COVID-19 with Positive Bronchoalveolar Lavage Fluid (BALF) But Negative Nasopharyngeal and Oropharyngeal Swabs: Case Report and Insights

Abstract

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mainly affects the respiratory system with some patients rapidly progressing to acute respiratory distress syndrome (ARDS). The most common symptoms of the patients are fever, cough, dyspnea, myalgia, and fatigue. Nasopharyngeal and oropharyngeal swab specimens tested by real-time reverse transcription-polymerase chain reaction (RT-PCR) are the most commonly used methods to diagnose COVID-19. Herein, we investigate and discuss a young case of COVID-19, without any pre-existing medical conditions, whose both nasopharyngeal and oropharyngeal swab tests of SARS-CoV-2 were negative in the prodromal phase. However, after three days, with severe dyspnea and rapidly progressed acute respiratory distress syndrome (ARDS), the case was identified as infected by COVID-19 by testing bronchoalveolar lavage fluid (BALF). The patient was intubated in the intensive care unit (ICU) but expired on the fourth day. This case shows the importance of active and accurate monitoring of the patients showing COVID-19 symptoms. Although the BALF test has a higher exposure risk, it is considered more accurate and recommended if performed by an expert operator.

Perbandingan Metode RT-PCR dan Tes Rapid Antibodi untuk Deteksi COVID-19

“…Selain pemilihan primer dan probe, jenis sampel yang digunakan juga mempengaruhi kemampuan RT-PCR untuk mendeteksi COVID-19. Akibat dari jumlah ekspresi angiotensin-converting enzyme-2 (ACE2) sebagai reseptor masuknya sel SARS-CoV-2 ke dalam tubuh yang lebih banyak diekspresikan di paru-paru dibandingkan saluran pernapasan atas, menyebabkan hasil deteksi di paru-paru lebih akurat namun risiko paparan akibat proses pengumpulan sampelnya pun lebih tinggi (Jahromi, Avazpour, Jahromi, & Alavi, 2020).…”