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Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019.
J Infect Dis. 2020 10 13; 222(10):1612-1619.JI

Abstract

BACKGROUND

Self-collected specimens have been advocated to avoid infectious exposure to healthcare workers. Self-induced sputum in those with a productive cough and saliva in those without a productive cough have been proposed, but sensitivity remains uncertain.

METHODS

We performed a prospective study in 2 regional hospitals in Hong Kong.

RESULTS

We prospectively examined 563 serial samples collected during the virus shedding periods of 50 patients: 150 deep throat saliva (DTS), 309 pooled-nasopharyngeal (NP) and throat swabs, and 104 sputum. Deep throat saliva had the lowest overall reverse-transcriptase polymerase chain reaction (RT-PCR)-positive rate (68.7% vs 89.4% [sputum] and 80.9% [pooled NP and throat swabs]) and the lowest viral ribonucleic acid (RNA) concentration (mean log copy/mL 3.54 vs 5.03 [sputum] and 4.63 [pooled NP and throat swabs]). Analyses with respect to time from symptom onset and severity also revealed similar results. Virus yields of DTS correlated with that of sputum (Pearson correlation index 0.76; 95% confidence interval, 0.62-0.86). We estimated that the overall false-negative rate of DTS could be as high as 31.3% and increased 2.7 times among patients without sputum.

CONCLUSIONS

Deep throat saliva produced the lowest viral RNA concentration and RT-PCR-positive rate compared with conventional respiratory specimens in all phases of illness. Self-collected sputum should be the choice for patients with sputum.

Authors+Show Affiliations

Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China.Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China.Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China.Department of Anesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China.United Christian Hospital, Hospital Authority, Hong Kong SAR, China.Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.United Christian Hospital, Hospital Authority, Hong Kong SAR, China.Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.United Christian Hospital, Hospital Authority, Hong Kong SAR, China.Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China.Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China.Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32738137

Citation

Lai, Christopher K C., et al. "Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019." The Journal of Infectious Diseases, vol. 222, no. 10, 2020, pp. 1612-1619.
Lai CKC, Chen Z, Lui G, et al. Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019. J Infect Dis. 2020;222(10):1612-1619.
Lai, C. K. C., Chen, Z., Lui, G., Ling, L., Li, T., Wong, M. C. S., Ng, R. W. Y., Tso, E. Y. K., Ho, T., Fung, K. S. C., Ng, S. T., Wong, B. K. C., Boon, S. S., Hui, D. S. C., & Chan, P. K. S. (2020). Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019. The Journal of Infectious Diseases, 222(10), 1612-1619. https://doi.org/10.1093/infdis/jiaa487
Lai CKC, et al. Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019. J Infect Dis. 2020 10 13;222(10):1612-1619. PubMed PMID: 32738137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019. AU - Lai,Christopher K C, AU - Chen,Zigui, AU - Lui,Grace, AU - Ling,Lowell, AU - Li,Timothy, AU - Wong,Martin C S, AU - Ng,Rita W Y, AU - Tso,Eugene Y K, AU - Ho,Tracy, AU - Fung,Kitty S C, AU - Ng,Siu T, AU - Wong,Barry K C, AU - Boon,Siaw S, AU - Hui,David S C, AU - Chan,Paul K S, PY - 2020/07/03/received PY - 2020/07/30/accepted PY - 2020/8/2/pubmed PY - 2020/11/3/medline PY - 2020/8/2/entrez KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - diagnosis KW - saliva SP - 1612 EP - 1619 JF - The Journal of infectious diseases JO - J Infect Dis VL - 222 IS - 10 N2 - BACKGROUND: Self-collected specimens have been advocated to avoid infectious exposure to healthcare workers. Self-induced sputum in those with a productive cough and saliva in those without a productive cough have been proposed, but sensitivity remains uncertain. METHODS: We performed a prospective study in 2 regional hospitals in Hong Kong. RESULTS: We prospectively examined 563 serial samples collected during the virus shedding periods of 50 patients: 150 deep throat saliva (DTS), 309 pooled-nasopharyngeal (NP) and throat swabs, and 104 sputum. Deep throat saliva had the lowest overall reverse-transcriptase polymerase chain reaction (RT-PCR)-positive rate (68.7% vs 89.4% [sputum] and 80.9% [pooled NP and throat swabs]) and the lowest viral ribonucleic acid (RNA) concentration (mean log copy/mL 3.54 vs 5.03 [sputum] and 4.63 [pooled NP and throat swabs]). Analyses with respect to time from symptom onset and severity also revealed similar results. Virus yields of DTS correlated with that of sputum (Pearson correlation index 0.76; 95% confidence interval, 0.62-0.86). We estimated that the overall false-negative rate of DTS could be as high as 31.3% and increased 2.7 times among patients without sputum. CONCLUSIONS: Deep throat saliva produced the lowest viral RNA concentration and RT-PCR-positive rate compared with conventional respiratory specimens in all phases of illness. Self-collected sputum should be the choice for patients with sputum. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/32738137/Prospective_Study_Comparing_Deep_Throat_Saliva_With_Other_Respiratory_Tract_Specimens_in_the_Diagnosis_of_Novel_Coronavirus_Disease_2019_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiaa487 DB - PRIME DP - Unbound Medicine ER -