COVID-19 Enfeksiyonunda Örnek Yönetimi
Özet
Koronavirüsler, insanların yanı sıra yarasa, fare, kuş, köpek, domuz, sığır gibi birçok hayvan türünü enfekte edebilen bir virüs ailesidir. SARS-CoV-2, hücre membranında bulunan anjiyotensin dönüştürücü enzim 2 (ACE2)’ye bağlanarak hücre içine girer. Enfeksiyonunun laboratuvar tanısı için altın standart, solunum yolundan toplanan örneklerde virüse özgü Gerçek Zamanlı Polimeraz Zincir Reaksiyonu (RT-PCR) ile viral RNA’nın gösterilmesidir. Pandeminin başlangıcında ABD Gıda ve İlaç Dairesi (FDA) tarafından, nazofarengeal (NP) örnekleme yöntemi referans yöntem olarak açıklanmıştır. Ancak Ekim 2020 itibariyle ABD Hastalık Kontrol ve Önleme Merkezi (CDC), NP sürüntü, NP yıkama/aspirat, nazal yıkama/aspirat, orofarengeal (OP) sürüntü, ön burun, orta burun sürüntüsü veya denetimli tükürük örneklerinden herhangi biriyle üst solunum yolu testi yapılabileceğini bildirmiştir. Üst solunum yolu örneklemesi özellikle asemptomatik veya hafif semptomatik olan şüpheli vakalarda enfeksiyonun erken günlerinde tercih edilirken, alt solunum yolu örneklemesi akciğer tutulumu olan ilerlemiş COVID-19 enfeksiyonunda daha güvenilir doğrulama sağlamaktadır. Hastadan alınan örneklerin potansiyel olarak enfeksiyöz olduğu unutulmamalı, örnek alma işlemi aerosol oluşturan prosedür olarak kabul edilmeli ve sağlık personeli buna yönelik kişisel koruyucu ekipmanları (en az N95/FFP2 maske, gözlük veya yüz koruyucu) kullanmalıdır.
Referanslar
McFee RB. Human pathogen coronaviruses - An overview. Disease-a-Month 2020;66(9): 101066. doi:10.1016/j.disamonth.2020.101066.
Alanagreh L, Alzoughool F, Atoum M. The Human Coronavirus Disease COVID-19: Its Origin, Characteristics, and Insights into Potential Drugs and Its Mechanisms. Pathogens 2020;9(5): 331. doi:10.3390/pathogens9050331.
Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. European Journal of Clinical Microbiology & Infectious Diseases 2021;40(5): 905-919. doi:10.1007/s10096-020-04138-6.
Shirbhate E, Pandey J, Patel VK, et al. Understanding the role of ACE-2 receptor in pathogenesis of COVID-19 disease: a potential approach for therapeutic intervention. Pharmacological Reports 2021;73(6): 1539-1550. doi:10.1007/s43440-021-00303-6.
Zou X, Chen K, Zou J, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine 2020;14(2): 185-192. doi:10.1007/s11684-020-0754-0.
Puhach O, Meyer B, Eckerle I. SARS-CoV-2 viral load and shedding kinetics. Nature Reviews Microbiology 2023;21(3): 147-161. doi:10.1038/s41579-022-00822-w.
Lee RA, Herigon JC, Benedetti A, et al. Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis. Journal of Clinical Microbiology 2021;59(5): e02881-20. doi:10.1128/JCM.02881-20.
Rao SN, Manissero D, Steele VR, et al. A Systematic Review of the Clinical Utility of Cycle Threshold Values in the Context of COVID-19. Infectious Diseases and Therapy 2020;9(3): 573-586. doi:10.1007/s40121-020-00324-3.
Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, et al. Tools and Techniques for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/COVID-19 Detection. Clinical Microbiology Reviews 2021;34(3): e00228-20. doi:10.1128/CMR.00228-20.
T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 Enfeksiyonu) Genel Bilgiler, Epidemiyoloji ve Tanı Bilimsel Danışma Kurulu Çalışması. 7 Aralık 2020, Ankara. (30 Mart 2023 tarihinde https://covid19.saglik.gov.tr/Eklenti/39551/0/covid-19rehberigenelbilgilerepidemiyolojivetanipdf.pdf adresinden ulaşılmıştır).
Centers for Disease Control and Prevention. Interim Guidelines for Collecting and Handling of Clinical Specimens for COVID-19 Testing. (30 Mart 2023 tarihinde https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html adresinden ulaşılmıştır).
Kukull B, Shakir SM, Hanson KE. Performance of Non-nasopharyngeal Sample Types for Molecular Detection of SARS-CoV-2. Clinics in Laboratory Medicine 2022;42(2): 249-259. doi:10.1016/j.cll.2022.02.002.
