COVID-19 Pandemic and Role of Human Saliva as a Testing Biofluid in Point-of-Care Technology
Novel coronavirus disease 2019 (COVID-19) outbreak has termed as a controllable pandemic, and the entire world has come to a standstill trying to mitigate the disease with health systems. Health care providers, around the globe, are fighting day and night. Currently, rapid testing is taking place with the help of nasopharyngeal, oropharyngeal swab, bronchoalveolar lavage, sputum, urine, and blood. All these approaches are invasive or embarrassing to the infected person. It is observed that salivary glands are hosting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) because of angiotensin-converting enzyme 2 and the detection of high viral loads in the saliva and is playing a crucial role in virus transmission, especially from individuals showing absolutely no symptoms. Saliva is proving to be a promising noninvasive sample specimen for the diagnosis of COVID-19, thus helping to monitor the infection and prevent it from further spreading by prompt isolation.
03 June 2020 (online)
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- 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223) 497-506
- 2 Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. In: Maier HJ, Bickerton E, Britton P. eds. Coronaviruses: Methods and Protocols. Vol. 1282. New York, NY: Springer; 2015: 1-23
- 3 Kim YI, Kim SG, Kim SM. et al. Infection and rapid transmission of SARS-CoV-2 in ferrets. Cell Host Microbe 2020; 27 (05) 704-709.e2 DOI: 10.1016/j.chom.2020.03.023.
- 4 Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology 2018; 23 (02) 130-137
- 5 Zaki AM, van S Boheemen, Bestebroer TM, Osterhaus ADME, Fouchier RAM. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367 (19) 1814-1820
- 6 To KK, Tsang OT, Chik-Yan Yip C. et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis 2020; 4–6: ciaa149
- 7 Wu Y, Ho W, Huang Y. et al. SARS-CoV-2 is an appropriate name for the new coronavirus. Lancet 2020; 395 (10228) 949-950
- 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 (07) 22-25
- 9 Azzi L, Carcano G, Gianfagna F. et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect 2020; 81 (01) e45-e50 S0163-4453(20)30213-9
- 10 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 (01) 11
- 11 Sohrabi C, Alsafi Z, O’Neill N. et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020; 76: 71-76
- 12 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223) 507-513
- 13 Thomas-Rüddel D, Winning J, Dickmann P. et al. Coronavirus disease 2019 (COVID-19): Update for anesthesiologists and intensivists March 2020 [published online ahead of print, 2020 Mar 24]. Anaesthesist 2020; 1-10 DOI: 10.1007/s00101-020-00760-3.
- 14 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
- 15 Patel R, Babady E, Theel ES. et al. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: value of diagnostic testing for SARS-CoV-2/COVID-19. MBio 2020; 11 (02) e00722-20
- 16 Report of the WHO-China Joint Mission on Coronavirus Disease. 2019 (COVID-19). Available at: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed May 8, 2020
- 17 To KK, Tsang OT, Leung WS. 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 (05) 565-574
- 18 Zheng S, Yu F, Fan J. et al. Saliva as a diagnostic specimen for SARS-CoV-2 by a PCR-based assay: a diagnostic validity study. Clin Microbiol Infect 2020; 25 (03) 372-378
- 19 Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res 2020; 99 (05) 481-487
- 20 Winichakoon P, Chaiwarith R, Liwsrisakun C. et al. Negative Nasopharyngeal and Oropharyngeal Swab Does Not Rule Out COVID-19 2 Downloaded from. J Clin Microbiol 2020; 58 (05) e00297-e007320
- 21 Bai Y, Yao L, Wei T. et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020; 323 (14) 1406-1407
- 22 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 (05) 601-604
- 23 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 (06) 846
- 24 Khurshid Z, Zafar MS, Khan RS, Najeeb S, Slowey PD, Rehman IU. Role of salivary biomarkers in oral cancer detection. Adv Clin Chem 2018; 86: 23-70
- 25 Sahibzada HA, Khurshid Z, Khan RS. et al. Salivary IL-8, IL-6 and TNF-αas potential diagnostic biomarkers for oral cancer. Diagnostics (Basel) 2017; 7 (02) 21
- 26 Abdul Rehman S, Khurshid Z, Hussain Niazi F. et al. Role of salivary biomarkers in detection of cardiovascular diseases (CVD). Proteomes 2017; 5 (03) 21
- 27 Khurshid Z, Moin SF, Khan RS, Agwan MAS, Alwadaani AH, Zafar MS. Human salivary protein extraction from RNAPro·SAL™, Pure·SAL™, and passive drooling method. Eur J Dent 2017; 11 (03) 385-389
- 28 Chen L, Zhao J, Peng J, et al. Detection of SARS-CoV-2 in saliva and characterization of oral symptoms in COVID-19 patients. Cell Prolif 2020;53(12):e12923 doi:10.1111/cpr.12923
- 29 Hamming I, Timens W, Bulthuis ML. Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203 (02) 631-637
- 30 Khurshid Z. Salivary point-of-care technology. Eur J Dent 2018; 12 (01) 1-2 DOI: 10.4103/ejd.ejd_376_17.
