scholarly journals Real-world evaluation of a computed tomography-first triage strategy for suspected Coronavirus disease 2019 in outpatients with fever in Japan: an observational cohort study

2020 ◽  
Author(s):  
Shigeta Miyake ◽  
Takuma Higurashi ◽  
Takashi Jono ◽  
Taisuke Akimoto ◽  
Fumihiro Ogawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Polymerase Chain Reaction ◽  
Cohort Study ◽  
Positive Predictive Value ◽  
Real World ◽  
Predictive Value ◽  
Chain Reaction ◽  
Triage Protocol ◽  
Polymerase Chain ◽  
Sensitivity Specificity

Abstract Background: The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.Methods: This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.Results: In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The sensitivity, specificity, positive predictive value, and negative predictive value of our computed tomography-first triage protocol for Coronavirus disease 2019 were 100%, 60.2%, 18.8%, and 100%, respectively. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.

scholarly journals Real-world evaluation of a computed tomography-first triage strategy for suspected coronavirus disease 2019 in emergency outpatients in Japan: an observational cohort study

2020 ◽  
Author(s):  
Shigeta Miyake ◽  
Takuma Higurashi ◽  
Takashi Jono ◽  
Taisuke Akimoto ◽  
Fumihiro Ogawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Polymerase Chain Reaction ◽  
Cohort Study ◽  
Real World ◽  
Clinical History ◽  
University Hospital ◽  
Diagnostic Systems ◽  
Chain Reaction ◽  
Triage Protocol ◽  
Polymerase Chain

Abstract Background: Coronavirus disease 2019 (COVID-19) continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with COVID-19 symptoms are suspected of disease. Computed tomography (CT) in patients with suspected COVID-19 may be reasonable for triaging, and CT-first triage strategies have been proposed. However, clinical evaluation of a CT-first triage protocol is lacking. The aim of this study is to investigate the real-world efficacy and limitations of a CT-first triage strategy in patients with suspected COVID-19.Methods: This was a single-center cohort study evaluating outpatients with suspected COVID-19 who underwent a medical examination at Yokohama City University Hospital and who were prospectively registered between 9 February and 5 May 2020. We treated patients according to the CT-first triage protocol. CT findings were classified into five categories according to the COVID-19 Reporting and Data System (CO-RADS). With the CT-first triage protocol, patients with a suspicious clinical history, symptoms, or suspicious findings on chest CT were allocated to the COVID-19 suspected group. The primary outcome was efficacy of the CT-first triage protocol for outpatients with suspected COVID-19. We conducted additional analyses of the isolation time of outpatients with suspected COVID-19 and reached final diagnoses.Results: In total, 108 outpatients with suspected COVID-19 were examined at our hospital. Forty-eight patients (44.9%) were categorized as CO-RADS 1, 26 patients (24.3%) as CO-RADS 2, 14 patients (13.1%) as CO-RADS 3, 6 patients (5.6%) as CO-RADS 4, and 13 patients (12.1%) as CO-RADS 5. One patient was excluded because of pregnancy. Using the CT-first triage protocol, 48 (44.9%) patients were suspected of having COVID-19. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group not suspected of having COVID-19 were diagnosed with COVID-19 during follow up. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our CT-first triage protocol was acceptable for triaging outpatients with suspected COVID-19. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is limited.

scholarly journals Peripheral Blood Leukocytes and Serum Nested Polymerase Chain Reaction Are Complementary Methods for Monitoring Active Cytomegalovirus Infection in Transplant Patients

2013 ◽  
Vol 24 (3) ◽  
pp. e69-e74 ◽  
Author(s):  
PD Andrade ◽  
MT Fioravanti ◽  
EBV Anjos ◽  
C De Oliveira ◽  
DM Albuquerque ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Cytomegalovirus Infection ◽  
Clinical Symptoms ◽  
Peripheral Blood Leukocytes ◽  
Active Infection ◽  
Chain Reaction ◽  
Blood Leukocytes ◽  
Polymerase Chain

