Deepthroat Saliva

Deepthroat Saliva
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Affiliations

1 Department of Oral and Maxillofacial surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address: Khiabani_ak@yahoo.com.

2 Department of Research, Arka Education and Clinical Research Consultants, Tehran, Iran; Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran.

Kazem Khiabani et al.

Am J Infect Control .

2021 Sep .

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Affiliations

1 Department of Oral and Maxillofacial surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address: Khiabani_ak@yahoo.com.

2 Department of Research, Arka Education and Clinical Research Consultants, Tehran, Iran; Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran.

The forest plot of SARS-CoV-2 detection sensitivity of saliva, based on RT-PCR analysis from symptomatic COVID-19 patients regarding the disease's severity.
The forest plot of SARS-CoV-2 detection sensitivity of deep throat sputum based on RT-PCR analysis from symptomatic COVID-19 patients regarding the disease's severity.
The forest plot of SARS-CoV-2 detection sensitivity of the nasopharyngeal sample and double naso/oropharyngeal samples based on RT-PCR analysis from symptomatic COVID-19 patients regarding the disease's severity.
(A) Summary of the quality assessment of the included saliva-based studies; (B) Summary of the quality assessment of the included DTS-based studies.

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Objective:

The COVID-19 pandemic raises an urgent need for large-scale control through easier, cheaper, and safer diagnostic specimens, including saliva and sputum. We aimed to conduct a systemic review and meta-analysis on the reliability and sensitivity of SARS-CoV-2 detection in saliva and deep throat sputum (DTS) compared to nasopharyngeal, combined naso/oropharyngeal, and oropharyngeal swabs.

Methods:

This systematic review and meta-analysis was performed according to the PRISMA statement. The inclusion criteria were studies that specifically assessed a sample of saliva or DTS with at least one other respiratory specimen in patients with COVID-19 infection, based on RT-PCR tests. The DerSimonian-Laird bivariate random-effects model analysis performed using STATA software with the "metaprop" package.

Results:

From 1598 studies, we retrieved 33 records, of which 26 studies were included for quantitative analysis. We found an overall sensitivity of 97% (95% confidence interval [CI], 86-100) for bronchoalveolar lavage fluid, 92% (95% CI, 80-99) for double naso/oropharyngeal swabs, 87% (95% CI, 77-95) for nasopharyngeal swabs, 83% (95% CI, 77-89) for saliva, 82% (95% CI, 76-88) for DTS, and 44% (95% CI, 35-52) for oropharyngeal swabs among symptomatic patients, respectively. Regardless of the type of specimens, the viral load and sensitivity in the severe patients were higher than mild and in the symptomatic patients higher than asymptomatic cases.

Conclusions:

The present review provides evidence for the diagnostic value of different respiratory specimens and supports saliva and DTS as promising diagnostic tools for first-line screening of SARS-CoV-2 infection. However, the methods of sampling, storing, and laboratory assay need to be optimized and validated before introducing as a definitive diagnosis tool. Saliva, DTS, and nasopharyngeal swab showed approximately similar results, and sensitivity was directly related to the disease severity. This review revealed a relationship between viral load, disease severity, and test sensitivity. None of the specimens showed appropriate diagnostic sensitivity for asymptomatic patients.

Keywords:

COVID-19; Nasopharyngeal swab; Oropharyngeal swab; RT-PCR diagnostic test; Sensitivity; Sputum.

Copyright © 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The forest plot of SARS-CoV-2 detection sensitivity of saliva, based on RT-PCR analysis…
The forest plot of SARS-CoV-2 detection sensitivity of deep throat sputum based on…
The forest plot of SARS-CoV-2 detection sensitivity of the nasopharyngeal sample and double…
(A) Summary of the quality assessment of the included saliva-based studies; (B) Summary…