- 31 Loeffelholz MJ, Tang YW. Laboratory diagnosis of emerging human coronavirus infections - the state of the art. Emerg Microbes Infect 2020; 9 (01) 747-756 DOI: 10.1080/22221751.2020.1745095.
- 32 Kozel TR, Burnham-Marusich AR. Point-of-care testing for infectious diseases: Past, present, and future. J Clin Microbiol 2017; 55 (08) 2313-2320
- 33 Gamio L; The New York Times. The Workers Who Face the Greatest Coronavirus Risk. Available at: https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html. Accessed May 8, 2020
- 34 Bonebreak CM, Demirci U, Kuo WP. The potential of salivary point of care diagnostics. J Appl Oral Sci 2011;19(4)
- 35 LaBarre P, Boyle D, Hawkins K, Weigl B. Instrument-free nucleic acid amplification assays for global health settings. In: Kumar BVKV, Prabhakar S, Ross AA. et al, eds. Sensing Technologies for Global Health, Military Medicine, Disaster Response, and Environmental Monitoring; and Biometric Technology for Human Identification VIII>. Vol 8029. Bellingham, WA: SPIE; 2011: 802902
- 36 Kosack CS, Page AL, Klatser PR. A guide to aid the selection of diagnostic tests. Bull World Health Organ 2017; 95 (09) 639-645
- 37 Guo ZD, Wang ZY, Zhang SF. et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020; 26 (07) 1583-1591 DOI: 10.3201/eid2607.200885.
- 38 Gan WH, Lm JW, Koh D. Preventing intra-hospital infection and transmission of coronavirus disease 2019 in health-care workers. Saf Health Work 2020; 11 (02) 241-243 DOI: 10.1016/j.shaw.2020.03.001.
- 39 Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet 2020; 395 (10234) 1418-1420
- 40 Malon RS, Sadir S, Balakrishnan M, Córcoles EP. Saliva-based biosensors: noninvasive monitoring tool for clinical diagnostics. BioMed Res Int 2014; 2014: 962903
- 41 Bhakta SA, Borba R, Taba Jr. M, Garcia CD, Carrilho E. Determination of nitrite in saliva using microfluidic paper-based analytical devices. Anal Chim Acta 2014; 809: 117-122
- 42 de Castro LF, de Freitas SV, Duarte LC, de Souza JAC, Paixão TRLC, Coltro WKT. Salivary diagnostics on paper microfluidic devices and their use as wearable sensors for glucose monitoring. Anal Bioanal Chem 2019; 411 (19) 4919-4928
- 43 Campuzano S, Yánez-Sedeño P, Pingarrón JM. Electrochemical bioaffinity sensors for salivary biomarkers detection. TrAC Trends in Analytical Chemistry 2017; 86: 14-24 DOI: 10.1016/j.trac.2016.10.002.
- 44 Xu J, Li Y, Gan F, Du Y, Yao Y. Salivary Glands: Potential Reservoirs for COVID-19 Asymptomatic Infection. J Dent Res 2020; 99 (08) 989 DOI: 10.1177/0022034520918518.
- 45 Liu L, Wei Q, Alvarez X. et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. J Virol 2011; 85 (08) 4025-4030
- 46 Wang WK, Chen SY, Liu IJ. et al. SDetection of SARS-associated coronavirus in throat wash and saliva in early diagnosis. Emerg Infect Dis 2004; 10 (07) 1213-1219 DOI: 10.3201/eid1007.031113.
- 47 Ahmed MA, Jouhar R, Ahmed N. et al. Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak. Int J Environ Res Public Health 2020; 17 (08) 2821 DOI: 10.3390/ijerph17082821.