BACKGROUND: Human cytomegalovirus is an important cause of morbidity and mortality in immunocompromised patients. Qualitative polymerase chain reaction (PCR) has proven to be a sensitive and effective technique in defining active cytomegalovirus infection, in addition to having low cost and being a useful test for situations in which there is no need for quantification. Real-time PCR has the advantage of quantification; however, the high cost of this methodology makes it impractical for routine use.OBJECTIVE: To apply a nested PCR assay to serum (sPCR) and to evaluate its efficiency to diagnose active cytomegalovirus infection compared with PCR of peripheral blood leukocytes (L-PCR).METHODS: Samples of 37 patients were prospectively evaluated. An internal control was created and applied to sPCR to exclude false-negative results.RESULTS: In total, 21 patients (57%) developed active cytomegalovirus infection. After analyzing the two methods for the diagnosis of active infection, higher sensitivity and negative predictive value of the L-PCR versus sPCR (100% versus 62%), and higher specificity and positive predictive value of sPCR versus L-PCR (81% versus 50% and 72%, respectively) were observed. Discordant results were observed in 11 patients who were L-PCR-positive but sPCR-negative for active cytomegalovirus infection, five of whom developed clinical symptoms of cytomegalovirus. Clinical symptoms were observed in 14 patients, 12 of whom were diagnosed with active infection by nested L-PCR (P=0.007) and seven by nested sPCR (P=0.02). Higher specificity and a positive predictive value for sPCR were observed.CONCLUSION: Nested L-PCR and sPCR were considered to be complementary methods for the diagnosis and management of symptomatic cytomegalovirus infection.

scholarly journals A Comparison of Ligase Chain Reaction to Polymerase Chain Reaction in the Detection ofChlamydia trachomatisEndocervical Infections

1998 ◽  
Vol 6 (2) ◽  
pp. 57-60 ◽  
Author(s):  
J. D. Davis ◽  
P. K. Riley ◽  
C. W. Peters ◽  
K. H. Rand
Keyword(s):  
Polymerase Chain Reaction ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Chain Reaction ◽  
True Negative ◽  
Predictive Values ◽  
Ligase Chain Reaction ◽  
Polymerase Chain

Objective:To compare the reliability of ligase chain reaction (LCR) to polymerase chain reaction (PCR) in detectingChlamydia trachomatisendocervical infections.Methods:We conducted a prospective study of 486 patients at risk for chlamydial infection of the endocervix. We obtained two endocervical specimens from each patient and used LCR and PCR to detectC. trachomatis. Discrepant results between the two techniques were resolved by repeat testing and by testing for the major outer membrane protein (MOMP) gene, if necessary. We determined the sensitivity, specificity, positive predictive value, and negative predictive value for each test, using concordant results or MOMP gene results as the “gold standard”.Results:Of the 486 patients, 42 (8.6%) had evidence ofC. trachomatisinfection after resolution of discrepant results. Of the 42 true positive specimens, 41 were positive by initial LCR and 38 were positive by initial PCR. Of the 444 true negative specimens, none had a positive initial LCR result, while 2 had a positive initial PCR test. Therefore, compared to the gold standard, LCR had a sensitivity of 97.6% and specificity of 100%, while PCR had a sensitivity of 90% and a specificity of 99.5%. The positive and negative predictive values of LCR were 100% and 99.8%, respectively. PCR had a positive predictive value of 95% and a negative predictive value of 99.1%. The difference in sensitivity of LCR versus PCR was not statistically significant (P= .125).Conclusion:LCR and PCR perform equally well in detectingC. trachomatisendocervical infections.

scholarly journals Role of multiplex polymerase chain reaction in diagnosing tubercular meningitis

2017 ◽  
Vol 9 (02) ◽  
pp. 145-147 ◽  
Author(s):  
Anupam Berwal ◽  
Kiran Chawla ◽  
Shashidhar Vishwanath ◽  
Vishnu Prasad Shenoy
Keyword(s):  
Polymerase Chain Reaction ◽  
Multiplex Pcr ◽  
Predictive Value ◽  
Multiplex Polymerase Chain Reaction ◽  
Extrapulmonary Tuberculosis ◽  
Smear Microscopy ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Sensitivity Specificity

