Der Nasen- oder Rachenabstrich in der COVID-19-Pandemie – Aspekte für den HNO-Arzt/die HNO-Ärztin – SARS-CoV-2, Coronavirus, Nasenabstrich, Rachenabstrich, Komplikationen

Zusammenfassung

Seit Beginn der SARS-CoV-2-Pandemie werden zunehmend Abstriche oder andere Beprobungen aus dem oberen Aerodigestivtrakt genommen, da hier vor allen Dingen in frühen Erkrankungsstadien hohe Viruslasten bestehen. Als diagnostische Möglichkeiten sind Abstriche aus der vorderen Nase, dem Nasopharynx oder dem Oropharynx sowie die Gewinnung von Rachenspülwasser oder Speichel möglich. Als Labormethoden stehen in einigen Minuten ablesbare Antigentests oder langwierigere RT-PCR-Methoden zur Verfügung. Abstriche werden von ärztlichem Personal, medizinischem Fachpersonal, Laien und im Eigentest, jeweils nach Instruktionen, durchgeführt. Auf die Aussagekraft und die Sensitivität des gesamten diagnostischen Prozesses haben somit viele dieser Faktoren einen Einfluss. Die PCR-Labormethode ist sensitiver als die Antigenmethode; der Abstrich aus dem Nasopharynx wird als der valideste Abstrichort angesehen. Eine korrekte Durchführung eines Tests kann auch bei nicht professionellen Personen mit guten Instruktionen erreicht werden. Komplikationen werden bei solchen Abstrichen, gemessen an der anzunehmenden Anzahl durchgeführter Prozeduren, sehr selten berichtet. Kurzfristiges Nasenbluten bei traumatischen Abstrichen ist anzunehmen, ohne dass darüber Publikationen aufgefunden werden konnten. Abgebrochene Abstrichträger mussten HNO-ärztlich entfernt werden. Verletzungen der Schädelbasis mit Liquorrhö wurden bisher sehr vereinzelt berichtet, davon 2-mal bei Anomalien wie Meningozelen. Die Wahl eines geeigneten diagnostischen Mediums hängt von vielen Parametern, wie Verfügbarkeit, zeitlicher Ablauf bis zum Ergebnis, Abstrich durch kundiges Personal oder Eigentest und etlichen anderen praktischen Erwägungen, ab.

Abstract

Since the beginning of the SARS-CoV-2 pandemic, swabs or other samples have increasingly been taken from the upper aero-digestive tract, since high viral loads exist here, especially in the early stages of the disease. As diagnostic options, swabs from the anterior nose, from the nasopharynx, from the oropharynx or the extraction of throat rinse water or saliva are possible. The laboratory methods available are antigen tests that can be read in a few minutes or more lengthy RT-PCR methods in a lab. Swabs are carried out by physicians, medical staff, laypeople and in the self-test, in each case according to prior instructions. Many of these factors therefore have an influence on the informative value and the sensitivity of the entire diagnostic process. The PCR laboratory method is more sensitive than the antigen method; the swabs from the nasopharynx are considered the most valid smear site; correct execution of a test can be achieved even with non-professional individuals with good instructions. Complications with such swabs are reported very rarely, given the assumed number of procedures performed. Short-term nosebleeds after traumatic smears can be assumed without publications about it being found. Broken parts of swabs had to be removed by an ENT doctor. There are only very few reports on injuries to the skullbase with CSF-leaks, including 2 times with anomalies such as meningoceles. The choice of a suitable diagnostic medium depends on many parameters such as availability, the timing of the result, a smear test by knowledgeable staff or a self-test, and a number of other practical considerations.

Publication History

Article published online:
19 May 2021

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