ABSTRACT
Introdução: Com a emergência do SARS-CoV-2 foi disponibilizado uma grande quantidade de ferramentas de diagnóstico. Neste contexto, a falta de vacina, de tratamento e o grande número de casos graves e morte, possibilitou a aprovação emergencial de diversos testes, que ainda necessitam de estudos populacionais para seu registro definitivo. Objetivo: Realizar uma revisão de literatura para avaliar as metodologias de diagnóstico disponíveis no Brasil, de acordo com a realidade local de saúde, explorando o momento epidemiológico a complexidade do teste e a finalidade da sua aplicação. Metodologia: Trata-se de um estudo bibliográfico, descritivo do tipo revisão de literatura. Foram utilizadas as seguintes bases de dados científicos para buscas: PUBMED, MEDLINE, LILACS E COCHRANE LIBRARY, através de descritores selecionados na plataforma DECS. Resultados: O cenário de diversos ensaios, baseados em diferentes metodologias, como os testes baseados em RNA viral, em detecção de antígenos virais ou de anticorpos, associados ao conhecimento da história natural do vírus, possibilita uma análise crítica do melhor diagnóstico de acordo com a clínica do paciente, os epidemiológicos, o objetivo do diagnóstico e a acurácia do ensaio. Atualmente, há mudança no padrão imunológico da população e a descrição de tipos e subtipos de SARS-CoV-2 com mudanças gênicas, que podem levar a mudanças na acurácia diagnóstica ou a re-emergência em surtos de doença grave. Conclusão: Ainda é incerto o caminho evolutivo da história natural da Covid-19 e os ensaios diagnósticos estão em diferentes estágios de desenvolvimento, validação e produção e cada tipo de teste tem suas próprias vantagens e desvantagens distintas inerentes a plataforma tecnológica de origem e uma combinação de tipos de testes usados em momentos diferentes pode ser útil para a condução clínica dos pacientes e no controle da pandemia por SARS-CoV-2.
Introduction: With the emergence of SARS-CoV-2, a large number of diagnostic tools were made available. In this context, the lack of vaccine, treatment and the large number of severe cases and death, allowed the emergency approval of several tests, which still require population studies for their definitive registration. Objective: To carry out a literature review to evaluate the diagnostic methodologies available in Brazil, according to the local health reality, exploring the epidemiological moment, the complexity of the test and the purpose of its application. Methodology: This is a bibliographic, descriptive study of the literature review type. The following scientific databases were used for searches: PUBMED, MEDLINE, LILACS AND COCHRANE LIBRARY, through selected descriptors on the DECS platform. Results: The scenario of several tests, based on different methodologies, such as tests based on viral RNA, on detection of viral antigens or antibodies, associated with knowledge of the natural history of the virus, allows a critical analysis of the best diagnosis according to the patient's clinical, epidemiological, diagnostic objective and assay accuracy. Currently, there is a change in the immune pattern of the population and the description of types and subtypes of SARS-CoV-2 with genetic changes, which can lead to changes in diagnostic accuracy or the re-emergence in outbreaks of severe disease. Conclusion: The evolutionary path of the natural history of Covid-19 is still uncertain and diagnostic assays are at different stages of development, validation and production and each type of test has its own distinct advantages and disadvantages inherent in the technology platform of origin and a combination of types of tests used at different times can be useful for the clinical management of patients and in the control of the SARS-CoV-2 pandemic.
Introducción: Con la aparición del SARS-CoV-2, se dispuso de un gran número de herramientas diagnósticas. En este contexto, la falta de vacuna, tratamiento y el gran número de casos graves y muerte, permitieron la aprobación de urgencia de varias pruebas, que aún requieren estudios poblacionales para su registro definitivo. Objetivo: Realizar una revisión bibliográfica para evaluar las metodologías diagnósticas disponibles en Brasil, de acuerdo con la realidad sanitaria local, explorando el momento epidemiológico, la complejidad de la prueba y la finalidad de su aplicación. Metodología: Se trata de un estudio bibliográfico, descriptivo, del tipo revisión de literatura. Para las búsquedas se utilizaron las siguientes bases de datos científicas PUBMED, MEDLINE, LILACS Y COCHRANE LIBRARY, a través de descriptores seleccionados en la plataforma DECS. Resultados: El escenario de varias pruebas, basadas en diferentes metodologías, como pruebas basadas en el ARN viral, en la detección de antígenos virales o anticuerpos, asociado al conocimiento de la historia natural del virus, permite un análisis crítico del mejor diagnóstico de acuerdo con la clínica del paciente, epidemiológica, objetivo diagnóstico y precisión de la prueba. Actualmente, hay un cambio en el patrón inmunológico de la población y la descripción de tipos y subtipos de SARS-CoV-2 con cambios genéticos, que pueden conducir a cambios en la precisión diagnóstica o la reaparición en brotes de enfermedad grave. Conclusiones: El camino evolutivo de la historia natural del Covid-19 es aún incierto y los ensayos de diagnóstico se encuentran en diferentes etapas de desarrollo, validación y producción y cada tipo de prueba tiene sus propias ventajas y desventajas distintas inherentes a la plataforma tecnológica de origen y una combinación de tipos de pruebas utilizadas en diferentes momentos puede ser útil para el manejo clínico de los pacientes y en el control de la pandemia de SARS- CoV-2.