AbstractTuberculous meningitis (TBM) is one of the most serious manifestations of extrapulmonary tuberculosis. Timely and accurate diagnosis provides a favorable prognosis in patients with TBM. The study evaluated the use of multiplex polymerase chain reaction (PCR) in the diagnosis of TBM. A study was conducted on 74 patients clinically suspected with TBM. The cerebrospinal fluid (CSF) specimens were processed for smear microscopy, middle brook 7H9 culture, and multiplex PCR using primers directed against IS6110 gene and 38 kD protein for detection of Mycobacterium tuberculosis. The results were analyzed to assess the role of multiplex PCR in the diagnosis of TBM. A total of 26 (35.1%) patients were diagnosed with TBM. Microscopy was negative in all while culture was positive in two cases only. Comparing with clinical diagnosis and CSF adenosine deaminase levels of ≥ 10 U/L, multiplex PCR showed sensitivity, specificity, positive predictive value, and negative predictive value of 71.4%, 89.6%, 83.3%, and 81.2%, respectively, in the diagnosis of TBM.

scholarly journals DETEKSI MOLEKULER Mycobacterium tuberculosis DI DAHAK CARA POLYMERASE CHAIN REACTION

2018 ◽  
Vol 15 (1) ◽  
pp. 16
Author(s):  
P. B. Notopuro ◽  
J. Nugraha ◽  
H. Notopuro
Keyword(s):  
Polymerase Chain Reaction ◽  
Mycobacterium Tuberculosis ◽  
Predictive Value ◽  
Culture Technique ◽  
Molecular Technique ◽  
Chain Reaction ◽  
Conventional Culture ◽  
Significant Difference ◽  
Polymerase Chain ◽  
Sensitivity Specificity

tuberculosis is a chronic infectious disease which is found in developing and developed country. It is one of community healthproblems which become priority in national and international health programs. Microbiologic examination is used to establish thediagnosis of tuberculosis beside clinical examination and radiologic examination. Conventional microscopic and culture examinationhave many limitation ie: such as for example low sensitivity, specificity and need a lot of time. New Molecular technique gives morevalue in sensitivity, specificity and the time for examination. the aim of this study was to know the diagnostic value of PolymeraseChain Reaction for detection of Mycobacterium tuberculosis in sputum. the sputum was collected from twenty eight patients suspectedtuberculosis based on the clinical and radiological examination. the study was performed from September 2006 until July 2007. Wedid the conventional culture technique as a diagnostic gold standard and molecular technique to detect the Mycobacterium tuberculosisin the sputum. For molecular technique, we used Polymerase Chain Reaction (PCR) with a set of IS6110 region primer which is specificfor the Mycobacterium tuberculosis Complex. the sensitivity of PCR with IS6110 region primer is 100% (very high), specificity is 82.4%(high), positive predictive value is 89.7% and negative predictive value is 100%. there was statistically no significant difference betweenthe result of PCR and conventional culture method. Based on the result, the Polymerase Chain Reaction examination with primer IS6110region primer can be used as the screening tool for tuberculosis infection, while the clinician waits for culture result.

scholarly journals DIAGNOSTIC ACCURACY OF PANBIO COVID-19 RAPID ANTIGEN METHOD FOR SCREENING IN EMERGENCY CASES

2021 ◽  
Vol 71 (5) ◽  
pp. 1607-10
Author(s):  
Raja Kamran Afzal ◽  
Saad Ali ◽  
Farooq Ahmad ◽  
Shafia Nasir ◽  
Muhammad Younas ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Military Hospital ◽  
Ethical Review ◽  
Nasopharyngeal Swab ◽  
Chain Reaction ◽  
Cross Sectional ◽  
Polymerase Chain ◽  
Sensitivity Specificity

