Uso da saliva como um espécime alternativo para diagnóstico de COVID-19: uma revisão sistemática

Abstract

Introdução: O padrão ouro atual para detectar o RNA de SARS-CoV-2 é por reação em cadeia da polimerase em tempo real de transcrição reversa (RT-rtPCR) em swabs nasofaríngeos (NPS). Por esse motivo, a demanda pelos NPS aumentou e sua escassez se tornou uma realidade em muitos países. Com isso o uso da saliva se mostra uma alternativa promissora na triagem epidemiológica além de ser de fácil coleta e não invasiva. Objetivo: realizar uma revisão sistemática da literatura para avaliar o uso da saliva como um espécime alternativo para a detecção de SARS-CoV-2. Metodologia: A pesquisa sistemática foi realizada em sete bancos de dados (PubMed, Cochrane Library, Lilacs, Scielo, Web of Science, Scopus e Google Scholar) usando a variação dos termos de pesquisa (COVID-19 OR SARS-CoV-2 OR 2019-nCoV) AND "Saliva" no ano de 2020, recuperando 5480 publicações. Resultados: Após a leitura dos títulos e resumos, 411 textos foram conduzidos para leitura integral e 30 publicações foram consideradas para avaliação qualitativa do artigo. Conclusão: A saliva se apresenta um método alternativo eficaz para a detecção de SARS-CoV-2 e diagnóstico de COVID-19.

Descritores: Infecções por Coronavírus; Betacoronavirus; Saliva; Diagnóstico.

