the palatine tonsils are included during the throat swab or not. OBJECTIVE The objective of this study is to examine the sensitivity and patient discomfort of a throat swab including the palatine tonsils compared to only swabbing the posterior oropharyngeal wall in molecular testing for SARS-CoV-2. METHODS We will conduct a randomized controlled study to compare the molecular detection rate of SARS-CoV-2 by a throat swab performed from the posterior oropharyngeal wall and the palatine tonsils (intervention group) or the posterior oropharyngeal wall only (control group). Participants will be randomized in a 1:1 ratio. All participants fill out a baseline questionnaire upon enrollment in the trial, examining their reason for being tested, symptoms, and previous tonsillectomy. A follow-up questionnaire will be sent to participants to explore the development of symptoms after testing. RESULTS A total of 2315 participants were enrolled in this study between November 10, 2022, and December 22, 2022. The results from the follow-up questionnaire are expected to be completed at the beginning of 2024. CONCLUSIONS This randomized clinical trial will provide us with information about whether throat swabs including specimens from the palatine tonsils will improve the diagnostic sensitivity for SARS-CoV-2 molecular detection. These results can, therefore, be used to improve future testing recommendations and provide additional information about tissue tropism for SARS-CoV-2. TRIAL REGISTRATION ClinicalTrials.gov NCT05611203; https://clinicaltrials.gov/study/NCT05611203. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47446.
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Affiliation(s)
- Benedikte Hartvigsen
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Amager and Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Niels Tobias Gredal
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mathias Waldemar Grønlund
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Nina Steenhard
- TestCenter Danmark, Statens Serum Institut, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Todsen
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Owen GS, Urban MJ, Calder AN, Husain IA, LoSavio PS, Revenaugh PC, Batra PS. Inpatient Otolaryngology Consultations and COVID-19: The Surge and Lasting Effects at an Urban, Academic Institution. EAR, NOSE & THROAT JOURNAL 2024; 103:60S-67S. [PMID: 37329277 PMCID: PMC10290929 DOI: 10.1177/01455613231182295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
Objective: This study aims to examine the lasting effects of the coronavirus disease 2019 (COVID-19) pandemic on inpatient otolaryngology consultations. Methods: In a retrospective analysis, inpatient otolaryngology consultations at an urban, academic tertiary care center were reviewed over the course of 2 years (Jun 2019-Jun 2021). The consultations were categorized by time period based on the local data for COVID-19 hospitalizations and deaths as follows: pre-COVID (Jun 2019-Feb 2020), Surge 1 (Mar 2020-May 2020), Surge 2 (Oct 2020-Jan 2021), and Post Surge (Mar 2021-Jun 2021). Results: A total of 897 patients undergoing an inpatient otolaryngology consultation across all 4 time periods were included for analysis. The average consultations per day was 1.67 ± 0.24 in pre-COVID times, and dropped acutely to 0.86 ± 0.33 consultations per day during Surge 1. The consultation volume was not statistically different from pre-COVID levels during Surge 2 (1.33 ± 0.35) and Post Surge (1.60 ± 0.20). Reason for consultation and procedures performed did not vary significantly between pre-COVID times and Post Surge, except that consultation for postoperative complaint was less frequent in Post Surge (4.8% vs 1.0%, P = .02). More patients had been screened with rapid antigen COVID testing in Post Surge versus Surge 1 (20.1% vs 7.6%, P = .04). Conclusions: Inpatient otolaryngology consultation volumes, indications, and procedures performed at an urban, academic institution returned to pre-COVID levels after being significantly impacted during Surge 1.
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Affiliation(s)
- Grant S. Owen
- Rush Medical College, Rush University, Chicago, IL, USA
| | - Matthew J. Urban
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Inna A. Husain
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Phillip S. LoSavio
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter C. Revenaugh
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pete S. Batra
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
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Berry GJ, Jhaveri TA, Larkin PMK, Mostafa H, Babady NE. ADLM Guidance Document on Laboratory Diagnosis of Respiratory Viruses. J Appl Lab Med 2024; 9:599-628. [PMID: 38695489 DOI: 10.1093/jalm/jfae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 06/06/2024]
Abstract
Respiratory viral infections are among the most frequent infections experienced worldwide. The COVID-19 pandemic has highlighted the need for testing and currently several tests are available for the detection of a wide range of viruses. These tests vary widely in terms of the number of viral pathogens included, viral markers targeted, regulatory status, and turnaround time to results, as well as their analytical and clinical performance. Given these many variables, selection and interpretation of testing requires thoughtful consideration. The current guidance document is the authors' expert opinion based on the preponderance of available evidence to address key questions related to best practices for laboratory diagnosis of respiratory viral infections including who to test, when to test, and what tests to use. An algorithm is proposed to help laboratories decide on the most appropriate tests to use for the diagnosis of respiratory viral infections.
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Affiliation(s)
- Gregory J Berry
- Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian-Columbia University Irving Medical Center, New York, NY, United States
| | - Tulip A Jhaveri
- Department of Internal Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, United States
| | - Paige M K Larkin
- University of Chicago Pritzker School of Medicine, NorthShore University Health System, Chicago, IL, United States
| | - Heba Mostafa
- Johns Hopkins School of Medicine, Department of Pathology, Baltimore, MD, United States
| | - N Esther Babady
- Clinical Microbiology and Infectious Disease Services, Department of Pathology and Laboratory Medicine and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Santos CAQ, Tseng M, Martinez AI, Shankaran S, Hodgson HA, Ahmad FS, Zhang H, Sievert DM, Trick WE. Comparative antimicrobial use in coronavirus disease 2019 (COVID-19) and non-COVID-19 inpatients from 2019 to 2020: A multicenter ecological study. Infect Control Hosp Epidemiol 2024; 45:335-342. [PMID: 37877166 DOI: 10.1017/ice.2023.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE We sought to determine whether increased antimicrobial use (AU) at the onset of the coronavirus disease 2019 (COVID-19) pandemic was driven by greater AU in COVID-19 patients only, or whether AU also increased in non-COVID-19 patients. DESIGN In this retrospective observational ecological study from 2019 to 2020, we stratified inpatients by COVID-19 status and determined relative percentage differences in median monthly AU in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (March-December 2020) and the pre-COVID-19 period (March-December 2019). We also determined relative percentage differences in median monthly AU in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period. Statistical significance was assessed using Wilcoxon signed-rank tests. SETTING The study was conducted in 3 acute-care hospitals in Chicago, Illinois. PATIENTS Hospitalized patients. RESULTS Facility-wide AU for broad-spectrum antibacterial agents predominantly used for hospital-onset infections was significantly greater in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (with relative increases of 73%, 66%, and 91% for hospitals A, B, and C, respectively), and during the pre-COVID-19 period (with relative increases of 52%, 64%, and 66% for hospitals A, B, and C, respectively). In contrast, facility-wide AU for all antibacterial agents was significantly lower in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period (with relative decreases of 8%, 7%, and 8% in hospitals A, B, and C, respectively). CONCLUSIONS AU for broad-spectrum antimicrobials was greater in COVID-19 patients compared to non-COVID-19 patients at the onset of the pandemic. AU for all antibacterial agents in non-COVID-19 patients decreased in the COVID-19 period compared to the pre-COVID-19 period.
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Affiliation(s)
- Carlos A Q Santos
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Marion Tseng
- Medical Research Analytics and Informatics Alliance, Chicago, Illinois
| | - Ashley I Martinez
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
- Division of Therapeutics and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Shivanjali Shankaran
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Hayley A Hodgson
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Huiyuan Zhang
- Center for Health Equity & Innovation, Cook County Health, Chicago, Illinois
| | - Dawn M Sievert
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William E Trick
- Center for Health Equity & Innovation, Cook County Health, Chicago, Illinois
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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Brogna C, Montano L, Zanolin ME, Bisaccia DR, Ciammetti G, Viduto V, Fabrowski M, Baig AM, Gerlach J, Gennaro I, Bignardi E, Brogna B, Frongillo A, Cristoni S, Piscopo M. A retrospective cohort study on early antibiotic use in vaccinated and unvaccinated COVID-19 patients. J Med Virol 2024; 96:e29507. [PMID: 38504586 DOI: 10.1002/jmv.29507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
The bacteriophage behavior of SARS-CoV-2 during the acute and post-COVID-19 phases appears to be an important factor in the development of the disease. The early use of antibiotics seems to be crucial to inhibit disease progression-to prevent viral replication in the gut microbiome, and control toxicological production from the human microbiome. To study the impact of specific antibiotics on recovery from COVID-19 and long COVID (LC) taking into account: vaccination status, comorbidities, SARS-CoV-2 wave, time of initiation of antibiotic therapy and concomitant use of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). A total of 211 COVID-19 patients were included in the study: of which 59 were vaccinated with mRNA vaccines against SARS-CoV-2 while 152 were unvaccinated. Patients were enrolled in three waves: from September 2020 to October 2022, corresponding to the emergence of the pre-Delta, Delta, and Omicron variants of the SARS-CoV-2 virus. The three criteria for enrolling patients were: oropharyngeal swab positivity or fecal findings; moderate symptoms with antibiotic intake; and measurement of blood oxygen saturation during the period of illness. The use of antibiotic combinations, such as amoxicillin with clavulanic acid (875 + 125 mg tablets, every 12 h) plus rifaximin (400 mg tablets every 12 h), as first choice, as suggested from the previous data, or azithromycin (500 mg tablets every 24 h), plus rifaximin as above, allows healthcare professionals to focus on the gut microbiome and its implications in COVID-19 disease during patient care. The primary outcome measured in this study was the estimated average treatment effect, which quantified the difference in mean recovery between patients receiving antibiotics and those not receiving antibiotics at 3 and 9 days after the start of treatment. In the analysis, both vaccinated and unvaccinated groups had a median illness duration of 7 days (interquartile range [IQR] 6-9 days for each; recovery crude hazard ratio [HR] = 0.94, p = 0.700). The median illness duration for the pre-Delta and Delta waves was 8 days (IQR 7-10 days), while it was shorter, 6.5 days, for Omicron (IQR 6-8 days; recovery crude HR = 1.71, p < 0.001). These results were confirmed by multivariate analysis. Patients with comorbidities had a significantly longer disease duration: median 8 days (IQR 7-10 days) compared to 7 days (IQR 6-8 days) for those without comorbidities (crude HR = 0.75, p = 0.038), but this result was not confirmed in multivariate analysis as statistical significance was lost. Early initiation of antibiotic therapy resulted in a significantly shorter recovery time (crude HR = 4.74, p < 0.001). Concomitant use of NSAIDs did not reduce disease duration and in multivariate analysis prolonged the disease (p = 0.041). A subgroup of 42 patients receiving corticosteroids for a median of 3 days (IQR 3-6 days) had a longer recovery time (median 9 days, IQR 8-10 days) compared to others (median 7 days, IQR 6-8 days; crude HR = 0.542, p < 0.001), as confirmed also by the adjusted HR. In this study, a statistically significant reduction in recovery time was observed among patients who received early antibiotic treatment. Early initiation of antibiotics played a crucial role in maintaining higher levels of blood oxygen saturation. In addition, it is worth noting that a significant number of patients who received antibiotics in the first 3 days and for a duration of 7 days, during the acute phase did not develop LC.
