https://doi.org/10.4081/itjm.2021.1474
Current challenges in COVID-19 diagnosis: a narrative review and implications for clinical practice
Published: 24 September 2021
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Early diagnosis of coronavirus disease 2019 (COVID-19) is crucial to early treatment and quarantine measures. In this narrative review, diagnostic tools for COVID-19 diagnosis and their main critical issues were reviewed. The COVID-19 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test is considered the gold standard test for the qualitative and quantitative detection of viral nucleic acid. In contrast, tests can be used for epidemiological surveys on specific communities, including occupational cohorts, but not for clinical diagnosis as a substitute for swab tests. Computed tomography (CT) scans can be useful for the clinical diagnosis of COVID-19, especially in symptomatic cases. The imaging features of COVID-19 are diverse and depend on the stage of infection after the onset of symptoms. CT sensitivity seems to be higher in patients with positive RT-PCR. Conventional chest sensitivity shows a lower sensitivity. An important diagnostic screening tool is ultrasounds, whose specificity and sensitivity depend on disease severity, patient weight, and operator skills. Nevertheless, ultrasounds could be useful as a screening tool in combination with clinical features and molecular testing to monitor disease progression. Clinical symptoms and non-specific laboratory findings may be useful if used in combination with RT-PCR test and CT-scanning.
Berekaa MM. Insights into the COVID-19 pandemic: Origin, pathogenesis, diagnosis, and therapeutic interventions. Front Biosci (Elite Ed) 2021;13:117-39.
DOI: https://doi.org/10.2741/874
Soy M, Keser G, Atagündüz P, et al. Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol 2020;39:2085-94.
DOI: https://doi.org/10.1007/s10067-020-05190-5
Magnavita N, Sacco A, Chirico F. Covid-19 pandemic in Italy: Pros and cons. Zdrowie Publiczne i ZarzÄ…dzanie 2020;16:32-5.
DOI: https://doi.org/10.4467/20842627OZ.20.002.12656
Chirico F, Sacco A, Bragazzi NL, Magnavita N. Can air-conditioning systems contribute to the spread of SARS/MERS/COVID-19 infection? Insights from a rapid review of the literature. Int J Environ Res Public Health 2020;17:6052.
DOI: https://doi.org/10.3390/ijerph17176052
Kaswa R, Govender I. Novel coronavirus pandemic: A clinical overview. S Afr Fam Pract (2004) 2020;62:e1-5.
DOI: https://doi.org/10.4102/safp.v62i1.5123
Chirico F, Nucera G, Magnavita N. Estimating case fatality ratio during COVID-19 epidemics: Pitfalls and alternatives. J Infect Dev Ctries 2020;14:438-9.
DOI: https://doi.org/10.3855/jidc.12787
Oliveira BA, Oliveira LC, Sabino EC, Okay TS. SARS-CoV-2 and the COVID-19 disease: a mini review on diagnostic methods. Rev Inst Med Trop Sao Paulo 2020;62:e44.
DOI: https://doi.org/10.1590/s1678-9946202062044
La Marca A, Capuzzo M, Paglia T, et al. Testing for SARS-CoV-2 (COVID-19): a systematic review and clinical guide to molecular and serological in-vitro diagnostic assays. Reprod Biomed Online 2020;41:483-99.
DOI: https://doi.org/10.1016/j.rbmo.2020.06.001
D'Cruz RJ, Currier AW, Sampson VB. Laboratory testing methods for novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Front Cell Dev Biol 2020;8:468.
DOI: https://doi.org/10.3389/fcell.2020.00468
Woelfel R, Corman VM, Guggemos W, et al. Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster. medRxiv 2020 Mar 8 [Epub ahead of print].
Alhazzani W, Møller MH, Arabi YM, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 2020 Mar 28 [Epub ahead of print].
DOI: https://doi.org/10.1097/CCM.0000000000004363
CDC. Interim guidelines for collecting, handling, and testing clinical specimens for COVID-19; Updated 06 Jan 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html Accessed: 6 February 2021.
Lippi G, Simundic AM, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med 2020;58:1070-6.
DOI: https://doi.org/10.1515/cclm-2020-0285
Xie X, Zhong Z, Zhao W, et al. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 2020;200343.
Winichakoon P, Chaiwarith R, Liwsrisakun C, et al. Negative nasopharyngeal and oropharyngeal swab does not rule out COVID 19. J Clin Microbiol 2020 [Epub ahead of print].
DOI: https://doi.org/10.1128/JCM.00297-20
Kumar DS, O'Neill SB, Johnston JC, et al. SARS-CoV-2 infection in a 76-year-old man with negative results for nasopharyngeal swabs and possible nosocomial transmission. CMAJ 2020;cmaj.200641. [Epub ahead of print].
DOI: https://doi.org/10.1503/cmaj.200641
Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 Cases. Radiology 2020;2020:200642.
DOI: https://doi.org/10.1148/radiol.2020200642
Chirico F, Nucera G, Magnavita N. Hospital infection and COVID-19: Do not put all your eggs on the "swab" tests [published online ahead of print, 2020 May 27]. Infect Control Hosp Epidemiol 2020;1-2.
DOI: https://doi.org/10.1017/ice.2020.254
Pan Y, Zhang D, Yang P, et al. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis 2020;20:411.
DOI: https://doi.org/10.1016/S1473-3099(20)30113-4
Yang Y, Yang M, Shen C, et al. Laboratory diagnosis and monitoring the viral shedding of 2019-nCoV Infections. medRxiv 2020 [Epub ahead of print].
DOI: https://doi.org/10.1101/2020.02.11.20021493
To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis 2020;20:565-74.
