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2.
J Immunother Cancer ; 8(2)2020 07.
Article in English | MEDLINE | ID: covidwho-662488

ABSTRACT

Pneumonitis is a rare but serious adverse event caused by cancer immunotherapy. The diagnosis between COVID-19-induced pneumonia and immunotherapy-induced pneumonitis may be challenging in the era of COVID-19 outbreak. Some clinical symptoms and radiological findings of pneumonitis can be attributed to the coronavirus infection as well as to an immune-related adverse event. Identifying the exact cause of a pneumonitis in patients on treatment with immunotherapy is crucial to promptly start the most appropriate treatment. The proper management of immune checkpoint inhibitors for the risk of pneumonia must take into account a series of parameters. Accurate attention should be payed to symptoms like cough, fever and dyspnea during immunotherapy.


Subject(s)
Antineoplastic Agents, Immunological/adverse effects , Coronavirus Infections/diagnosis , Neoplasms/drug therapy , Pneumonia, Viral/diagnosis , Pneumonia/chemically induced , Pneumonia/diagnosis , Betacoronavirus , CTLA-4 Antigen/antagonists & inhibitors , Clinical Laboratory Techniques , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Diagnosis, Differential , False Negative Reactions , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Lung/diagnostic imaging , Pandemics , Pneumonia/drug therapy , Pneumonia/immunology , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Reverse Transcriptase Polymerase Chain Reaction , Tomography, X-Ray Computed
4.
Medicine (Baltimore) ; 99(26): e20837, 2020 Jun 26.
Article in English | MEDLINE | ID: covidwho-616556

ABSTRACT

To compare clinical and imaging features between patients with an initial negative reverse-transcription-polymerase chain-reaction (RT-PCR) test and patients with an initial positive RT-PCR test. CT follow-up analysis in the negative RT-PCR group is also described.Thirty-three patients with SARS-CoV-2 infection confirmed by RT-PCR, with 216 lesions upon CT, were included. Demographic information and chest CT imaging features were collected.The average age in the whole study group was 46.9 ±â€Š11.1 years, with 18 males and 15 females. Patients in the positive RT-PCR test group were more likely to have a fever than patients in the negative RT-PCR test group (85.7% vs 50%, P < .05). Lesions in the positive group were more likely to be located in the peripheral area than lesions in the negative group (83.6% vs 68.2%, P < .05). Regarding the appearance of 216 lesions, ground-glass opacities (GGOs) with consolidation (43.2%) was the most common appearance in the negative group, followed by pure GGOs (31.8%), while in the positive group, pure GGOs (32%) and GGOs with interlobular septal thickening (32.8%) were both most frequent, and the difference between them was evident (P < .05). For the follow-up analysis, the largest short-axis of a lesion was smaller upon follow-up (median size 13.6 mm vs 14 mm), albeit by a smaller margin. Pure GGOs decreased in frequency, from 31.3% to 21.3%, while consolidation increased in frequency, from 7.5% to 12.5%.The manifestations of COVID-19 in patients with a first negative RT-PCR test and patients with a positive first RT-PCR test are different to some extent. The consolidation component may increase after follow-up.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/statistics & numerical data , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Adult , False Negative Reactions , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies
5.
J Med Virol ; 92(7): 903-908, 2020 07.
Article in English | MEDLINE | ID: covidwho-613952

ABSTRACT

In this study, we collected a total of 610 hospitalized patients from Wuhan between February 2, 2020, and February 17, 2020. We reported a potentially high false negative rate of real-time reverse-transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 in the 610 hospitalized patients clinically diagnosed with COVID-19 during the 2019 outbreak. We also found that the RT-PCR results from several tests at different points were variable from the same patients during the course of diagnosis and treatment of these patients. Our results indicate that in addition to the emphasis on RT-PCR testing, clinical indicators such as computed tomography images should also be used not only for diagnosis and treatment but also for isolation, recovery/discharge, and transferring for hospitalized patients clinically diagnosed with COVID-19 during the current epidemic. These results suggested the urgent needs for the standard of procedures of sampling from different anatomic sites, sample transportation, optimization of RT-PCR, serology diagnosis/screening for SARS-CoV-2 infection, and distinct diagnosis from other respiratory diseases such as fluenza infections as well.