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Affiliation(s)
- Carlo Brogna
- Craniomed Group Srl. Research Facility, Bresso, Italy
| | - Luigi Montano
- Andrology Unit and Service of Lifestyle Medicine in Uro-Andrology, Local Health Authority (ASL), Salerno, Italy
| | | | | | - Gianluca Ciammetti
- Otorhinolaryngology Unit, Hospital Ferdinando Veneziale Isernia, Regional Health Authority of Molise, Italy
| | | | - Mark Fabrowski
- Department of Emergency Medicine, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Abdul M Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Iapicca Gennaro
- Pineta Grande Hospital Group, Department of Urology, Santa Rita Clinic, Atripalda, Italy
| | | | - Barbara Brogna
- Department of Radiology, Moscati Hospital, Avellino, Italy
| | | | | | - Marina Piscopo
- Department of Biology, University of Naples Federico II, Naples, Italy
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Frediani JK, Parsons R, McLendon KB, Westbrook AL, Lam W, Martin G, Pollock NR. The New Normal: Delayed Peak SARS-CoV-2 Viral Loads Relative to Symptom Onset and Implications for COVID-19 Testing Programs. Clin Infect Dis 2024; 78:301-307. [PMID: 37768707 PMCID: PMC10874267 DOI: 10.1093/cid/ciad582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Early in the coronavirus disease 2019 (COVID-19) pandemic, peak viral loads coincided with symptom onset. We hypothesized that in a highly immune population, symptom onset might occur earlier in infection, coinciding with lower viral loads. METHODS We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A viral loads relative to symptom duration in symptomatic adults (≥16 years) presenting for testing in Georgia (4/2022-4/2023; Omicron variant predominant). Participants provided symptom duration and recent testing history. Nasal swabs were tested by Xpert Xpress SARS-CoV-2/Flu/RSV assay and cycle threshold (Ct) values recorded. Nucleoprotein concentrations in SARS-CoV-2 polymerase chain reaction (PCR)-positive samples were measured by single molecule array. To estimate hypothetical antigen rapid diagnostic test (Ag RDT) sensitivity on each day after symptom onset, percentages of individuals with Ct value ≤30 or ≤25 were calculated. RESULTS Of 348 newly-diagnosed SARS-CoV-2 PCR-positive individuals (65.5% women, median 39.2 years), 317/348 (91.1%) had a history of vaccination, natural infection, or both. By both Ct value and antigen concentration measurements, median viral loads rose from the day of symptom onset and peaked on the fourth/fifth day. Ag RDT sensitivity estimates were 30.0%-60.0% on the first day, 59.2%-74.8% on the third day, and 80.0%-93.3% on the fourth day of symptoms.In 74 influenza A PCR-positive individuals (55.4% women; median 35.0 years), median influenza viral loads peaked on the second day of symptoms. CONCLUSIONS In a highly immune adult population, median SARS-CoV-2 viral loads peaked around the fourth day of symptoms. Influenza A viral loads peaked soon after symptom onset. These findings have implications for ongoing use of Ag RDTs for COVID-19 and influenza.
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Affiliation(s)
- Jennifer K Frediani
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Richard Parsons
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kaleb B McLendon
- Emory/Children's Laboratory for Innovative Assay Development, Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Adrianna L Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Wilbur Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Greg Martin
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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8
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Mustafa RA, El Mikati IK, Murad MH, Hultcrantz M, Steingart KR, Yang B, Leeflang MMG, Akl EA, Dahm P, Schünemann HJ. GRADE guidance 37: rating imprecision in a body of evidence on test accuracy. J Clin Epidemiol 2024; 165:111189. [PMID: 38613246 DOI: 10.1016/j.jclinepi.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/07/2023] [Accepted: 10/13/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVES To provide guidance on rating imprecision in a body of evidence assessing the accuracy of a single test. This guide will clarify when Grading of Recommendations Assessment, Development and Evaluation (GRADE) users should consider rating down the certainty of evidence by one or more levels for imprecision in test accuracy. STUDY DESIGN AND SETTING A project group within the GRADE working group conducted iterative discussions and presentations at GRADE working group meetings to produce this guidance. RESULTS Before rating the certainty of evidence, GRADE users should define the target of their certainty rating. GRADE recommends setting judgment thresholds defining what they consider a very accurate, accurate, inaccurate, and very inaccurate test. These thresholds should be set after considering consequences of testing and effects on people-important outcomes. GRADE's primary criterion for judging imprecision in test accuracy evidence is considering confidence intervals (i.e., CI approach) of absolute test accuracy results (true and false, positive, and negative results in a cohort of people). Based on the CI approach, when a CI appreciably crosses the predefined judgment threshold(s), one should consider rating down certainty of evidence by one or more levels, depending on the number of thresholds crossed. When the CI does not cross judgment threshold(s), GRADE suggests considering the sample size for an adequately powered test accuracy review (optimal or review information size [optimal information size (OIS)/review information size (RIS)]) in rating imprecision. If the combined sample size of the included studies in the review is smaller than the required OIS/RIS, one should consider rating down by one or more levels for imprecision. CONCLUSION This paper extends previous GRADE guidance for rating imprecision in single test accuracy systematic reviews and guidelines, with a focus on the circumstances in which one should consider rating down one or more levels for imprecision.
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Affiliation(s)
- Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Centre, 3901 Rainbow Blvd, MS3002, Kansas City, KS 61160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 1st, ST, SW, Rochester, MN 55902, USA
| | - Monica Hultcrantz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodav. 18 A, SE-171 77 Stockholm, Sweden
| | - Karen R Steingart
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Bada Yang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Clinical Epidemiology and Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam, Meibergdreef 9, P.O.Box 227001100 DE, Amsterdam, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section 112D, One Veterans Drive, Minneapolis, MN 55417, USA
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8 Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milano, Italy; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Breisgau, Germany
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9
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Kyo H, Patel SA, Yamamoto M, Matsumura Y, Ikeda T, Nagao M. A population-based study of the trend in SARS-CoV-2 diagnostic modalities from the beginning of the pandemic to the Omicron surge in Kyoto City, Kyoto, Japan. BMC Public Health 2023; 23:2551. [PMID: 38129830 PMCID: PMC10734122 DOI: 10.1186/s12889-023-17498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) presents critical diagnostic challenges for managing the pandemic. We investigated the 30-month changes in COVID-19 testing modalities and functional testing sites from the early period of the pandemic to the most recent Omicron surge in 2022 in Kyoto City, Japan. METHODS This is a retrospective-observational study using a local anonymized population database that included patients' demographic and clinical information, testing methods and facilities from January 2020 to June 2022, a total of 30 months. We computed the distribution of symptomatic presentation, testing methods, and testing facilities among cases. Differences over time were tested using chi-square tests of independence. RESULTS During the study period, 133,115 confirmed COVID-19 cases were reported, of which 90.9% were symptomatic. Although nucleic acid amplification testing occupied 68.9% of all testing, the ratio of lateral flow devices (LFDs) rapidly increased in 2022. As the pandemic continued, the testing capability was shifted from COVID-19 designated facilities to general practitioners, who became the leading testing providers (57.3% of 99,945 tests in 2022). CONCLUSIONS There was a dynamic shift in testing modality during the first 30 months of the pandemic in Kyoto City. General practitioners increased their role substantially as the use of LFDs spread dramatically in 2022. By comprehending and documenting the evolution of testing methods and testing locations, it is anticipated that this will contribute to the establishment of an even more efficient testing infrastructure for the next pandemic.
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Affiliation(s)
- Hiroki Kyo
- MetroAtlanta Ambulance Service, Emory Healthcare Network, Atlanta, GA, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Masaki Yamamoto
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan
| | - Yasufumi Matsumura
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Ikeda
- Public Health and Welfare Bureau of Kyoto City, Kyoto, Japan
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
- Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan.
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10
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Van der Moeren N, Zwart VF, Louise van Leest M, Thijssen M, Groenewegen R, Heer MKD, Murk JL, Tjhie JT, Diederen BMW, Stohr JJJM. A SARS-CoV-2 and influenza rapid antigen test-based hospital isolation policy awaiting RT-PCR, a prospective observational study. Clin Microbiol Infect 2023; 29:1595-1599. [PMID: 37739262 DOI: 10.1016/j.cmi.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical performance of a combined SARS-CoV-2/influenza rapid antigen test (SIRAT) and to evaluate a SIRAT-based hospital isolation policy awaiting RT-PCR results for patients presenting at the emergency department (ED). METHODS We performed a prospective observational study including all adult patients presenting with influenza-like symptoms at the ED of two hospitals from 31 October 2022 to 31 March 2023. A SIRAT and SARS-CoV-2 and influenza RT-PCR were performed on upper respiratory samples. SIRAT results were compared with RT-PCR. Droplet and contact isolation measures (DCIM) were imposed based on SIRAT results awaiting RT-PCR. We monitored symptomatic nosocomial SARS-CoV-2 and influenza infections potentially caused by delayed isolation of patients with false negative SIRAT and the hours of unnecessary DCIM saved. RESULTS We included 1740 patients of whom 1296 were hospitalized. SARS-CoV-2 and influenza A/B prevalence were 12.7% (221/1740) and 9.9% (171/1740). Sensitivity and specificity of the SIRAT were 67.7% (95% CI 61.1-73.9%) (149/220) and 99.4% (95% CI 99.0-99.8%) (1510/1518) for SARS-CoV-2 and 52.7% (95% CI 44.9-60.4%) (89/169) and 99.1% (95% CI 98.5-99.5%) (1530/1544) for influenza A/B. We found a 0% nosocomial transmission risk for SARS-CoV-2 (95% CI 0-8.8%) and influenza (95% CI 0-10%). In all, 8712 hours in total or a median up to 6 hours 59 minutes (IQR (interquartile range) 11h03) per patient of unnecessary DCIM were saved. DISCUSSION A SIRAT-guided hospital isolation policy awaiting RT-PCR results for patients who present at the ED can save unnecessary isolation hours without having to lead to significant symptomatic nosocomial transmission of SARS-CoV-2 or influenza viruses.
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Affiliation(s)
- Nathalie Van der Moeren
- Department of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Vivian F Zwart
- Department of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Marie Louise van Leest
- Emergency Department, Bravis Hospital, Roosendaal, The Netherlands; Emergency Department, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Marcel Thijssen
- Emergency Department, Bravis Hospital, Roosendaal, The Netherlands
| | | | | | - Jean-Luc Murk
- Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Jeroen T Tjhie
- Department of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Bram M W Diederen
- Microvida, Laboratory of Medical Microbiology, Bravis Hospital, Roosendaal, The Netherlands
| | - Joep J J M Stohr
- Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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11
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Franklin A, John TM, Khawaja F, Jiang Y, Yepez E, Ahuja J, Faiz SA, Bashoura L, Sheshadri A, Shannon VR, Balachandran DD, McConn K, Mulanovich VE, Bhatti M, Chemaly RF. Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients With Cancer. J Infect Dis 2023; 228:1549-1558. [PMID: 37983000 DOI: 10.1093/infdis/jiad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients with cancer. METHODS We conducted a retrospective cohort study of adult patients with cancer who had BAL samples tested for SARS-CoV-2 at a comprehensive cancer center. Patients without NPS PCR for SARS-CoV-2 before BAL were excluded. RESULTS In a cohort of 345 patients, 12% and 17% tested positive for SARS-CoV-2 on NPS and BAL, respectively. There was a 6.3% NPS-/BAL+ discordance rate and a 9.5% NPS+/BAL- discordance rate. Patients with lymphoma (adjusted odds ratio [aOR] = 4.06; P = .007) and Hispanic patients (aOR = 3.76; P = .009) were more likely to have NPS-/BAL+ discordance on multivariate analysis. Among patients with NPS- /BAL- for SARS-CoV-2, an alternate infectious (23%) and a noninfectious etiology (16%) were identified in BAL. CONCLUSIONS Our discordance rates between NPS and BAL were sufficient to recommend BAL in certain patients with cancer with a high clinical suspicion of COVID-19. BAL has value in identifying alternative etiologies of illness in patients with suspected or confirmed COVID-19.
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Affiliation(s)
- Alexander Franklin
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Teny M John
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Yepez
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jitesh Ahuja
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly McConn
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Micah Bhatti
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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ElNahid MS, Issac MSM, Sadek KM. Outcome of COVID-19 in Egyptian living-donor kidney transplant recipients and relation to maintenance immunosuppressive drugs: a pilot study. Sci Rep 2023; 13:19002. [PMID: 37923735 PMCID: PMC10624883 DOI: 10.1038/s41598-023-45750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) in kidney transplant recipients is a subject of much debate and became of interest to nephrologists amidst the pandemic. The main concerns are the influence of the chronic use of immunosuppressive drugs, the viral-related risk of acute rejection, and the long-term outcome of allograft function. This single-center prospective study included kidney transplant recipients with COVID-19 infection. Patients were maintained on immunosuppressive regimens. The severity of disease was defined as oxygen saturation < 94%, the need for hospitalization and/or hemodialysis, the occurrence of acute kidney injury (AKI), and mortality. Seventeen patients (54.8%) required hospital admission, four patients needed hemodialysis (12.9%), twelve patients (38.7%) had AKI, and three patients died (9.7%). Oxygen saturation < 94% showed a positive correlation with the presence of diabetes (p value 0.031) and a negative correlation with the maintenance steroid dose (p value 0.046). A negative correlation existed between the need for hemodialysis and average Cyclosporin level (p value 0.019) and between the need for hospitalization and average Tacrolimus level (p value 0.046). Severity of disease was associated with the presence of lymphopenia (p value 0.042), the cumulative steroid dose (p value 0.001), increased serum levels of LDH (p value 0.010), Ferritin (p value 0.020), AST (p value 0.047), and ALT (p value 0.006) and D-dimer levels more than 0.5 mg/L (p value 0.038). This study highlighted that the immunocompromised state of renal transplant recipients may not be regarded as a disadvantage in the setting of COVID-19 infection. Studies on a larger scale are needed to validate these results.
