When to test for COVID-19 using real-time reverse transcriptase polymerase chain reaction: a systematic review

•The best time to perform real-time reverse transcriptase polymerase chain reaction is between days one and seven after symptom onset.•The three most frequent symptoms of COVID-19 are fever, cough, and dyspnea.•Evidence supports clinical practice.•The symptomatology of new variants of COVID-19 must...

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Published in:	International journal of infectious diseases Vol. 123; pp. 58 - 69
Main Authors:	dos Santos, Paula Gabrielli, Vieira, Helena Cristina Valentini Speggiorin, Wietholter, Vinícius, Gallina, João Pedro, Andrade, Thomás Ranquetat, Marinowic, Daniel Rodrigo, Zanirati, Gabriele Goulart, da Costa, Jaderson Costa
Format:	Journal Article
Language:	English
Published:	Canada Elsevier Ltd 01-10-2022 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases Elsevier
Subjects:	Clinical Laboratory Techniques - methods Coronavirus, COVID-19 COVID-19 - diagnosis COVID-19 Testing Humans Middle Aged Prospective Studies Real-Time Polymerase Chain Reaction Real-time reverse transcriptase polymerase chain reaction Retrospective Studies Reverse Transcriptase Polymerase Chain Reaction RNA-Directed DNA Polymerase RT-PCR SARS-CoV-2 Systematic review Coronavirus, COVID-19 Systematic review SARS-CoV-2 Real-time reverse transcriptase polymerase chain reaction RT-PCR Coronavirus(,) COVID-19
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Summary:	•The best time to perform real-time reverse transcriptase polymerase chain reaction is between days one and seven after symptom onset.•The three most frequent symptoms of COVID-19 are fever, cough, and dyspnea.•Evidence supports clinical practice.•The symptomatology of new variants of COVID-19 must be considered. The aim of this study was to evaluate the time in days between symptom onset and first positive real-time reverse transcriptase polymerase chain reaction (RT-PCR) result for COVID-19. This systematic review was conducted in the MEDLINE (PubMed), Embase, and Scopus databases using the following descriptors: "COVID-19”, “SARS-CoV-2”, “coronavirus”, “RT-PCR”, “real time PCR”, and “diagnosis”. The included studies were conducted in 31 different countries and reported on a total of 6831 patients. The median age of the participants was 49.95 years. The three most common symptoms were fever, cough, and dyspnea, which affected 4012 (58.68%), 3192 (46.69%), and 2009 patients (29.38%), respectively. Among the 90 included studies, 13 were prospective cohorts, 15 were retrospective cohorts, 36 were case reports, 20 were case series, and six were cross-sectional studies. The overall mean time between symptom onset and positive test result was 6.72 days. Fourteen articles were analyzed separately for the temporal profile of RT-PCR test results; the best performance was on days 22-24, when 98% of test results were positive. These findings corroborate the RT-PCR COVID-19 testing practices of some health units. In addition, the most frequently described symptoms of these patients can be considered the initial symptoms of infection and used in decision-making about RT-PCR testing.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 ObjectType-Undefined-4
ISSN:	1201-9712 1878-3511
DOI:	10.1016/j.ijid.2022.06.037