Positive conversion of COVID-19 after two consecutive negative RT-PCR results: A role of low-dose CT.
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ABSTRACT:
SUBMITTER: Chae KJ
PROVIDER: S-EPMC7282766 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
Positive conversion of COVID-19 after two consecutive negative RT-PCR results: A role of low-dose CT.
Chae Kum Ju KJ Jin Gong Yong GY Lee Chang-Seop CS Lee Heung Bum HB Lee Ju-Hyung JH Kwon Keun-Sang KS
European journal of radiology 20200609
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Project description:BackgroundOur hospital is a designated institution for COVID-19 patients in Chengdu, China. This study aimed to analyze the clinical and chest CT features of 15 COVID-19 patients with positive reverse transcription-polymerase chain reaction (RT-PCR) retest results after discharge. Patients who met the current standards of discharge could still carry the SARS-CoV-2 virus.MethodsClinical manifestations, laboratory data, and chest CT images were retrospectively reviewed and analyzed.ResultsThe most common symptoms at Covid-19COVID-19 initial onset were fever (12/15, 80%) and cough (11/15, 73.3%). Most of the patients had a normal white blood cells (12/15, 80%), neutrophils (12/15, 80%), and lymphocytes count (13/15, 86.7%); some patients had increased C-reactive protein (CRP) (5/15, 33.3%), and increased lactate dehydrogenase (LDH) (4/15, 26.7%) during first admission. Five patients (33.3%) had a cough before their first discharge. The average interval from the first discharge to re-admission was 17 days (range, 9–30 days). At re-admission, two (13.3%) patients presented with cough, and one (6.6%) had chest pain with anxiety. At re-admission, all patients had normal clinical results except five (33.3%) patients had increased CRP compared with first discharging, two (13.3%) patients had increased neutrophils count, and one (6.6%) had increased CRP. The majority of patients had normal procalcitonin. Ground glass opacities (GGOs) and reticulation in the peripheral and subpleural areas were the most common CT manifestations, and six patients (40%) showed a transformation from reticulation to GGOs when re-admitted.ConclusionsThere may be no specific clinical characteristics to predict the re-detectability of the virus. A regular medical observation and a bi-monthly follow-up is recommended.
| S-EPMC7276372 | biostudies-literature
Project description:BackgroundProlonged nucleic acid conversion and false-negative real-time polymerase chain reaction (RT-PCR) results might occur in COVID-19 patients rather than infection recurrence.Presentation of casesWe reported four cases who had negative RT-PCR results, in addition to the last two consecutive negative results. Patient-1 had negative RT-PCR results twice (the 6th and 8th) from a total of 11 swabs. Patient-2 had negative RT-PCR results once (the 5th) from a total of 8 swabs. Patient-3 showed negative results of RT-PCR twice (the 4th and 6th) from a total of 11 swabs. Patient-4 had negative RT-PCR results twice (the 2nd and 10th) from a total of 14 swabs.DiscussionThe fluctuating trend of our RT-PCR results in our cases might be due to insufficient viral material in the specimen, laboratory errors during sampling, restrictions on sample transportation, or mutations in the primary and probe target regions in the SARS-CoV-2 genome. Several factors might affect the occurrence of prolonged nucleic acid conversion, including older age, comorbidities, such as diabetes and hypertension, and impaired immune function.ConclusionHere, we confirmed the occurrence of prolonged nucleic acid conversion and the possibility of false negative RT-PCR results in COVID-19 patients.