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Affiliation(s)
- Maggie Said ElNahid
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Khaled Marzouk Sadek
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
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13
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Qureshi H, Balchander D, Cabrera CI, Tranchito E, Goslawski A, Vos D, Johnson B, Fowler N, Tamaki A, Rabbani CC. Examining the relationship between COVID-19 and Bell's palsy: Experience of a single tertiary care center. Am J Otolaryngol 2023; 44:103987. [PMID: 37579600 DOI: 10.1016/j.amjoto.2023.103987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND While the etiology of Bell's palsy (BP) is largely unknown, current evidence shows it may occur secondary to the immune response following a viral infection. Recently, BP has been reported as a clinical manifestation of coronavirus disease (COVID-19). OBJECTIVES To investigate an association between COVID-19 infection and BP. Additionally, to evaluate the need for COVID-19 testing in patients who present with BP. METHODS Hospital records of patients who presented to a single tertiary care center with BP in 2020 and 2021 were reviewed for presenting symptoms, demographics, COVID-19 infection and vaccination status. RESULTS There was no statistically significant difference between patients with BP who had a positive or negative COVID test in terms of sex, BMI, age, race, smoking history or alcohol use. All 7 patients with BP and a positive COVID test were unvaccinated. Of the total cohort of 94 patients, 82 % were unvaccinated at the time of the study. None of the 17 patients who were vaccinated had a positive COVID test. A history of BP showed no statistical significance (10.3 % vs 14.3 %, p-value 0.73). CONCLUSION We discovered a limited cohort of patients who underwent COVID-19 testing at the time of presentation for BP. Though there have been recent studies suggesting a COVID-19 and BP, we were unable to clearly identify a relationship between COVID-19 and BP. Interestingly, all patients with facial paralysis and COVID-19 were unvaccinated. To further study this relationship, we recommend consideration of a COVID-19 test for any patient that presents with facial paralysis.
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Affiliation(s)
- Hira Qureshi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | - Claudia I Cabrera
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eve Tranchito
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amanda Goslawski
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Derek Vos
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin Johnson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nicole Fowler
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Akina Tamaki
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Cyrus C Rabbani
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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14
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O'Grady NP, Alexander E, Alhazzani W, Alshamsi F, Cuellar-Rodriguez J, Jefferson BK, Kalil AC, Pastores SM, Patel R, van Duin D, Weber DJ, Deresinski S. Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med 2023; 51:1570-1586. [PMID: 37902340 DOI: 10.1097/ccm.0000000000006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
RATIONALE Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation. OBJECTIVES This is an update of the 2008 Infectious Diseases Society of America and Society (IDSA) and Society of Critical Care Medicine (SCCM) guideline for the evaluation of new-onset fever in adult ICU patients without severe immunocompromise, now using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. PANEL DESIGN The SCCM and IDSA convened a taskforce to update the 2008 version of the guideline for the evaluation of new fever in critically ill adult patients, which included expert clinicians as well as methodologists from the Guidelines in Intensive Care, Development and Evaluation Group. The guidelines committee consisted of 12 experts in critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration. All task force members followed all conflict-of-interest procedures as documented in the American College of Critical Care Medicine/SCCM Standard Operating Procedures Manual and the IDSA. There was no industry input or funding to produce this guideline. METHODS We conducted a systematic review for each population, intervention, comparison, and outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as best-practice statements. RESULTS The panel issued 12 recommendations and 9 best practice statements. The panel recommended using central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors when these devices are in place or accurate temperature measurements are critical for diagnosis and management. For patients without these devices in place, oral or rectal temperatures over other temperature measurement methods that are less reliable such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers were recommended. Imaging studies including ultrasonography were recommended in addition to microbiological evaluation using rapid diagnostic testing strategies. Biomarkers were recommended to assist in guiding the discontinuation of antimicrobial therapy. All recommendations issued were weak based on the quality of data. CONCLUSIONS The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue-including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.
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Affiliation(s)
- Naomi P O'Grady
- Internal Medicine Services, National Institutes of Health Clinical Center, Bethesda, MD
| | - Earnest Alexander
- Clinical Pharmacy Services, Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, Bethesda, MD
| | - Brian K Jefferson
- Division of Hepatobiliary and Pancreatic Surgery, Department of Internal Medicine-Critical Care Services, Atrium Health Cabarrus, Concord, NC
| | - Andre C Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, MN
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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15
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Todsen T, Tolsgaard MG, Benfield T, Folke F, Jakobsen KK, Gredal NT, Ersbøll AK, von Buchwald C, Kirkby N. Higher SARS-CoV-2 detection of oropharyngeal compared with nasopharyngeal or saliva specimen for molecular testing: a multicentre randomised comparative accuracy study. Thorax 2023; 78:1028-1034. [PMID: 37208187 PMCID: PMC10511974 DOI: 10.1136/thorax-2022-219599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/22/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Testing is critical for detecting SARS-CoV-2 infection, but the best sampling method remains unclear. OBJECTIVES To determine whether nasopharyngeal swab (NPS), oropharyngeal swab (OPS) or saliva specimen collection has the highest detection rate for SARS-CoV-2 molecular testing. METHODS We conducted a randomised clinical trial at two COVID-19 outpatient test centres where NPS, OPS and saliva specimens were collected by healthcare workers in different orders for reverse transcriptase PCR testing. The SARS-CoV-2 detection rate was calculated as the number positive by a specific sampling method divided by the number in which any of the three sampling methods was positive. As secondary outcomes, test-related discomfort was measured with an 11-point numeric scale and cost-effectiveness was calculated. RESULTS Among 23 102 adults completing the trial, 381 (1.65%) were SARS-CoV-2 positive. The SARS-CoV-2 detection rate was higher for OPSs, 78.7% (95% CI 74.3 to 82.7), compared with NPSs, 72.7% (95% CI 67.9 to 77.1) (p=0.049) and compared with saliva sampling, 61.9% (95% CI 56.9 to 66.8) (p<0.001). The discomfort score was highest for NPSs, at 5.76 (SD, 2.52), followed by OPSs, at 3.16 (SD 3.16) and saliva samples, at 1.03 (SD 18.8), p<0.001 between all measurements. Saliva specimens were associated with the lowest cost, and the incremental costs per detected SARS-CoV-2 infection for NPSs and OPSs were US$3258 and US$1832, respectively. CONCLUSIONS OPSs were associated with higher SARS-CoV-2 detection and lower test-related discomfort than NPSs for SARS-CoV-2 testing. Saliva sampling had the lowest SARS-CoV-2 detection but was the least costly strategy for mass testing. TRIAL REGISTRATION NUMBER NCT04715607.
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Affiliation(s)
- Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
| | - Martin G Tolsgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen Emergency Medical Services, Capital region of Denmark, Copenhagen, Denmark
| | - Kathrine K Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Tobias Gredal
- Copenhagen Emergency Medical Services, Capital region of Denmark, Copenhagen, Denmark
| | - Annette K Ersbøll
- Copenhagen Emergency Medical Services, Capital region of Denmark, Copenhagen, Denmark
- University of Southern Denmark National Institute of Public Health, Copenhagen, Hovedstaden, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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16
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Osman K, Mundodan J, Chowdhury J, Ravi R, Baaboura R, Albuquerque J, Riaz B, Emran RY, Batoul K, Esameldin AM, Al Tabatabaee Z, Khogali H, Albayat S. Pfizer-BioNTech mRNA Vaccine Protection among Children and Adolescents Aged 12-17 Years against COVID-19 Infection in Qatar. Vaccines (Basel) 2023; 11:1522. [PMID: 37896926 PMCID: PMC10610824 DOI: 10.3390/vaccines11101522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
Qatar was also hit hard by the global pandemic of SARS-CoV-2, with the original virus, Alpha variant, Beta variant, Omicron BA.1 and BA.2 variants, Omicron BA.4 and BA.5 variants, and Delta variant, sequentially. The two-dose primary series of BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine against SARS-CoV-2 infection has been approved for use in 30 µg formulations among children and adolescents aged 12-17 years as of 16 May 2021. This study aimed at estimating the effectiveness of the 30 µg BNT162b2 Pfizer-BioNTech mRNA COVID-19 vaccine against the pre-Omicron variants of SARS-CoV-2 infection in children and adolescents aged 12-17 years residing in Qatar. A test-negative matched case-control study was conducted. The subjects included any child or adolescent aged 12-17 years who had been tested for SARS-CoV-2 using RT-PCR tests performed on nasopharyngeal or oropharyngeal swabs, as part of contact tracing, between June and November 2021, and was eligible to receive the BNT162b2 vaccine as per the national guidelines. Data regarding 14,161 children/adolescents meeting inclusion-exclusion criteria were retrieved from the national Surveillance and Vaccine Electronic System (SAVES). Of the total, 3.1% (444) were positive for SARS-CoV-2. More than half (55.96%) were vaccinated with two doses of Pfizer-BioNTech-mRNA COVID-19 vaccine. Amongst those immunized with two doses, 1.2% tested positive for SARS-CoV-2, while 5.6% amongst the unvaccinated tested positive. The vaccine effectiveness was calculated to be 79%. Pfizer-BioNTech mRNA COVID-19 vaccine provides protection from COVID-19 infection for children/adolescents; hence, it is crucial to ensure they receive the recommended vaccines.
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Affiliation(s)
- Khadieja Osman
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
| | - Jesha Mundodan
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Juel Chowdhury
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Rejoice Ravi
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Rekayahouda Baaboura
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Jeevan Albuquerque
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Bilal Riaz
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Reem Yusuf Emran
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Khatija Batoul
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
| | - Abdul Mahmood Esameldin
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
| | - Zinah Al Tabatabaee
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
| | - Hayat Khogali
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Soha Albayat
- National COVID-19 Track & Trace Team, Ministry of Public Health, Doha P.O. Box 42, Qatar; (K.O.); (J.C.); (R.R.); (R.B.); (J.A.); (B.R.); (R.Y.E.); (H.K.); (S.A.)
- Vaccination Section, Ministry of Public Health, Doha P.O. Box 42, Qatar
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17
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Levine DA, Uy V, Krief W, Bornstein C, Daswani D, Patel D, Kriegel M, Jamal N, Patel K, Liang T, Arroyo A, Strother C, Lim CA, Langhan ML, Hassoun A, Chamdawala H, Kaplan CP, Waseem M, Tay ET, Mortel D, Sivitz AB, Kelly C, Lee HJ, Qiu Y, Gorelik M, Platt SL, Dayan P. Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region. Pediatr Emerg Care 2023; 39:555-561. [PMID: 36811547 DOI: 10.1097/pec.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock. METHODS We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors. RESULTS Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]). CONCLUSIONS Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.
