Limited role for bronchoalveolar lavage to exclude COVID-19 after negative upper respiratory tract swabs: a multicentre study. Issue 4 (8th October 2020)

• Record Type: Journal Article
• Authors: Geri, Pietro; Salton, Francesco; Zuccatosta, Lina; Tamburrini, Mario; Biolo, Marco; Busca, Annalisa; Santagiuliana, Mario; Zuccon, Umberto; Confalonieri, Paola; Ruaro, Barbara; D'Agaro, Pierlanfranco; Gasparini, Stefano; Confalonieri, Marco
• Is Part Of: European respiratory journal. Volume 56:Issue 4(2020)
• Publication Date: 2020-10-08
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01733-2020
• Languages: English
• ISSNs: 0903-1936

Abstract

Despite early and reliable recognition of coronavirus disease 2019 (COVID-19) being essential for disease control both at a community and hospital level, clinical picture and thoracic imaging alone are not sufficiently specific to distinguish it from other respiratory infections [1, 2]. Real-time reverse transcriptase (RT)-PCR is routinely used for qualitative and quantitative severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) detection in specimens collected from the upper respiratory tract including nasal or nasopharyngeal swabs, but a second-line investigation like bronchoalveolar lavage (BAL) is often required to diagnose or exclude SARS-CoV-2 infection in a clinical context of possible COVID-19. A significantly lower positive rate in nasopharyngeal swabs (32%) compared to BAL samples (93%) was recently reported [3]; however, BAL was collected in only 15 out of 205 patients and in only one case BAL and nasopharyngeal swab were collected simultaneously. Given the strong agreement between negative upper respiratory swabs and BAL, this study suggests that BAL has a limited role in the diagnosis of COVID-19 if thoracic imaging and upper respiratory swabs are concordantly negative https://bit.ly/3gpBC75