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PMC7987587

Am J Infect Control. 2021 Sep; 49(9): 1165–1176.
Published online 2021 Mar 24. doi: 10.1016/j.ajic.2021.03.008
a Department of Oral and Maxillofacial surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
b Department of Research, Arka Education and Clinical Research Consultants, Tehran, Iran
c Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran
⁎ Address correspondence to Kazem Khiabani, DMD, OMFS, Department of Oral and Maxillofacial surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Copyright © 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
This article has been cited by other articles in PMC.
Supplementary Figure S1 . PRISMA flow diagram of the selection process for identifying eligible records in the present systematic review and meta-analysis.
GUID: 1F341B5F-F3B3-4620-9611-517C03E831FE
Supplementary Figure S2 . The forest plot of SARS-CoV-2 detection sensitivity of saliva specimen based on RT-PCR analysis from symptomatic and asymptomatic COVID-19 patients regarding the disease's severity. The pooled sensitivity was 81% (95% CI= 74-87; I 2 = 81.26%), resulting from 90% (95% CI= 76-99; I 2 = 72.43%) for studies on critically ill (severe) patients, 81% (95% CI= 73-88; I 2 = 80.77%) for mild to moderate patients, and 46% (95% CI= 27-66) for asymptomatic patients. CI: Confidence Interval; I 2 : Inconsistency.
GUID: 54DA5430-D707-489E-B22F-1EE4912A2BC7
Supplementary Figure S3 . The forest plot of SARS-CoV-2 detection sensitivity of saliva specimen based on RT-PCR analysis from symptomatic COVID-19 patients regarding the method of disease confirmation. The pooled sensitivity was 83% (95% CI= 77-89; I 2 = 79.04%), resulting from 83% (95% CI= 68-95; I 2 = 85.23%) for studies of previously confirmed patients and 84% (95% CI= 77-90; I 2 = 65.21%) for studies based on pooled event rates. CI: Confidence Interval; I 2 : Inconsistency.
GUID: CDBFD172-59A3-4A74-B1C5-CFD81B6B207C
Supplementary Figure S4 . The pooled analysis of SARS-CoV-2 detection sensitivity of saliva, deep throat sputum (DTS), nasopharyngeal sample, oropharyngeal sample, double naso/oropharyngeal samples, and bronchoalveolar lavage fluid (BALF) from symptomatic COVID-19 patients based on RT-PCR analysis, including severe and mild patients.
GUID: 317C8FC4-4BD2-4FBB-98CA-A63D937DF13C
Supplementary Figure S5 . A. Quality assessment of the included saliva-based studies (individual assessment); B. Quality assessment of the included DTsputum-based studies (individual assessment).
GUID: 6C2035F3-D6E4-480D-93AF-25AA410680F6
Supplementary Table S1. Summary of characteristics of saliva-based studies.
GUID: 35071649-FF3A-4ED0-9289-D0430545D06E
Supplementary Table S2. Summary of characteristics of deep-throat sputum (DTS)-based studies.
GUID: 70A7AD1F-A2F6-4C8B-BEB2-D55E9C71F149
Key Words: COVID-19, Sputum, Nasopharyngeal swab, Oropharyngeal swab, Sensitivity, RT-PCR diagnostic test
Study was performed on patients who had been confirmed for COVID-19 infection by RT-PCR.
Diagnosis was based on a reference test, NPS or OPS or double NPS/OPS, collected in parallel with saliva or sputum (matched/paired sampling).
Infection was confirmed based on pooled event rates (positive and negative results) of saliva/ DTS and other respiratory specimens.
BALF, double NPS/OPS, NPS, saliva, and DTS, showed the highest sensitivity, respectively.
Saliva, DTS, and NPS showed approximately similar results.
Double NPS/OPS show higher viral detection than NPS; however, given the 5% difference in diagnosis, a rational and scientific decision is needed to continue to use combined NPS/OPS based on cost and benefit.
OPS is the most unreliable respiratory sample.
Viral load and disease severity and SARS-CoV-2 detection rate are directly related.
Viral load and sensitivity are higher in severe patients than mild patients.
Viral load and SARS-CoV-2 detection rate are significantly lower, and viral clearance is significantly faster in asymptomatic patients than in symptomatic individuals
Viral load is highest during the first week after symptom onset and subsequently declined with time.
None of the diagnostic specimens showed appropriate diagnostic se
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