DOI: https://doi.org/10.1016/S1473-3099(20)30196-1
Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177-9.
DOI: https://doi.org/10.1056/NEJMc2001737
He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020;26:672-5.
DOI: https://doi.org/10.1038/s41591-020-0869-5
Mak GC, Cheng PK, Lau SS, et al. Evaluation of rapid antigen test for detection of SARS-CoV-2 virus. J Clin Virol 2020;129:104500.
DOI: https://doi.org/10.1016/j.jcv.2020.104500
Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-4.
DOI: https://doi.org/10.1038/nature02145
Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020;25:2000045.
DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000045
Guo L, Ren L, Yang S, et al. Profiling early humoral response to diagnose novel coronavirus disease (COVID-19). Clin Infect Dis 2020;71:778-85.
DOI: https://doi.org/10.1093/cid/ciaa310
European Center for Disease Center and Control. Diagnostic testing and screening for SARS-CoV-2. Available from: https://www.ecdc.europa.eu/en/covid-19/latest-evidence/diagnostic-testing
Lisboa Bastos M, Tavaziva G, Abidi SK, et al. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ 2020;370:m2516.
DOI: https://doi.org/10.1136/bmj.m2516
Long QX, Liu BZ, Deng HJ, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med 2020 [Epub ahead of print].
Ministero della Salute. Direzione Generale della Prevenzione Sanitaria. COVID-19: test di screening e diagnostici. Circolare del 09 Maggio 2020 n. 0016106-09/05/2020-DGPRE-DGPRE-P.
Wang W, Yan F. Patients with RT-PCR confirmed COVID-19 and normal chest CT. Radiology 2020:200702.
Udugama B, Kadhiresan P, Kozlowski HN, et al. Diagnosing COVID-19: the disease and tools for detection. ACS Nano 2020;14:3822-35.
DOI: https://doi.org/10.1021/acsnano.0c02624
Kobayashi Y, Mitsudomi T. Management of ground-glass opacities: should all pulmonary lesions with ground-glass opacity be surgically resected? Transl Lung Cancer Res 2013;2:354-63.
Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020 [Epub ahead of print].
Pan F, Ye T, Sun P, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology 2020 [Epub ahead of print].
DOI: https://doi.org/10.1148/radiol.2020200370
Ye Z, Zhang Y, Wang Y, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020;30:4381-9.
DOI: https://doi.org/10.1007/s00330-020-06801-0
Yang W, Yan F. Patients with RT-PCR confirmed COVID-19 and normal chest CT. Radiology 2020 [Epub ahead of print].
DOI: https://doi.org/10.1148/radiol.2020200702
Yam WC, Chan KH, Poon LL, et al. Evaluation of reverse transcription-PCR assays for rapid diagnosis of severe acute respiratory syndrome associated with a novel coronavirus. J Clin Microbiol 2003;41:4521-4.
DOI: https://doi.org/10.1128/JCM.41.10.4521-4524.2003
Feng H, Liu Y, Lv M, et al. A case report of COVID-19 with false negative RT-PCR test: necessity of chest CT. Jpn J Radiol 2020. [Epub ahead of print].
DOI: https://doi.org/10.1007/s11604-020-00967-9
Zhuang GH, Shen MW, Zeng LX, et al. Potential falseâ€positive rate among the 'asymptomatic infected individuals’ in close contacts of COVIDâ€19 patients. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:485-8.
Kanne JP, Little BP, Chung JH, et al. Essentials for radiologists on COVIDâ€19: an update-radiology scientific expert panel. Radiology 2020;200527.
DOI: https://doi.org/10.1148/radiol.2020200527
Waller JV, Kaur P, Tucker A, et al. Diagnostic tools for coronavirus disease (COVID-19): comparing CT and RT-PCR viral nucleic acid testing. AJR Am J Roentgenol 2020;215:834-8.
DOI: https://doi.org/10.2214/AJR.20.23418
Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus diseaseâ€19 (COVID†19): relationship to duration of infection. Radiology 2020:200463.
DOI: https://doi.org/10.1148/radiol.2020200463
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
DOI: https://doi.org/10.1016/j.tmaid.2020.101623
Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med 2020;288:192-206.
DOI: https://doi.org/10.1111/joim.13091
Tan G, Lian X, Zhu Z, et al. Use of lung ultrasound to differentiate coronavirus disease 2019 (COVID-19) pneumonia from community-acquired pneumonia. Ultrasound Med Biol 2020;46:2651-8.
DOI: https://doi.org/10.1016/j.ultrasmedbio.2020.05.006
Zheng Z, Yao Z, Wu K, Zheng J. The diagnosis of SARS-CoV2 pneumonia: A review of laboratory and radiological testing results. J Med Virol 2020 [Epub ahead of print].
DOI: https://doi.org/10.1002/jmv.26081
Adhikari SP, Meng S, Wu YJ, et al Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVIDâ€19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020;9:29.
DOI: https://doi.org/10.1186/s40249-020-00646-x
Guo G, Ye L, Pan K, et al. New insights of emerging SARS-CoV-2: epidemiology, etiology, clinical features, clinical treatment, and prevention. Front Cell Dev Biol 2020;8:410.
DOI: https://doi.org/10.3389/fcell.2020.00410
Yan CH, Faraji F, Prajapati DP, et al. Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol 2020;10:806-13.
DOI: https://doi.org/10.1002/alr.22579
How to Cite
Nucera, G., Chirico, F., Raffaelli, V., & Marino, P. (2021). Current challenges in COVID-19 diagnosis: a narrative review and implications for clinical practice. Italian Journal of Medicine, 15(3). https://doi.org/10.4081/itjm.2021.1474
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