Öz
Şiddetli akut solunum yolu sendromu Koronavirüs-2’nin (SARS-CoV-2) teşhisi için tükürük örneklerinin kullanımı, nazofaringeal sürüntülere kıyasla daha konforlu toplanması, kendi kendine toplama kolaylığı ve kişisel koruyucu ekipmanın daha az kullanımı ve sağlık personelinin kontaminasyondan korunması gibi çeşitli avantajlar sağlar. Çalışmamıza, SARS-CoV-2’nin saptanması için tükürük örneklerinin duyarlılık, döngü eşiği ve özgüllüklerini nazofaringeal sürüntüyle karşılaştıran güncel çalışmaları dahil ettik. Literatürdeki çalışmalarda tükürük örneklerinin SARS-CoV-2 tanısında duyarlılık oranlarının %70 ile %98 arasında olduğu bildirilmiştir. Birçok farklı görüşe rağmen, tükürüğün SARS-CoV-2’nin tespiti için güvenilir bir örnek olduğu sonucuna vardık. Ancak, kesin ve güvenilir sonuçlara ulaşmak ve tanı kılavuzlarına COVID-19 tanısında tükürük numunelerini dahil etmek için geniş örneklemlerle ve farklı tanı yöntemlerini karşılaştıran çalışmalara ihtiyaç vardır.
Anahtar Kelimeler: Tükürük, COVID-19, SARS-CoV-2, kendi kendine örnek alma, pandemi
Kaynakça
WHO, COVID-19 Dashboard. Available from: https://covid19.who.int Accessed date: 23.11.2020
Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, Azman AS, Reich NG, Lessler J. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020;172:577-82.
ACR Recommendations for the Use of Chest Radiography and Computed Tomography (CT) for Suspected COVID- 19 Infection; American College of Radiology: Reston, VA, USA, March 11 2020. Available from: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection
Lan L, Xu D, Ye G, Xia C, Wang S, Li Y, Xu H. Positive RT-PCR Test Results in Patients Recovered From COVID-19. JAMA. 2020;323:1502-3.
Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, Tan W. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323:1843-4.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
Wu Y, Guo C, Tang L, Hong Z, Zhou J, Dong X, Yin H, Xiao Q, Tang Y, Qu X, Kuang L, Fang X, Mishra N, Lu J, Shan H, Jiang G, Huang X. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020;5:434-5.
To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, Yip CC, Cai JP, Chan JM, Chik TS, Lau DP, Choi CY, Chen LL, Chan WM, Chan KH, Ip JD, Ng AC, Poon RW, Luo CT, Cheng VC, Chan JF, Hung IF, Chen Z, Chen H, Yuen KY. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20:565-74.
To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JM, Leung WS, Chik TS, Choi CY, Kandamby DH, Lung DC, Tam AR, Poon RW, Fung AY, Hung IF, Cheng VC, Chan JF, Yuen KY. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect Dis. 2020;71:841-3.
Azzi L, Carcano G, Gianfagna F, Grossi P, Gasperina DD, Genoni A, Fasano M, Sessa F, Tettamanti L, Carinci F, Maurino V, Rossi A, Tagliabue A, Baj A. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020;81:45-50.
Pfaffe T, Cooper-White J, Beyerlein P, Kostner K, Punyadeera C. Diagnostic potential of saliva: current state and future applications. Clin Chem. 2011;57:675-87.
Buduneli N, Kinane DF. Host-derived diagnostic markers related to soft tissue destruction and bone degradation in periodontitis. J Clin Periodontol. 2011;38:85-105.
Kinane DF, Preshaw PM, Loos BG; Working Group 2 of Seventh European Workshop on Periodontology. Host-response: understanding the cellular and molecular mechanisms of host-microbial interactions--consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011;38:44-8.
Chiappin S, Antonelli G, Gatti R, De Palo EF. Saliva specimen: a new laboratory tool for diagnostic and basic investigation. Clin Chim Acta. 2007;383:30-40.
Yokota I, Shane PY, Okada K, Unoki Y, Yang Y, Inao T, Sakamaki K, Iwasaki S, Hayasaka K, Sugita J, Nishida M, Fujisawa S, Teshima T. Mass screening of asymptomatic persons for SARS-CoV-2 using saliva. Clin Infect Dis. 2020:1388.
Khurshid Z, Zafar M, Khan E, Mali M, Latif M. Human saliva can be a diagnostic tool for Zika virus detection. J Infect Public Health. 2019;12:601-4.
Gorchakov R, Berry RM, Patel SM, El Sahly HM, Ronca SE, Murray KO. Optimizing PCR Detection of Zika Virus from Various Body Fluids. Am J Trop Med Hyg. 2019;100:427-33.
Niedrig M, Patel P, El Wahed AA, Schädler R, Yactayo S. Find the right sample: A study on the versatility of saliva and urine samples for the diagnosis of emerging viruses. BMC Infect Dis. 2018;18:707.
Wang WK, Chen SY, Liu IJ, Chen YC, Chen HL, Yang CF, Chen PJ, Yeh SH, Kao CL, Huang LM, Hsueh PR, Wang JT, Sheng WH, Fang CT, Hung CC, Hsieh SM, Su CP, Chiang WC, Yang JY, Lin JH, Hsieh SC, Hu HP, Chiang YP, Wang JT, Yang PC, Chang SC; SARS Research Group of the National Taiwan University/National Taiwan University Hospital. Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis. Emerg Infect Dis. 2004;10:1213-9.
Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi A, Nagy Á, Lohinai Z, Szakács Z, Hegyi P, Steward MC, Varga G. Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis. Front Med (Lausanne). 2020;7:465. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438940/
Aita A, Basso D, Cattelan AM, Fioretto P, Navaglia F, Barbaro F, Stoppa A, Coccorullo E, Farella A, Socal A, Vettor R, Plebani M. SARS-CoV-2 identification and IgA antibodies in saliva: One sample two tests approach for diagnosis. Clin Chim Acta. 2020;510:717-22.
Byrne RL, Kay GA, Kontogianni K, Aljayyoussi G, Brown L, Collins AM, Cuevas LE, Ferreira DM, Fraser AJ, Garrod G, Hill H, Hughes GL, Menzies S, Mitsi E, Owen SI, Patterson EI, Williams CT, Hyder-Wright A, Adams ER, Cubas- Atienzar AI. Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis. Emerg Infect Dis. 2020;26:2770-1.
Wyllie AL, Fourmier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, Geng B, Muenker MC, Moore AJ, Vogels CBF, Petrone ME, Ott IM, Lu P, Venkataraman A, Lu-Culligan A, Klein J, Earnest R, Simonov M, Datta R, Handoko R, Naushad N, Sewanan LR, Valdez J, White EB, Lapidus S, Kalinich CC, Jiang X, Kim DJ, Kudo E, Linehan M, Mao T, Moriyama M, Oh JE, Park A, Silva J, Song E, Takahashi T, Taura M, Weizman OE, Wong P, Yang Y, Bermejo S, Odio C, Omer SB, Dela Cruz CS, Farhadian S, Martinello RA, Iwasaki A, Grubaugh ND, Ko AI. Saliva is more sensitive for SARS-CoV-2 detectionin COVID-19 patients than nasopharyngeal swabs. N Engl J Med. 2020;383:1283-1286. Available from: https://pubmed.ncbi.nlm.nih.gov/32857487/
Altawalah H, AlHuraish F, Alkandari WA, Ezzikouri S. Saliva specimens for detection of severe acute respiratory syndrome coronavirus 2 in Kuwait: A cross-sectional study. J Clin Virol. 2020;132:104652.
Vogels CBF, Watkins AE, Harden CA, Brackney DE, Shafer J, Wang J, Caraballo C, Kalinich CC, Ott IM, Fauver JR, Kudo E, Lu P, Venkataraman A, Tokuyama M, Moore AJ, Muenker MC, Casanovas-Massana A, Fournier J, Bermejo S, Campbell M, Datta R, Nelson A; Yale IMPACT Research Team, Dela Cruz CS, Ko AI, Iwasaki A, Krumholz HM, Matheus JD, Hui P, Liu C, Farhadian SF, Sikka R, Wyllie AL, Grubaugh ND. SalivaDirect: A Simplified and Flexible Platform to Enhance SARS-CoV-2 Testing Capacity. Med (N Y). 2020 Dec 26.
Zhu J, Guo J, Xu Y, Chen X. Viral dynamics of SARS-CoV-2 in saliva from infected patients. J Infect. 2020;81:48-50.
Tu YP, Jennings R, Hart B, Cangelosi GA, Wood RC, Wehber K, Verma P, Vojta D, Berke EM. Swabs Collected by Patients or Health Care Workers for SARS-CoV-2 Testing. N Engl J Med. 2020;383:494-6.
Wang X, Tan L, Wang X, Liu W, Lu Y, Cheng L, Sun Z. Comparison of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 detection in 353 patients received tests with both specimens simultaneously. Int J Infect Dis. 2020;94:107-9.
Böger B, Fachi MM, Vilhena RO, Cobre AF, Tonin FS, Pontarolo R. Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19. Am J Infect Control. 2021;49:21-9.
Dogan OA, Kose B, Agaoglu NB, Yildiz J, Alkurt G, Demirkol YK, Irvem A, Doganay GD, Doganay L. Does sampling saliva increase detection of SARS-CoV-2 by RT-PCR? Comparing saliva with oro-nasopharyngeal swabs. J Virol Methods. 2020;290:114049.
Hanson KE, Barker AP, Hillyard DR, Gilmore N, Barrett JW, Orlandi RR, Shakir SM. Self-Collected Anterior Nasal and Saliva Specimens versus Health Care Worker-Collected Nasopharyngeal Swabs for the Molecular Detection of SARS-CoV-2. J Clin Microbiol. 2020;58:e1824-20.
Miller M, Jansen M, Bisignano A, Mahoney S, Wechsberg C, Albanese N, Castillo L, Parinas P, Lazarin GA, Jaremko M. Validation of a self-administrable, saliva-based RT-qPCR test detecting SARS-CoV-2. Preprint. Posted online June 9, 2020. MedRxiv. 1-18. Available from: https://www.medrxiv.org/content/10.1101/2020.06.05.20122721v1.full
Sri Santosh T, Parmar R, Anand H, Srikanth K, Saritha M. A Review of Salivary Diagnostics and Its Potential Implication in Detection of Covid-19. Cureus. 2020;12:7708. Available from: https://pubmed.ncbi.nlm.nih.gov/32313785/
Bhattarai KR, Kim HR, Chae HJ. Compliance with Saliva Collection Protocol in Healthy Volunteers: Strategies for Managing Risk and Errors. Int J Med Sci. 2018;15:823-31. Available from: https://pubmed.ncbi.nlm.nih. gov/30008593/


