SARS-CoV-2-Diagnostik – was ist wirklich sinnvoll?

Zusammenfassung

Den Goldstandard zur Diagnose einer Infektion mit SARS-CoV-2 stellt aktuell (Stand November 2020) die PCR-Untersuchung dar. Diese ist jedoch vor allem zeitintensiv. In Zukunft könnten sog. Antigentests schnell und patientennah als Point-of-Care-Methode durchgeführt werden, um die Diagnosestellung einer SARS-CoV-2 Infektion zu erleichtern. Veränderungen serologischer Biomarker (wie D-Dimere, Troponin T, CRP) können helfen, Patienten mit einem Risiko für einen schweren COVID-19-Verlauf zu identifizieren. Ein routinemäßiges Screening-CT-Thorax zur Identifizierung einer COVID-19-Pneumonie wird derzeit von den meisten radiologischen Gesellschaften nicht empfohlen. Dennoch nimmt die Zahl der durchgeführten CT-Untersuchungen kontinuierlich zu, und die radiologische Diagnostik nimmt bei an COVID-19 erkrankten Patienten mit pulmonalen Symptomen einen immer wichtigeren Stellenwert in der klinischen Erfassung der Schwere der Lungenbeteiligung ein.

Abstract

The PCR-test for SARS-CoV-2 represents the state of the art in diagnosing COVID-19 disease as at November 2020. However, above all this is time-consuming. In future, so-called antigen tests could be carried out quickly and as a point-of-care method to facilitate the diagnosis of COVID-19. Changes in serological biomarkers (such as D-dimers, troponin T, CRP) can help to identify patients at risk for a severe COVID-19 course. A routine screening CT thorax to identify COVID-19 pneumonia is currently not recommended by most radiological societies. However, the number of CT examinations is increasing steadily and radiological diagnosis in COVID-19 patients with pulmonary symptoms is becoming more and more important.

Was ist wichtig?

• Die PCR-Untersuchung auf SARS-CoV-2 stellt aktuell (Stand November 2020) den Goldstandard bei der Diagnosestellung einer COVID-19-Erkrankung dar.

• Aufgrund der kürzeren Testlaufzeiten und einfacheren Verwendung werden Antigentests in Zukunft an Bedeutung gewinnen.

• Eine rasche Diagnose der Infektion hilft, Infektionsketten zu durchbrechen und den Patienten eine Therapieoption anbieten zu können.

• Die radiologische Untersuchung beschränkt sich meist auf die Computertomografie (CT) des Thorax. Hier können sich bereits früh Zeichen einer COVID-19-Pneumonie zeigen. Zudem kann die CT helfen, den Schweregrad der Erkrankung abzuschätzen. Ein routinemäßiges Screening-CT-Thorax zur Identifizierung einer COVID-19-Pneumonie wird derzeit von den meisten radiologischen Gesellschaften nicht empfohlen [1].

