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SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Since the onset of the novel coronavirus pandemic, reverse-transcription polymerase chain reaction (RT-PCR) has emerged as the standard for diagnosing patients with the virus We present a case of variable RT-PCR results stemming from one patient with COVID-19 CASE PRESENTATION: A 57-year-old male with no medical history was admitted for dyspnea and tested positive for COVID-19 via a RT-PCR nasal swab He initially needed 4L of oxygen but decompensated rapidly requiring intubation and ICU care His serologies were significant for elevated inflammatory markers and his chest x-ray showed multifocal opacities Based on the available evidence at the time, he was started on hydroxychloroquine but continued to decline into acute respiratory distress syndrome (ARDs) needing prone positioning and neuromuscular blockade Given his worsening pulmonary mechanics and hypoxia, he was also treated with convalescent plasma Despite this, he remained intubated for a total of 34 days before receiving tracheostomy due to the recommendations of waiting for 2 negative COVID-19 tests 24 hours apart which our patient did not exhibit During his stay, he was tested over 9 times to facilitate the procedure, with varying results, (see table) Given the risks of such prolonged intubation and his development of a nosocomial pneumonia, we ultimately proceeded with a tracheostomy despite the PCR results While this expedited his liberation from the ventilator, he continued to test positive throughout the remainder of his hospital stay but was eventually transferred out of the ICU DISCUSSION: Our case shows the importance of RT-PCR in the testing and diagnosis of patients with COVID-19 Such a test allows for early detection and appropriate triage of patients However, it also indicates a significant false-positive and negative rate showing the limited role RT-PCR plays in viral infectivity The genetic diversity and rapid evolution of the coronavirus causes mutations in its genome This in addition to errors in sampling technique and location can lead to significant false-negative RT-PCR tests, as we know that nasopharyngeal sampling is less accurate than tracheal or bronchial sampling Other data suggests that RT-PCR positivity typically declines after 3 weeks but may persist up to 6 weeks in severely ill patients due to persistent viral shedding which may be the case for our patient Finally, previous studies have indicated different viral load kinetics in different patients suggesting that sampling timing and period of the disease development play an important role in real-time PCR results CONCLUSIONS: As we continue to learn more about this novel coronavirus, the role of viral culture, may prove more helpful when caring for patients, and creating public health guidelines For now, we must be cautious when using RT- PCR as a sole criterion for hospital discharge and the discontinuation of patient isolation Reference #1: Tahamtan A, Ardebili A Real-time RT-PCR in COVID-19 detection: issues affecting the results Taylor & Francis;2020 DISCLOSURES: No relevant relationships by Viral Desai, source=Web Response No relevant relationships by Khushboo Gala, source=Web Response No relevant relationships by Dipan Karmali, source=Web Response No relevant relationships by Sally Suliman, source=Web Response
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