Recurrent Symptomatic SARS-CoV-2 RT PCR Positivity among Healthcare Professionals: A Series of Cases

Abstract Objectives SARS-CoV-2 is mainly transmitted by inhalation of droplets and aerosols. This puts healthcare professionals from specialties with close patient contact at high risk of nosocomial infections with SARS-CoV-2. In this context, preprocedural mouthrinses with hydrogen peroxide have been recommended before conducting intraoral procedures. Therefore, the aim of this study was to investigate the effects of a 1% hydrogen peroxide mouthrinse on reducing the intraoral SARS-CoV-2 load. Methods Twelve out of 98 initially screened hospitalized SARS-CoV-2-positive patients were included in this study. Intraoral viral load was determined by RT-PCR at baseline, whereupon patients had to gargle mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. After 30 min, a second examination of intraoral viral load was performed by RT-PCR. Furthermore, virus culture was performed for specimens exhibiting viral load of at least 103 RNA copies/mL at baseline. Results Ten out of the 12 initially included SARS-CoV-2-positive patients completed the study. The hydrogen peroxide mouthrinse led to no significant reduction of intraoral viral load. Replicating virus could only be determined from one baseline specimen. Conclusion A 1% hydrogen peroxide mouthrinse does not reduce the intraoral viral load in SARS-CoV-2-positive subjects. However, virus culture did not yield any indication on the effects of the mouthrinse on the infectivity of the detected RNA copies. Clinical relevance The recommendation of a preprocedural mouthrinse with hydrogen peroxide before intraoral procedures is questionable and thus should not be supported any longer, but strict infection prevention regimens are of paramount importance. Trial registration German Clinical Trials Register (ref. DRKS00022484)

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ENVIRONMENTAL SAFETY EVALUATION OF THE PROTECTION AND ISOLATION SYSTEM FOR PATIENTS WITH COVID-19.

10.1101/2020.06.04.20122838 ◽

2020 ◽

Author(s):

Claudio Almeida Quadros ◽

Maria Carolina BDM Leal ◽

Carlos A Baptista-Sobrinho ◽

Carolina KV Nonaka ◽

Bruno SF Souza ◽

...

Keyword(s):

Mechanical Ventilation ◽

Healthcare Professionals ◽

High Flow ◽

Invasive Ventilation ◽

High Flow Nasal Cannula ◽

Rt Pcr ◽

Isolation System ◽

Non Invasive ◽

Non Invasive Ventilation ◽

And Biological Markers

Background SARS-CoV-2 has high transmissibility through respiratory droplets and aerosol, making COVID-19 a worldwide pandemic. In its severe form, patients progress to respiratory failure. Non-invasive mechanical ventilation restrictions and early orotracheal intubation have collapsed health systems due to insufficient intensive care unit beds and mechanical ventilators. COVID-19 dedicated healthcare professionals have high infection rates. This publication describes experimental testing of the Protection and Isolation System for Patients with COVID-19 (PISP/COVID-19). Method PISP/COVID-19 is a disposable transparent polyethylene plastic that covers the patient's entire hospital bed, with its internal air aspirated by the hospital's vacuum system attached to a microparticle filter. Experiments validated PISP/COVID-19's ability to block aerosolized microparticles dissemination. Caffeine was used as a molecular marker, with leakage evaluation through sensors analysis using nuclear magnetic resonance spectroscopy. The biological marker was synthetic SARS-CoV-2 RNA, using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the detection method. Results PISP/COVID-19 was effective against molecular and biological markers environmental dispersion in simulations of non-invasive ventilation, high-flow nasal cannula oxygen and mechanical ventilation isolation. Caffeine was not detected in any of the sensors positioned at points outside the PISP/COVID-19. The ability of PISP/COVID-19 to retain virus particles and protect the surrounding environment was confirmed by detection and gradients quantification of synthetic SARS-CoV-2 RNA by RT-PCR. Conclusion PISP/COVID-19 was effective in the retention of the molecular and biological markers in all tested simulations. Considering the current pandemic, PISP/COVID-19 might increase the use of non-invasive ventilation, high-flow nasal cannula oxygen and provide additional protection to healthcare professionals.