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Affiliation(s)
- Deborah A Levine
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Vincent Uy
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - William Krief
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Cara Bornstein
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Dina Daswani
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Darshan Patel
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Marni Kriegel
- Department of Emergency Medicine and Pediatrics, Hackensack University Medical Center/Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nazreen Jamal
- Department of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons
| | - Kavita Patel
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Tian Liang
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Alexander Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn
| | - Christopher Strother
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Czer Anthoney Lim
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa L Langhan
- Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven CT
| | - Ameer Hassoun
- Department of Emergency Medicine, NewYork-Presbyterian Queens/Weill Cornell Medicine, Flushing
| | - Haamid Chamdawala
- Department of Pediatrics, Jacobi Hospital Center/North Central Bronx Hospital, The Bronx
| | - Carl Philip Kaplan
- Departments of Pediatrics and Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook
| | - Muhammad Waseem
- Departments of Emergency Medicine and Pediatrics, Lincoln Medical Center/Weill Cornell Medicine, The Bronx
| | - Ee Tein Tay
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine/Bellevue Hospital Center
| | - David Mortel
- Departments of Emergency Medicine and Pediatrics, Harlem Hospital Center, New York
| | - Adam B Sivitz
- Departments of Emergency Medicine and Pediatrics, Newark Beth Israel Medical Center/Children's Hospital of New Jersey, New Jersey Medical School, Rutgers University, Newark
| | - Christopher Kelly
- Department of Emergency Medicine, NewYork-Presbyterian/Brooklyn Methodist Hospital, Brooklyn
| | | | | | | | - Shari L Platt
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Peter Dayan
- Emergency Medicine, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons, New York, NY
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18
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Tanzarella ES, Vargas J, Menghini M, Postorino S, Pozzana F, Vallecoccia MS, De Matteis FL, Franchi F, Infante A, Larosa L, Mazzei MA, Cutuli SL, Grieco DL, Bisanti A, Carelli S, Lombardi G, Piervincenzi E, Pintaudi G, Pirronti T, Tumbarello M, Antonelli M, De Pascale G. An Observational Study to Develop a Predictive Model for Bacterial Pneumonia Diagnosis in Severe COVID-19 Patients-C19-PNEUMOSCORE. J Clin Med 2023; 12:4688. [PMID: 37510807 PMCID: PMC10381000 DOI: 10.3390/jcm12144688] [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: 06/18/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
In COVID-19 patients, antibiotics overuse is still an issue. A predictive scoring model for the diagnosis of bacterial pneumonia at intensive care unit (ICU) admission would be a useful stewardship tool. We performed a multicenter observational study including 331 COVID-19 patients requiring invasive mechanical ventilation at ICU admission; 179 patients with bacterial pneumonia; and 152 displaying negative lower-respiratory samplings. A multivariable logistic regression model was built to identify predictors of pulmonary co-infections, and a composite risk score was developed using β-coefficients. We identified seven variables as predictors of bacterial pneumonia: vaccination status (OR 7.01; 95% CI, 1.73-28.39); chronic kidney disease (OR 3.16; 95% CI, 1.15-8.71); pre-ICU hospital length of stay ≥ 5 days (OR 1.94; 95% CI, 1.11-3.4); neutrophils ≥ 9.41 × 109/L (OR 1.96; 95% CI, 1.16-3.30); procalcitonin ≥ 0.2 ng/mL (OR 5.09; 95% CI, 2.93-8.84); C-reactive protein ≥ 107.6 mg/L (OR 1.99; 95% CI, 1.15-3.46); and Brixia chest X-ray score ≥ 9 (OR 2.03; 95% CI, 1.19-3.45). A predictive score (C19-PNEUMOSCORE), ranging from 0 to 9, was obtained by assigning one point to each variable, except from procalcitonin and vaccine status, which gained two points each. At a cut-off of ≥3, the model exhibited a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 84.9%, 55.9%, 69.4%, 75.9%, and 71.6%, respectively. C19-PNEUMOSCORE may be an easy-to-use bedside composite tool for the early identification of severe COVID-19 patients with pulmonary bacterial co-infection at ICU admission. Its implementation may help clinicians to optimize antibiotics administration in this setting.
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Affiliation(s)
- Eloisa Sofia Tanzarella
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Joel Vargas
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Menghini
- U.O.C. Terapia Intensiva OM e Hub Maxi Emergenze, Ospedale Maggiore Carlo Alberto Pizzardi, 40133 Bologna, Italy
| | - Stefania Postorino
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Pozzana
- Dipartimento di Anestesia e Rianimazione, Ospedale Santa Maria Goretti, 04100 Latina, Italy
| | - Maria Sole Vallecoccia
- Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, Santa Maria Nuova Hospital, 50122 Florence, Italy
| | - Francesco Lorenzo De Matteis
- Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University of Siena, 53100 Siena, Italy
| | - Federico Franchi
- Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University of Siena, 53100 Siena, Italy
| | - Amato Infante
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luigi Larosa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Salvatore Lucio Cutuli
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandra Bisanti
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Simone Carelli
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianmarco Lombardi
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Edoardo Piervincenzi
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriele Pintaudi
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Tommaso Pirronti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Mario Tumbarello
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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19
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Peaper DR, Kerantzas CA, Durant TJS. Advances in molecular infectious diseases testing in the time of COVID-19. Clin Biochem 2023; 117:94-101. [PMID: 35181291 PMCID: PMC8843810 DOI: 10.1016/j.clinbiochem.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 12/23/2022]
Abstract
The Coronavirus Disease of 2019 (COVID-19) pandemic has been a challenging event for laboratory medicine and diagnostics manufacturers. We have had to confront numerous unique and previously unthinkable issues on a daily basis in order to continue offering diagnostic testing for not only Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), but other testing that was significantly impacted by supply chain and staffing disruptions related to COVID-19. Out of this tremendously stressful and, at times, chaotic environment, decades of innovations and advances in testing methodologies and instrumentation became essential to handle the overwhelming volume of samples with clinically appropriate turn-around-time. Additionally, a number of novel testing approaches and technological innovations emerged to address laboratory and public health needs for widespread testing. In this review we consider both technological advances in infectious diseases testing and other innovations in sample collection, processing, automation, workflow, and testing that have embodied the laboratory response to the COVID-19 pandemic.
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Affiliation(s)
- David R Peaper
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States.
| | - Christopher A Kerantzas
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Thomas J S Durant
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
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20
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Berus SM, Nowicka AB, Wieruszewska J, Niciński K, Kowalska AA, Szymborski TR, Dróżdż I, Borowiec M, Waluk J, Kamińska A. SERS Signature of SARS-CoV-2 in Saliva and Nasopharyngeal Swabs: Towards Perspective COVID-19 Point-of-Care Diagnostics. Int J Mol Sci 2023; 24:ijms24119706. [PMID: 37298658 DOI: 10.3390/ijms24119706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
In this study, the intrinsic surface-enhanced Raman spectroscopy (SERS)-based approach coupled with chemometric analysis was adopted to establish the biochemical fingerprint of SARS-CoV-2 infected human fluids: saliva and nasopharyngeal swabs. The numerical methods, partial least squares discriminant analysis (PLS-DA) and support vector machine classification (SVMC), facilitated the spectroscopic identification of the viral-specific molecules, molecular changes, and distinct physiological signatures of pathetically altered fluids. Next, we developed the reliable classification model for fast identification and differentiation of negative CoV(-) and positive CoV(+) groups. The PLS-DA calibration model was described by a great statistical value-RMSEC and RMSECV below 0.3 and R2cal at the level of ~0.7 for both type of body fluids. The calculated diagnostic parameters for SVMC and PLS-DA at the stage of preparation of calibration model and classification of external samples simulating real diagnostic conditions evinced high accuracy, sensitivity, and specificity for saliva specimens. Here, we outlined the significant role of neopterin as the biomarker in the prediction of COVID-19 infection from nasopharyngeal swab. We also observed the increased content of nucleic acids of DNA/RNA and proteins such as ferritin as well as specific immunoglobulins. The developed SERS for SARS-CoV-2 approach allows: (i) fast, simple and non-invasive collection of analyzed specimens; (ii) fast response with the time of analysis below 15 min, and (iii) sensitive and reliable SERS-based screening of COVID-19 disease.
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Affiliation(s)
- Sylwia M Berus
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Ariadna B Nowicka
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Julia Wieruszewska
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Krzysztof Niciński
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Aneta A Kowalska
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Tomasz R Szymborski
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Izabela Dróżdż
- Department of Clinical Genetics, Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland
| | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland
| | - Jacek Waluk
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
- Faculty of Mathematics and Science, Cardinal Stefan Wyszyński University, Dewajtis 5, 01-815 Warsaw, Poland
| | - Agnieszka Kamińska
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
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21
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Frediani JK, Parsons R, McLendon KB, Westbrook AL, Lam W, Martin G, Pollock NR. The New Normal: Delayed Peak SARS-CoV-2 Viral Loads Relative to Symptom Onset and Implications for COVID-19 Testing Programs. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.09.23289735. [PMID: 37214887 PMCID: PMC10197800 DOI: 10.1101/2023.05.09.23289735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Early in the COVID-19 pandemic, peak viral loads coincided with symptom onset. We hypothesized that in a highly immune population, symptom onset might occur earlier in infection, coinciding with lower viral loads. Methods We assessed SARS-CoV-2 and influenza A viral loads relative to symptom duration in recently-tested adults. Symptomatic participants ≥16y presenting to testing sites in Georgia (4/2022-4/2023; Omicron variant predominant) provided symptom duration. Nasal swab samples were tested by the Xpert Xpress SARS-CoV-2/Flu/RSV assay and Ct values recorded. Nucleoprotein concentrations in SARS-CoV-2 PCR-positive samples were measured by Single Molecule Array. To estimate hypothetical antigen rapid diagnostic test (Ag RDT) sensitivity on each day after symptom onset, percentages of individuals with Ct value ≤30 or ≤25 were calculated. Results Of 621 SARS-CoV-2 PCR-positive individuals (64.1% women, median 40.9y), 556/621 (89.5%) had a history of vaccination, natural infection, or both. By both Ct value and antigen concentration measurements, median viral loads rose from the day of symptom onset and peaked on the fourth day. Ag RDT sensitivity estimates were 35.7-71.4% on the first day, 63.9-78.7% on the third day, and 78.6-90.6% on the fourth day of symptoms.In 74 influenza A PCR-positive individuals (55.4% women; median 35.0y), median influenza viral loads peaked on the second day of symptoms. Conclusions In a highly immune adult population, median SARS-CoV-2 viral loads peaked on the fourth day of symptoms. Influenza A viral loads peaked soon after symptom onset. These findings have implications for ongoing use of Ag RDTs for COVID-19 and influenza. Key Points In a highly immune adult population, median SARS-CoV-2 viral loads by cycle threshold and antigen measurements peaked on the fourth day of symptoms, with implications for testing practice. In contrast, viral loads for influenza A peaked soon after symptom onset.
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Affiliation(s)
| | - Richard Parsons
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA USA
| | - Kaleb B. McLendon
- Emory/Children’s Laboratory for Innovative Assay Development, Department of Pathology, Emory University, Atlanta, GA USA
| | - Adrianna L. Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA USA
| | - Wilbur Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, GA USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA USA
| | - Greg Martin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Nira R. Pollock
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, MA USA
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22
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Kami W, Kinjo T, Hashioka H, Arakaki W, Uechi K, Takahashi A, Oki H, Tanaka K, Motooka D, Nakamura S, Nakamatsu M, Maeda S, Yamamoto K, Fujita J. Impact of G29179T mutation on two commercial PCR assays for SARS-CoV-2 detection. J Virol Methods 2023; 314:114692. [PMID: 36796678 PMCID: PMC9930255 DOI: 10.1016/j.jviromet.2023.114692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
Nucleic acid amplification test (NAAT) is the gold standard for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. However, genetic mutations in the virus can affect the result. Cycle threshold (Ct) values of N genes and their association with mutations using SARS-CoV-2 positive specimens diagnosed by the Xpert Xpress SARS-CoV-2 were examined in this study. In total, 196 nasopharyngeal swab specimens were tested for SARS-CoV-2 infection using the Xpert Xpress SARS-CoV-2, and 34 were positive. WGS was performed for four outlier samples with increased ΔCt identified by Scatterplot analysis as well as seven control samples without increased ΔCt in the Xpert Xpress SARS-CoV-2. The presence of the G29179T mutation was identified as a cause of increased ΔCt. PCR using the Allplex™ SARS-CoV-2 Assay did not show a similar increase in ΔCt. Previous reports focusing on N-gene mutations and their effects on SARS-CoV-2 testing including the Xpert Xpress SARS-CoV-2 were also summarized. While a single mutation that impacts one target of a multiplex NAAT is not a true detection failure, mutation compromising NAAT target region can cause confusion of the results and render the assay susceptible to diagnostic failure.
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Affiliation(s)
- Wakaki Kami
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Takeshi Kinjo
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara Nishihara, Okinawa 903-0215, Japan.
| | - Hiroe Hashioka
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Wakako Arakaki
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Kohei Uechi
- Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Ami Takahashi
- Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Hiroya Oki
- Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kentaro Tanaka
- Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Daisuke Motooka
- Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shota Nakamura
- Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masashi Nakamatsu
- Infection Control Center, University of the Ryukyus Hospital, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Shiro Maeda
- Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Kazuko Yamamoto
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara Nishihara, Okinawa 903-0215, Japan
| | - Jiro Fujita
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara Nishihara, Okinawa 903-0215, Japan
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Nahar K, Begum MN, Tony SR, Jubair M, Hossain MA, Karim Y, Faisal AA, Hossain ME, Rahman MZ, Rahman M. Nasal swab as an alternative specimen for the detection of severe acute respiratory syndrome coronavirus 2. Health Sci Rep 2023; 6:e1213. [PMID: 37077182 PMCID: PMC10106929 DOI: 10.1002/hsr2.1213] [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: 12/05/2022] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and Aims The coronavirus disease 2019 (COVID-19) has brought serious threats to public health worldwide. Nasopharyngeal, nasal swabs, and saliva specimens are used to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, limited data are available on the performance of less invasive nasal swab for testing COVID-19. This study aimed to compare the diagnostic performance of nasal swabs with nasopharyngeal swabs using real-time reverse transcription polymerase chain reaction (RT-PCR) considering viral load, onset of symptoms, and disease severity. Methods A total of 449 suspected COVIDCOVID-19 individuals were recruited. Both nasopharyngeal and nasal swabs were collected from the same individual. Viral RNA was extracted and tested by real-time RT-PCR. Metadata were collected using structured questionnaire and analyzed by SPSS and MedCalc software. Results The overall sensitivity of the nasopharyngeal swab was 96.6%, and the nasal swab was 83.4%. The sensitivity of nasal swabs was more than 97.7% for low and moderate C t values. Moreover, the performance of nasal swab was very high (>87%) for hospitalized patients and at the later stage >7 days of onset of symptoms. Conclusion Less invasive nasal swab sampling with adequate sensitivity can be used as an alternative to nasopharyngeal swabs for the detection of SARS-CoV-2 by real-time RT-PCR.
