key: cord-0696192-3q201sa6
authors: Vannucci, Jacopo; Ruberto, Franco; Diso, Daniele; Galardo, Gioacchino; Mastroianni, Claudio M.; Raponi, Giammarco; Bassi, Massimiliano; Ceccarelli, Giancarlo; Mancone, Massimo; Antonelli, Guido; Venuta, Federico; Pugliese, Francesco
title: Usefulness of brochoalveolar lavage in suspect covid-19 repeatedly negative swab test and interstitial lung disease
date: 2020-08-15
journal: J Glob Antimicrob Resist
DOI: 10.1016/j.jgar.2020.07.030
sha: 3211d49d3b5f403537bd920a734af5f375e9ff43
doc_id: 696192
cord_uid: 3q201sa6

nan

COVID-19 diagnosis lies on nasopharyngeal swab that shows a 20-30% risk of false negativity (1) . Bronchoalveolar lavage (BAL) is reported to be useful in patients with pulmonary interstitial infiltrates at High Resolution Computed Tomography (HRCT). We investigated the usefulness of BAL in symptomatic patients with positive HRCT and a repeatedly negative swab test ("grey zone").

We performed a retrospective study on 81 consecutive patients (Male: 50) with HRCT suggestive of COVID-19 interstitial lung disease undergoing BAL. The study was approved by Ethics Committee (protocol number: 109/2020) All patients showing HRCT findings suggesting interstitial pneumonia and at least two negative nasopharyngeal swabs were included. When serological test for SARS-CoV-2 became available, patients were submitted to this test also; IgG and IgM were assessed using LIAISON® SARS-CoV-2 S1/S2 IgG (Italy). The last consecutive 42 patients were sampled. 

The number of pre-BAL negative swabs were 2 in 53 patients (65.4%) and 3 in 28 (34.6%).

At admission, symptoms were fever (> 37. 5 A high level of suspicion should be kept if epidemiology and clinical status of the patient support the doubt. In this setting, if doubts persist, the patient should be kept in the "grey area" and submitted to other exams. However, we now tend to discharge home or transfer BAL negative patients more liberally due to BAL's high negative predictive value. Moreover, since we have started to perform BAL in repeatedly swab negative patients (5), the "grey area" turnover of patients dramatically increased, reducing the hospital overload and giving the hospital management more chances to arrange spaces for other patients. We did not have patients with positive antibody and negative BAL but, in that case, the patients would have remained isolated in the "grey zone" and submitted to swab again. The "grey zone" was set up to offer a continuous monitoring of general and respiratory function in isolated spaces. Those patients with mild symptoms were discharged home and followed up by local medical resources. Hospital physicians were not involved in the out-patient recovery but we had no return to hospital from discharged patients becoming positive belatedly. 

The Appropriate Use of Testing for COVID-19

Detection of SARS-CoV-2 in Different Types of Clinical Specimens

Interpreting Diagnostic Tests for SARS-CoV-2

Usefulness of bronchoalveolar lavage in the management of patients presenting with lung infiltrates and suspect COVID-19-associated pneumonia: A case report

Negative Nasopharyngeal and Oropharyngeal Swabs Do Not Rule Out COVID-19