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Potential Use of Antigen-Based Rapid Test for SARS-CoV-2 in Respiratory Specimens in Low-Resource Settings in Egypt for Symptomatic Patients and High-Risk Contacts

Laboratory Medicine ◽

10.1093/labmed/lmaa104 ◽

2020 ◽

Author(s):

Abeer Mohamed Abdelrazik ◽

Shahira Morsy Elshafie ◽

Hossam M Abdelaziz

Keyword(s):

Test Performance ◽

Healthcare Professionals ◽

Rapid Test ◽

University Hospital ◽

Antigen Test ◽

Rt Pcr ◽

Viral Loads ◽

Viral Transport Medium ◽

Public Health Challenges ◽

Polymerase Chain

Abstract Objective Because of the rapidly emerging SARS-CoV-2 pandemic and its wide public health challenges, rapid diagnosis is essential to decrease the spread. Antigen-based rapid detection tests are available; however, insufficient data about their performance are available. Methods The lateral-flow immunochromatographic BIOCREDIT COVID-19 antigen test was evaluated using nasopharyngeal swabs in a viral transport medium from patients with confirmed infection, contacts, and exposed healthcare professionals at Fayoum University Hospital in Egypt. Test performance was determined in comparison to the SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (RT-PCR) test. Results Three hundred ten specimens from 3 categories—patients with confirmed diagnoses of COVID-19, contacts, and exposed healthcare professionals—were included; 188 specimens were RT-PCR-positive, from which 81 were detected by rapid antigen test. Overall sensitivity was 43.1%. Sensitivity was significantly higher in specimens with high viral loads. Conclusion Poor sensitivity of the BIOCREDIT COVID-19 test does not permit its use for diagnosis, and it can only be used in conjunction with RT-PCR for screening.

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Proposal to protect patients and healthcare professionals undergoing elective surgery during COVID-19 outbreak

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00478-1 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Gülten Arslan ◽

Kemal Tolga Saraçoğlu ◽

Ömer Aydiner ◽

Recep Demirhan

Keyword(s):

Healthcare Professionals ◽

Elective Surgery ◽

Chest Ct ◽

Rt Pcr ◽

Vital Status ◽

American Society ◽

The Right ◽

Surgery Department ◽

American Society Of Anesthesiologists

Abstract Background The aim of this study was to investigate the reliability of COVID-19 Reporting and Data System (CO-RADS) scale on chest computerized tomography (CT) in addition to the reverse transcriptase-polymerase chain reaction (RT-PCR) test in diagnosis of COVID-19 on patients who will undergo elective surgery to protect patients and healthcare professionals during the intense pandemic period and the correlation between CO-RADS scale and Total Severity Score (TSS). During the intensive pandemic until normalization, 253 patients aged ≥ 18 years who underwent elective surgery with two negative RT-PCR results within the last 5 days and CO-RADS scale ≤ 3 on chest CT were included in the study. Demographic characteristics, American Society of Anesthesiologists classification, type of anesthesia and surgery, department of clinic, chest CT findings, scale of CO-RADS and TSS on CT, patients’ postoperative hospital stay, follow-up time, and vital status (whether or not COVID-19 disease) at the hospital and discharge information were collected for each patient. Results The most frequently calculated CO-RADS score was found to be 1 (73.1%). It was followed by scale of CO-RADS 2 (20.9%). Regarding TSS, the most common TSS for the right and left lungs was 0 (91.7% and 92.5%, respectively). COVID-19 was not detected in any of the patients who were hospitalized for an average of 4.9 ± 6.4 days and followed-up for an average of 14.3 ± 8.2 days. It was observed that the CO-RADS score and TSS were positively and moderately correlated with each other (p < 0.001). Conclusion It was concluded that in early diagnostic of COVID-19, chest CT scans serve like a complementary diagnostic method in addition to RT-PCR testing to keep safe both the patients and health professionals and the scale of CO-RADS and TSS on CT are valuable in correlation with each other.

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Evaluation of Anti-SARS-CoV-2 IgG Antibody in Healthcare Professionals Infected with COVID-19

Jundishapur Journal of Microbiology ◽

10.5812/jjm.119892 ◽

2021 ◽

Vol 14 (11) ◽

Author(s):

Borhan Moradveisi ◽

Shirin Behzadi ◽

Farima Zakaryaei ◽

Ali Jalili ◽

Khaled Rahmani ◽

...

