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False-negative RT-PCR in SARS-CoV-2 disease: experience from an Italian COVID-19 unit

Marcello Di Paolo, Alessandra Iacovelli, Federica Olmati, Ilaria Menichini, Alessandra Oliva, Martina Carnevalini, Elda Graziani, Claudio Maria Mastroianni, Paolo Palange
ERJ Open Research 2020 6: 00324-2020; DOI: 10.1183/23120541.00324-2020
Marcello Di Paolo
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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  • ORCID record for Marcello Di Paolo
  • For correspondence: marcello.dipaolo@uniroma1.it
Alessandra Iacovelli
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Federica Olmati
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Ilaria Menichini
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Alessandra Oliva
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Martina Carnevalini
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Elda Graziani
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Claudio Maria Mastroianni
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Paolo Palange
Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Tables

  • TABLE 1

    Patients’ characteristics

    Age years59.5 (30–86)
    Males/females n11/5
    Comorbidities
     Arterial hypertension11 (68.7%)
     Type 2 diabetes mellitus5 (31.2%)
     Malignancies2 (12.5%)
     Pre-existing respiratory diseases3 (18.7%)
     Other6 (37.5%)
    Data at hospital admission
     Time between symptoms onset and admission days5 (0–15)
     Reported symptoms
      Fever ≥38.0°C14 (87.5%)
      Dyspnoea14 (87.5%)
      Cough7 (43.7%)
      Gastrointestinal symptoms2 (12.5%)
      Other3 (18.7%)
     Body temperature °C37.5 (37.2–38.9)
     Blood gas analysis#
      PaO2 mmHg69 (48–98)
      PaCO2 mmHg31 (27–38)
      pH7.46 (7.39–7.52)
      PaO2/FIO2 mmHg329 (228–467)
     Laboratory findings
      Haemoglobin g·dL−113.8 (9.2–15.0)
      Red blood cells ×1012 per L4.7 (3–0–5.4)
      White blood cells ×109 per L8.6 (3.8–20.6)
      Neutrophils ×109 per L7.2 (3.9–18.9)
      Lymphocytes ×109 per L0.8 (0.4–2.0)
      Monocytes ×109 per L0.4 (0.1–3.0)
      Platelets ×109 per L231.0 (102.0–561.0)
      C-reactive protein g·dL−113.6 (1.1–37.5)
      Ferritin µg·L−1371 (80–1364)
      D-dimer µg·L−11256 (197–4473)
    Respiratory support
     Oxygen12 (75.0%)
     Positive end-expiratory pressure7 (43.7%)
     High-flow nasal cannula1 (6.2%)
     Noninvasive ventilation0 (0%)
     Orotracheal intubation0 (0%)
    Length of hospitalisation days25 (8–49)
    Outcome
     Discharge home14 (87.5%)
     Intensive care unit0 (0%)
     Death2 (12.5%)
    RT-PCR assays
     Nasopharyngeal swabs66 (89.2%)
     BALF6 (8.1%)
     Rectal swabs2 (2.7%)
    RT-PCR repetitions during hospital stay/time from symptom onset days
     316 (100%)/8 (2–20)
     413 (81.2%)/18 (9–27)
     59 (56.2%)/21 (10–27)
     64 (25.0%)/24 (17–24)
    RT-PCR positive results¶
     Patients3 (18.7%)
     Testing3 (4.1%)
    Anti-SARS-CoV-2 serum antibodies+
     IgM8 (88.9%)
     IgG9 (100%)
     Time from symptom onset days25 (20–35)

    Data are presented as median (range) or n (%), unless otherwise stated. FIO2: inspiratory oxygen fraction; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; BALF: bronchoalveolar lavage fluid. #: FIO2 0.21; ¶: after two first negative results; +: N=9.

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    False-negative RT-PCR in SARS-CoV-2 disease: experience from an Italian COVID-19 unit
    Marcello Di Paolo, Alessandra Iacovelli, Federica Olmati, Ilaria Menichini, Alessandra Oliva, Martina Carnevalini, Elda Graziani, Claudio Maria Mastroianni, Paolo Palange
    ERJ Open Research Apr 2020, 6 (2) 00324-2020; DOI: 10.1183/23120541.00324-2020

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    False-negative RT-PCR in SARS-CoV-2 disease: experience from an Italian COVID-19 unit
    Marcello Di Paolo, Alessandra Iacovelli, Federica Olmati, Ilaria Menichini, Alessandra Oliva, Martina Carnevalini, Elda Graziani, Claudio Maria Mastroianni, Paolo Palange
    ERJ Open Research Apr 2020, 6 (2) 00324-2020; DOI: 10.1183/23120541.00324-2020
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