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Upper respiratory tract sampling in COVID-19.
Malays J Pathol. 2020 Apr; 42(1):23-35.MJ

Abstract

INTRODUCTION

To review the present literature on upper respiratory tract sampling in COVID-19 and provide recommendations to improve healthcare practices and directions in future studies.

METHODS

Twelve relevant manuscripts were sourced from a total of 7288 search results obtained using PubMed, Medline and Google Scholar. The search keywords used were COVID-19, nasopharyngeal, oropharyngeal, swabs, SARS and CoV2. Original manuscripts were obtained and analysed by all authors. The review included manuscripts which have not undergone rigorous peer-review process in view of the magnitude of the topic discussed.

RESULTS

The viral load of SARS-CoV-2 RNA in the upper respiratory tract was significantly higher during the first week and peaked at 4-6 days after onset of symptoms, during which it can be potentially sampled. Nasopharyngeal swab has demonstrated higher viral load than oropharyngeal swab, where the difference in paired samples is best seen at 0-9 days after the onset of illness. Sensitivity of nasopharyngeal swab was higher than oropharyngeal swabs in COVID-19 patients. Patient self-collected throat washing has been shown to contain higher viral load than nasopharyngeal or oropharyngeal swab, with significantly higher sensitivity when compared with paired nasopharyngeal swab.

RECOMMENDATIONS

Routine nasopharyngeal swab of suspected COVID-19 infection should take anatomy of the nasal cavity into consideration to increase patient comfort and diagnostic yield. Routine oropharyngeal swab should be replaced by throat washing which has demonstrated better diagnostic accuracy, and it is safe towards others.

Authors+Show Affiliations

Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Malaysia. marinamatbaki@ppukm.ukm.edu.my.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32342928

Citation

Mawaddah, A, et al. "Upper Respiratory Tract Sampling in COVID-19." The Malaysian Journal of Pathology, vol. 42, no. 1, 2020, pp. 23-35.
Mawaddah A, Gendeh HS, Lum SG, et al. Upper respiratory tract sampling in COVID-19. Malays J Pathol. 2020;42(1):23-35.
Mawaddah, A., Gendeh, H. S., Lum, S. G., & Marina, M. B. (2020). Upper respiratory tract sampling in COVID-19. The Malaysian Journal of Pathology, 42(1), 23-35.
Mawaddah A, et al. Upper Respiratory Tract Sampling in COVID-19. Malays J Pathol. 2020;42(1):23-35. PubMed PMID: 32342928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upper respiratory tract sampling in COVID-19. AU - Mawaddah,A, AU - Gendeh,H S, AU - Lum,S G, AU - Marina,M B, PY - 2020/4/29/entrez PY - 2020/4/29/pubmed PY - 2020/5/1/medline SP - 23 EP - 35 JF - The Malaysian journal of pathology JO - Malays J Pathol VL - 42 IS - 1 N2 - INTRODUCTION: To review the present literature on upper respiratory tract sampling in COVID-19 and provide recommendations to improve healthcare practices and directions in future studies. METHODS: Twelve relevant manuscripts were sourced from a total of 7288 search results obtained using PubMed, Medline and Google Scholar. The search keywords used were COVID-19, nasopharyngeal, oropharyngeal, swabs, SARS and CoV2. Original manuscripts were obtained and analysed by all authors. The review included manuscripts which have not undergone rigorous peer-review process in view of the magnitude of the topic discussed. RESULTS: The viral load of SARS-CoV-2 RNA in the upper respiratory tract was significantly higher during the first week and peaked at 4-6 days after onset of symptoms, during which it can be potentially sampled. Nasopharyngeal swab has demonstrated higher viral load than oropharyngeal swab, where the difference in paired samples is best seen at 0-9 days after the onset of illness. Sensitivity of nasopharyngeal swab was higher than oropharyngeal swabs in COVID-19 patients. Patient self-collected throat washing has been shown to contain higher viral load than nasopharyngeal or oropharyngeal swab, with significantly higher sensitivity when compared with paired nasopharyngeal swab. RECOMMENDATIONS: Routine nasopharyngeal swab of suspected COVID-19 infection should take anatomy of the nasal cavity into consideration to increase patient comfort and diagnostic yield. Routine oropharyngeal swab should be replaced by throat washing which has demonstrated better diagnostic accuracy, and it is safe towards others. SN - 0126-8635 UR - https://www.unboundmedicine.com/medline/citation/32342928/Upper_respiratory_tract_sampling_in_COVID_19_ L2 - http://www.mjpath.org.my/2020/v42n1/sampling-in-COVID-19.pdf DB - PRIME DP - Unbound Medicine ER -