scholarly journals Does Every Patient with a Positive SARS-CoV-2 RT-PCR Test Require Isolation? A Prospective Analysis

2021 ◽  
Vol 1 (S1) ◽  
pp. s8-s9
Author(s):  
Chanu Rhee ◽  
Meghan Baker ◽  
Sanjat Kanjilal ◽  
Robert Tucker ◽  
Vineeta Vaidya ◽  
...  
Keyword(s):  
Infection Control ◽  
False Positives ◽  
Hospitalized Patients ◽  
Prior History ◽  
Rt Pcr ◽  
Positive Serology ◽  
Recent Infection ◽  
History Of ◽  
Hospital Resources ◽  
Pcr Test

Group Name: CDC Prevention Epicenters Program Background: Reverse-transcriptase polymerase chain reaction (RT-PCR) tests are the reference standard for diagnosing SARS-CoV-2 infection, but false positives can occur and viral RNA may persist for weeks-to-months following recovery. Isolating such patients increases pressure on limited hospital resources and may impede care. Therefore, we quantified the percentage of patients who tested positive by RT-PCR yet were unlikely to be infectious and could be released from isolation. Methods: We prospectively identified all adults hospitalized at Brigham and Women’s Hospital (Boston, MA) who tested positive for SARS-CoV-2 by RT-PCR (primarily Hologic Panther Fusion or Cepheid Xpert platforms) between December 24, 2020, and January 24, 2021. Each case was assessed by infection control staff for possible discontinuation of isolation using an algorithm that incorporated the patient’s prior history of COVID-19, current symptoms, RT-PCR cycle threshold (Ct) values, repeat RT-PCR testing at least 24 hours later, and SARS-CoV-2 serologies (Figure 1). Results: Overall, 246 hospitalized patients (median age, 66 years [interquartile range, 50–74]; 131 [53.3%] male) tested positive for SARS-CoV-2 by RT-PCR during the study period. Of these, 201 (81.7%) were deemed new diagnoses of active disease on the basis of low Ct values and/or progressive symptoms. Moreover, 44 patients (17.9%) were deemed noninfectious: 35 (14.2%) had prior known resolved infections (n = 21) or unknown prior infection but positive serology (n = 14), high Ct values on initial testing, and negative or stably high Ct values on repeat testing. Also, 5 (2.0%) had recent infection but >10 days had passed since symptom onset and they were clinically improving. In addition, 4 (1.6%) results were deemed false positives based on lack of symptoms and at least 1 negative repeat RT-PCR test (Figure 2). One patient was asymptomatic with Ct value <35 but was discharged before further testing could be obtained. Among the 44 noninfectious patients, isolation was discontinued a median of 3 days (IQR, 2–4) after the first positive test. We did not identify any healthcare worker infections attributable to early discontinuation of isolation in these patients. Conclusions: During the winter COVID-19 second surge in Massachusetts, nearly 1 in 5 hospitalized patients who tested positive for SARS-CoV-2 by RT-PCR were deemed noninfectious and eligible for discontinuation of precautions. Most of these cases were consistent with residual RNA from prior known or undiagnosed infections. Active assessments of SARS-CoV-2 RT-PCR tests by infection control practitioners using clinical data, Ct values, repeat tests, and serologies can safely validate the release many patients from isolation and thereby conserve resources and facilitate patient care.Funding: NoDisclosures: None

scholarly journals Serologic SARS-CoV-2 testing in healthcare workers with positive RT-PCR test or Covid-19 related symptoms

2020 ◽  
Author(s):  
Giovanni Visci ◽  
Vittorio Lodi ◽  
Roberta Bonfiglioli ◽  
Tiziana Lazzarotto ◽  
Francesco S. Violante ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Lateral Flow ◽  
Public Hospitals ◽  
Lateral Flow Immunoassay ◽  
Enzyme Linked Immunosorbent Assay ◽  
Limited Information ◽  
Rt Pcr ◽  
Positive Serology ◽  
Serologic Response ◽  
Pcr Test