Keyword(s):

Healthcare Professionals ◽

Total Population ◽

Igg Antibodies ◽

Rt Pcr ◽

Igg Antibody ◽

Disease Symptoms ◽

Positive Antibody ◽

Antibody Titers ◽

Polymerase Chain ◽

And Gender

Background: The knowledge of antibody’s significance and frequency in patients cured of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is extremely limited. Objectives: This study aimed to evaluate anti-SARS-CoV-2 IgG antibodies in patients exposed to SARS-CoV-2. Methods: Healthcare professionals infected with SARS-CoV-2 were enrolled in this study. The levels of anti-SARS-CoV-2 IgG antibodies were detected 15 days after the onset of symptoms and five months later. Results: A total of 167 patients with coronavirus disease 2019 (COVID-19) were evaluated, including 119 (71.3%) females and 48 (28.7%) males. Of the 88 polymerase chain reaction (PCR)-positive patients, 55 (62.5%) had IgG-positive antibodies, and of the 79 reverse transcriptase (RT)-PCR-negative patients, 12 (16.9%) had IgG-positive antibodies. Out of 23 anosmia cases, 19 (82.6%) had positive antibodies. There was a significant relationship between anosmia and positive antibody (P = 0.001), but there was no correlation between antibody titers and gender and other disease symptoms. Immortally, 63 (94%) cases demonstrated high levels of anti-SARS-CoV-2 IgG antibodies after five months of infection. Moreover, 6.5% (N = 11) of the total population were re-infected with COVID-19 six months later. Conclusions: Overall, anti-SARS-CoV-2 IgG antibodies detection may be an appropriate method to identify suspected patients with a negative RT-PCR test. Antibodies can remain high in most infected patients for up to five months after infection. Moreover, anosmia seems to be a valuable diagnostic factor, and the healthcare system should implement isolation measures for patients with anosmia.

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Age and Sex Modulate SARS-CoV-2 Viral Load Kinetics: A Longitudinal Analysis of 1735 Subjects

Journal of Personalized Medicine ◽

10.3390/jpm11090882 ◽

2021 ◽

Vol 11 (9) ◽

pp. 882

Author(s):

Valerio Caputo ◽

Andrea Termine ◽

Carlo Fabrizio ◽

Giulia Calvino ◽

Laura Luzzi ◽

...

Keyword(s):

Viral Load ◽

Healthcare Professionals ◽

High Viral Load ◽

Digital Pcr ◽

Original Strain ◽

Rt Pcr ◽

Subgenomic Rna ◽

Slow Decay ◽

Male Sex ◽

Age And Sex

The COVID-19 pandemic caused by SARS-CoV-2 represents a public health emergency, which became even more challenging since the detection of highly transmissible variants and strategies against COVID-19 were indistinctly established. We characterized the temporal viral load kinetics in individuals infected by original and variant strains. Naso-oropharyngeal swabs from 33,000 individuals (admitted to the IRCCS Santa Lucia Foundation Drive-in, healthcare professionals and hospitalized patients who underwent routinary screening) from November 2020 to June 2021 were analyzed. Of them, 1735 subjects were selected and grouped according to the viral strain. Diagnostic analyses were performed by CE-IVD RT-PCR-based kits. The subgenomic-RNA component was assessed in 36 subjects using digital PCR. Infection duration, viral load decay speed, effects of age and sex were assessed and compared by extensive statistical analyses. Overall, infection duration and viral load differed between the groups (p < 0.05). Male sex was more present among both original and variant carriers affected with high viral load and showing fast decay speed, whereas original strain carriers with slow decay speed resulted in older (p < 0.05). Subgenomic-RNA was detected in the positive samples, including those with low viral load. This study provides a picture of the viral load kinetics, identifying individuals with similar patterns and showing differential effects of age and sex, thus providing potentially useful information for personalized management of infected subjects.

