Detection of SARS-CoV-2 by real time Reverse Transcriptase-Polymerase Chain Reaction assay in pleural effusion
- COVID-19; SARS-CoV-2; Pleural effusion
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SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a novel coronavirus identified for the first time in Wuhan (China) in 2019, responsible of the current pandemic infection known as Coronavirus-19 disease (COVID-19). Wide range of clinical presentation of COVD -19 has been observed, from asymptomatic carriers to ARDS.
The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnoea; the severity of the disease is due to the impairment of the respiratory function.
The radiological findings include a large variety of lesions; bilateral interstitial pneumonia is the most concerning presentation of COVID-19. Pleural involvement has been described in a minority of cases: pleural thickening had been observed in 32% of cases whereas pleural effusion is uncommon being described in only 5%. Furthermore, pleural involvement has been significantly associated with a worse prognosis.
Coronavirus 2 (SARS-CoV-2), beyond the nasopharyngeal swab, has been detected in other samples; up to now, data about RT-PCR specific results in the pleural fluid of patients suffering from coronavirus disease 2019 5 (COVID-19) are very limited.
The current gold standard for diagnosis is nucleic acid detection by real time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in nasopharyngeal swab.
In this report, a case of a positive RT-PCR for Sars-Cov-2 in the pleura fluid and in the naso- pharyngeal swab of a patient affected by bilateral interstitial pneumonia and severe respiratory failure is described.
As the presence of SARS-Cov-2 in the pleural fluid seems to be associated to a poor prognosis, physicians should carry out the specific RT-PCR assay both in the nasopharyngeal swab and in the pleural sample also when the fluid amount is very scarce and not recognizable in the chest X ray. Furthermore, the analysis of multiple samples allows to increase the test reliability.
- W. Joost Wiersinga, MD, PhD; Andrew Rhodes, MD, PhD; Allen C. Cheng, MD, PhD; Sharon J. Peacock, PhD; Hallie C. Prescott, MD, Msc. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19). A Review Published Online: July 10,2020; doi:10.1001/jama.2020.12839
- Jacek Baj, Hanna Karakula-Jucnowicz, Grzegorz Teresinski, Grzegorg Buszewicz, Marzanna Ciesielka, Elzbieta Sitarz, Alicjia Forma, Kaja Karakula, Wojciech Flieger, Piero Portincasa, Ryszard Maciejewski. COVID-19: Specific and Non-Specific Clinical Manifestations and Symp-toms: The Current State of Knowledge. J Clin Med. 2020; Jun 5;9 (6): 1753.
- Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. doi: 10.1056/NEJMoa2002032
- Rodriguez-Morales AJ, Cardona-Ospina JA, Gutierrez-Ocampo E, et al; Latin American Net-work of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19) Clinical, laboratory and imaging features of COVID-19: a systematic re-view and meta-analysis. Travel Med Infect Dis. 2020; 34:101623. doi:10.1016/j.tmaid.2020.101623
- Bernheim A, Mei X, HuangM, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020;295(3):200463.doi:10.1148/radiol. 2020200463
- Song, F.; Shi, N.; Shan, F.; Zhang, Z.; Shen, J.; Lu, H.; Ling, Y.; Jiang, Y.; Shi, Y.Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology, 2020; 295, 210–217.
- Nilam J. Soni, MD, Ricardo Franco, MD, Maria I. Velez, MD, Daniel Schnobrich, MD, Ria Dancel, MD, Marcos I. Restrepo, MD, MS, and Paul H. Mayo, MD. Ultrasound in the Diagnosis and Man-agement of Pleural Effusion. J Hosp Med, 2015; December,10(12): 811–816.
- Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical speci-mens. JAMA,2020; 323 (18): 1843.
- Sun J, Xiao J, Sun R, et al. Prolonged persistence of SARS-CoV-2 RNA in body fluids. Emerg Infect Dis. Published online May 8, 2020. doi:10.3201/eid2608.201097
- Federico Mei, MD; Martina Bonifazi, MD; Stefano Menzo, MD; Alessandro Di Marco Berardino, MD; Michele Sediari, MD; Luca Paolini, MD; Antonina Re, MD; Francesca Gonnelli, MD; Claudia Duranti, MD; Martina Grilli, MD; Giacomo Spurio Vennarucci, MD; Maria Agnese Latini, MD; Lina Zuccatosta, MD; and Stefano Gasparini, MD. First Detection of SARS-CoV-2 by RealTime Reverse Transcriptase-Polymerase Chain Reaction Assay in Pleural Fluid. CHEST, 2020; 158(4): e143-e146.