AbstractBackgroundLimited information is available on prevalence and determinants of serologic response to SARS-CoV-2 infection among healthcare workers (HCWs).MethodsWe analyzed the results of serologic testing with chemiluminescence immunoassay analyzer (CLIA), lateral flow immunoassay (LFIA) and enzyme-linked immunosorbent assay (ELISA) test among 544 HCWs with at least one positive RT-PCR test and 157 HCWs with Covid-19 related symptoms without a positive RT-PCR test from public hospitals in Bologna, Northern Italy. Tests were performed between March and August 2020. We fitted multivariate logistic regression models to identify determinants of positive serology.ResultsThe sensitivity of SARS-CoV-2 was 75.2% (LFIA) and 90.6% (CLIA). No differences in seropositivity were observed by sex, while older HCWs had higher positivity than other groups, and nurses had higher positivity compared to physicians, but not other HCWs. An estimated 73.4% of HCWs with Covid-19 symptoms without RT-PCR test were not infected with SARS-CoV-2.ConclusionsOur study provides the best available data on sensitivity of serologic tests and on determinants of serologic response among HCWs positive for SARS-CoV-2, and provide evidence on the low specificity of Covid-19 related symptoms to identify infected HCWs.SummaryThe sensitivity of SARS-CoV-2 lateral flow immunoassay serology in healthcare workers (HCWs) was 75.2%. Older HCWs and nurses had higher positivity than other groups. An estimated 73.4% of HCWs with Covid-19 symptoms without RT-PCR test were not infected with SARS-CoV-2.

scholarly journals Sero-prevalence of anti-SARS-CoV-2 Antibodies in Addis Ababa, Ethiopia

2020 ◽  
Author(s):  
Berhanu Nega Alemu ◽  
Adamu Addissie ◽  
Gemechis Mamo ◽  
Negussie Deyessa ◽  
Tamrat Abebe ◽  
...  
Keyword(s):  
Serological Test ◽  
Addis Ababa ◽  
Rapid Test ◽  
Cross Sectional Study ◽  
Rt Pcr ◽  
Serological Tests ◽  
Cross Sectional ◽  
History Of ◽  
Community Transmission ◽  
Pcr Test

AbstractBackgroundAnti-SARS-CoV-2 antibody tests are being increasingly used for sero-epidemiological purposes to provide better understanding of the extent of the infection in the community, and monitoring the progression of the COVID-19 epidemic. We conducted sero-prevalence study to estimate prior infection with with SARS-CoV-2 in Addis Ababa.MethodsA cross-sectional study was done from April 23 to 28, 2020 among 301 randomly selected residents of Addis Ababa; with no known history of contact with confirmed COVID-19 person. Interviews on socio demographic and behavioural risk factor followed by serological tests were performed for SARS-CoV-2 IgM, and IgG antibodies, using COVID-19 IgG/IgM Rapid Test Cassette. The test has sensitivity of 87·9% and specificity of 100% for lgM; and a sensitivity of 97·2% and specificity of 100% for IgG. RT-PCR test was also done on combined nasopharyngeal and oropharengeal swabs as an important public health consideration.FindingsThe unadjusted antibody-based crude SARS-CoV-2 prevalence was 7·6% and the adjusted true SARS-CoV-2 prevalence was estimated at 8·8% (95% CI 5·5%-11·6%) for the study population. Higher sero-prevalence were observed for males (9.0%), age below 50 years (8.2%), students and unemployed (15.6%), those with primary education (12.1%), smokers (7.8%), alcohol consumers (8.6%), chatt-chewers (13.6%) and shish smokers (18.8%). Seroprevalence was not significantly associated neither with socio-demographic not behavioral characteristics. According to the findings, possibly more individuals had been infected in Addis Ababa than what was being detected and reported by RT-PCR test suggestive of community transmission. The use of serological test for epidemiological estimation of the extent of SARS-CoV-2 epidemic gives a more precise estimate of magnitude which would be used for further monitoring and surveillance of the magnitude of the SARS CoV-2 infection.