Subject(s)
Systematic Reviews as Topic , COVID-19 Serological Testing/methods , COVID-19 Testing/methods , COVID-19 Nucleic Acid Testing/methods , Health Services Research , Antibodies/analysis , Antigens/analysisABSTRACT
OBJECTIVE: To assess the characteristics of suspected coronavirus disease 19 (COVID-19) and the rate of confirmed COVID-19 in a pediatric population at the beginning of the pandemic in Portugal. STUDY DESIGN: Suspected COVID-19 pediatric cases that were tested in a Portuguese hospital between March 17 and April 2 2020 were included in this descriptive retrospective study. The analyzed data included socio-demographic parameters, characteristics of the household, underlying medical conditions and symptoms. RESULTS: Ninety-four patients were included and all of them were symptomatic and treated without hospitalization. The most common symptoms were cough (80%;n=75), rhinorrhea (72%;n=68) and fever (60%;n=56). There was only one positive for SARS-CoV-2 in a five-year-old child with mild illness without epidemiologic linkage. CONCLUSION: This study showed a low rate of confirmed COVID-19 in children. The causes for this low rate can be multifactorial and illustrates how differently this virus spreads in the pediatric population.
Subject(s)
COVID-19 , Child , Child, Preschool , Humans , Pandemics , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2ABSTRACT
ObjectiveTo assess the characteristics of suspected coronavirus disease 19 (COVID-19) and the rate of confirmed COVID-19 in a pediatric population at the beginning of the pandemic in Portugal.Study designSuspected COVID-19 pediatric cases that were tested in a Portuguese hospital between March 17 and April 2 2020 were included in this descriptive retrospective study. The analyzed data included socio-demographic parameters, characteristics of the household, underlying medical conditions and symptoms.ResultsNinety-four patients were included and all of them were symptomatic and treated without hospitalization. The most common symptoms were cough (80%;n=75), rhinorrhea (72%;n=68) and fever (60%;n=56). There was only one positive for SARS-CoV-2 in a five-year-old child with mild illness without epidemiologic linkage.ConclusionThis study showed a low rate of confirmed COVID-19 in children. The causes for this low rate can be multifactorial and illustrates how differently this virus spreads in the pediatric population.
ObjetivoEvaluar las características en casos sospechosos y la tasa de casos confirmados de enfermedad por coronavirus 19 (COVID-19) en una población pediátrica al inicio de la pandemia en Portugal.MétodosEn este estudio descriptivo-retrospectivo se incluyeron casos pediátricos sospechosos de COVID-19 que se testearon en un hospital portugués entre el 17 de marzo y el 2 de abril de 2020. Los datos fueron analizados bajo parámetros sociodemográficos, características del hogar, condiciones médicas subyacentes y síntomas.ResultadosSe incluyeron 94 pacientes, todos sintomáticos y tratados sin hospitalización. Los síntomas más frecuentes fueron tos (80%; n=75), rinorrea (72%; n=68) y fiebre (60%; n=56). Solo hubo un caso positivo para SARS-CoV-2, un niño de 5 años con una enfermedad leve, sin vínculo epidemiológico.ConclusiónEste estudio mostró una baja tasa de casos confirmados de COVID-19 en niños. Las causas de esta baja tasa pueden ser multifactoriales e ilustran cuán diferente se propaga este virus en la población pediátrica.
Subject(s)
Humans , Child , Health Sciences , Coronavirus , Pediatrics , Portugal , Child Health , Polymerase Chain Reaction , Severe acute respiratory syndrome-related coronavirus , Pandemics , Retrospective Studies , Epidemiology, Descriptive , Communicable DiseasesABSTRACT
OBJECTIVE: To assess the characteristics of suspected coronavirus disease 19 (COVID-19) and the rate of confirmed COVID-19 in a pediatric population at the beginning of the pandemic in Portugal. STUDY DESIGN: Suspected COVID-19 pediatric cases that were tested in a Portuguese hospital between March 17 and April 2 2020 were included in this descriptive retrospective study. The analyzed data included socio-demographic parameters, characteristics of the household, underlying medical conditions and symptoms. RESULTS: Ninety-four patients were included and all of them were symptomatic and treated without hospitalization. The most common symptoms were cough (80%;n=75), rhinorrhea (72%;n=68) and fever (60%;n=56). There was only one positive for SARS-CoV-2 in a five-year-old child with mild illness without epidemiologic linkage. CONCLUSION: This study showed a low rate of confirmed COVID-19 in children. The causes for this low rate can be multifactorial and illustrates how differently this virus spreads in the pediatric population.
