Correlation Between the COVID-19 Respiratory Triage Score and SARS-COV-2 PCR Test.

Background: COVID-19 clinical presentation is usually non-specific and includes commonly encountered symptoms like fever, cough, nausea, and vomiting. It has been reported that COVID-19 patients can potentially transmit the disease to others before developing symptoms. Thus, extensive surveillance and screening of individuals at risk of the disease is required to limit SARS-COV-2 spread. The COVID-19 respiratory triage score has been used for patient screening. We aimed to determine its diagnostic performance characteristics, which have not been adequately studied before. Methodology: This is a retrospective observational study involving all patients screened for COVID-19 at a tertiary care facility. Patients were tested using nasopharyngeal swab for SARS-COV-2 PCR. The Saudi CDC COVID-19 respiratory triage score was measured for all subjects. The sensitivity, specificity, positive predictive value, and negative predicted value of COVID-19 respiratory triage score were measured with reference to SARS-COV-2 PCR test. Multivariate regression analysis was done to identify factors that can predict a positive SARS-COV-2 PCR test. Result: A total of 1,435 subjects were included. The COVID-19 respiratory triage score provided a marginal diagnostic performance with a receiver-operating characteristics (ROC) area under the curve value of 0.60 (95% CI: 0.57-0.64). A triage score of 5 provided the best cut-off value for the combined sensitivity and specificity. Clinical characteristics that independently predicted positive COVID-19 PCR test include male sex (adjusted OR: 1.47; p = 0.034), healthcare workers and their family members (adjusted OR: 1.99; 95%; p = 0.016), fever (adjusted OR: 2.98; p < 0.001), and moderate disease severity (adjusted OR: 5; p < 0.001). Conclusion: The current COVID-19 respiratory triage score has marginal diagnostic performance characteristics. Its performance can improve by including additional predictors to the respiratory symptoms in order to avoid missing COVID-19 patients with atypical presentation and to limit unnecessary SARS-COV-2 PCR testing.

First confirmed case of human rabies in Saudi Arabia.

Rabies is an almost invariably fatal Lyssavirus-induced disease, that causes acute encephalitis in humans and other mammals. The viral reservoirs include both wild and domestic animals. The infection causes about 24000 to 60000 deaths worldwide per year (Giesen et al., 2015; Naghavi et al., 2015) with Africa and Asia having the majority of human deaths (95%) caused by rabies. Rabies is endemic in animals in Arabian peninsula. Some countries in the region such as Saudi Arabia, Yemen and Oman are reporting increasing number of cases of wildlife rabies. Among these countries Saudi Arabia is largest, but published data regarding the rabies status in the country are scarce. We report a case of a 60 year old Saudi man who was admitted to cardiac ICU of a tertiary care hospital in Makkah, primarily with history of chest pain for cardiac evaluation, who was found to have signs suggestive hydrophobia. On history, it was found that he had an unprovoked scratch on his face by a dog in Morocco a month prior to admission and his saliva PCR test confirmed rabies virus.