Very High Negative Concordance Rate of RT-PCR for SARS-CoV-2 in Nasopharyngeal Swab and Tracheo-Bronchial Aspirate in Children
Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP)...
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| Veröffentlicht in: | Frontiers in pediatrics Jg. 10; S. 866111 |
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| Abstract | Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980–0.999). Two patients with positive NP swabs tested negative on TA. |
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| AbstractList | Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980-0.999). Two patients with positive NP swabs tested negative on TA.Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980-0.999). Two patients with positive NP swabs tested negative on TA.Our study shows that the specificity of SARS-CoV-2 RT-PCR on TA swab, compared to results of SARS-CoV-2 RT-PCR on NP, was very high for negative cases in our pediatric cohort during a period of high epidemiological pressure.ConclusionOur study shows that the specificity of SARS-CoV-2 RT-PCR on TA swab, compared to results of SARS-CoV-2 RT-PCR on NP, was very high for negative cases in our pediatric cohort during a period of high epidemiological pressure. Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980-0.999). Two patients with positive NP swabs tested negative on TA. Our study shows that the specificity of SARS-CoV-2 RT-PCR on TA swab, compared to results of SARS-CoV-2 RT-PCR on NP, was very high for negative cases in our pediatric cohort during a period of high epidemiological pressure. Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980–0.999). Two patients with positive NP swabs tested negative on TA.ConclusionOur study shows that the specificity of SARS-CoV-2 RT-PCR on TA swab, compared to results of SARS-CoV-2 RT-PCR on NP, was very high for negative cases in our pediatric cohort during a period of high epidemiological pressure. Reliable testing methods for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are essential to allow normal activities. Diagnosis of SARS-CoV-2 infection is currently based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) performed on nasopharyngeal (NP) swabs; concerns have been raised regarding NP swab accuracy in children to detect the virus because of potential lack of cooperation of the patients or due to general uncertainties about concordance between high and low respiratory tract specimens in children. The aim of the study (IRB approval: ST/2020/405) is to prospectively compare RT-PCR results on NP and tracheo-bronchial aspirate (TA) in children admitted to the hospital for surgery or admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary children hospital in Milano, Italy, during a peak of COVID-19 infections in the city. A total of 385 patients were enrolled in the study: 364 from surgical theater and 21 from PICU. Two patients (0.5%) tested positive on TA and were negative on NP; both cases occurred in November 2020, during a peak of infection in the city. Specificity of NP swab was.995 (95% CI: 0.980–0.999). Two patients with positive NP swabs tested negative on TA. |
| Author | Ferrario, Stefania De Ferrari, Alessandra Mileto, Davide Buonsenso, Danilo Diotto, Veronica Eccher, Laura Messina, Francesco Pelizzo, Gloria Camporesi, Anna Calcaterra, Valeria De Silvestri, Annalisa |
| AuthorAffiliation | 1 Department of Pediatric Anesthesia and Intensive Care, “Vittore Buzzi” Children's Hospital , Milan , Italy 2 Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy 6 Clinical Microbiology, Virology, and Bio-Emergence Diagnosis, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan , Milan , Italy 8 Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” , Rome , Italy 4 Department of Pediatric Surgery, “V. Buzzi” Children's Hospital, University of Milan , Milan , Italy 5 Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital , Milan , Italy 3 Pediatric Ear, Nose and Throat Unit, “Vittore Buzzi” Children's Hospital , Milan , Italy 7 Department of Pediatrics, “Vittore Buzzi” Children's Hospital , Milan , Italy |
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| References | Frezza (B6) 2021; 6 Böger (B2) 2021; 49 Gadenstaetter (B9) 2021; 59 Bwire (B3) 2021; 93 Rodrigues (B10) 2021; 57 Manzulli (B11) 2021; 10 Mohammadi (B8) 2020; 59 Li (B1) 2020; 10 B7 Fabbris (B13) 2022; 279 Wurzel (B5) 2013; 58 Capecchi (B4) 2020; 39 Yoshida (B12) 2022; 602 |
| References_xml | – volume: 58 start-page: 683 year: 2013 ident: B5 article-title: Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms publication-title: J Clin Virol. doi: 10.1016/j.jcv.2013.09.016 – volume: 10 start-page: 021101 year: 2020 ident: B1 article-title: UNCOVER. The role of children in the transmission of SARS-CoV2: updated rapid review publication-title: J Glob Health. doi: 10.7189/jogh.10.0201101 – volume: 6 start-page: 646 year: 2021 ident: B6 article-title: A severe acute respiratory syndrome coronavirus 2 detection method based on nasal and nasopharyngeal lavage fluid: a pilot feasibility study publication-title: Laryngoscope Investig Otolaryngol. doi: 10.1002/lio2.625 – volume: 10 start-page: 309 year: 2021 ident: B11 article-title: Real time PCR and culture-based virus isolation test in clinically recovered patients: is the subject still infectious for SARS-CoV2? publication-title: J Clin Med. doi: 10.3390/jcm10020309 – ident: B7 – volume: 602 start-page: 321 year: 2022 ident: B12 article-title: Local and systemic responses to SARS-CoV-2 infection in children and adults publication-title: Nature. doi: 10.1038/s41586-021-04345-x – volume: 59 start-page: 410 year: 2021 ident: B9 article-title: Nasopharyngeal versus nasal swabs for detection of SARS-CoV-2: a systematic review publication-title: Rhinology doi: 10.4193/Rhin21.162 – volume: 57 start-page: 1078 year: 2021 ident: B10 article-title: Comparison of nasopharyngeal samples for SARS-CoV-2 detection in a paediatric cohort publication-title: J Paediatr Child Health. doi: 10.1111/jpc.15405 – volume: 279 start-page: 2193 year: 2022 ident: B13 article-title: Discrepancies of SARS-CoV-2 testing results among patients with total laryngectomy publication-title: Eur Arch Otorhinolaryngol. doi: 10.1007/s00405-021-07203-8 – volume: 39 start-page: e288 year: 2020 ident: B4 article-title: Testing pediatric COVID-19 (TPC-19). is nasopharyngeal swab comparable with nasopharyngeal aspirate to detect SARS-CoV-2 in children? publication-title: Pediatr Infect Dis J. doi: 10.1097/INF.0000000000002824 – volume: 49 start-page: 21 year: 2021 ident: B2 article-title: Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19 publication-title: Am J Infect Control. doi: 10.1016/j.ajic.2020.07.011 – volume: 59 start-page: 102903 year: 2020 ident: B8 article-title: SARS-CoV-2 detection in different respiratory sites: a systematic review and meta-analysis publication-title: EBioMedicine. doi: 10.1016/j.ebiom.2020.102903 – volume: 93 start-page: 719 year: 2021 ident: B3 article-title: Detection profile of SARS-CoV-2 using RT-PCR in different types of clinical specimens: a systematic review and meta-analysis publication-title: J Med Virol. doi: 10.1002/jmv.26349 |
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| Title | Very High Negative Concordance Rate of RT-PCR for SARS-CoV-2 in Nasopharyngeal Swab and Tracheo-Bronchial Aspirate in Children |
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