scholarly journals Association of Underlying Diseases and Clinical Characteristics with Mortality in Patients with 2019 Novel Coronavirus in Iran

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Mohammadhossein Zamanian ◽  
Zohre Foroozanfar ◽  
Zhila Izadi ◽  
Samira Jafari ◽  
Hossein Derakhshankhah ◽  
...  
Keyword(s):  
Heart Disease ◽  
Clinical Characteristics ◽  
Underlying Disease ◽  
Test Results ◽  
Rt Pcr ◽  
Factors Associated ◽  
History Of ◽  
Novel Coronavirus ◽  
Underlying Diseases ◽  
Pcr Test

Objectives: The first case of 2019 novel coronavirus disease (COVID-19) was reported in Iran in February 2020. Here, we report the epidemiological and clinical characteristics of patients with COVID-19 and factors associated with mortality in these patients. Methods: A retrospective cohort study was conducted from February 22, 2020, to March 24, 2020, in Golestan Hospital in Kermanshah, Iran. Demographic data including underlying diseases and clinical data including the presenting symptoms, chest computed tomography (CT) scan, reverse transcription polymerase chain reaction (RT-PCR) test results, and outcomes were extracted from electronic medical records. Simple and multiple logistic regression methods were used to explore the factors associated with mortality. Results: Of 245 patients admitted with COVID-19, 155 (63.30%) were male. The mean age of the subjects was 54.68 ± 19.21. Forty-five (18.48%) patients had underlying diseases. Common symptoms were dyspnea (n = 137; 55.9%), cough (n = 93; 38.0%), and fever (n = 78; 31.8%). All patients had pneumonia with abnormal findings on chest CT scan (100%), and RT-PCR test results were positive in 87 (35.50%) patients. Of the total admitted cases, 38 (15.5%) patients died during hospitalization. An old age (OR = 1.09; 95% CI: 1.02 to 1.06), history of heart disease (OR = 5.07; 95% CI: 1.46 to 17.58), hypertension (OR = 5.82; 95% CI: 1.13 to 30.04), smoking (OR = 11.44; 95% CI: 1.01 to 29.53), history of at least one underlying disease (OR = 3.31; 95%CI: 1.54 to 7.09), and symptoms of decreased consciousness at the time of admission (OR = 24.23; 95% CI: 2.62 to 223.39) were associated with mortality. Also, the symptoms of cough (OR = 0.383; 95% CI: 0.17 to 0.88) and fever (OR = 0.278; 95% CI: 0.10 to 0.74) had a negative association with mortality. Conclusions: In the current study, factors including old age, smoking, symptoms of decreased consciousness, and underlying diseases such as heart disease, hypertension, and history of at least one underlying disease were associated with mortality. Factors associated with mortality should be considered so that we can better manage patients with COVID-19.

scholarly journals Changes in RT-PCR test results and symptoms during the menstrual cycle of a female individual infected with SARS-CoV-2: a case report

2020 ◽  
Author(s):  
Hua Zheng ◽  
Juan Tan ◽  
Ke Ma ◽  
Weihua Meng
Keyword(s):  
Menstrual Cycle ◽  
Hospital Discharge ◽  
Disease Susceptibility ◽  
Menstrual Period ◽  
Test Results ◽  
Rt Pcr ◽  
Case Presentation ◽  
Management Protocol ◽  
History Of ◽  
Pcr Test

Abstract Background: The implications of the menstrual cycle for disease susceptibility, development, and severity of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are largely unknown.Case presentation: We report a 37-year-old woman infected with SARS-CoV-2 who showed a 16-day incubation period. She developed a fever on the first day of her menstrual period, and again on the first day of her next menstrual period after hospital discharge. RT-PCR test results were positive during the first menstrual period before admission, turned negative during hospitalization, and then positive again during the second menstrual period after hospital discharge.Conclusions: This case indicates sex hormones may play an important role in SARS-CoV-2 infection. For women with history of exposure to SARS-CoV-2, the management protocol should include assessment of the menstrual status.