| S-EPMC7536520 | biostudies-literature
Project description:Worldwide, the infectivity and disease burden of the H1N1 pandemic were overestimated because of limited clinical experience concerning patient presentation and outcome of those infected with the novel H1N1 virus.This study aimed to compare the epidemiologic clinical data among H1N1 RT-PCR-positive and RT-PCR-negative pneumonic patients during the 2009-2010 pandemic in Mansoura University Hospitals, Egypt.A record-based, case-control study was conducted for 43 adult patients admitted to the chest department isolation unit with community-acquired pneumonia during the 2009-2010 H1N1 pandemic after reviewing of 198 suspected and confirmed H1N1 hospitalized cases. Of these patients, 20 cases were confirmed to be H1N1-positive using an RT-PCR detection technique. The remaining 23 patients were RT-PCR-negative. Demographic, clinical, laboratory and radiological data were collected and analyzed using spss version 11.A review of 198 hospital case records for revealed one main peak of H1N1 influenza during the last week of December 2009. Pneumonic patients who were H1N1-positive were more likely to present with sore throat (P = 0·005), dyspnea (P = 0·002), and gastrointestinal (GIT) complaints (vomiting and diarrhea P = 0·02) when compared to the H1N1-negative group. Also, complications were significantly more frequent (P = 0·01) in the H1N1-confirmed group than in the non-confirmed group. However, no significant differences were found between the groups regarding length of hospital stay, intensive care unit (ICU), and admission or mortality.Sore throat, dyspnea, and presence of GIT complaints increase the suspicion of H1N1 positivity in pneumonia acquired during an H1N1 pandemic. However, H1N1 did not worsen the disease burden of pneumonia.
| S-EPMC4634549 | biostudies-other
Project description:BackgroundCOVID-19 is a multi-system infection with emerging evidence-based antiviral and anti-inflammatory therapies to improve disease prognosis. However, a subset of patients with COVID-19 signs and symptoms have repeatedly negative RT-PCR tests, leading to treatment hesitancy. We used comparative serology early in the COVID-19 pandemic when background seroprevalence was low to estimate the likelihood of COVID-19 infection among RT-PCR negative patients with clinical signs and/or symptoms compatible with COVID-19.MethodsBetween April and October 2020, we conducted serologic testing of patients with (i) signs and symptoms of COVID-19 who were repeatedly negative by RT-PCR ('Probables'; N = 20), (ii) signs and symptoms of COVID-19 but with a potential alternative diagnosis ('Suspects'; N = 15), (iii) no signs and symptoms of COVID-19 ('Non-suspects'; N = 43), (iv) RT-PCR confirmed COVID-19 patients (N = 40), and (v) pre-pandemic samples (N = 55).ResultsProbables had similar seropositivity and levels of IgG and IgM antibodies as propensity-score matched RT-PCR confirmed COVID-19 patients (60.0% vs 80.0% for IgG, p-value = 0.13; 50.0% vs 72.5% for IgM, p-value = 0.10), but multi-fold higher seropositivity rates than Suspects and matched Non-suspects (60.0% vs 13.3% and 11.6% for IgG; 50.0% vs 0% and 4.7% for IgM respectively; p-values < 0.01). However, Probables were half as likely to receive COVID-19 treatment than the RT-PCR confirmed COVID-19 patients with similar disease severity.ConclusionsFindings from this study indicate a high likelihood of acute COVID-19 among RT-PCR negative with typical signs/symptoms, but a common omission of COVID-19 therapies among these patients. Clinically diagnosed COVID-19, independent of RT-PCR positivity, thus has a potential vital role in guiding treatment decisions.
| S-EPMC8841043 | biostudies-literature
Project description: Not available
| S-EPMC7262304 | biostudies-literature
Project description: Not available
| S-EPMC7330744 | biostudies-literature
Project description:Real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard for diagnosing coronavirus disease 2019 (COVID-19). However, RT-PCR may yield false-positive results, leading to unnecessary countermeasures. Here, we report a "positive" nucleic acid test on a 10-pooled sample during the routine screening that caused many adverse societal effects, and financial and resource losses. However, they were subsequently determined to be a case of vaccine contamination. This case study increases awareness of false-positive RT-PCR results for SARS-CoV-2, especially when participants are vaccinators. Moreover, it could provide relevant suggestions to prevent the recurrence of such incidents.
