Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Sep 20, 2021; 11(4): 44-54
Published online Sep 20, 2021. doi: 10.5493/wjem.v11.i4.44
Role of serological rapid antibody test in the management of possible COVID-19 cases
Fatma Yıldırım, Pinar Yildiz Gulhan, Özlem Ercen Diken, Aylin Capraz, Meltem Simsek, Berna Botan Yildirim, Muhammet Ridvan Taysi, Sakine Yilmaz Ozturk, Nurcan Demirtas, Julide Ergil, Adem Dirican, Tugce Uzar, Irem Karaman, Sevket Ozkaya
Fatma Yıldırım, Department of Pulmonary and Critical Care Medicine, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey
Pinar Yildiz Gulhan, Department of Pulmonary Medicine, Düzce University, Faculty of Medicine, Düzce 81100, Turkey
Özlem Ercen Diken, Department of Chest Diseases, Adana Research and Education Hospital, University of Health Sciences, Adana 01230, Turkey
Aylin Capraz, Department of Pulmonary Medicine, Amasya University Sabuncuoglu Serefeddin Research and Education Hospital, Amasya 05200, Turkey
Meltem Simsek, Medical Intensive Care Unit, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey
Berna Botan Yildirim, Department of Pulmonology, Research and Education Hospital of Baskent University, Konya 42030, Turkey
Muhammet Ridvan Taysi, Department of Infectious and Clinical Microbiology, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey
Sakine Yilmaz Ozturk, Department of Pulmonary Medicine, Vezirkopru State Hospital, Samsun 55090, Turkey
Nurcan Demirtas, Department of Pulmonary Medicine, Kumluca State Hospital, Antalya 07070, Turkey
Julide Ergil, Department of Anaesthesiology and Reanimation, Diskapi Yildirim Beyazit Research and Education Hospital, University of Health Sciences, Ankara 06110, Turkey
Adem Dirican, Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun 55090, Turkey
Tugce Uzar, Irem Karaman, Medical Student/Intern, Bahcesehir University Faculty of Medicine, Istanbul 34734, Turkey
Sevket Ozkaya, Department of Pulmonary Medicine, Bahcesehir University, Faculty of Medicine, Istanbul 34734, Turkey
Author contributions: Yıldırım F, Gulhan PY, Diken ÖE, Capraz A, Şimsek M, Yildirim BB, Taysi MR, Ozturk SY, Demirtas N, Ergil J, Dirican A, and Ozkaya S collected and analyzed the data and wrote the first draft of the manuscript; Uzar T and Karaman I reviewed the literature and wrote the seconddraft of the manuscript; All authors contributed equally and approved the final version of the manuscript.
Institutional review board statement: This is a retrospective multi-center study which is the responsibility of the institutional review committee of relevant colleges and universities. No patient name, address, images or any identifier or patient were used in this study.
Informed consent statement: The informed consent statement was waived.
Conflict-of-interest statement: All authors have contributed significantly, and that all authors are in agreement with the content and honesty of the manuscript. All authors declare that they have no conflict of interest.
Data sharing statement: Data is available from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sevket Ozkaya, MD, Associate Professor, Doctor, Department of Pulmonary Medicine, Bahcesehir University, Faculty of Medicine, Sahrayı Cedit District, Batman Street, No. 66, 34734 Kadıköy, Istanbul 34734, Turkey. ozkayasevket@yahoo.com
Received: January 12, 2021
Peer-review started: January 12, 2021
First decision: July 8, 2021
Revised: July 26, 2021
Accepted: September 1, 2021
Article in press: September 1, 2021
Published online: September 20, 2021
Processing time: 247 Days and 0.8 Hours
Abstract
BACKGROUND

Although the detection of viral particles by reverse transcription polymerase chain reaction (RT-PCR) is the gold standard diagnostic test for coronavirus disease 2019 (COVID-19), the false-negative results constitute a big challenge.

AIM

To examine a group of patients diagnosed and treated as possible COVID-19 pneumonia whose multiple nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR but then serological immunoglobulin M/immunoglobulin G (IgM/IgG) antibody against SARS-CoV-2 were detected by rapid antibody test.

METHODS

Eighty possible COVID-19 patients who had at least two negative consecutive COVID-19 RT-PCR test and were subjected to serological rapid antibody test were evaluated in this study.

RESULTS

The specific serological total IgM/IgG antibody against SARS-CoV-2 was detected in twenty-two patients. The mean age of this patient group was 63.2± 13.1-years-old with a male/female ratio of 11/11. Cough was the most common symptom (90.9%). The most common presenting chest computed tomography findings were bilateral ground glass opacities (77.2%) and alveolar consolidations (50.1%). The mean duration of time from appearance of first symptoms to hospital admission, to hospital admission, to treatment duration and to serological positivity were 8.6 d, 11.2 d, 7.9 d, and 24 d, respectively. Compared with reference laboratory values, serologically positive patients have shown increased levels of acute phase reactants, such as C-reactive protein, ferritin, and procalcitonin and higher inflammatory markers, such as erythrocyte sedimentation rate, lactate dehydrogenase enzyme, and fibrin end-products, such as D-dimer. A left shift on white blood cell differential was observed with increased neutrophil counts and decreased lymphocytes.

CONCLUSION

Our study demonstrated the feasibility of a COVID-19 diagnosis based on rapid antibody test in the cases of patients whose RT-PCR samples were negative. Detection of antibodies against SARS-CoV-2 with rapid antibody test should be included in the diagnostic algorithm in patients with possible COVID-19 pneumonia.

Keywords: COVID-19; Rapid antibody test; Reverse transcription polymerase chain reaction; High resolution computed tomography; Serology; Pneumonia

Core Tip: This is the first clinical retrospective study in Turkey that reports the features of the patients that were diagnosed and treated as possible coronavirus disease 2019 (COVID-19) cases whose multiple nasopharyngeal swab samples were negative by reverse transcription polymerase chain reaction (RT-PCR) but serological immunoglobulin M/immunoglobulin G antibody against severe acute respiratory syndrome coronavirus 2 was detected by a rapid antibody test. Our study demonstrated the feasibility of COVID-19 diagnosis based on rapid antibody tests in the cases of patients whose RT-PCR samples were negative. An effective diagnosis for COVID-19 is likely to require a hybrid strategy of PCR and serologic testing with the radiological demonstration.