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While detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) using nasopharyngeal swab specimens represents the reference standard for the diagnosis of SARS-CoV-2 infection, this technique requires specialized medical personnel, centralized laboratory facilities, and time for result turnaround. It also exposes the operator to a non-negligible risk of viral transmission. Since salivary droplets represent the main source of human-to-human transmission of SARS-CoV-2 infection, use of saliva as a diagnostic specimen would have the advantages of sample self-collection, not requiring specialized medical workers, and reducing the risks for the operator. This review provides an update on the latest research comparing the different methods and techniques developed for the salivary diagnosis of COVID-19.
Reverse transcription loop-mediated isothermal amplification and other point-of-care technologies under development can be performed at the time and place of patient care, the medical office. An example of point-of-need testing devices for providing very rapid diagnoses for screening large populations is the Rapid Salivary Test, which can detect the presence of the spike protein in a salivary sample in under 10 minutes with a sensitivity of 93%. The authors conclude that, as the sensitivity of salivary samples is comparable to that of respiratory samples, and as saliva collection overcomes limitations imposed by collection of respiratory samples, the role of salivary diagnostics is promising for direct testing in the field (point-of-need) as part of a mass screening program for containment of this pandemic outbreak.
– Laurie C. Carter, DDS, PhD
This abstract is available on the publisher's site.
The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.