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Affiliation(s)
- Kamrun Nahar
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mst. Noorjahan Begum
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Selim R. Tony
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mohammad Jubair
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Md. Abir Hossain
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Yeasir Karim
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Abdullah Al. Faisal
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mohammad Enayet Hossain
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mohammed Ziaur Rahman
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
| | - Mustafizur Rahman
- Virology LaboratoryInfectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, BangladeshMohakhaliDhaka1212Bangladesh
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Terada N, Akashi Y, Takeuchi Y, Ueda A, Notake S, Nakamura K, Suzuki H. Prospective study of three saliva qualitative antigen testing kits for the detection of SARS-CoV-2 among mainly symptomatic patients in Japan. J Infect Chemother 2023; 29:654-659. [PMID: 36894015 PMCID: PMC9990886 DOI: 10.1016/j.jiac.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Rapid qualitative antigen testing has been widely used for the laboratory diagnosis of COVID-19 with nasopharyngeal samples. Saliva samples have been used as alternative samples, but the analytical performance of those samples for qualitative antigen testing has not been sufficiently evaluated. METHODS A prospective observational study evaluated the analytical performance of three In Vitro Diagnostics (IVD) approved COVID-19 rapid antigen detection kits for saliva between June 2022 and July 2022 in Japan using real-time reverse transcription polymerase chain reaction (RT-qPCR) as a reference. A nasopharyngeal sample and a saliva sample were simultaneously obtained, and RT-qPCR was performed. RESULTS In total, saliva samples and nasopharyngeal samples were collected from 471 individuals (RT-qPCR-positive, n = 145) for the analysis. Of these, 96.6% were symptomatic. The median copy numbers were 1.7 × 106 copies/mL for saliva samples and 1.2 × 108 copies/mL for nasopharyngeal samples (p < 0.001). Compared with the reference, the sensitivity and specificity were 44.8% and 99.7% for ImunoAce SARS-CoV-2 Saliva, 57.2% and 99.1% for Espline SARS-CoV-2 N, and 60.0% and 99.1% for QuickChaser Auto SARS-CoV-2, respectively. The sensitivities of all antigen testing kit were 100% for saliva samples with a high viral load (>107 copies/mL), whereas the sensitivities were <70% for high-viral-load nasopharyngeal samples (>107 copies/mL). CONCLUSION COVID-19 rapid antigen detection kits with saliva showed high specificity, but the sensitivity varied among kits, and were also insufficient for the detection of symptomatic COVID-19 patients.
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Affiliation(s)
- Norihiko Terada
- Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan; Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Yusaku Akashi
- Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan; Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan; Akashi Internal Medicine Clinic, 3-1-63 Asahigaoka, Kashiwara, Osaka, 582-0026, Japan.
| | - Yuto Takeuchi
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan; Department of Infectious Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Atsuo Ueda
- Department of Clinical Laboratory, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Shigeyuki Notake
- Department of Clinical Laboratory, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Koji Nakamura
- Department of Clinical Laboratory, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Hiromichi Suzuki
- Department of Infectious Diseases, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan; Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan; Department of Infectious Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
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Peeling RW, Sia SK. Lessons from COVID-19 for improving diagnostic access in future pandemics. LAB ON A CHIP 2023; 23:1376-1388. [PMID: 36629022 DOI: 10.1039/d2lc00662f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Throughout the COVID-19 pandemic, we have witnessed the critical and expanding roles of testing. Despite the development of over a thousand brand of tests - with some close to fulfilling the 4As (accuracy, access, affordability, and actionability via quick time to result) of an ideal diagnostic test - gaps persisted in developing tests to fit public health needs, and in providing equitable access. Here, we review how the use cases for testing evolved over the course of the COVID-19 pandemic, with associated engineering challenges (and potential lessons) at each phase for test developers. We summarise lessons learnt from the recent epidemic and propose four areas for future cooperative effort among test developers, government regulators and policy makers, public health experts, and the public: 1) develop new models for public sector funding and research and development; 2) increase testing capacity by investing in adaptable open-platform technologies at every level of the healthcare system; 3) build data connectivity infrastructures to support a connected diagnostic system as a backbone for surveillance; and 4) facilitate the rapid translation of innovation into use through a coordinated framework for regulatory approval and policy development.
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Affiliation(s)
- Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Samuel K Sia
- Department of Biomedical Engineering, Columbia University, USA
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Bourgin M, Durand S, Kroemer G. Diagnostic, Prognostic and Mechanistic Biomarkers of COVID-19 Identified by Mass Spectrometric Metabolomics. Metabolites 2023; 13:metabo13030342. [PMID: 36984782 PMCID: PMC10056171 DOI: 10.3390/metabo13030342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
A number of studies have assessed the impact of SARS-CoV-2 infection and COVID-19 severity on the metabolome of exhaled air, saliva, plasma, and urine to identify diagnostic and prognostic biomarkers. In spite of the richness of the literature, there is no consensus about the utility of metabolomic analyses for the management of COVID-19, calling for a critical assessment of the literature. We identified mass spectrometric metabolomic studies on specimens from SARS-CoV2-infected patients and subjected them to a cross-study comparison. We compared the clinical design, technical aspects, and statistical analyses of published studies with the purpose to identify the most relevant biomarkers. Several among the metabolites that are under- or overrepresented in the plasma from patients with COVID-19 may directly contribute to excessive inflammatory reactions and deficient immune control of SARS-CoV2, hence unraveling important mechanistic connections between whole-body metabolism and the course of the disease. Altogether, it appears that mass spectrometric approaches have a high potential for biomarker discovery, especially if they are subjected to methodological standardization.
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Affiliation(s)
- Mélanie Bourgin
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
- Centre de Recherche des Cordeliers, Equipe Labellisée par la Ligue Contre le Cancer, Université de Paris Cité, Sorbonne Université, Inserm U1138, Institut Universitaire de France, 75005 Paris, France
- Correspondence:
| | - Sylvère Durand
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
- Centre de Recherche des Cordeliers, Equipe Labellisée par la Ligue Contre le Cancer, Université de Paris Cité, Sorbonne Université, Inserm U1138, Institut Universitaire de France, 75005 Paris, France
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
- Centre de Recherche des Cordeliers, Equipe Labellisée par la Ligue Contre le Cancer, Université de Paris Cité, Sorbonne Université, Inserm U1138, Institut Universitaire de France, 75005 Paris, France
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, 75610 Paris, France
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Huang Q, Sun Y, Jia M, Zhang T, Chen F, Jiang M, Wang Q, Feng L, Yang W. Quantitative Analysis of the Effectiveness of Antigen- and Polymerase Chain Reaction-Based Combination Strategies for Containing COVID-19 Transmission in a Simulated Community. ENGINEERING (BEIJING, CHINA) 2023; 28:S2095-8099(23)00050-4. [PMID: 36819830 PMCID: PMC9918319 DOI: 10.1016/j.eng.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/09/2022] [Accepted: 01/15/2023] [Indexed: 05/29/2023]
Abstract
The number of coronavirus disease 2019 (COVID-19) cases continues to surge, overwhelming healthcare systems and causing excess mortality in many countries. Testing of infectious populations remains a key strategy to contain the COVID-19 outbreak, delay the exponential spread of the disease, and flatten the epidemic curve. Using the Omicron variant outbreak as a background, this study aimed to evaluate the effectiveness of testing strategies with different test combinations and frequencies, analyze the factors associated with testing effectiveness, and optimize testing strategies based on these influencing factors. We developed a stochastic, agent-based, discrete-time susceptible-latent-infectious-recovered model simulating a community to estimate the association between three levels of testing strategies and COVID-19 transmission. Antigen testing and its combination strategies were more efficient than polymerase chain reaction (PCR)-related strategies. Antigen testing also showed better performance in reducing the demand for hospital beds and intensive care unit beds. The delay in the turnaround time of test results had a more significant impact on the efficiency of the testing strategy compared to the detection limit of viral load and detection-related contacts. The main advantage of antigen testing strategies is the short turnaround time, which is also a critical factor to be optimized to improve PCR strategies. After modifying the turnaround time, the strategies with less frequent testing were comparable to daily testing. The choice of testing strategy requires consideration of containment goals, test efficacy, community prevalence, and economic factors. This study provides evidence for the selection and optimization of testing strategies in the post-pandemic era and provides guidance for optimizing healthcare resources.
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Affiliation(s)
- Qiangru Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yanxia Sun
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ting Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Fangyuan Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- School of Arts and Sciences, Beijing Institute of Fashion Technology, Beijing 100105, China
| | - Mingyue Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Qing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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28
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El Mikati IK, Morgan RL, Murad MH, Sultan S, Falck-Ytter Y, Mustafa RA. Testing guidelines during times of crisis: challenges and limitations of developing rapid and living guidelines. Clin Microbiol Infect 2023; 29:424-428. [PMID: 36736663 PMCID: PMC9892317 DOI: 10.1016/j.cmi.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/30/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The start of the COVID-19 pandemic presented a situation in which there was an urgent need for decision-making that relates to diagnosis, but the evidence was lacking, of low certainty or constantly changing. Rapid and living guideline development methods were needed and had to be applied to rigorous guideline approaches, such as the Grading of Recommendations Assessment, Development, and Evaluation approach. OBJECTIVES To describe the process of developing rapid diagnosis guidelines when there is limited and imperfect available data at the time of crisis. SOURCES Case example from four Infectious Disease Society of America COVID-19 diagnostic guidelines. CONTENT As the world was experiencing panic with COVID-19, there were serious doubts about the feasibility of following a rigorous process for guideline development when timeliness was of extreme value. The Infectious Disease Society of America guideline panels supported by several methodologists strongly believed that at times of crisis, it is more important than ever to follow a rigorous process. The panel adopted a rapid and living systematic review methodology and applied the Grading of Recommendations Assessment, Development and Evaluation approach to four diagnosis guidelines despite the challenges of scarce and dynamic evidence. We describe the methodological details of the rapid and living approach (data extraction, meta-analysis, Evidence to Decision framework, and recommendation development), the challenge of resources, the challenge of scarce evidence, the challenge of rapidly changing evidence, as well as 'wins' from the Infectious Disease Society of America experience. IMPLICATIONS Mitigation of pandemics relies on rapid and accurate diagnosis, which is challenged by many knowledge gaps. This necessitates emerging evidence is rapidly incorporated in a living fashion with several decisional and contextual factors to ensure the best public health strategies and care for patients. This process must be systematic and transparent for developing trustworthy guidelines and should be supported by all stakeholders, including researchers, editors, publishers, professional societies, and policymakers.