Objective: To determine the diagnostic accuracy of PANBIO COVID-19 rapid antigen method in nasopharyngeal swab, for screening of COVID-19 infection in emergency cases. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Multan, from Jan to Mar 2021. Methodology: After taking approval from institutional ethical review committee, total 1539 patients were included in this study according to sample size. With informed consent, nasopharyngeal swab specimens were taken for PANBIO COVID-19 rapid antigen method from each patient presenting as emergency medical/surgical case to Combined Military Hospital Multan as well as for Polymerase Chain Reaction for SARS CoV-2 RNA. PANBIO COVID-19 rapid antigen method and polymerase chain reaction for SARS CoV-2 RNA were performed simultaneously on swabs. Polymerase chain reaction for SARS CoV-2 RNA was considered to be the gold standard for comparison with the PANBIO COVID-19 rapid antigen method. Results: A total of 21 patients had SARS CoV-2 RNA detected by polymerase chain reaction indicating COVID-19 infection. Out of polymerase chain reaction positive patients, PANBIO™ COVID-19 Ag test was able to detect 19 cases. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was calculated and found to be 90.47%, 100%, 100%, 99.8% and 99.8% respectively. Conclusion: PANBIO™ COVID-19 rapid antigen method was found to have excellent diagnostic accuracy in detection of COVID-19 infection. It can provide as a good alternate test for screening of masses with a short turn around time of only 15 minutes.

Detection of Human Cytomegalovirus Retinitis and Monitoring of Ganciclovir Treatment Using Conjunctival Swab with Polymerase Chain Reaction in AIDS Patients

2000 ◽  
Vol 11 (2) ◽  
pp. 85-91
Author(s):  
S H Chiou ◽  
J H Liu ◽  
W W Wong ◽  
Y J Chan ◽  
Y C Chang ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Human Cytomegalovirus ◽  
Predictive Value ◽  
Cytomegalovirus Retinitis ◽  
Chain Reaction ◽  
Aids Patients ◽  
Conjunctival Swab ◽  
Patients At Risk ◽  
Polymerase Chain ◽  
Sensitivity Specificity

This report studies the accuracy of conjunctival swab polymerase chain reaction (CS-PCR) for the diagnosis of human cytomegalovirus retinitis (HCMV) in AIDS patients. PCR and virus culture were used for the detection of HCMV in conjunctival swab, serum, and urine specimens from 38 AIDS patients between April 1996 and April 1998. The clinical utility of the identification of HCMV retinitis by these 6 different methods was demonstrated by their prediction power to estimate AIDS patients at risk of contracting HCMV retinitis. The sensitivity, specificity, positive predictive value, and negative predictive value of CS-PCR for the detection of HCMV retinitis were 91.5%, 80.9%, 60.8%, and 92.7%, respectively; for serum PCR were 74.3%, 81.7%, 57.2%, and 90.3%; for urine PCR were 100%, 17.3%, 20.4%, and 100%; for conjunctival swab culture were 22.7%, 100%, 100%, and 86%; for serum culture were 27.3%, 98.1%, 75%, and 86.4%; and for urine culture were 90.9%, 44.2%, 25.6%, and 95.8%.

Introduction of routine polymerase chain reaction testing for Neisseria gonorrhoeae in a community laboratory

Sexual Health ◽  
2013 ◽  
Vol 10 (4) ◽  
pp. 387 ◽  
Author(s):  
Arlo Upton ◽  
Janet Wilson ◽  
Liselle Bissessor
Keyword(s):  
Polymerase Chain Reaction ◽  
Neisseria Gonorrhoeae ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Positive Culture ◽  
Chain Reaction ◽  
Polymerase Chain Reaction Testing ◽  
Additional Testing ◽  
Polymerase Chain ◽  
Culture Negative

We introduced polymerase chain reaction (PCR) testing for Neisseria gonorrhoeae (NG) on the Cobas 4800 CT/NG assay for all samples received with a Chlamdyia trachomatis request in March 2012. From 1 March 2012 to 30 June 2012, all PCR-positive/culture-negative specimens had additional testing at another assay. A total of 40053 tests were performed. The estimated specificity and positive predictive value were 99.9% and 97.1%, respectively; thus routine additional testing is not required.

