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Supplemento Speciale - Pandemia da SARS-CoV-2 (COVID-19)

IL VALORE DELLA MEDICINA DI LABORATORIO NELLA PANDEMIA DA SARS-CoV-2
The value of laboratory medicine in SARS-CoV-2 outbreak
M. Plebani  | 

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a challenge to all heathcare systems. It represents, however, a formidabile opportunity to highlight the value of laboratory medicine. Laboratory tests, in fact, play a key role in allowing the etiological diagnosis thanks to the reverse transcription-plymerase chain reaction (rRT-PCR) to detect the virus in nasopharingeal specimes as well as in other samples collected by using a flocked swab. The second essential contribution that laboratory tests are providing encompasses staging, prognostication and therapeutic monitoring of COVID-19. Finally, serological tests play a central role for surveillance purposes, for using plasma containing antibodies from recovered patients as experimental treatment and for better understanding the immune response to SARS-CoV-2 to eventually address vaccine developments.

TAG: SARS-CoV-2   COVID-19   medicina di laboratorio  
Biochimica Clinica
DOI: 10.19186/BC_2020.053
Pubblicato online il: 18.05.2020
COVID-19 - COVID-19
 
Guida sintetica alla diagnostica della malattia da coronavirus 2019 (COVID-19)
Concise guide to coronavirus disease 2019 (COVID-19) diagnostics

Several months after its emergence, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still prepotently disrupting health, societies and economies worldwide. The current approach for diagnosing SARS-CoV-2 remains based on identification of viral RNA by means of molecular biology techniques in upper or lower respiratory tracts specimens. Nevertheless, the development of immune response against the virus may also provide valuable diagnostic information. The paradigmatic kinetics of anti-SARS-CoV-2 antibodies in patients with COVID-19 would allow to conclude that serological testing shall not replace viral RNA detection in diagnosing acute SARS-CoV-2 infection, but may instead remain an essential tool for identifying patients who have been infected and have developed an immune response, as well as for monitoring the progress of herd immunity. For this purpose, the choice of the antigens used for constructing the immunoassays appears critical, as these shall use epitopes towards which neutralizing antibodies could be generated. Other important aspects in serological testing encompass the absence of cross-reactivity with other coronaviruses, the ability to distinguish the antibody class (i.e. IgG, IgA and/or IgM), quantitative assessment, wide range of linearity and low imprecision at diagnostic thresholds. A finalaspect, almost essential for both clinical and public health purposes, is the evidence of analytical and clinical validation before each method enters clinical practice.

TAG: SARS-CoV-2   COVID-19   diagnostica di laboratorio  
Biochimica Clinica
DOI: 10.19186/BC_2020.052
Pubblicato online il: 18.05.2020
COVID-19 - COVID-19
 
Diagnosi del diabete gestazionale durante l’emergenza COVID-19: semplificazione del protocollo
TAG: SARS-CoV-2   COVID-19   diabete gestazionale  
Biochimica Clinica
DOI: 10.19186/BC_2020.055
Pubblicato online il: 25.05.2020
COVID-19 - COVID-19
 
Importanza dello screening per il deficit di G6PD durante l’emergenza Covid-19
Screening for G6PD deficit during COVID-19 emergency

Hydroxychloroquine, a well known anti-malaria drug, is now widely used in the early treatment of patients infected with SARS-CoV-2. Since chloroquine and its derivatives may cause an acute hemolytic crisis in subjects with glucose 6-phoshpate dehydrogenase (G6PD) deficiency, with different penetrance in men and in women, we recommend that: a) before using these drugs, especially in elderly subjects, the G6PD catalytic activity should be quantitatively estimated; b) all the G6PD deficient subjects treated with chloroquine and its derivatives have to be characterized at molecular level, in order to identify G6PD deficient subjects in their families; c) to be on the safe side, the use of hydoxycholoroquine or chloroquine in carriers of severe G6PD deficiency, and infected by SARS-CoV-2, should be avoided; if treated, the patients should be alerted on the possible hemolytic risks, and care should be paid to the best laboratory indicators of such episodes (whole blood cell count, serum bilirubin, serum LDH, and hemoglobinuria).

