Accuracy of SARS-CoV-2 Detection in Saliva for COVID-19 Diagnosis: A Systematic Review and Meta-Analysis
Context: There is an unmet clinical need to develop simple, easy, rapid, and accessible testing for the detection of SARS-CoV-2. Recent reports suggested that saliva may be a host for the virus. The existence of SARS-CoV-2 in saliva can be associated with oral manifestations in infected patients. A systematic review was conducted as well as a meta-analysis to evaluate the diagnostic accuracy of detecting SARS-CoV-2 in saliva and investigate the association between positive saliva test and oral manifestations of COVID-19. Evidence acquisition: A literature search in MEDLINE via PubMed, Scopus, Web of Science, and Cochrane was done in June 2020 and updated in February 2021 using relevant keywords. We screened studies for eligibility. The extracted data were analyzed using Meta-Disc software. Results: Eighteen studies were included. Pooled data from eligible studies showed that the sensitivity of diagnosis of SARS-CoV-2 in saliva was 0.86 (95% CI, 0.83–0.89), and the specificity was 0.98 (95% CI, 0.96–0.98). COVID-19 was associated with oral diseases as amblygeustia, dry mouth, dryness, inflammation of the mouth, and enlargement of lymph nodes in the submandibular regions. Conclusions: Our results showed that the saliva has a high accuracy in the detection of SARS-CoV-2.
2. Poortahmasebi V, Zandi M, Soltani S, Jazayeri SM. Clinical performance of RT-PCR and chest CT scan for COVID-19 diagnosis; a systematic review. Adv J Emerg Med. 2020;4(2s):e57.
3. 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(5):565-74.
4. Vlek A, Wesselius T, Achterberg R, Thijsen S. Combined throat/nasal swab sampling for SARS-CoV-2 is equivalent to nasopharyngeal sampling. Eur J Clin Microbiol Infect Dis. 2021;40(1):193-5.
5. 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(1):e45-50.
6. Fallahi HR, Keyhan SO, Zandian D, Kim S-G, Cheshmi B. Being a front-line dentist during the Covid-19 pandemic: a literature review. Maxillofac Plast Reconstr Surg. 2020;42(1):12.
7. Liu L, Wei Q, Alvarez X, Wang H, Du Y, Zhu H, 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(8):4025-30.
8. Fini MB. What dentists need to know about COVID-19. Oral Oncol. 2020:104741.
9. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Inter Med. 2011;155(8):529-36.
10. 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. SSRN. 2020; preprint.
11. Caly L, Druce J, Roberts J, Bond K, Tran T, Kostecki R, et al. Isolation and rapid sharing of the 2019 novel coronavirus (SARS‐CoV‐2) from the first patient diagnosed with COVID‐19 in Australia. Med J Aust. 2020;212(10):459-62.
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; [Epub ahead of print].
13. Caulley L, Corsten M, Eapen L, Whelan J, Angel JB, Antonation K, et al. Salivary detection of COVID-19. Ann Inter Med. 2021;174(1):131-3.
14. Hanson KE, Barker AP, Hillyard D, Gilmore N, Barrett JW, Orlandi RR, et al. Self-collected anterior nasal and saliva specimens versus health care worker-collected nasopharyngeal swabs for the molecular detection of SARS-CoV-2. J Clin Microbiol. 2020;58(11):e01824-20.
15. 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;81(2):e145-7.
16. Kojima N, Turner F, Slepnev V, Bacelar A, Deming L, Kodeboyina S, et al. Self-collected oral fluid and nasal swabs demonstrate comparable sensitivity to clinician collected nasopharyngeal swabs for Covid-19 detection. MedRxIV. 2020; preprint.
17. Landry ML, Criscuolo J, Peaper DR. Challenges in use of saliva for detection of SARS CoV-2 RNA in symptomatic outpatients. J Clin Virol. 2020;130:104567.
18. 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;58(8):e01109-20.
19. 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: a cross-sectional study. Clin Microbiol Infect. 2021;27(2):285.e1-4.
20. Vaz SN, Santana DSd, Netto EM, Pedroso C, Wang W-K, Santos FDA, et al. Saliva is a reliable, non-invasive specimen for SARS-CoV-2 detection. Braz J Infect Dis. 2020;24(5):422-7.
21. 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;58(8):e00776-20.
22. Wong SCY, Tse H, Siu HK, Kwong TS, Chu MY, Yau FYS, et al. Posterior oropharyngeal saliva for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020;71(11):2939-46.
23. To KKW, Tsang OTY, Yip CCY, Chan KH, Wu TC, Chan JMC, et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis. 2020;71(15):841-3
24. Zheng S, Yu F, Fan J, Zou Q, Xie G, Yang X. Saliva as a diagnostic specimen for SARS-CoV-2 by a PCR-based assay: a diagnostic validity study. SSRN. 2020; preprint.
25. 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(5):493-8.
26. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol. 2020;94(7):e00127-20.
27. Yadav K, Prakash S. A Review of Dental Caries. Asian J Biomed Pharm Sci. 2016:73-80.
28. de Almeida PDV, Gregio A, Machado M, De Lima A, Azevedo LR. Saliva composition and functions: a comprehensive review. J Contemp Dent Pract. 2008;9(3):72-80.
29. Li Y, Ren B, Peng X, Hu T, Li J, Gong T, et al. Saliva is a non‐negligible factor in the spread of COVID‐19. Mol Oral Microbiol. 2020;35(4):141-5.
30. 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(8):727-33.
31. 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(7):2225.
32. Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020;24(4):1619-21.
33. Loeffelholz MJ, Tang Y-W. Laboratory diagnosis of emerging human coronavirus infections–the state of the art. Emerg Microbes Infect. 2020;9(1):747-56.
34. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-4.
35. Butler-Laporte G, Lawandi A, Schiller I, Yao MC, Dendukuri N, McDonald EG, et al. Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Intern Med. 2021;181(3):353-60.
36. Galván Casas C, Catala A, Carretero Hernández G, Rodríguez‐Jiménez P, Fernández‐Nieto D, Rodríguez‐Villa Lario A, et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71-7.
37. Carrouel F, Conte MP, Fisher J, Gonçalves LS, Dussart C, Llodra JC, et al. COVID-19: a recommendation to examine the effect of mouthrinses with β-cyclodextrin combined with citrox in preventing infection and progression. J Clin Med. 2020;9(4):1126.
|Issue||Vol 5 No 4 (2021): Autumn (October)|
|Section||Systematic review / Meta-analysis|
|COVID-19 Meta-analysis Saliva SARS-CoV-2|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|