scholarly journals A meta-analysis of accuracy and sensitivity of chest CT and RT-PCR in COVID-19 diagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fatemeh Khatami ◽  
Mohammad Saatchi ◽  
Seyed Saeed Tamehri Zadeh ◽  
Zahra Sadat Aghamir ◽  
Alireza Namazi Shabestari ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Reverse Transcriptase ◽  
Ct Scan ◽  
Predictive Value ◽  
Meta Analysis ◽  
Chest Ct ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Chest Ct Scan

AbstractNowadays there is an ongoing acute respiratory outbreak caused by the novel highly contagious coronavirus (COVID-19). The diagnostic protocol is based on quantitative reverse-transcription polymerase chain reaction (RT-PCR) and chests CT scan, with uncertain accuracy. This meta-analysis study determines the diagnostic value of an initial chest CT scan in patients with COVID-19 infection in comparison with RT-PCR. Three main databases; PubMed (MEDLINE), Scopus, and EMBASE were systematically searched for all published literature from January 1st, 2019, to the 21st May 2020 with the keywords "COVID19 virus", "2019 novel coronavirus", "Wuhan coronavirus", "2019-nCoV", "X-Ray Computed Tomography", "Polymerase Chain Reaction", "Reverse Transcriptase PCR", and "PCR Reverse Transcriptase". All relevant case-series, cross-sectional, and cohort studies were selected. Data extraction and analysis were performed using STATA v.14.0SE (College Station, TX, USA) and RevMan 5. Among 1022 articles, 60 studies were eligible for totalizing 5744 patients. The overall sensitivity, specificity, positive predictive value, and negative predictive value of chest CT scan compared to RT-PCR were 87% (95% CI 85–90%), 46% (95% CI 29–63%), 69% (95% CI 56–72%), and 89% (95% CI 82–96%), respectively. It is important to rely on the repeated RT-PCR three times to give 99% accuracy, especially in negative samples. Regarding the overall diagnostic sensitivity of 87% for chest CT, the RT-PCR testing is essential and should be repeated to escape misdiagnosis.

scholarly journals EXPRESS: Clinical performance of the Elecsys® Anti-SARS-CoV-2 combined in an algorithm with two specific anti-IgG immunoassays for the evaluation of the serological response of patients with COVID-19 in a population with a high prevalence of infection

2021 ◽  
pp. 000456322110380
Author(s):  
Xavier Gabaldó-Barrios ◽  
Simona Iftimie ◽  
Anna Hernández-Aguilera ◽  
Isabel Pujol ◽  
Frederic Ballester ◽  
...  
Keyword(s):  
Immune Response ◽  
Polymerase Chain Reaction ◽  
Predictive Value ◽  
Clinical Performance ◽  
Polymerase Chain Reaction Test ◽  
Serological Response ◽  
Chain Reaction ◽  
Automated Assay ◽  
High Prevalence ◽  
Polymerase Chain

Background: Anti-SARS-CoV-2 antibodies have been used in the study of the immune response in infected patients. However, differences in sensitivity and specificity have been reported, depending on the method of analysis. The aim of the present study was to evaluate the diagnostic accuracy of an algorithm in which a high-throughput automated assay for total antibodies was used for screening and two semi-automated IgG-specific methods were used to confirm the results, and also to correlate the analytical results with the clinical data and the time elapsed since infection. Methods: We studied 306 patients, some hospitalized and some outpatients, belonging to a population with a high prevalence of COVID-19. One-hundred and ten patients were classified as SARS-CoV-2 negative and 196 as positive by polymerase chain reaction. Results: The algorithm and automated assay alone had a specificity and a positive predictive value of 100%, although the sensitivity and negative predictive value of the algorithm was higher. Both methods showed a good sensitivity from day 11 of the onset of symptoms in asymptomatic and symptomatic patients. The absorbance of the total antibodies was significantly higher in severely symptomatic than in asymptomatic or mildly symptomatic patients, which suggests the antibody level was higher. We found 15 patients that did not present seroconversion at 12 days from the onset of symptoms or the first polymerase chain reaction test. Conclusion: This study highlights the proper functioning of algorithms in the diagnosis of the immune response to COVID-19, which can help to define testing strategies against this disease.

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