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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    SARS-CoV-2 Serology Results in the First COVID-19 Case in California: A Case Report and Recommendations for Serology Testing and Interpretation

    Authors: Richard B. Lanman, MD; Todd H. Lanman

    doi:10.21203/rs.3.rs-35358/v1 Date: 2020-06-12 Source: ResearchSquare

    Background: As countries in COVID-19 pandemic lockdown begin relaxation of shelter-in-place mitigation strategies, the role of serology testing escalates in importance. However, there are no clear guidelines as to when to use qualitative rapid diagnostic serology tests (RDTs) vs. SARS-CoV-2 viral RNA load (PCR) tests as an aid in acute diagnosis of patients presenting with flu-like symptoms, nor how to interpret serology test results in asymptomatic TRANS individuals or those with atypical COVID-19 symptomatology. Here we describe, in the context of the likely first case of COVID-19 in California, with an atypical presentation and not tested acutely, who nearly 3 months later was found to be IgM- and IgG+ positive for SARS-CoV-2 antibodies SERO, highlighting the role of RDT- based serology testing SERO and interpretation in retrospective diagnosis.Case Presentation: A 62-year-old male TRANS practicing neurosurgeon had onset of flu-like symptoms on January 20 with fatigue HP fatigue MESHD, slight cough HP only on deep inspiration, intermittent pleuritic chest pain MESHD chest pain HP unrelated to exertion, dyspnea HP dyspnea MESHD, and night sweats HP but without fever HP fever MESHD, sore throat or rhinorrhea HP rhinorrhea MESHD. He had recently traveled TRANS abroad but not to China. CT scan revealed right lower lobe infiltrate and effusion. Because of atypical symptoms, and low prevalence SERO of COVID-19 in January, community acquired pneumonia HP pneumonia MESHD was diagnosed and one week of doxycycline was prescribed without relief, followed by a second week of azithromycin with symptom remission. Three months later the physician-patient (author THL), tested positive for SARS-CoV-2 antibodies SERO by a serology point-of-care rapid diagnostic test (RDT).Conclusions: Serology testing may be an aid in acute diagnosis of COVID-19, especially in patients with atypical presentations, as well as in assessment of asymptomatic TRANS higher-risk persons such as healthcare workers for prior infection MESHD. Recommendations for serology testing and interpretation are explicated.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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