Detection of SARS-CoV-2 by real time Reverse Transcriptase-Polymerase Chain Reaction assay in pleural effusion

Detection of SARS-CoV-2 by real time Reverse Transcriptase-Polymerase Chain Reaction assay in pleural effusion

Gatti E. MD1, Ulisciani S. MD2, Guglielmo M.  MD1*, Tinivella M. MD2, Farina C. MD2, Ascenzi C. MD2, Righi L. MD3, De Renzi G. MD4, Ciacco C. MD1

1Respiratory Physiopathology Department and COVID Department, San Luigi Gonzaga   Hospital, Orbassano, Torino, Italy. 2COVID Department, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy 3Pathology Unit, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. 4Microbiology Department, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.

SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a novel coronavirus identified for the first time in Wuhan (China) in 2019, responsible of the current pandemic infection known as Coronavirus-19 disease (COVID-19). Wide range of clinical presentation of COVD -19 has been observed, from asymptomatic carriers to ARDS.

The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnoea; the severity of the disease is due to the impairment of the respiratory function.

The radiological findings include a large variety of lesions; bilateral interstitial pneumonia is the most concerning presentation of COVID-19. Pleural involvement has been described in a minority of cases: pleural thickening had been observed in 32% of cases whereas pleural effusion is uncommon being described in only 5%. Furthermore, pleural involvement has been significantly associated with a worse prognosis.

Coronavirus 2 (SARS-CoV-2), beyond the nasopharyngeal swab, has been detected in other samples; up to now, data about RT-PCR specific results in the pleural fluid of patients suffering from coronavirus disease 2019 5 (COVID-19) are very limited.

The current gold standard for diagnosis is nucleic acid detection by real time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in nasopharyngeal swab.

In this report, a case of a positive RT-PCR for Sars-Cov-2 in the pleura fluid and in the naso- pharyngeal swab of a patient affected by bilateral interstitial pneumonia and severe respiratory failure is described.

As the presence of SARS-Cov-2 in the pleural fluid seems to be associated to a poor prognosis, physicians should carry out the specific RT-PCR assay both in the nasopharyngeal swab and in the pleural sample also when the fluid amount is very scarce and not recognizable in the chest X ray. Furthermore, the analysis of multiple samples allows to increase the test reliability.

Keywords: COVID-19; SARS-CoV-2; Pleural effusion

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How to cite this article:

Gatti E., Ulisciani S., Guglielmo M., Tinivella M., Farina C., Ascenzi C., Righi L., De Renzi G., Ciacco C.. Detection of SARS-CoV-2 by real time Reverse Transcriptase-Polymerase Chain Reaction assay in pleural effusion. International Journal of Case Reports, 2021; 5:201. DOI: 10.28933/ijcr-2021-02-1605


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