“Bringing Down the Flag”: Removing the Contact Precautions Label for Non-hospitalized Patients with Prior Methicillin-Resistant Staphylococcus aureus Infection or Colonization

2015 ◽  
Vol 36 (5) ◽  
pp. 578-580 ◽  
Author(s):  
Paul J. Carson ◽  
Mallory Danford ◽  
Grace Carson ◽  
Christine Hanish ◽  
Jody Thompson ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Hospitalized Patients ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Aureus Infection ◽  
History Of ◽  
Pcr Test

A policy consensus has not been reached regarding discontinuing contact precautions in patients with a history of methicillin-resistant Staphylococcus aureus (MRSA). We found that as many as 72% of outpatients flagged for past MRSA were no longer carriers, and a single nasal PCR test provided a reasonable negative predictive value for removing contact precautions.Infect Control Hosp Epidemiol 2015;00(0): 1–3

scholarly journals 1494. Clinical Factors Associated with a Positive C. difficile PCR Test

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S544-S544
Author(s):  
Teresa Cushman ◽  
Michelle Barron ◽  
Jaron Arbet ◽  
Rachel Weber ◽  
Yaxu Zhuang ◽  
...  
Keyword(s):  
Hospital Length Of Stay ◽  
Positive Test ◽  
Prior History ◽  
Antibiotic Administration ◽  
Clinical Factors ◽  
Factors Associated ◽  
The Past ◽  
Test Order ◽  
History Of ◽  
Pcr Test

Abstract Background C. difficile infection (CDI) remains a significant cause of morbidity and mortality. The most appropriate clinical scenario for CDI testing is unclear. The IDSA/SHEA guideline recommends testing patients with unexplained new-onset ≥3 stools in 24 hours. This study sought to evaluate clinical factors associated with a positive C. difficile PCR test. Methods We conducted a retrospective cohort study of adults (age >18 years old) admitted to the University of Colorado Hospital for whom a C. difficile PCR, either as a standalone test or part of the Biofire® Filmarray® Gastrointestinal Panel (GI Panel), was ordered between October 1, 2015 and August 31, 2017. Data collected included time since admission to test order, hospital length of stay, history of CDI, antibiotic use in the past 90 days, clinical presentation in the 24 hours preceding test order (fever, leukocytosis, number of stools), and laxative or antibiotic administration within 24 hours of test order. Multivariate logistic regression was used to evaluate the association of the above variables with having a positive C. difficile PCR test. If multiple tests were ordered during a single hospital encounter, only the first test was included in our analysis. Results 3,070 tests were performed; of these, 72% were ordered in the first 72 hours of admission. Overall, 19% of tests were positive. After adjusting for clinical variables, patients with a prior history of C. difficile or who had received antibiotics in the past 24 hours were significantly more likely to have a positive test [OR 2.2 95% CI (1.54, 3.18) P < 0.0001] and [OR 16 95% CI (8.22, 31.41) P < 0.0001], respectively. Patients who used laxatives were significantly less likely to have a positive test [OR 0.75 95% CI (0.61, 0.91) P = 0.004]. The number of stools and presence of fever or leukocytosis were not significantly associated with a positive test. Conclusion Prior history of C. difficile and antibiotics use was highly associated with a positive C. difficile test, while laxatives use was associated with a negative test. The number of stools was not significantly associated with a positive C. difficile test, suggesting this may be less important clinical factor than previously believed; however, restricting testing in patients receiving laxatives is likely warranted. Disclosures All authors: No reported disclosures.

