Diagnosis of COVID-19: Considerations, Controversies and Challenges in South Africa
Diagnosis of COVID-19: Considerations, Controversies and Challenges in South Africa
复制标题
DOI：
10.18772/26180197.2020.v2nsia1
复制
发表时间：
2020-04
期刊：
影响因子：
--
通讯作者：
Preiser W
中科院分区：
文献类型：
--
作者：
Dheda K;Jaumdally S;Davids M;Chang JW;Gina P;Pooran A;Makambwa E;Esmail A;Vardas E;Preiser W
由严重急性呼吸系统综合征冠状病毒2型引起的2019年冠状病毒病（COVID-19）是一场全球大流行病，已导致超过150万例确诊病例和近10万例死亡。在大多数有症状的病例中，COVID-19导致以上呼吸道症状为主要特征的轻度疾病。使用鼻咽样本的逆转录聚合酶链反应（RT-PCR）是诊断的主要方法，但在疾病早期和轻度疾病患者中存在约30%的假阴性率。RT-PCR阳性可在症状消退后持续数天。IgM和IgG抗体反应在症状发作后几天变为阳性，并且在疾病的第二周可检测到强烈的抗体反应。基于抗体的免疫测定在早期症状性疾病的诊断中具有有限的作用。然而，在疾病的前2周内，它们相对于RT-PCR的增量益处目前正在进行中的研究中得到澄清。此类测定可用于监测目的。然而，它们在潜在地选择可能从疫苗接种中受益的个人方面的作用，或者作为识别可以重新部署到基本就业角色的人的生物标志物，正在进行调查。目前正在开发和评估用于检测鼻咽样本中病毒抗原的快速抗体免疫测定法。
Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 is a global pandemic that has resulted in over 1.5 million confirmed cases and close to 100,000 deaths. In the majority of symptomatic cases COVID-19 results in a mild disease predominantly characterised by upper respiratory tract symptoms. Reverse transcription polymerase chain reaction (RT-PCR), using a nasopharyngeal sample, is the mainstay of diagnosis, but there is an ~30% false negative rate early in the disease and in patients with mild disease. RT-PCR positivity can persist for several days after a resolution of symptoms. IgM and IgG antibody responses become positive several days after the onset of symptoms, and robust antibody responses are detectable in the second week of illness. Antibody-based immunoassays have a limited role in the diagnosis of early symptomatic disease. However, their incremental benefit over RT-PCR in the first 2 weeks of illness is currently being clarified in ongoing studies. Such assays may be useful for surveillance purposes. However, their role in potentially selecting individuals that may benefit from vaccination, or as a biomarker identifying persons that could be redeployed into essential employment roles are being investigated. Rapid antibody-based immunoassays that detect viral antigen in nasopharyngeal samples are being developed and evaluated.