SARS-CoV-2: A Promising Path in Salivary Diagnosis (2025)

Saliva in the Diagnosis of COVID-19: A Review and New Research Directions

Journal of Dental Research, 2020

SARS-CoV-2, COVID-19), causing a severe acute respiratory syndrome due to phylogenetic similarity with SARS-CoV (Huang et al. 2020). COVID-19-infected cases have since grown exponentially, and as a result, the World Health Organization declared a public health emergency of international interest (Coronavirus Disease 2019). More than 18.2 million cases have now been confirmed worldwide, with close to 700,000 deaths. Human-to-human transmission of SARS-CoV-2 majorly relies on respiratory droplets, which are naturally produced by talking and coughing and which contain saliva (Peng et al. 2020). An effective and safe vaccine that provides herd immunity is yet to be developed (Clemente-Suárez et al. 2020). Thus far, the main strategy for controlling the pandemic depends on testing as many individuals as possible to avoid the risk of transmission to other patients and health care professionals, including transmission from asymptomatic people, who account for approximately 79% of the contagion (Li et al. 2020). Unfortunately, only part of the population has access to rapid testing, while COVID-19 testing should be widely available. Currently available tests are technically demanding and expensive, and some can provide a high proportion of falsenegative results on samples from the upper respiratory tract. In addition, respiratory sample collection can cause discomfort to the patients and pose a high risk of transmission to the health professional. Previously, studies showed the validity of affordable and rapid diagnostic salivary tests against other viruses (HIV, Zika, etc.) for use in laboratory and at-home settings (Reynolds and Muwonga 2004). Since high SARS-CoV-2 RNA is detectable in the oropharyngeal cavity, saliva serves as 960070J DRXXX10.

Saliva as a Potential Diagnostic Tool for SARS–CoV-2

Journal of Evolution of Medical and Dental Sciences

BACKGROUND COVID 19 has been labelled as a global pandemic by the World Health Organization (WHO). The sudden rise in death toll and devastation associated with it has put the entire infrastructure, economy and health sector to test. The only way for the prevention and control of this infectious disease is rapid and accurate screening of masses. Public Health Authorities mainly use antibody testing in hot spots using a mix of RT-PCR and antibody testing nasopharyngeal and orpharyngeal swabs. Considering the potential risk factors, constraints of time, cost and manpower, mass screening for COVID is not possible through nasopharyngeal and oropharyngeal swabs alone. Hence, to search an alternate method to diagnose for the initial screening of patients is the need of the hour globally. Saliva can also be used as one of the diagnostic modalities for coronavirus, helping in the rapid testing of individuals at home or at hospital. The article intends to explain the evidence regarding the r...

Role of Saliva as a Non-Invasive Diagnostic Method for Detection of COVID-19

Cureus

SARS coronavirus2 is the primary cause of new Coronavirus illness (COVID-19) (SARS-COV-2). Today, COVID-19 is a global epidemic. Coronavirus illness may be diagnosed using a variety of approaches. The gold standard is RT-PCR, which is used in all of these assays. Swabs from the nose, pharynx, or mouth are the most often used sampling methods for coronavirus detection. For COVID-19 testing, saliva may be utilized as an alternate sample. When compared to a nasopharyngeal swab, saliva samples have a number of advantages and disadvantages. Saliva has also been reviewed as a non-invasive diagnostic tool for the detection of COVID-19. The affordability of the salivary diagnostic process makes it an effective process for detecting the COVID-19 viruses. The researchers have found that salivary diagnostic processes have greater chances of success than other processes of Coronavirus detection. However, healthcare professionals need to make positive changes to their working processes to ensure the sustainability of the salivary diagnosis processes.

Saliva Sample as a Non-Invasive Specimen for the Diagnosis of Coronavirus Disease-2019 (COVID-19): a Cross-Sectional Study

