Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/M, Germany.
Occupational Health Service, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/M, Germany.
Eur Arch Otorhinolaryngol. 2021 Sep;278(9):3551-3558. doi: 10.1007/s00405-021-06726-4. Epub 2021 Mar 7.
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) replicates predominantly in the upper respiratory tract and is primarily transmitted by droplets and aerosols. Taking the medical history for typical COVID-19 symptoms and PCR-based SARS-CoV-2 testing have become established as screening procedures. The aim of this work was to describe the clinical appearance of SARS-CoV-2-PCR positive patients and to determine the SARS-CoV-2 contact risk for health care workers (HCW).
The retrospective study included n = 2283 SARS-CoV-2 PCR tests from n = 1725 patients with otorhinolaryngological (ORL) diseases performed from March to November 2020 prior to inpatient treatment. In addition, demographic data and medical history were assessed.
n = 13 PCR tests (0.6%) were positive for SARS-CoV-2 RNA. The positive rate showed a significant increase during the observation period (p < 0.01). None of the patients had clinical symptoms that led to a suspected diagnosis of COVID-19 before PCR testing. The patients were either asymptomatic (n = 4) or had symptoms that were interpreted as symptoms typical of the ORL disease or secondary diagnoses (n = 9).
The identification of SARS-CoV-2-positive patients is a considerable challenge in clinical practice. Our findings illustrate that taking a medical history alone is of limited value and cannot replace molecular SARS-CoV-2 testing, especially for patients with ORL diseases. Our data also demonstrate that there is a high probability of contact with SARS-CoV-2-positive patients in everyday clinical practice, so that the use of personal protective equipment, even in apparently "routine cases", is highly recommended.
严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）主要在上呼吸道复制，主要通过飞沫和气溶胶传播。对典型 COVID-19 症状进行医学史询问和基于 PCR 的 SARS-CoV-2 检测已成为既定的筛查程序。本研究的目的是描述 SARS-CoV-2-PCR 阳性患者的临床特征，并确定医护人员（HCW）接触 SARS-CoV-2 的风险。
这项回顾性研究纳入了 2020 年 3 月至 11 月在住院治疗前对 1725 例耳鼻喉科（ORL）疾病患者进行的 2283 次 SARS-CoV-2 PCR 检测，此外还评估了人口统计学数据和病史。
13 次（0.6%）PCR 检测 SARS-CoV-2 RNA 阳性。阳性率在观察期间呈显著增加（p<0.01）。在 PCR 检测前，没有患者出现导致疑似 COVID-19 的临床症状。患者要么无症状（n=4），要么出现被解释为 ORL 疾病或次要诊断的症状（n=9）。
在临床实践中识别 SARS-CoV-2 阳性患者是一项重大挑战。我们的研究结果表明，仅进行医学史询问的价值有限，不能替代分子 SARS-CoV-2 检测，特别是对于 ORL 疾病患者。我们的数据还表明，在日常临床实践中接触 SARS-CoV-2 阳性患者的可能性很高，因此强烈建议即使在看似“常规病例”中也要使用个人防护设备。
