Abstract
Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (p < 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.
Highlights
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in Wuhan, China, in December 2019
The main route of SARS-CoV-2 transmission is person-to-person contact through respiratory droplets, there is the possibility of spread by touching the eyes, nose, or mouth after touching contaminated surfaces [3,4,5]
SARS-CoV-2 was detected in 71.4% (10/14) of those with a severe risk of bleeding
Summary
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in Wuhan, China, in December 2019. The clinical manifestations of COVID-19 are widely heterogeneous, ranging from asymptomatic infection to severe pneumonia with respiratory failure and multi-organ dysfunction or death [2,3]. The main route of SARS-CoV-2 transmission is person-to-person contact through respiratory droplets, there is the possibility of spread by touching the eyes, nose, or mouth after touching contaminated surfaces [3,4,5]. As a support strategy for virus transmission, massive testing of the population and social isolation have been recommended by the WHO [6]. The increase in massive testing capacity imposes the development of new strategies for COVID-19 diagnosis, with non-invasive and self-collection samples of patients
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