scholarly journals Ischaemic stroke as the presenting feature of COVID-19: a series of three cases from Qatar

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Yousaf Iqbal ◽  
Peter M Haddad ◽  
Javed Latoo ◽  
Mohammed Ibrahim Alhatou ◽  
Majid Alabdulla
Keyword(s):  
Ischaemic Stroke ◽  
Stroke Risk ◽  
Respiratory Illness ◽  
Prior History ◽  
Rt Pcr ◽  
Vessel Occlusion ◽  
Stroke Risk Factors ◽  
Cerebrovascular Events ◽  
History Of ◽  
Polymerase Chain

Abstract Most cases of stroke associated with coronavirus disease 2019 (COVID-19) occur during the course of a characteristic COVID-19 respiratory illness. We report three patients where the presenting feature of COVID-19 was stroke. Two patients had no respiratory symptoms throughout their clinical course. In each case, COVID-19 was confirmed by a reverse transcription polymerase chain reaction (RT-PCR) test and the diagnosis of ischaemic stroke by brain imaging. The patients were relatively young (40, 45 and 50 years). None had a prior history of cerebrovascular events. Stroke risk factors were absent in one, limited to overweight and smoking in another but more prominent in the third patient. Two patients had large vessel occlusion and elevated D-dimer levels. Multiple infarcts were seen in two patients. Clinicians should consider the possibility of COVID-19 in patients presenting with stroke and conversely consider investigating for stroke if a patient with COVID-19, even if mildly ill, develops acute neurological symptoms.

scholarly journals COVID-19 pneumonia in a 66-year old Honduran female with false negative RT-PCR but typical tomography pattern

2020 ◽  
Vol 9 (1) ◽  
pp. 14
Author(s):  
Carlos Aguilar ◽  
Nora Maradiaga ◽  
Nelson Menocal ◽  
Suyapa Sosa ◽  
Wendy Moncada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Respiratory Distress ◽  
Pulmonary Thromboembolism ◽  
False Negative ◽  
Ground Glass ◽  
Rt Pcr ◽  
History Of ◽  
Pcr Test ◽  
Rule Out

During the first weeks of the SARS-CoV-2 pandemic in Honduras, a 66-year-old female patient was admitted to the ICU with a 5-day history of cough, fever, and respiratory distress. She had contact with a COVID-19 patient in previous days. The chest radiograph showed signs of bilateral ground-glass opacities (A). Since the RT-PCR was negative, a computed tomography angiography was done at day 7 to rule out a pulmonary embolism. This showed a diffuse, patchy, bilateral increase in density with ground-glass opacities, poorly defined edges, and slight predominance in subpleural regions (B and C). There was no evidence of a pulmonary thromboembolism. The swab test was repeated at day 7, resulting positive. In this case, the clinical and CT findings were highly suggestive before RT-PCR confirmed the diagnosis. This is the first COVID-19 case with a false negative PCR test in our hospital. She recovered fully.

scholarly journals Evolving phenotypes of non-hospitalized patients that indicate long COVID

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hossein Estiri ◽  
Zachary H. Strasser ◽  
Gabriel A. Brat ◽  
Yevgeniy R. Semenov ◽  
James R. Aaron ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Time Windows ◽  
Chronic Fatigue ◽  
Hospitalized Patients ◽  
Future Research ◽  
Rt Pcr ◽  
Accurate Identification ◽  
Age And Gender ◽  
And Gender ◽  
Pcr Test

