Use of Saliva for Diagnosis and Monitoring the SARS-CoV-2: A General Perspective
Abstract
:1. Introduction
2. Advantages of the Use of Saliva
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- It can be collected by the patient, even at home, minimizing the exposure of health care workers to nosocomial infections. This also reduces the need for health care personnel and waiting times for sample collection, resulting in easier crowd control regulations in clinical settings and thus avoiding further virus transmission.
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- It is easily accepted by the patients since it is non-painful and non-stressful. Therefore, it can be used for serial samplings and in large scale or epidemiological studies, being especially advantageous in certain populations, such as children [11].
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- It is easy, fast, and cheap to collect, allowing widespread testing.
3. Quantification of Coronavirus in Saliva
3.1. Evidence for SARS-CoV-2 in Saliva
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- The group of Dr. To published two reports using saliva collected by asking the patient to cough out saliva from their throat into a sterile container and adding a viral transport medium to the sample [12,13]. These samples, in addition to salivary gland secretions, contained material from the posterior oropharynx, that could have come from respiratory secretions swept up from the tracheal–bronchial tree, and also secretions coming down from the nasopharynx.In these reports, the RNA of the virus was identified in the saliva of 20 out of 23 patients who had previously been confirmed as infected by the detection of SARS-CoV-2 RNA in their nasopharyngeal or sputum specimens, giving an overall diagnostic sensitivity of 87%. In addition, saliva tested negative in 33 patients from whom nasopharyngeal specimens were negative for SARS-Cov-2. The detection of the virus was by a real-time reverse transcription-quantitative polymerase chain reaction (rRT-PCR) and the range of values was from 9.9 × 102 copies/mL to 1.2 × 108 copies/mL.
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- Azzi et al. [14] collected saliva through passive drool. In cases of patients who were undergoing endotracheal intubation and mechanical ventilation, the collection was performed intraorally by a physician with the use of a pipette. These specimens possibly also contained respiratory secretions. In these conditions, SARS-CoV-2 was detected in all saliva samples collected from a group of 25 patients with severe to very severe disease, who were diagnosed by detection of the virus in pharyngeal or bronchoalveolar swabs. An rRT-PCR that detected a trend in viral load without quantification of the viral copies per millimeter, was used for virus detection.In this study, two patients who were monitored showed positive salivary results on the same days that their pharyngeal or bronchoalveolar swabs were negative. This raises the possibility that individuals can be contagious through their saliva even when pharyngeal swabs are negative. This could be a point in favor of the use of saliva for the virus detection and would be in line with the description of salivary glands as potential reservoirs for Covid-19 in asymptomatic but infected people [15].
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- Han et al. [16] collected saliva from a 27-day-old neonate diagnosed with Covid-19 and reported values in the range of 105 copies/mL that were similar to the values obtained with pharyngeal swabs but lower than those from bronchoalveolar swabs.
3.2. Evidence from the Previous SARS-CoV Epidemic
3.3. Evidence from Other Coronavirus and Virus in General
4. Quantification of Specific Antibodies against Virus in Saliva
5. Quantification of Markers of the Non-Specific Immune Response in Saliva
6. Saliva as a Source for New Disease Biomarkers and/or Understanding of Pathways Involved in Disease
7. Recommendations and Points to Improve for an Optimal Use of Saliva as Sample
8. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Ceron, J.J.; Lamy, E.; Martinez-Subiela, S.; Lopez-Jornet, P.; Capela-Silva, F.; Eckersall, P.D.; Tvarijonaviciute, A. Use of Saliva for Diagnosis and Monitoring the SARS-CoV-2: A General Perspective. J. Clin. Med. 2020, 9, 1491. https://doi.org/10.3390/jcm9051491
Ceron JJ, Lamy E, Martinez-Subiela S, Lopez-Jornet P, Capela-Silva F, Eckersall PD, Tvarijonaviciute A. Use of Saliva for Diagnosis and Monitoring the SARS-CoV-2: A General Perspective. Journal of Clinical Medicine. 2020; 9(5):1491. https://doi.org/10.3390/jcm9051491
Chicago/Turabian StyleCeron, Jose J., Elsa Lamy, Silvia Martinez-Subiela, Pia Lopez-Jornet, Fernando Capela-Silva, Peter David Eckersall, and Asta Tvarijonaviciute. 2020. "Use of Saliva for Diagnosis and Monitoring the SARS-CoV-2: A General Perspective" Journal of Clinical Medicine 9, no. 5: 1491. https://doi.org/10.3390/jcm9051491