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Affiliation(s)
- Ibrahim K. El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - M. Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA
| | - Yngve Falck-Ytter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA,VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | - Reem A. Mustafa
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Departments of Internal Medicine and Population Health, University of Kansas Medical Centre, Kansas City, KS, USA,Corresponding author. Reem A. Mustafa, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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29
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Mustafa RA, Schünemann H. Challenges with need to improve the reference standard in diagnosis: paper 2: real-world case examples from GRADE for when a reference standard is not clearly defined/ easily replicable or when it is infeasible/ unethical to perform the reference standard. J Clin Epidemiol 2023; 154:206-207. [PMID: 36455853 DOI: 10.1016/j.jclinepi.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Reem A Mustafa
- University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA.
| | - Holger Schünemann
- University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA
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Larsen KD, Jensen MM, Homøe AS, Arndal E, Samuelsen GB, Koch A, Nielsen XC, Homøe P, Todsen T. Head-to-Head Comparison of Nasopharyngeal, Oropharyngeal and Nasal Swabs for SARS-CoV-2 Molecular Testing. Diagnostics (Basel) 2023; 13:diagnostics13020283. [PMID: 36673094 PMCID: PMC9857511 DOI: 10.3390/diagnostics13020283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Nasopharyngeal swabs (NPS) are considered the gold standard for SARS-CoV-2 testing but are technically challenging to perform and associated with discomfort. Alternative specimens for viral testing, such as oropharyngeal swabs (OPS) and nasal swabs, may be preferable, but strong evidence regarding their diagnostic sensitivity for SARS-CoV-2 testing is still missing. We conducted a head-to-head prospective study to compare the sensitivity of NPS, OPS and nasal swabs specimens for SARS-CoV-2 molecular testing. Adults with an initial positive SARS-CoV-2 test were invited to participate. All participants had OPS, NPS and nasal swab performed by an otorhinolaryngologist. We included 51 confirmed SARS-CoV-2-positive participants in the study. The sensitivity was highest for OPS at 94.1% (95% CI, 87 to 100%) compared to NPS at 92.5% (95% CI, 85 to 99%) (p = 1.00) and lowest for nasal swabs at 82.4% (95% CI, 72 to 93%) (p = 0.07). Combined OPS/NPS was detected in 100% of cases, while the combined OPS/nasal swab increased the sensitivity significantly to 96.1% (95% CI, 90 to 100%) compared to that of the nasal swab alone (p = 0.03). The mean Ct value for NPS was 24.98 compared to 26.63 for OPS (p = 0.084) and 30.60 for nasal swab (p = 0.002). OPS achieved a sensitivity comparable to NPS and should be considered an equivalent alternative for SARS-CoV-2 testing.
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Affiliation(s)
- Kasper Daugaard Larsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, 4600 Koege, Denmark
- Department of Otolaryngology—Head and Neck Surgery and Audiology, Rigshospitalet, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-27633007
| | - Mads Mose Jensen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, 4600 Koege, Denmark
| | - Anne-Sophie Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, 4600 Koege, Denmark
- Department of Otorhinolaryngology, Nordsjaellands Hospital, 3400 Hilleroed, Denmark
| | - Elisabeth Arndal
- Department of Otolaryngology—Head and Neck Surgery and Audiology, Rigshospitalet, 2100 Copenhagen, Denmark
| | | | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
- Staten Serum Institut (SSI), 2100 Copenhagen, Denmark
| | - Xiaohui Chen Nielsen
- Department of Clinical Microbiology, Zealand University Hospital, 4600 Koege, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, 4600 Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, 4600 Koege, Denmark
- Department of Otolaryngology—Head and Neck Surgery and Audiology, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 1353 Copenhagen, Denmark
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Cheyne S, Fraile Navarro D, Hill K, McDonald S, Tunnicliffe D, White H, Whittle S, Karpusheff J, Mustafa R, Morgan RL, Sultan S, Turner T. Methods for living guidelines: early guidance based on practical experience. J Clin Epidemiol 2023; 155:84-96. [PMID: 36639038 DOI: 10.1016/j.jclinepi.2022.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To introduce methods for living guidelines based on practical experiences by the Australian Living Evidence Consortium (ALEC), the National Institute of Health and Care Excellence (NICE), and the Infectious Diseases Society of America (IDSA), with methodological support from the US Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Network. STUDY DESIGN AND SETTING Members of ALEC, NICE, and the US GRADE Network, convened a working group to share experiences of the methods used to develop living guidelines and outline the key differences between traditional and living guidelines methods. RESULTS The guidance includes the following steps: 1) deciding if the guideline is a priority for a living approach, 2) preparing for living guideline development, 3) literature surveillance and frequency of searching, 4) assessment and synthesis of the evidence, 5) publication and dissemination, and 6) transitioning recommendations out of living mode. CONCLUSION This paper introduces methods for living guidelines and provides examples of the similarities and differences in approach across multiple organizations conducting living guidelines. It also introduces a series of papers exploring methods for living guidelines based on our practical experiences, including consumer involvement, selecting and prioritizing questions, search decisions, and methods decisions.
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Affiliation(s)
- Saskia Cheyne
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - David Fraile Navarro
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Steve McDonald
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - David Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Heath White
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Whittle
- Australia and New Zealand Musculoskeletal Clinical Trials Network, Melbourne, Australia; The Queen Elizabeth Hospital, South Australia, Australia; Department of Epidemiology and Preventive Medicine, School of Preventive Medicine and Public Health, Monash University, Melbourne, Australia
| | | | - Reem Mustafa
- University of Kansas Medical Center, KS, USA; The Evidence Foundation, Cleveland Heights, OH, USA
| | - Rebecca L Morgan
- The Evidence Foundation, Cleveland Heights, OH, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shahnaz Sultan
- The Evidence Foundation, Cleveland Heights, OH, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Tari Turner
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Cheyne S, Fraile Navarro D, Buttery AK, Chakraborty S, Crane O, Hill K, McFarlane E, Morgan RL, Mustafa RA, Poole A, Tunnicliffe D, Vogel JP, White H, Whittle S, Turner T. Methods for living guidelines: early guidance based on practical experience. Paper 3: selecting and prioritizing questions for living guidelines. J Clin Epidemiol 2023; 155:73-83. [PMID: 36603743 DOI: 10.1016/j.jclinepi.2022.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This article is part of a series on methods for living guidelines, consolidating practical experiences from developing living guidelines. It focuses on methods for identification, selection, and prioritization of clinical questions for a living approach to guideline development. STUDY DESIGN AND SETTING Members of the Australian Living Evidence Consortium, the National Institute of Health and Care Excellence and the US Grading of Recommendations, Assessment, Development and Evaluations Network, convened a working group. All members have expertize and practical experience in the development of living guidelines. We collated methods, documents on prioritization from each organization's living guidelines, conducted interviews and held working group discussions. We consolidated these to form best practice principles which were then edited and agreed on by the working group members. RESULTS We developed best practice principles for (1) identification, (2) selection, and (3) prioritization, of questions for a living approach to guideline development. Several different strategies for undertaking prioritizing questions are explored. CONCLUSION The article provides guidance for prioritizing questions in living guidelines. Subsequent articles in this series explore consumer involvement, search decisions, and methods decisions that are appropriate for questions with different priority levels.
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Affiliation(s)
- Saskia Cheyne
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - David Fraile Navarro
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Samantha Chakraborty
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Olivia Crane
- National Institute of Health and Care Excellence, Manchester, UK
| | | | - Emma McFarlane
- National Institute of Health and Care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Evidence Foundation, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, McMaster, Canada
| | - Reem A Mustafa
- Evidence Foundation, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, McMaster, Canada; University of Kansas Medical Center, KS, USA
| | - Alex Poole
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Joshua P Vogel
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Maternal, Child and Adolescent Health Program, Burnet Institute, Australia
| | - Heath White
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Whittle
- Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, Melbourne, Australia; The Queen Elizabeth Hospital, South Australia, Australia; Department of Epidemiology and Preventive Medicine, School of Preventive Medicine and Public Health, Monash University, Melbourne, Australia
| | - Tari Turner
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Bovine lactoferrin for the prevention of COVID-19 infection in health care personnel: a double-blinded randomized clinical trial (LF-COVID). Biometals 2022; 36:463-472. [PMID: 36474100 PMCID: PMC9735051 DOI: 10.1007/s10534-022-00477-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
Lactoferrin (LF) has in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the effect of bovine lactoferrin (bLF) in the prevention of SARS-CoV-2 infection in health care personnel. A randomized, double-blinded, placebo-controlled clinical trial was conducted in two tertiary hospitals that provide care to patients with SARS-CoV-2 infection in Lima, Peru. Daily supplementation with 600 mg of enteral bLF versus placebo for 90 days was compared. Participants were weekly screened for symptoms suggestive of SARS-CoV-2 infection and molecular testing was performed on suspected episodes. A serological test was obtained from all participants at the end of the intervention. The main outcome included symptomatic and asymptomatic cases. A sub-analysis explored the time to symptomatic infection. Secondary outcomes were the severity, frequency, and duration of symptomatic infection. The study was prematurely cancelled due to the availability of vaccines against SARS-CoV-2 in Peru. 209 participants were enrolled and randomized, 104 received bLF and 105 placebo. SARS-CoV-2 infection occurred in 11 (10.6%) participants assigned to bLF and in 9 (8.6%) participants assigned to placebo without significant differences (Incidence Rate Ratio = 1.23, 95%CI 0.51-3.06, p-value = 0.64). There was no significant effect of bLF on time to symptomatic infection (Hazard Ratio = 1.61, 95%CI 0.62-4.19, p-value = 0.3). There were no significant differences in secondary outcomes. A significant effect of bLF in preventing SARS-CoV-2 infection was not proven. Further studies are needed to assess the effect of bLF supplementation on SARS-CoV-2 infection.Clinical trial registration ClinicalTrials.gov Identifier: NCT04526821, https://clinicaltrials.gov/ct2/show/NCT04526821?term=LACTOFERRIN&cond=COVID-19&cntry=PE&city=Lima&draw=2&rank=1 .
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Kinch JS, Isenberg K, Vaughn L, Shultz B, Upperman JS. Strategies for Safely Maintaining Surgical Volume During the COVID-19 Pandemic: A Mixed-Methods Study. AORN J 2022; 116:416-424. [PMID: 36301057 PMCID: PMC9874482 DOI: 10.1002/aorn.13807] [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: 07/08/2021] [Revised: 01/22/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022]
Abstract
Resuming elective surgeries that were canceled during the COVID-19 pandemic necessitated a change to preprocedure patient preparation at a pediatric tertiary care center in middle Tennessee. We conducted a prospective, observational, mixed-methods study to determine the effectiveness of a preprocedure COVID-19 testing team to prevent COVID-19-related cancellations among pediatric patients receiving planned anesthesia. The intervention involved family member and patient education and a change in health record reporting to include COVID-19 test results. A team tasked with follow-up reviewed test results, consulted with families, and coordinated the administration of rapid tests if necessary. We compared preimplementation and postimplementation cancellation rates in four procedural areas and found no significant difference in the cancellation or rescheduling rates (P = .89, 95% confidence interval = -4.29 to 3.09). The team-based intervention was associated with the preservation of low procedural cancellation rates by mitigating barriers to preprocedural testing.
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Affiliation(s)
- Jill S. Kinch
- Director of Advanced Practice, Ambulatory, Perioperative and Acute Care Services MonroeCarell Jr. Children’s Hospital at Vanderbilt2200 Children’s Way NashvilleTN37232United States
| | - Kim Isenberg
- Manager of Advanced PracticeMonroe Carell Jr. Children’s Hospital at Vanderbilt2200 Children’s WayNashvilleTN37232United States
| | - Lexie Vaughn
- Resident Physician General SurgeryMonroe Carell Jr. Children’s Hospital at Vanderbilt2200 Children’s WayNashvilleTN37232United States
| | - Barbara Shultz
- Administrative Director of Surgical ServicesMonroe Carell Jr. Children’s Hospital at Vanderbilt2200 Children’s WayNashvilleTN37232United States
| | - Jeffrey S. Upperman
- Surgeon‐In‐ChiefMonroe Carell Jr. Children’s Hospital at Vanderbilt2200 Children’s WayNashvilleTN37232United States
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Schmitz JE, Stratton CW, Persing DH, Tang YW. Forty Years of Molecular Diagnostics for Infectious Diseases. J Clin Microbiol 2022; 60:e0244621. [PMID: 35852340 PMCID: PMC9580468 DOI: 10.1128/jcm.02446-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nearly 40 years have elapsed since the invention of the PCR, with its extremely sensitive and specific ability to detect nucleic acids via in vitro enzyme-mediated amplification. In turn, more than 2 years have passed since the onset of the coronavirus disease 2019 (COVID-19) pandemic, during which time molecular diagnostics for infectious diseases have assumed a larger global role than ever before. In this context, we review broadly the progression of molecular techniques in clinical microbiology, to their current prominence. Notably, these methods now entail both the detection and quantification of microbial nucleic acids, along with their sequence-based characterization. Overall, we seek to provide a combined perspective on the techniques themselves, as well as how they have come to shape health care at the intersection of technologic innovation, pathophysiologic knowledge, clinical/laboratory logistics, and even financial/regulatory factors.