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Head-to-head comparison of SARS-CoV-2 antigen-detecting rapid test with professional-collected anterior nasal versus nasopharyngeal swab

10.1101/2020.12.03.20243725 ◽

2020 ◽

Author(s):

Andreas K. Lindner ◽

Olga Nikolai ◽

Chiara Rohardt ◽

Susen Burock ◽

Claudia Hülso ◽

...

Keyword(s):

Healthcare Professionals ◽

Rapid Test ◽

High Viral Load ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Test Procedures ◽

Testing Strategies ◽

Percent Agreement ◽

Accuracy Study ◽

Antigen Testing

AbstractBackgroundNasopharyngeal (NP) swab samples for antigen-detecting rapid diagnostic tests (Ag-RDTs) require qualified healthcare professionals and are frequently perceived as uncomfortable by patients.MethodsWe performed a manufacturer-independent, prospective diagnostic accuracy study, comparing professional-collected anterior nasal (AN) to nasopharyngeal swab, using the test kits of a WHO-listed SARS-CoV-2 Ag-RDT (STANDARD Q COVID-19 Ag Test, SD Biosensor), which is also being distributed by Roche. Individuals with high suspicion for COVID-19 infection were tested. The reference standard was RT-PCR using a combined oro-/nasopharyngeal swab sample. Percent positive and negative agreement, as well as sensitivity and specificity were calculated.ResultsAmong the 179 participants, 41 (22.9%) tested positive for SARS-CoV-2 by RT-PCR. The positive percent agreement of the two different sampling techniques for the Ag-RDT was 93.5% (CI 79.3-98.2). The negative percent agreement was 95.9% (CI 91.4-98.1). The Ag-RDT with AN-sampling showed a sensitivity of 80.5% (33/41 PCR positives detected; CI 66.0-89.8) and specificity of 98.6% (CI 94.9-99.6) compared to RT-PCR. The sensitivity with NP-sampling was 73.2% (30/41 PCR positives detected; CI 58.1-84.3) and specificity was 99.3% (CI 96.0-100). In patients with high viral load (>7.0 log10 RNA SARS-CoV2/swab), the sensitivity of the Ag-RDT with AN-sampling was 100% and 94.7% with NP-sampling.ConclusionThis study demonstrates that sensitivity of a WHO-listed SARS-CoV-2 Ag-RDT using a professional AN-sampling kit is at least equal to that of the NP-sampling kit, although confidence intervals overlap. Of note, differences in the IFUs of the test procedures could have contributed to different sensitivities. AN-sampling can be performed with less training, reduces patient discomfort, and it enables scaling of antigen testing strategies. Additional studies of patient self-sampling should be considered to further facilitate the scaling-up of Ag-RDT testing.

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Relapse of clinical symptoms of COVID-19 or probable reinfection in a laboratory professional: a case report from Northeast Brazil

Research Society and Development ◽

10.33448/rsd-v10i5.14730 ◽

2021 ◽

Vol 10 (5) ◽

pp. e13210514730

Author(s):

Kledoaldo Lima ◽

Alexsandro Pedro da Silva ◽

Madi Veiga Diniz ◽

Aline Cavalcante de Lira ◽

Arione Vieira do Nascimento ◽

...

Keyword(s):

Immunoglobulin G ◽

Healthcare Professionals ◽

Methylenetetrahydrofolate Reductase ◽

Clinical Symptoms ◽

Renal Cysts ◽

Mthfr Gene ◽

Rt Pcr ◽

History Of ◽

Oropharyngeal Swab ◽

Polymerase Chain

Healthcare professionals constitute one of the groups that are most vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we report the case of a non-overweight and non-smoking 42-year-old woman with thrombophilia due to methylenetetrahydrofolate reductase (MTHFR) gene mutation, hereditary renal cysts, and no history of diabetes or arterial hypertension, who presented the first symptoms between 10 and 17 August 2020, with a SARS-CoV-2-positive naso-oropharyngeal swab by qualitative real-time polymerase chain reaction (RT-PCR). However, the result for SARS-CoV-2 immunoglobulin G (IgG) was non-reactive 41 days after (21 September 2020) the onset of symptoms. Nevertheless, on 7 October 2020 (57 days after the first symptoms), the patient presented new symptoms suggestive of COVID-19, with another SARS-CoV-2-positive RT-PCR result, and on 21 October 2020, SARS-CoV-2 immunoglobulin G was positive. Considering this, we interrogated the results to determine whether the case was reinfection or reactivation. This outcome highlights the importance of surveillance over relapses or reinfections.

