COVID-19 pneumonia: when negative PCR testing does not rule out the disease
Keywords:
COVID-19, SARS CoV-2, pneumonia, false negative rRT-PCR
Abstract
In diagnosing COVID-19, false negative findings from the biological sample taken from a mucosal swab of the upper respiratory tract and tested with the real-time reverse-transcription polymerase chain reaction (RT-PCR) technique have been reported. This patient has had a proven contact with an infected person, clear symptoms of viral respiratory disease, yet negative test results on the fifth day of self-isolation. On repeated test after 48 hours, on the 7th day of isolation, due to persistence of some symptoms, he tested positive for SARS-CoV-2. The existence of symptoms and characteristic sings after laboratory and radiological analysis of the patient prompted the repetition of the tests, which at the end led to the confirmed diagnosis and the possibility for adequate treatment of the patient as well.
References
1. Mijović B. COVID-19 – lessons learned. Scr Med 2020;51(1):1-5.
2. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of Coronavirus disease 2019 (COVID-19). J Gen Intern Med 2020 Mar 4. doi: 10.1007/s11606-020-05762-w.
3. Sharfstein JM, Becker SJ, Mello MM. Diagnostic testing for the novel Coronavirus. JAMA Mar 9. doi: 10.1001/jama.2020.3864.
4. He F, Deng Y, Li W. Coronavirus Disease 2019 (COVID-19): What we know? J Med Virol 2020 Mar 14. doi: 10.1002/jmv.25766. Review.
5. Igić R. Pharmacologist's view of the new corona virus. Scr Med 2020;51(1):6-8.
6. World Health Organization. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases: interim guidance, 2 March 2020 [Internet]. [cited 2020-Mar-28]. Available from: https://apps.who.int/iris/handle/10665/331329
7. World Health Organization. Laboratory testing strategy recommendations for COVID-19. Interim guidance. 22 March 2020. [Internet]. [cited 2020-Mar-28]. Available from: https://apps.who.int/iris/handle/10665/331509
8. Goldstein ND, Burstyn I. On the importance of early testing even when imperfect in a pandemic such as COVID-19. OSF Preprints 18 Mar 2020. Web. doi:10.31219/osf.io/9pz4d.
9. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020; 382(12):1177-1179.
10. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DKW, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020 Jan;25(3). doi: 10.2807/1560-7917.ES.2020.25.3.2000045.
11. Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. medRxiv 2020. doi: https://doi.org/10.1101/2020.02.11.20021493
12. Chen R, Chen J, Meng QT. Chest computed tomography images of early coronavirus disease (COVID-19). Can J Anaesth 2020 Mar 11. doi: 10.1007/s12630-020-01625-4.
13. Chen Z, Li Y, Wu B, Hou Y, Bao J, Deng X. A patient with COVID-19 presenting a false-negative reverse transcriptase polymerase chain reaction result. Korean J Radiol 2020 Mar 20. doi: 10.3348/kjr.2020.0195.
14. Li D, Wang D, Dong J, Wang N, Huang H, Xu H, et al. False-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome Coronavirus 2: role of deep-learning-based CT diagnosis and insights from two cases. Korean J Radiol 2020;21(4):505-8.
15. Lee EYP, Ng MY, Khong PL. COVID-19 pneumonia: what has CT taught us? Lancet Infect Dis 2020 Feb 24. pii: S1473-3099(20)30134-1. doi: 10.1016/S1473-3099(20)30134-1.
16. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in Coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020 Feb 20:200463. doi: 10.1148/radiol.2020200463.
17. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel Coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020 Apr;21(4):494-500.
18. Zheng Y, Huang Z, Yin G, Zhang X, Ye W, Hu Z, et al. Comparative study of the lymphocyte change between COVID-19 and non-COVID-19 pneumonia cases suggesting uncontrolled inflammation might not be the main reason of tissue injury. medRxiv preprint doi: https://doi.org/10.1101/2020.02.19.20024885
19. McIntosh K. Coronavirus disease 2019 (COVID-19). [Internet]. Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19/contributors. [Internet]. [Cited 2020-Mar-28].
2. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of Coronavirus disease 2019 (COVID-19). J Gen Intern Med 2020 Mar 4. doi: 10.1007/s11606-020-05762-w.
3. Sharfstein JM, Becker SJ, Mello MM. Diagnostic testing for the novel Coronavirus. JAMA Mar 9. doi: 10.1001/jama.2020.3864.
4. He F, Deng Y, Li W. Coronavirus Disease 2019 (COVID-19): What we know? J Med Virol 2020 Mar 14. doi: 10.1002/jmv.25766. Review.
5. Igić R. Pharmacologist's view of the new corona virus. Scr Med 2020;51(1):6-8.
6. World Health Organization. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases: interim guidance, 2 March 2020 [Internet]. [cited 2020-Mar-28]. Available from: https://apps.who.int/iris/handle/10665/331329
7. World Health Organization. Laboratory testing strategy recommendations for COVID-19. Interim guidance. 22 March 2020. [Internet]. [cited 2020-Mar-28]. Available from: https://apps.who.int/iris/handle/10665/331509
8. Goldstein ND, Burstyn I. On the importance of early testing even when imperfect in a pandemic such as COVID-19. OSF Preprints 18 Mar 2020. Web. doi:10.31219/osf.io/9pz4d.
9. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020; 382(12):1177-1179.
10. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DKW, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020 Jan;25(3). doi: 10.2807/1560-7917.ES.2020.25.3.2000045.
11. Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. medRxiv 2020. doi: https://doi.org/10.1101/2020.02.11.20021493
12. Chen R, Chen J, Meng QT. Chest computed tomography images of early coronavirus disease (COVID-19). Can J Anaesth 2020 Mar 11. doi: 10.1007/s12630-020-01625-4.
13. Chen Z, Li Y, Wu B, Hou Y, Bao J, Deng X. A patient with COVID-19 presenting a false-negative reverse transcriptase polymerase chain reaction result. Korean J Radiol 2020 Mar 20. doi: 10.3348/kjr.2020.0195.
14. Li D, Wang D, Dong J, Wang N, Huang H, Xu H, et al. False-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome Coronavirus 2: role of deep-learning-based CT diagnosis and insights from two cases. Korean J Radiol 2020;21(4):505-8.
15. Lee EYP, Ng MY, Khong PL. COVID-19 pneumonia: what has CT taught us? Lancet Infect Dis 2020 Feb 24. pii: S1473-3099(20)30134-1. doi: 10.1016/S1473-3099(20)30134-1.
16. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in Coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020 Feb 20:200463. doi: 10.1148/radiol.2020200463.
17. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel Coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020 Apr;21(4):494-500.
18. Zheng Y, Huang Z, Yin G, Zhang X, Ye W, Hu Z, et al. Comparative study of the lymphocyte change between COVID-19 and non-COVID-19 pneumonia cases suggesting uncontrolled inflammation might not be the main reason of tissue injury. medRxiv preprint doi: https://doi.org/10.1101/2020.02.19.20024885
19. McIntosh K. Coronavirus disease 2019 (COVID-19). [Internet]. Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19/contributors. [Internet]. [Cited 2020-Mar-28].
Published
2020/04/04
Issue
Section
Case report
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