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Affiliation(s)
- Jonathan E. Schmitz
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles W. Stratton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David H. Persing
- Medical and Scientific Affairs, Cepheid, Sunnyvale, California, USA
| | - Yi-Wei Tang
- Medical Affairs, Danaher Diagnostic Platform/Cepheid, Shanghai, China
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Jung J, Yang H, Park S, Lim HJ, Kim SK, Lim YJ, Kim EO, Kim SH. Usefulness of universal SARS-CoV-2 PCR testing for inpatients and their caregivers during the omicron era. Heliyon 2022; 8:e11008. [PMID: 36247133 PMCID: PMC9549749 DOI: 10.1016/j.heliyon.2022.e11008] [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: 05/17/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Since January 2022, the Omicron variant has become the dominant strain in South Korea, and COVID-19 cases among hospitalized patients and their guardians or caregivers have increased. We evaluated the usefulness of universal periodic screening for SARS-CoV-2 in patients and resident caregivers in a South Korean tertiary care hospital. Methods We evaluated the reason for testing in COVID-19 confirmed patients and resident caregivers during their hospitalization from March 3 to 31, 2022. The rate of positive PCR universal testing in hospital (or residency) (HD) on days 3 and 7 in asymptomatic patients and caregivers were evaluated. The test for SARS-CoV-2 was done by RT-PCR. Results During the study period, 677 patients were diagnosed with COVID-19. The reasons for testing were the symptoms (226 (33%)), pre-admission test (183 (27%)), exposure to COVID-19 (124 (18%)), universal testing on HD 3 (94 (14%)), and that on HD 7 (34 (5%)). Caregivers (n = 340) were tested during their residency due to exposure to COVID-19 cases, 103 (30%); universal testing on HD 3, 90 (26%); symptom development, 46 (14%); pre-stay, 39 (11%); and universal testing on HD 7, 29 (9%). The positive test rates of inpatients and caregivers on HD 3 and HD 7 were as follows: 1.4% (93/6553) and 2.1% (55/2646) in inpatients, and 1.3% (79/5989) and 1.7% (35/2106) in caregivers, respectively. Conclusions Universal testing, regardless of symptom or epidemiologic link, is useful for detecting pre-symptomatic and asymptomatic COVID-19 cases among hospitalized patients and caregivers and preventing a nosocomial outbreak during the Omicron era.
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Affiliation(s)
- Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Hyejin Yang
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Soyeon Park
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Hyun-Jung Lim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Sun-Kyung Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Young-Ju Lim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
- Corresponding author.
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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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Lotan I, Nishiyama S, Manzano GS, Lydston M, Levy M. COVID-19 and the risk of CNS demyelinating diseases: A systematic review. Front Neurol 2022; 13:970383. [PMID: 36203986 PMCID: PMC9530047 DOI: 10.3389/fneur.2022.970383] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Viral infections are a proposed possible cause of inflammatory central nervous system (CNS) demyelinating diseases, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). During the past 2 years, CNS demyelinating events associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but causality is unclear. Objective To investigate the relationship between CNS demyelinating disease development and exacerbation with antecedent and/or concurrent SARS-CoV-2 infection. Methods A systematic literature review of all publications describing either a new diagnosis or relapse of CNS demyelinating diseases (MS, NMOSD, MOGAD) in association with SARS-CoV-2 infection was performed utilizing PRISMA guidelines. Descriptive statistics were used for data analysis, using a case analysis approach. Results Sixty-seven articles met the inclusion criteria for the study. Most of the reported cases of NMOSD (n = 13, 72.2% of reported cases) and MOGAD (n = 27, 96.5% of reported cases) were of new disease onset, presenting with typical clinical and radiographic features of these conditions, respectively. In contrast, reported MS cases varied amongst newly diagnosed cases (n = 10, 10.5% of reported cases), relapses (n = 63, 66.4%) and pseudo-relapses (n = 22, 23.2%). The median duration between COVID-19 infection and demyelinating event onset was 11.5 days (range 0–90 days) in NMOSD, 6 days (range−7 to +45 days) in MOGAD, and 13.5 days (range−21 to +180 days) in MS. Most cases received high-dose corticosteroids with a good clinical outcome. Conclusion Based upon available literature, the rate of CNS demyelinating events occurring in the setting of preceding or concurrent SARS-CoV-2 infection is relatively low considering the prevalence of SARS-CoV-2 infection. The clinical outcomes of new onset or relapsing MS, NMOSD, or MOGAD associated with antecedent or concurrent infection were mostly favorable. Larger prospective epidemiological studies are needed to better delineate the impact of COVID-19 on CNS demyelinating diseases.
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Affiliation(s)
- Itay Lotan
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Itay Lotan ;
| | - Shuhei Nishiyama
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Giovanna S. Manzano
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Melissa Lydston
- Treadwell Virtual Library for the Massachusetts General Hospital, Boston, MA, United States
| | - Michael Levy
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Khan J, Rasmi Y, Kırboğa KK, Ali A, Rudrapal M, Patekar RR. Development of gold nanoparticle-based biosensors for COVID-19 diagnosis. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022; 11:111. [PMID: 36092513 PMCID: PMC9444098 DOI: 10.1186/s43088-022-00293-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative organism of coronavirus disease 2019 (COVID-19) which poses a significant threat to public health worldwide. Though there are certain recommended drugs that can cure COVID-19, their therapeutic efficacy is limited. Therefore, the early and rapid detection without compromising the test accuracy is necessary in order to provide an appropriate treatment for the disease suppression.
Main body
Nanoparticles (NPs) can closely mimic the virus and interact strongly with its proteins due to their morphological similarities. NPs have been widely applied in a variety of medical applications, including biosensing, drug delivery, antimicrobial treatment, and imaging. Recently, NPs-based biosensors have attracted great interest for their biological activities and specific sensing properties, which allows the detection of analytes such as nucleic acids (DNA or RNA), aptamers, and proteins in clinical samples. Further, the advances of nanotechnologies have enabled the development of miniaturized detection systems for point-of-care biosensors, a new strategy for detecting human viral diseases. Among the various NPs, the specific physicochemical properties of gold NPs (AuNPs) are being widely used in the field of clinical diagnostics. As a result, several AuNP-based colorimetric detection methods have been developed.
Short conclusion
The purpose of this review is to provide an overview of the development of AuNPs-based biosensors by virtue of its powerful characteristics as a signal amplifier or enhancer that target pathogenic RNA viruses that provide a reliable and effective strategy for detecting of the existing or newly emerging SARS-CoV-2.
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Shang Y, Wu J, Liu J, Long Y, Xie J, Zhang D, Hu B, Zong Y, Liao X, Shang X, Ding R, Kang K, Liu J, Pan A, Xu Y, Wang C, Xu Q, Zhang X, Zhang J, Liu L, Zhang J, Yang Y, Yu K, Guan X, Chen D. Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19). JOURNAL OF INTENSIVE MEDICINE 2022; 2:199-222. [PMID: 36785648 PMCID: PMC9411033 DOI: 10.1016/j.jointm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/16/2022]
Affiliation(s)
- You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
| | - Jinglun Liu
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Jianfeng Xie
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yuan Zong
- Department of Critical Care Medicine, Shaanxi Provincial Hospital, Xi'an, Shannxi 710068, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian 350001, China
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Aijun Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150001, China
| | - Qianghong Xu
- Department of Critical Care Medicine, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang 310013, China
| | - Xijing Zhang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi 710032, China
| | - Jicheng Zhang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ling Liu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yi Yang
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
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The difference in strategies for prevention of COVID-19 transmission in hospitals: A nationwide survey results in the Republic of Korea. J Hosp Infect 2022; 129:22-30. [PMID: 35998837 PMCID: PMC9391228 DOI: 10.1016/j.jhin.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hospital infection control measures against coronavirus disease 2019 (COVID-19) are often based on expert discretion due to the lack of detailed guidelines. AIM To survey the current strategies for preventing COVID-19 spread in medical institutions. METHODS Thirteen key issues related to COVID-19 transmission prevention within medical institutions were selected via discussion among infectious diseases specialists, and related critical questions were subsequently obtained following a review of national-level guidelines in government databases. Six hospitals had an open survey between 11th and 25th August 2020 to provide responses to these topics. An online questionnaire developed from these data was sent to infection control teams of 46 South Korean hospitals between 31st January 2021 and 20th February 2021. FINDINGS All 46 hospitals responded to the survey. All operated screening clinics, but 89.1% (41/46) allowed symptomatic patients without COVID-19-associated symptoms to visit the general outpatient clinics. Most hospitals (87.2%; 34/39) conducted PCR tests for all hospitalised patients. Of 35/46 (76.1%) hospitals with preemptive isolation policies for hospitalised patients, 31 (88.6%) released patients from isolation after a single negative PCR test while most (76.9%; 20/26) allowed shared-room accommodation for patients meeting the national criteria for release from isolation despite positive PCR results with above cycle threshold values (34.6%; 9/26) or after a certain period that satisfied the national criteria (26.9%; 7/26). CONCLUSION Individual hospitals in South Korea are currently relying on experience to frame relevant guidelines and responded differently to some infection control issues on hospital settings during the COVID-19 pandemic.
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Davis P, Rosychuk R, Hau JP, Cheng I, McRae AD, Daoust R, Lang E, Turner J, Khangura J, Fok PT, Stachura M, Brar B, Hohl CM. Diagnostic yield of screening for SARS-CoV-2 among patients admitted to hospital for alternate diagnoses: an observational cohort study. BMJ Open 2022; 12:e057852. [PMID: 35948378 PMCID: PMC9378945 DOI: 10.1136/bmjopen-2021-057852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19 and to identify risk factors for positive tests. DESIGN Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network registry. SETTING 30 acute care hospitals across Canada. PARTICIPANTS Patients hospitalised for non-COVID-19-related diagnoses who were tested for SARS-CoV-2 between 1 March and 29 December 2020. MAIN OUTCOME Positive nucleic acid amplification test for SARS-CoV-2. OUTCOME MEASURE Diagnostic yield. RESULTS We enrolled 15 690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% to 0.92%). Factors associated with a positive test included presence of fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases. CONCLUSIONS Universal screening of hospitalised patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence. TRIAL REGISTRATION NUMBER NCT04702945.
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Affiliation(s)
- Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Saskatoon, Canada
| | - Rhonda Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey P Hau
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ivy Cheng
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Emergency Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raoul Daoust
- Département Médecine de Famille et Médecine d'Urgence, Université de Montréal, Montreal, Quebec, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joel Turner
- Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada
| | - Jaspreet Khangura
- Department of Emergency Medicine, Northeast Community Health Centre, Edmonton, Alberta, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maja Stachura
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Baljeet Brar
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Diagnostic Role of Bronchoalveolar Lavage in Patients with Suspected SARS-CoV-2 Pneumonia and Negative Upper Respiratory Tract Swab: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11164656. [PMID: 36012892 PMCID: PMC9409822 DOI: 10.3390/jcm11164656] [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: 07/07/2022] [Revised: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 12/01/2022] Open
Abstract
The added role of bronchoalveolar lavage (BAL) in SARS-CoV-2 detection in hospitalized patients with suspected COVID-19 pneumonia and at least one negative nasopharyngeal swab (NPS) has yet to be definitively established. We aimed to provide a systematic review and meta-analysis to summarize data from the literature on the diagnostic yield of BAL in this context. We searched Medline and Embase for all studies reporting outcomes of interest published up to October 2021. Two authors reviewed all titles/abstracts and retrieved the selected full texts according to predefined selection criteria. The summary estimate was derived using the random-effects model. Thirteen original studies, involving 868 patients, were included. The summary estimate of proportions of SARS-CoV-2 positivity in BAL fluid in patients with at least one previous negative NPS was 20% (95% confidence interval [CI]; 11–30%). Moreover, microbiological tests of BAL fluid led to the identification of other pathogens, mainly bacteria, in up to two-thirds of cases. BAL plays a crucial role in the diagnostic work-up of patients with clinical suspicion of COVID-19 and previous negative NPS, as it allowed to detect the infection in a significant proportion of subjects, who would have been otherwise misclassified, with relevant implications in the prevention of disease spread, especially in hospital settings.
