Utility of Stool PCR for the Diagnosis of COVID-19: Comparison of Two Commercial Platforms

The ability to detect SARS-CoV-2 in the upper respiratory tract ceases after 2 to 3 weeks post-symptom-onset in most patients. In contrast, SARS-CoV-2 can be detected in the stool of some patients for greater than 4 weeks, suggesting that stool may hold utility as an additional source for diagnosis....

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Veröffentlicht in:Journal of clinical microbiology 2020-08, Vol.58 (9)
Hauptverfasser: Szymczak, Wendy A, Goldstein, D Yitzchak, Orner, Erika P, Fecher, Roger A, Yokoda, Raquel T, Skalina, Karin A, Narlieva, Momka, Gendlina, Inessa, Fox, Amy S
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container_issue 9
container_start_page
container_title Journal of clinical microbiology
container_volume 58
creator Szymczak, Wendy A
Goldstein, D Yitzchak
Orner, Erika P
Fecher, Roger A
Yokoda, Raquel T
Skalina, Karin A
Narlieva, Momka
Gendlina, Inessa
Fox, Amy S
description The ability to detect SARS-CoV-2 in the upper respiratory tract ceases after 2 to 3 weeks post-symptom-onset in most patients. In contrast, SARS-CoV-2 can be detected in the stool of some patients for greater than 4 weeks, suggesting that stool may hold utility as an additional source for diagnosis. We validated the Cepheid Xpert Xpress SARS-CoV-2 and Hologic Panther Fusion real-time RT-PCR assays for detection of viral RNA in stool specimens and compared performance. We utilized remnant stool specimens ( = 79) from 77 patients with gastrointestinal symptoms. Forty-eight patients had PCR-confirmed COVID-19, and 29 either were nasopharyngeal/oropharyngeal PCR negative or presented for reasons unrelated to COVID-19 and were not tested. Positive percent agreement between the Cepheid and Hologic assays was 93% (95% confidence interval [CI]: 81.1% to 98.2%), and negative percent agreement was 96% (95% CI: 89% to 0.99%). Four discrepant specimens (Cepheid positive only, = 2; Hologic positive only, = 2) exhibited average cycle threshold ( ) values of >37 for the targets detected. Of the 48 patients with PCR-confirmed COVID-19, 23 were positive by both assays (47.9%). For the negative patient group, 2/29 were positive by both assays (6.9%). The two stool PCR-positive, nasopharyngeal/oropharyngeal PCR-negative patients were SARS-CoV-2 IgG positive. Our results demonstrate acceptable agreement between two commercially available molecular assays and support the use of stool PCR to confirm diagnosis when SARS-CoV-2 is undetectable in the upper respiratory tract.
doi_str_mv 10.1128/JCM.01369-20
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source American Society for Microbiology; MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central
subjects Betacoronavirus - genetics
Clinical Laboratory Techniques - methods
Clinical Laboratory Techniques - standards
Clinical Laboratory Techniques - statistics & numerical data
Coronavirus Infections - diagnosis
COVID-19
COVID-19 Testing
COVID-19 Vaccines
Feces - virology
Humans
Limit of Detection
Pandemics
Pneumonia, Viral - diagnosis
Polymerase Chain Reaction - methods
Polymerase Chain Reaction - standards
Polymerase Chain Reaction - statistics & numerical data
Reproducibility of Results
RNA, Viral - analysis
RNA, Viral - genetics
SARS-CoV-2
Virology
title Utility of Stool PCR for the Diagnosis of COVID-19: Comparison of Two Commercial Platforms
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