Advanced search
Publication Cover
Acta Clinica Belgica
International Journal of Clinical and Laboratory Medicine
Volume 77, 2022 - Issue 2
Submit an article Journal homepage
1,638
Views
4
CrossRef citations to date
0
Altmetric
Research Article

Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol

J. De Clercqa Department of Internal Medicine and Paediatrics, Ghent University, Ghent, BelgiumORCID Iconhttps://orcid.org/0000-0001-9291-0658View further author information
ORCID Icon,
T. Malfaitb Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
,
S. Malfaitc Strategic Policy Unit, Ghent University Hospital, Ghent, BelgiumView further author information
,
J. Boelensd Department of Medical Microbiology, Ghent University Hospital, Ghent, BelgiumView further author information
,
L. Coorevitsd Department of Medical Microbiology, Ghent University Hospital, Ghent, BelgiumView further author information
,
E. Padalkod Department of Medical Microbiology, Ghent University Hospital, Ghent, BelgiumView further author information
,
S. Vandendriessched Department of Medical Microbiology, Ghent University Hospital, Ghent, BelgiumView further author information
,
B. Verhasseltd Department of Medical Microbiology, Ghent University Hospital, Ghent, BelgiumView further author information
,
L. Morbéee Department of Radiology, Ghent University Hospital, Ghent, BelgiumView further author information
,
F. Bautersb Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
,
K. Hertegonnea Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;b Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
,
D. Stevensb Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
,
Y. Vande Weygaerdeb Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
,
K. Vermaelena Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;b Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
,
W. Van Biesena Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;f Department of Nephrology, Ghent University Hospital, Ghent, BelgiumORCID Iconhttps://orcid.org/0000-0002-4782-5224View further author information
ORCID Icon,
F. Vanommeslaeghef Department of Nephrology, Ghent University Hospital, Ghent, BelgiumView further author information
,
F. Verbekea Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;f Department of Nephrology, Ghent University Hospital, Ghent, BelgiumView further author information
,
R. Piersa Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;g Department of Geriatrics, Ghent University Hospital, Ghent, BelgiumView further author information
,
N. Van Den Noortgatea Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;g Department of Geriatrics, Ghent University Hospital, Ghent, BelgiumView further author information
,
T. Desmeth Emergency Department, Ghent University Hospital, Ghent, BelgiumView further author information
,
F. Vermasseni Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, BelgiumView further author information
,
L. Vandekerckhovea Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;j Department of General Internal Medicine, Ghent University Hospital, Ghent, BelgiumView further author information
&
E. Van Braeckela Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium;b Department of Respiratory Medicine, Ghent University Hospital, Ghent, BelgiumCorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-7242-0747View further author information
ORCID Icon show all
Pages 368-376 | Published online: 13 Feb 2021
 
Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days

ABSTRACT

Introduction

We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19.

Results

Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group.

Conclusion

In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.

Acknowledgments

We would like to acknowledge all staff of Ghent University Hospital involved in the care for patients with COVID-19.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by internal funding.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Order Reprints Request Corporate Permissions

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

Request Academic Permissions

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.

Related research

People also read lists articles that other readers of this article have read.

Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine.

Cited by lists all citing articles based on Crossref citations.
Articles with the Crossref icon will open in a new tab.