Referências

1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
2. Wang L, Wang Y, Ye D, Liu Q. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence. J Antimicrob Agents 2020;105948.
3. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727-733.
4. Coronaviridae Study Group of the International Committee on Taxonomy of V. 2020. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5:536-544.
5. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of Coronavirus Disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172:577-82.
6. To KK, Tsang OT, Chik-Yan Yip C, Chan KH, Wu TC, Chan JMC, et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis. 2020;149:5734265.
7. Xu R, Cui B, Duan X, Zhang P, Zhou X, Yuan Q. Saliva: potential diagnostic value and transmission of 2019-nCoV. Int J Oral Sci. 2020;12:11.
8. Khurshid Z, Asiri FYI, Al Wadaani H. Human Saliva: Non-Invasive Fluid for Detecting Novel Coronavirus (2019-nCoV). Int J Environ Res Public Health. 2020;17.
9. Khurshid Z, Zohaib S, Najeeb S, Zafar MS, Slowey PD, Almas K. Human Saliva Collection Devices for Proteomics: An Update. Int J Mol Sci. 2016;17.
10. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA.  Epidemiol. E Serviços Saúde 2015;24:335–42.
11. Abdul MSM, Fatima U, Khanna SS, Bhanot R, Sharma A, Srivastava AP. Oral Manifestations of Covid-19-Are they the introductory symptoms?. J Adv Dent Sci Res. 2020;8:5.
12. Azzi L, Carcano G, Dalla Gasperina D, Sessa F, Maurino V, Baj A. Two cases of COVID-19 with positive salivary and negative pharyngeal or respiratory swabs at hospital discharge: A rising concern. Oral Dis. 2020;00:1-3.
13. Azzi L, Carcano G, Gianfagna F, Grossi P, Dalla Gasperina D, Genoni A, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020;81:45-50.
14. Becker D, Sandoval E, Amin A, De Hoff P, Leonetti N, Lim YW, et al. Saliva is less sensitive than nasopharyngeal swabs for COVID-19 detection in the community setting. medRxiv. 2020;20092338.
15. Braz-Silva PH, Pallos D, Giannecchini S, To KKW. SARS-CoV-2: What can saliva tell us?. Oral Dis. 2020;13365.
16. Chan JFW, Yip CCY, To KKW, Tang THC, Wong SCY, Leung KH, et al. Improved molecular diagnosis of COVID-19 by the novel, highly sensitive and specific COVID-19-RdRp/Hel real-time reverse transcription-PCR assay validated in vitro and with clinical specimens. J Clin Microbiol. 2020;58:5.
17. Chen L, Zhao J, Peng J, Li X, Deng X, Geng Z, et al. Detection of 2019-nCoV in saliva and characterization of oral symptoms in COVID-19 patients. Lancet. 2020;3556665.
18. Cheng VC, Wong SC, Chen JH, Yip CC, Chuang VW, Tsang OT, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020;41:493-498.
19. Han P, Ivanovski S. Saliva—Friend and Foe in the COVID-19 Outbreak. Diagn. 2020;10:290.
20. Iwasaki S, Fujisawa S, Nakakubo S, Kamada K, Yamashita Y, Fukumoto T, et al. Comparison of SARS-CoV-2 detection in nasopharyngeal swab and saliva. J Infect. 2020;20:30349.
21. Krajewska J, Krajewski W, Zub K, Zatoński T. COVID-19 in otolaryngologist practice: a review of current knowledge. Eur Arch Otorhinolaryngol. 2020;1-13.
22. Lalli MA, Chen X, Langmade SJ, Fronick CC, Sawyer CS, Burcea LC, et al. Rapid and extraction-free detection of SARS-CoV-2 from saliva with colorimetric LAMP. medRxiv. 2020;7273276.
23. Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10:101-108.
24. Li H, Liu SM, Yu XH, Tang SL, Tang CK. Coronavirus disease 2019 (COVID-19): current status and future perspective. Int J Antimicrob Agents. 2020;105951.
25. McCormick-Baw C, Morgan K, Gaffney D, Cazares Y, Jaworski K, Byrd A, et al. Saliva as an Alternate Specimen Source for Detection of SARS-CoV-2 in Symptomatic Patients Using Cepheid Xpert Xpress SARS-CoV-2. J Clin Microbiol. 2020;01109-20.
26. Pasomsub E, Watcharananan SP, Boonyawat K, Janchompoo P, Wongtabtim G, Suksuwan W, et al. Saliva sample as a non-invasive specimen for the diagnosis of coronavirus disease-2019 (COVID-19): a cross-sectional study. Clin Microbiol Infect. 2020;20302780.
27. Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clinical oral investigations. 2020;1-3.
28. Sapkota D, Thapa SB, Hasséus B, Jensen JL. Saliva testing for COVID-19?. BDJ. 2020;228:658-659.
29. Sharma S, Kumar V, Chawla A, Logani A. Rapid detection of SARS-CoV-2 in saliva: Can an endodontist take the lead in point-of-care COVID-19 testing?. Int Endod J. 2020;13317.
30. Tang YW, Schmitz JE, Persing DH, Stratton CW. Laboratory Diagnosis of COVID-19: Current Issues and Challenges. J Clin Microbiol. 2020;58(6).
31. Tatikonda SS, Reshu P, Hanish A, Konkati S, Madham S. A Review of Salivary Diagnostics and Its Potential Implication in Detection of Covid-19. Cureus. 2020;12(4).
32. To KKW, Tsang OTY, Leung WS, Tam AR, Wu TC, Lung DC, et al. 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;20:565-574.
33. Vinayachandran D, Saravanakarthikeyan B. Salivary diagnostics in COVID-19: Future research implications. J Dent Sci. 2020;7177105.
34. Williams E, Bond K, Zhang B, Putland M, Williamson DA. Saliva as a non-invasive specimen for detection of SARS-CoV-2. J Clin Microbiol. 2020;00776-20.
35. Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, et al. Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs. Medrxiv. 2020;20067835.
36. Yoon JG, Yoon J, Song JY, Yoon SY, Lim CS, Seong H, et al. Clinical Significance of a High SARS-CoV-2 Viral Load in the Saliva. J Korean Med Sci. 2020;35(20).
37. Zheng S, Yu F, Fan J, Zou Q, Xie G, Yang X, et al. Saliva as a Diagnostic Specimen for SARS-CoV-2 by a PCR-Based Assay: A Diagnostic Validity Study. Lancet. 2020;3543605.
38. Zhong F, Liang Y, Xu J, Chu M, Tang G, Hu F, et al. Continuously High Detection Sensitivity of Saliva, Viral Shedding in Salivary Glands and High Viral Load in Patients with COVID-19. Lancet. 2020;3576869.