Atieh MA, Guirguis M, Alsabeeha NHM, et al. The diagnostic accuracy of saliva testing for SARS-CoV-2: A systematic review and meta-analysis. Oral Diseases 2022;28 Suppl 2: 2347-2361. doi:10.1111/odi.13934.
Tsang NNY, So HC, Ng KY, et al. Diagnostic performance of different sampling approaches for SARS-CoV-2 RT-PCR testing: a systematic review and meta-analysis. The Lancet Infectious Diseases 2021;21(9): 1233-1245. doi:10.1016/S1473-3099(21)00146-8.
Stanoeva KR, van der Eijk AA, Meijer A, et al. Towards a sensitive and accurate interpretation of molecular testing for SARS-CoV-2: a rapid review of 264 studies. Euro Surveillance 2021;26(10): 2001134. doi:10.2807/1560-7917.ES.2021.26.10.2001134.
Huang Y, Chen S, Yang Z, et al. SARS-CoV-2 Viral Load in Clinical Samples from Critically Ill Patients. American Journal of Respiratory and Critical Care Medicine 2020;201(11): 1435-1438. doi:10.1164/rccm.202003-0572LE.
Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020;323(18): 1843-1844. doi:10.1001/jama.2020.3786.
Johnson H, Garg M, Shantikumar S, et al. COVID-19 (SARS-CoV-2) in Non-Airborne body fluids: A systematic review & Meta-analysis. Turkish Journal of Urology 2021;47(2):87-97. doi:10.5152/tud.2021.20586.
Ebner B, Volz Y, Mumm JN, et al. The COVID-19 pandemic - what have urologists learned? Nature Reviews Urology 2022;19(6): 344-356. doi:10.1038/s41585-022-00586-1.
Machado B, Barcelos Barra G, Scherzer N, et al. Presence of SARS-CoV-2 RNA in Semen-Cohort Study in the United States COVID-19 Positive Patients. Infectious Disease Reports 2021;13(1): 96-101. doi:10.3390/idr13010012.
Erdem D, Kayaaslan B, Cakir EY, et al. Investigation of SARS-CoV-2 using RT-PCR in vaginal swab samples of female patients with a diagnosis of severe COVID-19. Taiwanese Journal of Obstetrics and Gynecology 2023;62(2): 270-274. doi:10.1016/j.tjog.2022.11.007.
Öcal D, Vezir S, Karahan ZC. Mikrobiyolojik Tanı Yöntemleri, Memikoğlu O, Genç V (ed), COVID-19 içinde. Ankara: Ankara Üniversitesi Basımevi; 2020; p. 17-27. (30 Mart 2023 tarihinde http://www.medicine.ankara.edu.tr/wp-content/uploads/sites/121/2020/05/COVID-19-Kitap.pdf adresinden ulaşılmıştır).
World Health Organization. Laboratory testing of 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. (30 Mart 2023 tarihinde https://www.who.int/publications/i/item/10665-331501 adresinden ulaşılmıştır).
Hong KH, Lee SW, Kim TS, et al. Guidelines for Laboratory Diagnosis of Coronavirus Disease 2019 (COVID-19) in Korea. Annals of Laboratory Medicine 2020;40(5): 351-360. doi:10.3343/alm.2020.40.5.351.
Referanslar
McFee RB. Human pathogen coronaviruses - An overview. Disease-a-Month 2020;66(9): 101066. doi:10.1016/j.disamonth.2020.101066.
Alanagreh L, Alzoughool F, Atoum M. The Human Coronavirus Disease COVID-19: Its Origin, Characteristics, and Insights into Potential Drugs and Its Mechanisms. Pathogens 2020;9(5): 331. doi:10.3390/pathogens9050331.
Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. European Journal of Clinical Microbiology & Infectious Diseases 2021;40(5): 905-919. doi:10.1007/s10096-020-04138-6.
Shirbhate E, Pandey J, Patel VK, et al. Understanding the role of ACE-2 receptor in pathogenesis of COVID-19 disease: a potential approach for therapeutic intervention. Pharmacological Reports 2021;73(6): 1539-1550. doi:10.1007/s43440-021-00303-6.
Zou X, Chen K, Zou J, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine 2020;14(2): 185-192. doi:10.1007/s11684-020-0754-0.
Puhach O, Meyer B, Eckerle I. SARS-CoV-2 viral load and shedding kinetics. Nature Reviews Microbiology 2023;21(3): 147-161. doi:10.1038/s41579-022-00822-w.
Lee RA, Herigon JC, Benedetti A, et al. Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis. Journal of Clinical Microbiology 2021;59(5): e02881-20. doi:10.1128/JCM.02881-20.