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Clinical and laboratory characteristics in outpatient diagnosis of COVID-19 in healthcare professionals in Rio de Janeiro, Brazil

10.1101/2020.10.22.20217851 ◽

2020 ◽

Author(s):

Luís Cristóvão Porto ◽

Claudia Henrique da Costa ◽

Alessandra Sant’Anna Nunes ◽

Isabel Bouzas ◽

Tiago C. Ferreira ◽

...

Keyword(s):

Healthcare Professional ◽

Clinical Features ◽

Rio De Janeiro ◽

Healthcare Professionals ◽

Early Stage ◽

Laboratory Data ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Body Pain

AbstractAimsThis study aimed to identify the symptoms associated with early stage SARS-CoV-2 (COVID-19) infections in healthcare professionals (HCP) using both clinical and laboratory data.MethodsA total of 1,297 patients, admitted between March 18 and April 8, 2020, were stratified according to their risk of developing COVID-19 using their responses to a questionnaire designed to evaluate symptoms and risk conditions.ResultsAnosmia/hyposmia (p <0.0001), fever (p<0.0001), body pain (p<0.0001), and chills (p=0.001) were all independent predictors for COVID-19, with a 72% estimated probability for detecting COVID-19 in nasopharyngeal swab samples. Leukopenia, relative monocytosis, decreased eosinophil values, CRP, and platelets were also shown to be significant independent predictors for COVID-19.ConclusionsThe significant clinical features for COVID-19 were identified as anosmia, fever, chills, and body pain. Elevated CRP, leukocytes under 5,400 x 109/L, and relative monocytosis (>9%) were common among patients with a confirmed COVID-19 diagnosis. These variables may help, in the absence of RT-PCR tests, to identify possible COVID-19 infections during pandemic outbreaks.SummaryFrom March 19 to April 8 2020, 1,297 patients attended the Polyclinic Piquet Carneiro for COVID-19 detection. Healthcare professional data was analyzed, significant clinical features were anosmia, fever, chills and body pain. Elevated CRP, leukopenia and monocytosis were common in COVID-19.

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Detection of Nucleic Acids in Cells or Tissue Sections Using In situ Polymerase Chain Reaction (PCR)

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100162545 ◽

1996 ◽

Vol 54 ◽

pp. 16-17

Author(s):

J. R. Hully ◽

K. R. Luehrsen ◽

K. Aoyagi ◽

C. Shoemaker ◽

R. Abramson

Keyword(s):

Nucleic Acids ◽

Viral Infections ◽

Anatomical Location ◽

Rt Pcr ◽

Reverse Transcription Pcr ◽

Cellular Source ◽

Gene Transcripts ◽

Initial Description ◽

In Cells

The development of PCR technology has greatly accelerated medical research at the genetic and molecular levels. Until recently, the inherent sensitivity of this technique has been limited to isolated preparations of nucleic acids which lack or at best have limited morphological information. With the obvious exception of cell lines, traditional PCR or reverse transcription-PCR (RT-PCR) cannot identify the cellular source of the amplified product. In contrast, in situ hybridization (ISH) by definition, defines the anatomical location of a gene and/or it’s product. However, this technique lacks the sensitivity of PCR and cannot routinely detect less than 10 to 20 copies per cell. Consequently, the localization of rare transcripts, latent viral infections, foreign or altered genes cannot be identified by this technique. In situ PCR or in situ RT-PCR is a combination of the two techniques, exploiting the sensitivity of PCR and the anatomical definition provided by ISH. Since it’s initial description considerable advances have been made in the application of in situ PCR, improvements in protocols, and the development of hardware dedicated to in situ PCR using conventional microscope slides. Our understanding of the importance of viral latency or viral burden in regards to HIV, HPV, and KSHV infections has benefited from this technique, enabling detection of single viral copies in cells or tissue otherwise thought to be normal. Clearly, this technique will be useful tool in pathobiology especially carcinogenesis, gene therapy and manipulations, the study of rare gene transcripts, and forensics.

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