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Duncan DB, Mackett K, Ali MU, Yamamura D, Balion C. Performance of saliva compared with nasopharyngeal swab for diagnosis of COVID-19 by NAAT in cross-sectional studies: Systematic review and meta-analysis. Clin Biochem 2022; 117:84-93. [PMID: 35952732 PMCID: PMC9359767 DOI: 10.1016/j.clinbiochem.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
Nucleic acid amplification testing (NAAT) is the preferred method to diagnose coronavirus disease 2019 (COVID-19). Saliva has been suggested as an alternative to nasopharyngeal swabs (NPS), but previous systematic reviews were limited by the number and types of studies available. The objective of this systematic review and meta-analysis was to assess the diagnostic performance of saliva compared with NPS for COVID-19. We searched Ovid MEDLINE, Embase, Cochrane, and Scopus databases up to 24 April 2021 for studies that directly compared paired NPS and saliva specimens taken at the time of diagnosis. Meta-analysis was performed using an exact binomial rendition of the bivariate mixed-effects regression model. Risk of bias was assessed using the QUADAS-2 tool. Of 2683 records, we included 23 studies with 25 cohorts, comprising 11,582 paired specimens. A wide variety of NAAT assays and collection methods were used. Meta-analysis gave a pooled sensitivity of 87 % (95 % CI = 83-90 %) and specificity of 99 % (95 % CI = 98-99 %). Subgroup analyses showed the highest sensitivity when the suspected individual is tested in an outpatient setting and is symptomatic. Our results support the use of saliva NAAT as an alternative to NPS NAAT for the diagnosis of COVID-19.
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Affiliation(s)
- Donald Brody Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada
| | - Katharine Mackett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Deborah Yamamura
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada; Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario L8V 1C3, Canada
| | - Cynthia Balion
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
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Agard A, Elsheikh O, Bell D, Relich RF, Schmitt BH, Sadowski J, Fadel W, Webb DH, Dbeibo L, Kelley K, Carozza M, Lei GS, Calkins P, Beeler C. Clinical comparison and agreement of PCR, antigen, and viral culture for the diagnosis of COVID-19. JOURNAL OF CLINICAL VIROLOGY PLUS 2022; 2:100099. [PMID: 35880110 PMCID: PMC9300048 DOI: 10.1016/j.jcvp.2022.100099] [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: 03/23/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to compare the COVID-19 nasopharyngeal PCR (NP PCR) to antigen, nasal PCR, and viral culture. One-hundred-and-fourteen risk-stratified patients were tested by culture, nasal PCR, NP PCR, and Ag testing. Twenty (48%) of the high risk and 23 (32%) of the low risk were NP PCR positive. Compared with NP PCR, the sensitivity of nasal PCR, Sofia Ag, BinaxNOW Ag, and culture were 44%, 31%, 37%, and 15%. In the high risk group, the sensitivity of these tests improved to 71%, 37%, 50%, and 22%. Agreement between tests was highest between nasal PCR and both antigen tests. Patients who were NP PCR positive but antigen negative were more likely to have remote prior COVID-19 infection (p<0.01). Nasal PCR and antigen positive patients were more likely to have symptoms (p = 0.01).
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Affiliation(s)
| | | | - Drew Bell
- Indiana University School of Medicine
| | | | | | | | - William Fadel
- Indiana University Richard M. Fairbanks School of Public Health
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Bond KA, Smith B, Gardiner E, Liew KC, Williams E, Walsham N, Putland M, Williamson DA. Utility of SARS-CoV-2 rapid antigen testing for patient triage in the emergency department: A clinical implementation study in Melbourne, Australia. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 25:100486. [PMID: 35655473 PMCID: PMC9150863 DOI: 10.1016/j.lanwpc.2022.100486] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Early, rapid detection of SARS-CoV-2 is essential in healthcare settings in order to implement appropriate infection control precautions and rapidly assign patients to care pathways. Rapid testing methods, such as SARS-CoV-2 rapid antigen testing (RAT) may improve patient care, despite a lower sensitivity than real-time PCR (RT-PCR) testing. Methods Patients presenting to an Emergency Department (ED) in Melbourne, Australia, were risk-stratified for their likelihood of active COVID-19 infection, and a non-randomised cohort of patients were tested by both Abbott Panbio™ COVID-19 Ag test (RAT) and SARS-CoV-2 RT-PCR. Patients with a positive RAT in the ‘At or High Risk’ COVID-19 group were moved immediately to a COVID-19 ward rather than waiting for a RT-PCR result. Clinical and laboratory data were assessed to determine test performance characteristics; and length of stay in the ED was compared for the different patient cohorts. Findings Analysis of 1762 paired RAT/RT-PCR samples demonstrated an overall sensitivity of 75.5% (206/273; 95% CI: 69·9-80·4) for the Abbott Panbio™ COVID-12 Ag test, with specificity of 100% (1489/1489; 95% CI: 99·8-100). Sensitivity improved with increasing risk for COVID-19 infection, from 72·4% (95% CI: 52·8-87·3) in the ‘No Risk’ cohort to 100% (95% CI: 29·2-100) in the ‘High Risk’ group. Time in the ED for the ‘At/High Risk’ group decreased from 421 minutes (IQR: 281, 525) for those with a positive RAT result to 274 minutes (IQR:140, 425) for those with a negative RAT result, p = 0.02. Interpretation The positive predictive value of a positive RAT in this setting was high, allowing more rapid instigation of COVID-19 care pathways and an improvement in patient flow within the ED. Funding Royal Melbourne Hospital, Melbourne, Australia.
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Abigail A, Marisa B, Victoria L, Megha T, Lorna K, Kathleen B, Zain AS. Rates of COVID-19 infection among in vitro fertilization patients undergoing treatment at a university reproductive health center. J Assist Reprod Genet 2022; 39:2163-2168. [PMID: 35881271 PMCID: PMC9314538 DOI: 10.1007/s10815-022-02581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) caused an unprecedented challenge for in-vitro fertilization (IVF) patients. The incidence of COVID-19 infection among this population is a fundamental knowledge gap. OBJECTIVE The purpose of this study was to determine the rate of COVID-19 infection among IVF patients compared to other gynecologic surgery patients. MATERIALS AND METHODS This retrospective study evaluated the incidence of COVID-19 infection among patients undergoing IVF, female fertility-related surgeries (FRS) and other gynecologic surgeries at a single academic institution in Los Angeles, California. All patients underwent routine COVID-19 polymerase chain reaction (PCR) screening prior to treatment. RESULT A total of 2742 patients underwent asymptomatic COVID-19 screening before a surgical procedure or IVF between March 1, 2020, and April 5, 2021. The rate of COVID-19 infection among patients who underwent preoperative testing for a non-fertility-related gynecologic procedure was 1.74% (28/1612). In comparison, the positive test results for those who underwent either FRS or IVF were 0.56% (1/180) and 0.34% (1/290), respectively, representing 6.70% (2/30) of positive tests for the whole cohort. The infertility patients had a significantly lower positivity rate compared to the other gynecologic patients during preoperative COVID-19 testing (0.43% vs 1.74%, p = 0.03). CONCLUSION(S) Our study demonstrated that there was a significantly lower incidence of COVID-19 infections in infertility patients undergoing IVF or FRS compared to other gynecologic surgery patients. Future studies should evaluate the cost-effectiveness of routine screening in both the gynecology and infertility patient population, especially in the setting of different variant surges and vaccination rates.
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Affiliation(s)
- Armstrong Abigail
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, CA, USA
| | - Berger Marisa
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Lee Victoria
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Tandel Megha
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Kwan Lorna
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Brennan Kathleen
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, CA, USA
| | - Al-Safi Zain
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, CA, USA
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Hong KH, Kim GJ, Roh KH, Sung H, Lee J, Kim SY, Kim TS, Park JS, Huh HJ, Park Y, Kim JS, Kim HS, Seong MW, Ryoo NH, Song SH, Lee H, Kwon GC, Yoo CK. Update of Guidelines for Laboratory Diagnosis of COVID-19 in Korea. Ann Lab Med 2022; 42:391-397. [PMID: 35177559 PMCID: PMC8859556 DOI: 10.3343/alm.2022.42.4.391] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
Korean Society for Laboratory Medicine and the Korea Disease Prevention and Control Agency have announced guidelines for diagnosing coronavirus disease (COVID-19) in clinical laboratories in Korea. With the ongoing pandemic, we propose an update of the previous guidelines based on new scientific data. This update includes recommendations for tests that were not included in the previous guidelines, including the rapid molecular test, antigen test, antibody test, and self-collected specimens, and a revision of the previous recommendations. This update will aid clinical laboratories in performing laboratory tests for diagnosing COVID-19.
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Affiliation(s)
- Ki Ho Hong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Gab Jung Kim
- Bureau of Infectious Disease Diagnosis Control, the Korea Disease Control and Prevention Agency, Osong, Korea
| | - Kyoung Ho Roh
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaehyeon Lee
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - So Yeon Kim
- Department of Laboratory Medicine, National Medical Center, Seoul, Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Sun Park
- Bureau of Infectious Disease Diagnosis Control, the Korea Disease Control and Prevention Agency, Osong, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Younhee Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam Hee Ryoo
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Gye Cheol Kwon
- Department of Laboratory Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Cheon Kwon Yoo
- Bureau of Infectious Disease Diagnosis Control, the Korea Disease Control and Prevention Agency, Osong, Korea
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Penney JA, Doron SI. Finding the off-ramp: Rethinking severe acute respiratory coronavirus virus 2 (SARS-CoV-2) preoperative screening. Infect Control Hosp Epidemiol 2022; 43:918-919. [PMID: 34986925 PMCID: PMC8795772 DOI: 10.1017/ice.2022.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Jessica A. Penney
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
| | - Shira I. Doron
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
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Veguilla V, Fowlkes AL, Bissonnette A, Beitel S, Gaglani M, Porucznik CA, Stockwell MS, Tyner HL, Naleway AL, Yoon SK, Caban-Martinez AJ, Wesley MG, Duque J, Jeddy Z, Stanford JB, Daugherty M, Dixon A, Burgess JL, Odean M, Groom HC, Phillips AL, Schaefer-Solle N, Mistry P, Rolfes MA, Thompson M, Dawood FS, Meece J. Detection and Stability of SARS-CoV-2 in Three Self-Collected Specimen Types: Flocked Midturbinate Swab (MTS) in Viral Transport Media, Foam MTS, and Saliva. Microbiol Spectr 2022; 10:e0103322. [PMID: 35665629 PMCID: PMC9241800 DOI: 10.1128/spectrum.01033-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
Respiratory specimen collection materials shortages hampers severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We compared specimen alternatives and evaluated SARS-CoV-2 RNA stability under simulated shipping conditions. We compared concordance of RT-PCR detection of SARS-CoV-2 from flocked midturbinate swabs (MTS) in viral transport media (VTM), foam MTS without VTM, and saliva. Specimens were collected between August 2020 and April 2021 from three prospective cohorts. We compared RT-PCR cycle quantification (Cq) for Spike (S), Nucleocapsid (N), and the Open Reading Frame 1ab (ORF) genes for flocked MTS and saliva specimens tested before and after exposure to a range of storage temperatures (4-30°C) and times (2, 3, and 7 days). Of 1,900 illnesses with ≥2 specimen types tested, 335 (18%) had SARS-CoV-2 detected in ≥1 specimen; 304 (91%) were concordant across specimen types. Among illnesses with SARS-CoV-2 detection, 97% (95% confidence interval [CI]: 94-98%) were positive on flocked MTS, 99% (95% CI: 97-100%) on saliva, and 89% (95% CI: 84-93%) on foam MTS. SARS-CoV-2 RNA was detected in flocked MTS and saliva stored up to 30°C for 7 days. All specimen types provided highly concordant SARS-CoV-2 results. These findings support a range of viable options for specimen types, collection, and transport methods that may facilitate SARS-CoV-2 testing during supply and personnel shortages. IMPORTANCE Findings from this analysis indicate that (1) self-collection of flocked and foam MTS and saliva samples is feasible in both adults and children, (2) foam MTS with VTM and saliva are both viable and reasonable alternatives to traditional flocked MTS in VTM for SARS-CoV-2 detection, and (3) these sample types may be stored and transported at ambient temperatures for up to 7 days without compromising sample quality. These findings support methods of sample collection for SARS-CoV-2 detection that may facilitate widespread community testing in the setting of supply and personnel shortages during the current pandemic.
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Affiliation(s)
- Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Adam Bissonnette
- Integrated Research & Development Laboratory, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Christina A. Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Allison L. Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Sarang K. Yoon
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | - Jazmin Duque
- Abt Associates, Inc., Cambridge, Massachusetts, USA
| | - Zuha Jeddy
- Abt Associates, Inc., Cambridge, Massachusetts, USA
| | - Joseph B. Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Ashton Dixon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Marilyn Odean
- St. Luke’s Regional Health Care System, Duluth, Minnesota, USA
- The Whiteside Institute for Clinical Research, Duluth, Minnesota, USA
| | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Andrew L. Phillips
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Mark Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer Meece
- Integrated Research & Development Laboratory, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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