Rao SN, Manissero D, Steele VR, et al. A Systematic Review of the Clinical Utility of Cycle Threshold Values in the Context of COVID-19. Infectious Diseases and Therapy 2020;9(3): 573-586. doi:10.1007/s40121-020-00324-3.
Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, et al. Tools and Techniques for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/COVID-19 Detection. Clinical Microbiology Reviews 2021;34(3): e00228-20. doi:10.1128/CMR.00228-20.
T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 Enfeksiyonu) Genel Bilgiler, Epidemiyoloji ve Tanı Bilimsel Danışma Kurulu Çalışması. 7 Aralık 2020, Ankara. (30 Mart 2023 tarihinde https://covid19.saglik.gov.tr/Eklenti/39551/0/covid-19rehberigenelbilgilerepidemiyolojivetanipdf.pdf adresinden ulaşılmıştır).
Centers for Disease Control and Prevention. Interim Guidelines for Collecting and Handling of Clinical Specimens for COVID-19 Testing. (30 Mart 2023 tarihinde https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html adresinden ulaşılmıştır).
Kukull B, Shakir SM, Hanson KE. Performance of Non-nasopharyngeal Sample Types for Molecular Detection of SARS-CoV-2. Clinics in Laboratory Medicine 2022;42(2): 249-259. doi:10.1016/j.cll.2022.02.002.
Atieh MA, Guirguis M, Alsabeeha NHM, et al. The diagnostic accuracy of saliva testing for SARS-CoV-2: A systematic review and meta-analysis. Oral Diseases 2022;28 Suppl 2: 2347-2361. doi:10.1111/odi.13934.
Tsang NNY, So HC, Ng KY, et al. Diagnostic performance of different sampling approaches for SARS-CoV-2 RT-PCR testing: a systematic review and meta-analysis. The Lancet Infectious Diseases 2021;21(9): 1233-1245. doi:10.1016/S1473-3099(21)00146-8.
Stanoeva KR, van der Eijk AA, Meijer A, et al. Towards a sensitive and accurate interpretation of molecular testing for SARS-CoV-2: a rapid review of 264 studies. Euro Surveillance 2021;26(10): 2001134. doi:10.2807/1560-7917.ES.2021.26.10.2001134.
Huang Y, Chen S, Yang Z, et al. SARS-CoV-2 Viral Load in Clinical Samples from Critically Ill Patients. American Journal of Respiratory and Critical Care Medicine 2020;201(11): 1435-1438. doi:10.1164/rccm.202003-0572LE.
Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020;323(18): 1843-1844. doi:10.1001/jama.2020.3786.
Johnson H, Garg M, Shantikumar S, et al. COVID-19 (SARS-CoV-2) in Non-Airborne body fluids: A systematic review & Meta-analysis. Turkish Journal of Urology 2021;47(2):87-97. doi:10.5152/tud.2021.20586.
Ebner B, Volz Y, Mumm JN, et al. The COVID-19 pandemic - what have urologists learned? Nature Reviews Urology 2022;19(6): 344-356. doi:10.1038/s41585-022-00586-1.
Machado B, Barcelos Barra G, Scherzer N, et al. Presence of SARS-CoV-2 RNA in Semen-Cohort Study in the United States COVID-19 Positive Patients. Infectious Disease Reports 2021;13(1): 96-101. doi:10.3390/idr13010012.
Erdem D, Kayaaslan B, Cakir EY, et al. Investigation of SARS-CoV-2 using RT-PCR in vaginal swab samples of female patients with a diagnosis of severe COVID-19. Taiwanese Journal of Obstetrics and Gynecology 2023;62(2): 270-274. doi:10.1016/j.tjog.2022.11.007.
Öcal D, Vezir S, Karahan ZC. Mikrobiyolojik Tanı Yöntemleri, Memikoğlu O, Genç V (ed), COVID-19 içinde. Ankara: Ankara Üniversitesi Basımevi; 2020; p. 17-27. (30 Mart 2023 tarihinde http://www.medicine.ankara.edu.tr/wp-content/uploads/sites/121/2020/05/COVID-19-Kitap.pdf adresinden ulaşılmıştır).
World Health Organization. Laboratory testing of 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. (30 Mart 2023 tarihinde https://www.who.int/publications/i/item/10665-331501 adresinden ulaşılmıştır).
Hong KH, Lee SW, Kim TS, et al. Guidelines for Laboratory Diagnosis of Coronavirus Disease 2019 (COVID-19) in Korea. Annals of Laboratory Medicine 2020;40(5): 351-360. doi:10.3343/alm.2020.40.5.351.