Subject(s)
Betacoronavirus/genetics , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , RNA, Viral/blood , Reverse Transcriptase Polymerase Chain Reaction/standards , Adult , Aged , Aged, 80 and over , Betacoronavirus/pathogenicity , Biomarkers/blood , China/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , False Negative Reactions , Female , Hospitalization , Humans , Male , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , RNA, Viral/genetics , Severity of Illness Index , Specimen Handling/standards , Tomography, X-Ray Computed
7.
Tidsskr Nor Laegeforen ; 140(9)2020 06 16.
Article in English, Norwegian | MEDLINE | ID: covidwho-608543

ABSTRACT

BACKGROUND: The diagnosis of COVID-19 is made by detection of SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR). Studies have shown a percentage of up to 30 % false negative results. CASE PRESENTATION: A previously healthy man in his late thirties was admitted to the hospital after 3-5 days of suffering chest pain, dyspnoea and abdominal discomfort. He had hypoxic respiratory failure and required oxygen therapy. The routine nasopharyngeal swab for PCR was negative at days 5 and 7 after onset of symptoms. A specimen obtained from bronchoalveolar lavage on day 8 was positive. INTERPRETATION: This case report shows us that even in the early course of SARS-Cov-2 infection, when the viral load in the upper respiratory tract has been shown to be at its highest, there might be false negative tests. It also emphasises the importance of including other clinical measures before discontinuation of isolation.


Subject(s)
Betacoronavirus , Coronavirus Infections , Nasopharynx , Pandemics , Pneumonia, Viral , Adult , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , False Negative Reactions , Humans , Male , Nasopharynx/virology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Viral Load
8.
J Infect Dis ; 221(12): 1940-1947, 2020 06 11.
Article in English | MEDLINE | ID: covidwho-599713

ABSTRACT

BACKGROUND: We retrospectively analyzed 26 persistently asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carriers. METHODS: Epidemiological and clinical characteristics from the 26 asymptomatic patients with positive results for SARS-CoV-2 ribonucleic acid testing were obtained. RESULTS: Twenty-two patients (84.6%) correlated with clustering occurrence. The median period from contact to diagnosis and the last positive nucleic acid test was 19 (8-24 days) and 21.5 days (10-36 days), respectively. The median period from diagnosis to negative nucleic acid test was significantly different between patients with normal or atypical chest computed tomography (CT) findings (n = 16, 61.5%; 7.5 days [2-20 days]) and patients with typical ground-glass or patchy opacities on CT (n = 10, 38.5%; 12.5 days [8-22 days]; P < .01). Seven patients (70.0%) with initial positive nucleic acid test results had a negative result simultaneously with improved CT findings. Obvious improvement in CT findings was observed in 3 patients (30.0%) despite positive nucleic acid test results. CONCLUSIONS: In asymptomatic patients, changes in biochemical and inflammatory variables are small and changes on chest CT can occur. It is worth noting that the long existence of SARS-CoV-2 in some asymptomatic patients and false-negative results need to be considered in SARS-CoV-2 nucleic acid test.


Subject(s)
Asymptomatic Infections , Carrier State/virology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , China , Coronavirus Infections/diagnostic imaging , False Negative Reactions , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , RNA, Viral/isolation & purification , Retrospective Studies , Tomography, X-Ray Computed , Young Adult
10.
In Vivo ; 34(3 Suppl): 1681-1684, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-539714

ABSTRACT

AIM: To describe the incidental detection of COVID-19 disease on positron-emission tomography/computed tomography (PET/CT) in a patient with cancer despite initial negative swab by polymerase chain reaction (PCR). CASE REPORT: Clinical and radiographic data were obtained from the electronic medical record. Nasopharyngeal swabs were obtained and evaluated for COVID-19 by the Food and Drug Administration-approved reverse transcription-PCR assays. On radiographic examination, PET/CT was consistent with COVID-19-related pneumonia not seen on prior imaging. Initial nasopharyngeal swab 2 days after PET/CT imaging was negative for COVID-19. Subsequent repeat swab 10 days later was positive for COVID-19, while the patient was febrile on screening assessment. The patient remained COVID-19-positive until 1 month after abnormal PET/CT imaging. CONCLUSION: PET/CT can be sensitive for early COVID-19 detection, even in the setting of a negative confirmatory PCR test. This highlights the importance of continued patient surveillance and use of appropriate personal protective equipment to minimize COVID-19 transmission.


Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Positron Emission Tomography Computed Tomography , Tonsillar Neoplasms/diagnostic imaging , Asymptomatic Diseases , Betacoronavirus/genetics , Carcinoma, Squamous Cell/complications , Clinical Laboratory Techniques/methods , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , False Negative Reactions , Humans , Incidental Findings , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Nasopharynx/virology , New York City , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Protective Devices , Reverse Transcriptase Polymerase Chain Reaction , Sensitivity and Specificity , Tonsillar Neoplasms/complications
11.
Indian J Public Health ; 64(Supplement): S128-S131, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-539540

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted (at the time of writing) in over 3.3 million cases and 233,000 deaths globally and ~33,000 cases and ~1,100 deaths in India. The mainstay of the diagnosis is a reverse-transcription polymerase chain reaction assay to detect SARS-CoV-2 RNA. The accurate diagnosis is contingent on appropriate specimen choice, time of collection, and assay employed. In this commentary, we highlight the role of laboratory diagnostic tests used in the different stages of India's COVID-19 pandemic response.


Subject(s)
Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Antibodies, Viral/metabolism , Betacoronavirus , Coronavirus Infections/epidemiology , False Negative Reactions , Humans , Immunoassay , India/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Reverse Transcriptase Polymerase Chain Reaction , Virus Cultivation
13.
J Clin Microbiol ; 58(8)2020 Jul 23.
Article in English | MEDLINE | ID: covidwho-381895

ABSTRACT

Several point-of-care (POC) molecular tests have received emergency use authorization (EUA) from the Food and Drug Administration (FDA) for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The test performance characteristics of the Accula (Mesa Biotech) SARS-CoV-2 POC test need to be evaluated to inform its optimal use. The aim of this study was to assess the test performance of the Accula SARS-CoV-2 test. The performance of the Accula test was assessed by comparing results of 100 nasopharyngeal swab samples previously characterized by the Stanford Health Care EUA laboratory-developed test (SHC-LDT), targeting the envelope (E) gene. Assay concordance was assessed by overall percent agreement, positive percent agreement (PPA), negative percent agreement (NPA), and Cohen's kappa coefficient. Overall percent agreement between the assays was 84.0% (95% confidence interval [CI], 75.3 to 90.6%), PPA was 68.0% (95% CI, 53.3 to 80.5%), and the kappa coefficient was 0.68 (95% CI, 0.54 to 0.82). Sixteen specimens detected by the SHC-LDT were not detected by the Accula test and showed low viral load burden, with a median cycle threshold value of 37.7. NPA was 100% (95% CI, 94.2 to 100%). Compared to the SHC-LDT, the Accula SARS-CoV-2 test showed excellent negative agreement. However, positive agreement was low for samples with low viral load. The false-negative rate of the Accula POC test calls for a more thorough evaluation of POC test performance characteristics in clinical settings and for confirmatory testing in individuals with moderate to high pretest probability of SARS-CoV-2 who test negative on Accula.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Molecular Diagnostic Techniques/methods , Pneumonia, Viral/diagnosis , Point-of-Care Testing , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus/genetics , Child , Child, Preschool , Coronavirus Infections/virology , False Negative Reactions , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Nasopharynx/virology , Pandemics , Pneumonia, Viral/virology , RNA, Viral/genetics , Sensitivity and Specificity , Young Adult
15.
Emerg Microbes Infect ; 9(1): 1259-1268, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-342833