TAG: SARS-CoV-2   COVID-19   G6PD  
Biochimica Clinica
DOI: 10.19186/BC_2020.059
Pubblicato online il: 29.05.2020
COVID-19 - COVID-19
 
Alterazioni dei meccanismi dell’emostasi in corso di infezione da SARS-CoV-2 (COVID-19)
Alterations of hemostasis during SARS-CoV-2 infection (COVID-19)

The corona virus infection (named COVID-19), first identified in December 2019 in Wuhan, China, has contributed to significant mortality in several countries with the number of infected cases increasing exponentially worldwide, in particular in Italy and in the USA. The majority of the most severely ill patients initially presents with single organ failure (i.e. severe respiratory syndrome), but some of them progress to more systemic disease and multiple organ failure (MOF). One of the most significant poor prognostic features in these patients is the development of coagulopathy, similarly to patients who develop sepsis from various infectious agents. Coagulopathy in patients with COVID-19 may be asymptomatic but, in some cases, the septic state may evolve into Sepsis-Induced Coagulopathy (SIC) and overt Disseminated Intravascular Coagulopathy (DIC). In patients with severe clinical manifestations, a cytokine storm occurs that contributes to triggering a greater imbalance of the hemostatic mechanisms by promoting the development of microthrombosis at the level of the pulmonary endothelium. The effectiveness of anticoagulant therapies, performed primarily with low-molecular weight heparin, is greater the earlier the diagnosis is made. This is possible through the adoption of diagnostic protocols that include laboratory tests and clinical scores. The laboratory tests suggested for this purpose by the available Guidelines are prothrombin time, platelet count, D-dimer and fibrinogen. D-dimer appears to be the parameter with the greatest prognostic significance since it also allows a stratification of the thrombotic risk.

TAG: SARS-CoV-2   COVID-19   emostasi  
Biochimica Clinica
DOI: 10.19186/BC_2020.056
Pubblicato online il: 01.06.2020
COVID-19 - COVID-19
 
Valutazione di IgG e IgM anti-SARS-CoV-2 su Maglumi 800 (Snibe)
Evaluation of Anti-SARS-CoV-2 immunoglobulin G and M on Snibe Maglumi 800

Introduction: the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a due to new beta-coronavirus causing the pandemic called Coronavirus disease 2019 (COVID-19). The evaluation of the presence of immunoglobulin G and M anti-SARS-CoV-2 (IgG and IgM) is important to understand the epidemiology of the disease and to confirm the presence of the disease when clinical signs are present, but RNA is not detected.
Methods: leftover serum samples from different types of patients were used: sera from biobank collected in 2018 as negative controls; patients recovering from the disease as positive controls; patients presenting at the Emergency Room with a positive rhino-pharyngeal swab; patients in Intensive Care Units. Anti-SARS-CoV-2 IgG and IgM were measured with MAGLUMI 2019-nCoV IgM/IgG Kits on Maglumi 800.
Results: one out of 61 expected negative resulted positive, and 2 were borderline for IgG (95% specificity, 95%CI 89.6-100), 1 positive for IgM (98.4% specificity, 95%CI 95.2-100); one out of 41 expected IgG positive resulted negative (97.6% sensitivity, 95%CI 92.8-100). All the 13 Intensive Care patients were positive for IgG, 11 for IgM. IgG were negative in 50.9% of the 55 swab positive from Emergency Room patients, while IgM were negative in 87.3%.
Discussion: sensitivity and specificity of the test appear good for IgG, some false positive is expected and low antibody titles in subjects with no disease story should be rechecked with an alternative method. IgM show a good specificity, but the unexpected low percentage of positivity in Emergency Room patients compared to IgG, pose some relevant doubts on the sensitivity of the test.

TAG: SARS-CoV-2   COVID-19   indagini epidemiologiche  
Biochimica Clinica
DOI: 10.19186/BC_2020.054
Pubblicato online il: 25.05.2020
COVID-19 - COVID-19
 
Prevalenza di anticorpi anti-SARS-CoV-2 in una popolazione di operatori sanitari e amministrativi di un ospedale toscano
Serum prevalence of anti-SARS-CoV-2 antibody in a population of health care and administrative workers in a hospital in Tuscany (Italy).
F. Balboni  |  A. Baldini  |  G. Forgeschi  |  F. Sequi  |  S. Burbui  |  G. Lippi  | 

Introduction: the challenges due to COVID-19 pandemic forced scientific community to focus their efforts to improve diagnosis and management of patients. The recognized gold standard for the diagnosis is the reverse transcription polymerase chain reaction (RT-PCR) on orofaringeal and nasal swabs. Recently, the antibody detection surge to attention with the aim of estimating the epidemiological impact of the pandemic.
Methods: the Screen Test COVID-19 2019-nCov IgG/IgM (Screen Italia, Perugia, Italy) an immunochromatographic lateral flow test has been used to assess the immunological status of 356 asymptomatic healthcare and administrative workers of our hospital.
Results: only 26 (7.3%) of the screened subjects was positive for IgM and/or IgG anti SARS-CoV-2 virus although the beginning of the epidemic in Tuscany can be dated two months before. The RT-PCR performed on these samples revealed that only 5 (19%) of them were positive for viral RNA on orofaringeal swab.
Conclusions: antibody detection will be of great value in the near future to assess global pandemic impact on population and to drive health policy for the lock down release.

TAG: SARS-CoV-2   COVID-19   screening  
Biochimica Clinica
DOI: 10.19186/BC_2020.057
Pubblicato online il: 01.06.2020
COVID-19 - COVID-19