Abstract Background For some SARS-CoV-2 survivors, recovery from the acute phase of the infection has been grueling with lingering effects. Many of the symptoms characterized as the post-acute sequelae of COVID-19 (PASC) could have multiple causes or are similarly seen in non-COVID patients. Accurate identification of PASC phenotypes will be important to guide future research and help the healthcare system focus its efforts and resources on adequately controlled age- and gender-specific sequelae of a COVID-19 infection. Methods In this retrospective electronic health record (EHR) cohort study, we applied a computational framework for knowledge discovery from clinical data, MLHO, to identify phenotypes that positively associate with a past positive reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19. We evaluated the post-test phenotypes in two temporal windows at 3–6 and 6–9 months after the test and by age and gender. Data from longitudinal diagnosis records stored in EHRs from Mass General Brigham in the Boston Metropolitan Area was used for the analyses. Statistical analyses were performed on data from March 2020 to June 2021. Study participants included over 96 thousand patients who had tested positive or negative for COVID-19 and were not hospitalized. Results We identified 33 phenotypes among different age/gender cohorts or time windows that were positively associated with past SARS-CoV-2 infection. All identified phenotypes were newly recorded in patients’ medical records 2 months or longer after a COVID-19 RT-PCR test in non-hospitalized patients regardless of the test result. Among these phenotypes, a new diagnosis record for anosmia and dysgeusia (OR 2.60, 95% CI [1.94–3.46]), alopecia (OR 3.09, 95% CI [2.53–3.76]), chest pain (OR 1.27, 95% CI [1.09–1.48]), chronic fatigue syndrome (OR 2.60, 95% CI [1.22–2.10]), shortness of breath (OR 1.41, 95% CI [1.22–1.64]), pneumonia (OR 1.66, 95% CI [1.28–2.16]), and type 2 diabetes mellitus (OR 1.41, 95% CI [1.22–1.64]) is one of the most significant indicators of a past COVID-19 infection. Additionally, more new phenotypes were found with increased confidence among the cohorts who were younger than 65. Conclusions The findings of this study confirm many of the post-COVID-19 symptoms and suggest that a variety of new diagnoses, including new diabetes mellitus and neurological disorder diagnoses, are more common among those with a history of COVID-19 than those without the infection. Additionally, more than 63% of PASC phenotypes were observed in patients under 65 years of age, pointing out the importance of vaccination to minimize the risk of debilitating post-acute sequelae of COVID-19 among younger adults.

scholarly journals Dynamic profile of SARS-CoV-2 infection among hospitalized patients in Kuwait: a descriptive study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nada Madi ◽  
Ebaa’ Al-Awadhi ◽  
Fajer Al-Assaf
Keyword(s):  
Descriptive Study ◽  
Hospitalized Patients ◽  
Test Results ◽  
Rt Pcr ◽  
Global Knowledge ◽  
Viral Shedding ◽  
Median Period ◽  
First Time ◽  
Dynamic Profile ◽  
Pcr Test

Abstract Background The coronavirus induced disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan (China) in December 2019 is currently spreading rapidly worldwide. This study aimed to analyze the dynamic profile of SARS-CoV-2 infection among hospitalized patients that would characterize the period of viral shedding and detection among patients. Methods Retrospectively, 103 confirmed SARS-CoV-2 patients hospitalized at Jaber hospital in Kuwait were included. Demographic and clinical characteristics of the patients were collected. Nasopharyngeal swabs were obtained at different time intervals and analyzed by Real-Time RT-PCR for SARS-CoV-2 infection. Results Of 103 hospitalized patients with SARS-CoV-2 infection, the median age was 41 years, and 64% were male. The median period from admission to the positive SARS-CoV-2 RT-PCR test was 19 days (IQR, 13–22). The median period from admission to active negative SARS-CoV-2 RT-PCR test result was 22 days (IQR, 16–26). Older patients, patients with comorbidities, and patients with symptoms were more likely to have extended viral shedding. Conclusion For the first time, this descriptive study conducted in Kuwait on SARS-CoV-2 RT-PCR test results from 103 patients positive for SARS-provided solid proof and a good understanding of the dynamic profile of SARS-CoV-2 infection among patients in Kuwait. This information will further enrich the global knowledge on the emerging SARS-CoV-2.

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