| S-EPMC9226675 | biostudies-literature
Project description:BackgroundA false-negative case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is defined as a person with suspected infection and an initial negative result by reverse transcription-polymerase chain reaction (RT-PCR) test, with a positive result on a subsequent test. False-negative cases have important implications for isolation and risk of transmission of infected people and for the management of coronavirus disease 2019 (COVID-19). We aimed to review and critically appraise evidence about the rate of RT-PCR false-negatives at initial testing for COVID-19.MethodsWe searched MEDLINE, EMBASE, LILACS, as well as COVID-19 repositories, including the EPPI-Centre living systematic map of evidence about COVID-19 and the Coronavirus Open Access Project living evidence database. Two authors independently screened and selected studies according to the eligibility criteria and collected data from the included studies. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the proportion of false-negative test results using a multilevel mixed-effect logistic regression model. The certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. All information in this article is current up to July 17, 2020.ResultsWe included 34 studies enrolling 12,057 COVID-19 confirmed cases. All studies were affected by several risks of bias and applicability concerns. The pooled estimate of false-negative proportion was highly affected by unexplained heterogeneity (tau-squared = 1.39; 90% prediction interval from 0.02 to 0.54). The certainty of the evidence was judged as very low due to the risk of bias, indirectness, and inconsistency issues.ConclusionsThere is substantial and largely unexplained heterogeneity in the proportion of false-negative RT-PCR results. The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 54% of COVID-19 patients may have an initial false-negative RT-PCR (very low certainty of evidence).Systematic review registrationProtocol available on the OSF website: https://tinyurl.com/vvbgqya.
| S-EPMC7728293 | biostudies-literature
Project description:A subset of patients with Covid-19 presents with negative RT-PCR screening but suspect CT findings. Using four commercially available anti-SARS-CoV-2 IgG immuno-assays, we found this subset constituted 9.2% of all consecutively admitted outpatients with Covid-19 in our hospital. Clinical specificity for Covid-19 of some N protein-based immuno-assays was suboptimal, as positive results were observed in control patients with recent common human coronavirus, influenza B and adenovirus infections.
| S-EPMC7482374 | biostudies-literature
Project description:ObjectiveDuring the follow-up of patients recovered from coronavirus disease 2019 (COVID-19) in the quarantine and observation period, some of the cured patients showed positive results again. The recurrent positive RT-PCR test results drew widespread concern. We observed a certain number of cured COVID-19 patients with positive RT-PCR test results and try to analyze the factors that caused the phenomenon.MethodsWe conducted an observational study in COVID-19 patients discharged from 6 rehabilitation stations in Wuhan, China. All observed subjects met the criteria for hospital discharge and were in quarantine. Data regarding age, sex, body mass index (BMI), course of disease, comorbidity, smoking status and alcohol consumption, symptoms in and out of quarantine, and intervention were collected from the subjects' medical records and descriptively analyzed. The main outcome of this study was the RT-PCR test result of the observed subjects at the end of quarantine (negative or positive). Logistic regression analysis was used to identify the influencing factors related to recurrent positive RT-PCR test results.ResultsIn this observational study, 420 observed subjects recovered from COVID-19 were included. The median age was 56 years, 63.6% of the subjects were above 50 years old, and 50.7% (213/420) were female. The most common comorbidities were hypertension [26.4% (111/420)], hyperlipidemia [10.7% (45/420)], and diabetes [10.5% (44/420)]. 54.8% (230/420) manifested one or more symptoms at the beginning of the observation period, the most common symptoms were cough [27.6% (116/420)], shortness of breath 23.8% (100/420)], and fatigue [16.2% (68/420)], with fever rare [2.6% (11/420)]. A total of 325 subjects were exposed to comprehensive intervention; 95 subjects were absence of intervention. The recurrence rate of positive RT-PCR test results with comprehensive intervention was 2.8% (9/325), and that with no intervention was 15.8% (15/95). The results of logistic regression analysis showed that after adjusted for factors such as age, sex, and comorbidity and found out that comprehensive intervention was correlated with the recurrent positive RT-PCR test results. There was appreciably less recurrence in the comprehensive intervention group.ConclusionsThe factors related to positive RT-PCR test results in observed subjects recovered from COVID-19 were age, comorbidity, and comprehensive intervention, among which comprehensive intervention might be a protective factor.Clinical trial registrationChictr.org.cn, identifier ChiCTR2000030747.
| S-EPMC7577046 | biostudies-literature