ABSTRACT

Quantitative real time PCR (RT-PCR) is widely used as the gold standard for clinical detection of SARS-CoV-2. However, due to the low viral load specimens and the limitations of RT-PCR, significant numbers of false negative reports are inevitable, which results in failure to timely diagnose, cut off transmission, and assess discharge criteria. To improve this situation, an optimized droplet digital PCR (ddPCR) was used for detection of SARS-CoV-2, which showed that the limit of detection of ddPCR is significantly lower than that of RT-PCR. We further explored the feasibility of ddPCR to detect SARS-CoV-2 RNA from 77 patients, and compared with RT-PCR in terms of the diagnostic accuracy based on the results of follow-up survey. 26 patients of COVID-19 with negative RT-PCR reports were reported as positive by ddPCR. The sensitivity, specificity, PPV, NPV, negative likelihood ratio (NLR) and accuracy were improved from 40% (95% CI: 27-55%), 100% (95% CI: 54-100%), 100%, 16% (95% CI: 13-19%), 0.6 (95% CI: 0.48-0.75) and 47% (95% CI: 33-60%) for RT-PCR to 94% (95% CI: 83-99%), 100% (95% CI: 48-100%), 100%, 63% (95% CI: 36-83%), 0.06 (95% CI: 0.02-0.18), and 95% (95% CI: 84-99%) for ddPCR, respectively. Moreover, 6/14 (42.9%) convalescents were detected as positive by ddPCR at 5-12 days post discharge. Overall, ddPCR shows superiority for clinical diagnosis of SARS-CoV-2 to reduce the false negative reports, which could be a powerful complement to the RT-PCR.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Real-Time Polymerase Chain Reaction/methods , False Negative Reactions , Humans , Limit of Detection , Pandemics , RNA, Viral/genetics , Viral Load/methods
16.
Radiography (Lond) ; 26(3): e189-e194, 2020 08.
Article in English | MEDLINE | ID: covidwho-333098

ABSTRACT

Due to the wide availability, rapid execution, low cost, and possibility of being acquired at the patient's bed, chest X-Ray is a fundamental tool in the diagnosis, follow-up and evaluation of the treatment effectiveness of patients with pneumonia, also in the context of COVID-19 infection. However, false negative cases are possible. We report 4 cases of false negative chest X-Rays, in patients who were diagnosed positive for COVID-19 by real-time transverse-transcript-polymerase chain reaction (RT-PCR), and executed chest unenhanced CTs just after the X-Rays, demonstrating signs of COVID-19 pneumonia.


Subject(s)
Coronavirus Infections/diagnostic imaging , Multidetector Computed Tomography/methods , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Severe Acute Respiratory Syndrome/diagnostic imaging , Adult , Coronavirus Infections/diagnosis , False Negative Reactions , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Risk Assessment , Sampling Studies , Sensitivity and Specificity , Severe Acute Respiratory Syndrome/diagnosis
17.
J Infect Chemother ; 26(8): 851-853, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-308545

ABSTRACT

We here report a case of coronavirus disease-19 (COVID-19) in Japan in which the initial throat swab polymerase chain reaction result was negative The possibility of false-negative results in the early phase of disease suggest reconsideration of the feasibility of a community or national infection control framework to prevent transmission. We recommend establishing an alternative feasible system, such as self-isolation by contact history in non-endemic community and by symptoms in endemic community, not relying on the PCR examination, to minimize this ongoing COVID-19 outbreak. Further rapid accumulation of knowledge including incubation period, clinical course and types of transmission is warranted to control this outbreak.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pharynx/virology , Pneumonia, Viral/diagnostic imaging , Betacoronavirus/genetics , China , Coronavirus Infections/complications , False Negative Reactions , Female , Humans , Japan , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Polymerase Chain Reaction , Travel
20.
J Card Surg ; 35(6): 1342-1344, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-248227

ABSTRACT

While elective cardiac surgeries have been postponed to prevent coronavirus disease 2019 (COVID-19) transmission and to reduce resource utilization, patients with urgent indications necessitating surgery may still be at risk of contracting the disease throughout their postoperative recovery. We present a case of an 81-year-old female who underwent urgent coronary artery bypass grafting and was readmitted following discharge to a nursing facility with a cluster of COVID-19 cases. Despite symptomatology and imaging concerning for COVID-19, two initial reverse transcription polymerase chain reaction (RT-PCR) tests were negative but a third test was positive. This case emphasizes the risks of discharge location in the COVID-19 era as well as the importance of clinical suspicion, early isolation practices for those presumed positive, and repeat testing, given the marginal sensitivity of available COVID-19 RT-PCR.


Subject(s)
Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Coronary Artery Bypass/methods , Coronavirus Infections/diagnosis , Disease Transmission, Infectious/prevention & control , Patient Isolation , Pneumonia, Viral/diagnosis , Aged, 80 and over , Betacoronavirus , Coronary Angiography/methods , False Negative Reactions , Female , Follow-Up Studies , Homes for the Aged , Humans , Needs Assessment , Nursing Homes , Pandemics , Patient Discharge , Real-Time Polymerase Chain Reaction/methods , Reproducibility of Results , Risk Assessment
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