Diagnostic testing for SARS-CoV-2 infection in HHT patients: nasopharyngeal versus oropharyngeal swab
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LETTER TO THE EDITOR
Diagnostic testing for SARS‑CoV‑2 infection in HHT patients: nasopharyngeal versus oropharyngeal swab Fabio Pagella1,2, Roberta Lizzio1* , Sara Ugolini1,2, Giuseppe Spinozzi1, Eugenia Maiorano1,2, Patrizia Suppressa3, Carlo Sabbà3 and Elina Matti1
Abstract On March 11, 2020, WHO has defined the novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak as a pandemic that still today continues to affect much of the world. Among the reasons for the rapid spread of SARS-CoV-2 infection, there is the role of asymptomatic or minimally symptomatic carriers. Therefore diagnostic testing is central to contain the global pandemic. Up to now real-time reverse transcriptase polymerase chain reaction-based molecular assays for detecting SARS-CoV-2 in respiratory specimens is the current reference standard for COVID-19 diagnosis. Based on current knowledge regarding the sensitivity of the molecular test, the highest positive detection rate is from lower respiratory tract specimens; alternatively it is possible to perform a nasopharyngeal or oropharyngeal swab. Nasopharyngeal swab is the preferred choice for SARS-CoV-2 testing since it seems to have a greater sensitivity; however the procedure is not always free of complications and an epistaxis can occur. Among patients with greatest risk of massive nosebleed there are HHT patients. Hereditary hemorrhagic telangiectasia is an autosomal dominant disease that leads to multiregional mucocutanous telangiectases and visceral arteriovenous malformations. Clinically, the presence of telangiectases in nasal mucosa is the cause of recurrent epistaxis. In HHT patients the execution of the nasopharyngeal swab can determine from little or no consequences to a massive epistaxis leading to the necessity of nasal packing generally followed by hospital admission. In HHT patients undergoing a diagnostic test to evaluate the SARS-CoV-2 infection status, especially in those patients with frequent epistaxis with a history of anemia and repeated hospitalizations, it is therefore advisable to perform an oropharyngeal swab. This, compared to the nasopharyngeal swab, exposes to a lower risk of severe nosebleeds related treatments, such as blood transfusions or invasive procedures. According to the risk-benefit assessment and based on our experience, we consider that, despite a lower diagnostic sensitivity, oropharyngeal swab is preferable to nasopharyngeal swab for the diagnosis of SARS CoV-2 infection in patients with HHT. Keywords: Nasopharyngeal swab, Oropharyngeal swab, SARS-CoV-2, COVID-19, RT-PCR, SARS-CoV-2 diagnosis, HHT, Nosebleeding, Epistaxis Dear Editor,
*Correspondence: [email protected] 1 Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Full list of author information is available at the end of the article
Since the World Health Organization (WHO) declared the novel Coronavirus disease (COVID-19) outbreak as pandemic, on March 11th, 2020, the virus has spread to more than 48,786,440 individuals, resultin
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