A guide to laboratory diagnosis of Corona Virus Disease-19 for the gastroenterologists
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REVIEW ARTICLE
A guide to laboratory diagnosis of Corona Virus Disease-19 for the gastroenterologists Ujjala Ghoshal 1 & Shruthi Vasanth 1 & Nidhi Tejan 1 Received: 21 June 2020 / Accepted: 21 July 2020 # Indian Society of Gastroenterology 2020
Abstract The outbreak of Corona Virus Disease-19 (COVID-19), caused by Severe Acute Respiratory Syndrome Corona Virus - 2 (SARS-CoV-2), a global pandemic, is having a significant impact on healthcare, especially the clinical microbiology laboratories all around the world. There are many reports which suggest that the disease can present with gastrointestinal symptoms such as nausea, vomiting, diarrhea, and loss of appetite, which the gastroenterologists may have to deal with. Hence, knowledge about the diagnosis of COVID-19 is important to gastroenterologists as well. The current review therefore covers the challenges faced while choosing appropriate sample collection, transport, and tests for SARS-CoV-2 infection. The right sample at the right time from the right anatomical site with the proper precautions is crucial in prompt and accurate diagnosis of COVID-19. The tests can be divided into direct, indirect, and complementary tests. In the direct test, real-time polymerase chain reaction (RT-PCR) assays are the molecular tests of choice for the diagnosis of COVID-19. Other direct tests include GeneXpert and TrueNAT. In indirect testing, antigen-antibody-based techniques are recommended for surveillance for the disease, which may help to formulate the control measures. Finally, the additional tests help in assessing the disease severity and evaluating the prognosis. All the above tests are important not only for diagnosis but also for management strategy and prognosis. Keywords Beta coronavirus . COVID-19 . Novel Corona virus . Pandemic . Real-time PCR . Severe acute respiratory syndrome . TrueNAT . Viral pneumonia
Introduction Corona Viruses are positive-stranded ribonucleic acid (RNA) viruses, which belong to the Coronaviridae family. These viruses cause illness, which may range from asymptomatic infections or mild flu to severe disease like pneumonia [1–3]. The recently emerged strain, Severe Acute Respiratory Syndrome Corona Virus - 2 (SARS-CoV-2), also has a varied presentation. In a recent systematic review, data from 29 studies including 6064 cases showed that the prevalence of gastrointestinal (GI) symptoms was 15% among patients with Corona Virus Disease-19 (COVID-19) [4]. It was also observed that nearly 10% of patients had only GI symptoms. Feco-oral transmission can be one potential route for * Ujjala Ghoshal [email protected] 1
Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow 226 014, India
transmission of the disease apart from respiratory route [5]. A study testing different samples from patients with SARSCoV-2 infection observed that around 29% fecal samples were positive for viral nucleic acid [6]. In another study by Xu et al., rectal swabs in 8 of 10 pediatric patients with COVID-19 were persistent
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