Schlüsselwörter

COVID-19 - Diagnostik - PCR - Radiologie - CT - SARS-CoV-2

Key words

COVID-19 - diagnostic - PCR - radiology - CT - SARS-CoV-2

Publikationsverlauf

Artikel online veröffentlicht:
21. Januar 2021

• Literatur

• 1 Simpson S, Kay FU, Abbara S. et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA – Secondary Publication. J Thorac Imaging 2020; 35: 219-227 doi:10.1097/RTI.0000000000000524
• 2 Struyf T, Deeks JJ, Dinnes J. et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. Cochrane Database Syst Rev 2020; (07) CD013665 DOI: 10.1002/14651858.CD013665.
• 3 Richardson S, Hirsch JS, Narasimhan M. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020; DOI: 10.1001/jama.2020.6775.
• 4 Spinato G, Fabbris C, Polesel J. et al. Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection. JAMA 2020; DOI: 10.1001/jama.2020.6771.
• 5 Henry BM, Vikse J. Clinical Characteristics of Covid-19 in China. N Engl J Med 2020; 382: 1860-1861 doi:10.1056/nejmc2005203
• 6 Corman VM, Landt O, Kaiser M. et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020; DOI: 10.2807/1560-7917.es.2020.25.3.2000045.
• 7 Sethuraman N, Jeremiah SS, Ryo A. Interpreting Diagnostic Tests for SARS-CoV-2. JAMA 2020; DOI: 10.1001/jama.2020.8259.
• 8 He JL, Luo L, Luo ZD. et al. Diagnostic performance between CT and initial real-time RT-PCR for clinically suspected 2019 coronavirus disease (COVID-19) patients outside Wuhan, China. Respir Med 2020; DOI: 10.1016/j.rmed.2020.105980.
• 9 Sutjipto S, Lee PH, Tay JY. et al. The Effect of Sample Site, Illness Duration, and the Presence of Pneumonia on the Detection of SARS-CoV-2 by Real-time Reverse Transcription PCR. Open Forum Infect Dis 2020; 7: ofaa335 doi:10.1093/ofid/ofaa335
• 10 Wang W, Xu Y, Gao R. et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020; 323: 1843-1844 doi:10.1001/jama.2020.3786
• 11 Robert Koch-Institut. Hinweise zur Testung von Patienten auf Infektion mit dem neuartigen Coronavirus SARS-CoV-2. Im Internet (Stand: 30.11.2020): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Vorl_Testung_nCoV.html
• 12 He X, Lau EHY, Wu P. et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020; 26: 672-675 doi:10.1038/s41591-020-0869-5
• 13 Wölfel R, Corman VM, Guggemos W. et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581: 465-469 doi:10.1038/s41586-020-2196-x
• 14 van Kampen JJA, van de Vijver DAMC, Fraaij PLA. et al. Shedding of infectious virus in hospitalized patients with coronavirus disease-2019 (COVID-19): duration and key determinants. medRxiv 2020; DOI: 10.1101/2020.06.08.20125310.
• 15 La Scola B, Le Bideau M, Andreani J. et al. Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards. Eur J Clin Microbiol Infect Dis 2020; 39: 1059-1061 doi:10.1007/s10096-020-03913-9
• 16 Porte L, Legarraga P, Vollrath V. et al. Evaluation of a novel antigen-based rapid detection test for the diagnosis of SARS-CoV-2 in respiratory samples. Int J Infect Dis 2020; 99: 328-333 doi:10.1016/j.ijid.2020.05.098
• 17 Zhao J, Yuan Q, Wang H. et al. Antibody Responses to SARS-CoV-2 in Patients of Novel Coronavirus Disease 2019. Clin Infect Dis 2020; 71: 2027-2034 doi:10.1093/cid/ciaa344
• 18 Sun B, Feng Y, Mo X. et al. Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients. Emerg Microbes Infect 2020; 9: 940-948 doi:10.1080/22221751.2020.1762515
• 19 Lisboa Bastos M, Tavaziva G, Abidi SK. et al. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ 2020; DOI: 10.1136/bmj.m2516.
• 20 Lin Q, Zhu L, Ni Z, Meng H. et al. Duration of serum neutralizing antibodies for SARS-CoV-2: Lessons from SARS-CoV infection. J Microbiol Immunol Infect 2020; DOI: 10.1016/j.jmii.2020.03.015.
• 21 Singh N, Anchan RK, Besser SA. et al. High Sensitivity Troponin-T for Prediction of Adverse Events in Patients with COVID-19. Biomarkers 2020; DOI: 10.1080/1354750X.2020.1829056.
• 22 Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis 2020; 95: 304-307 doi:10.1016/j.ijid.2020.04.061
• 23 Han M, Xu M, Zhang Y. et al. Assessing SARS-CoV-2 RNA levels and lymphocyte/T cell counts in COVID-19 patients revealed initial immune status as a major determinant of disease severity. Med Microbiol Immunol 2020; DOI: 10.1007/s00430-020-00693-z.
• 24 Qun S, Wang Y, Chen J. et al. Neutrophil-to-Lymphocyte Ratios Are Closely Associated With the Severity and Course of Non-mild COVID-19. Front Immunol 2020; 11: 2160 doi:10.3389/fimmu.2020.02160
• 25 Song CY, Xu J, He JQ. et al. Immune dysfunction following COVID-19, especially in severe patients. Sci Rep 2020; 10: 15838 doi:10.1038/s41598-020-72718-9
• 26 Chung M, Bernheim A, Mei X. et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology 2020; 295: 202-207 doi:10.1148/radiol.2020200230
• 27 Wang D, Hu B, Hu C. et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069 doi:10.1001/jama.2020.1585
• 28 Kim H. Outbreak of novel coronavirus (COVID-19): What is the role of radiologists?. Eur Radiol 2020; 30: 3266-3267 doi:10.1007/s00330-020-06748-2
• 29 Kim H. Outbreak of novel coronavirus (COVID-19): what is the role of radiologists?. Eur Radiol 2020; DOI: 10.1007/s00330-020-06748-2.
• 30 Chung M, Bernheim A, Mei X. et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology 2020; 295: 202-207 doi:10.1148/radiol.2020200230
• 31 Bai HX, Hsieh B, Xiong Z. et al. Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CT. Radiology 2020; 296: E46-E54 doi:10.1148/radiol.2020200823
• 32 Pan F, Ye T, Sun P. et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology 2020; 295: 715-721 doi:10.1148/radiol.2020200370
• 33 Wu X, Cai Y, Huang X. et al. Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China. Emerg Infect Dis 2020; 26: 1324-1326 doi:10.3201/eid2606.200299
• 34 Shi H, Han X, Jiang N. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20: 425-434 doi:10.1016/S1473-3099(20)30086-4
• 35 Bernheim A, Mei X, Huang M. et al. Chest CT findings in coronavirus Disease-19 (COVID-19): relationship to duration of infection. Radiology 2020; DOI: 10.1148/radiol.2020200463.