2020

Objectives. Amid the increasing number of global pandemic coronavirus disease 2019 (COVID-19) cases, there is a need for a quick and easy method to obtain a non-invasive sample for the detection of this novel coronavirus 2019 (SARS-CoV-2). We aimed to investigate the potential use of saliva samples as a non-invasive tool for the diagnosis of COVID-19. Methods. From 27 March to 4 April, 2020, we prospectively collected saliva samples and a standard nasopharyngeal and throat swab in persons seeking care at an acute respiratory infection clinic in a university hospital during the outbreak of COVID-19. Real-time polymerase chain reaction (RT-PCR) was performed, and the results of the two specimens were compared. Results. Two-hundred pairs of the samples were collected. Sixty-nine (34.5%) patients were male, and the median (interquartile) age was 36 (28-48) years. Using nasopharyngeal and throat swab RT-PCR as the reference standard, the prevalence of COVID-19 diagnosed by nasopharyngeal and throat swab RT-PCR was 9.5%. The sensitivity and specificity of the saliva sample RT-PCR were 84.2% [95% confidence interval (CI) 79.2%-89.3%], and 98.9% (95% CI 97.5-100.3%), respectively. An analysis of the agreement between the two specimens demonstrated 97.5% observed agreement (kappa coefficient 0.851, 95% CI 0.723-0.979; p <0.001). Conclusions. Saliva specimens can be used for the diagnosis of COVID-19. The collection method is non-invasive, and non-aerosol generating. Using a saliva sample as a specimen for the detection of SARS-CoV-2 could facilitate the diagnosis of the disease, which is one of the strategies that helps in controlling the epidemic.

Saliva is a reliable, non-invasive specimen for SARS-CoV-2 detection

The Brazilian Journal of Infectious Diseases, 2020

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of Coronavirus Disease 2019 (COVID-19). Although Real Time Reverse Transcription Polymerase Chain Reaction (qRT-PCR) of respiratory specimens is the gold standard test for detection of SARS-CoV-2 infection, collecting nasopharyngeal swabs causes discomfort to patients and may represent considerable risk for healthcare workers. The use of saliva as a diagnostic sample has several advantages. Objectives: The aim of this study was to validate the use of saliva as a biological sample for diagnosis of COVID-19. Methods: This study was conducted at Infectious Diseases Research Laboratory (LAPI), in Salvador, Brazil. Participants presenting with signs/symptoms suggesting SARS-CoV-2 infection underwent a nasopharyngeal swab (NPS) and/or oropharyngeal swab (OPS), and saliva collection. Saliva samples were diluted in PBS, followed by RNA isolation and RT-Real Time PCR for SARS-CoV-2. Results of conventional vs saliva samples testing were compared. Statistical analyses were performed using Statistical Package for the Social Sciences software (SPSS) version 18.0. Results: One hundred fifty-five participants were recruited and samples pairs of NPS/OPS and saliva were collected. The sensitivity and specificity of RT-PCR using saliva samples were 94.4% (95% CI 86.4-97.8) and 97.62% (95% CI 91.7-99.3), respectively. There was an overall high agreement (96.1%) between the two tests. Conclusions: Use of self-collected saliva samples is an easy, convenient, and low-cost alternative to conventional NP swab-based molecular tests. These results may allow a broader use of molecular tests for management of COVID19 pandemic, especially in resources-limited settings.

Whole Saliva (Oral Bio Fluid) as a Non-Invasive Biological Marker or Specimen for Detecting the Novel Corona Virus in Covid-19 Patients: A Multicentric Study in Surat, Gujarat Population

https://www.ijrrjournal.com/IJRR_Vol.8_Issue.3_March2021/IJRR-Abstract085.html, 2021

Covid-19 is a respiratory disease caused by the SARS COV-2 virus. WHO states sample collection on upper respiratory specimens, including nasopharyngeal and oropharyngeal swabs along with endotracheal aspirate and bronchoalveolar lavage, among the various sample collection methods saliva has been investigated and reported as a potential source for diagnosis. Thus we propose to evaluate the current situation to investigate the potential use of saliva sample as a noninvasive tool for diagnosis of covid-19. Objective: We aimed to detect and estimate the potential use of saliva as a noninvasive tool for diagnostic of SARS-cov-2 Methods: A study was conducted among 200 individuals who attended the designated Covid Hospital, Surat, and Gujarat between 19/10/2020 to 1/12/2020. We collected saliva samples along with the nasal and oral swabs. Real time polymerase chain reaction was performed, and the results of the saliva samples and nasal/oral swabs were compared. Results: A total of 200 samples were analyzed. 20%samples were tested positive in both swab and saliva and 82 % were tested negative from both the samples. From the overall samples, 11 % were tested positive from swab samples but were negative from saliva samples. However 5% of the samples were tested positive from saliva sample but were negative for swab samples. In the overall samples there was a significant difference in the results between the swab and saliva samples (p<0.001) the Wilcox on signed rank test between the saliva and swab results revealed a similar pattern in Surat. Conclusions: the collection of saliva samples is non invasive and non aerosol generating with significant advantages, such as lower cost, easy to obtain, sample self collection, lower risk of contamination and there is no need of trained staff for sample collection. So it should an alternative specimen for the diagnosis of covid-19.

Salivary Diagnosis: A Potential Tool for Coronavirus Disease Detection

2021

Coronavirus disease basically caused by novel coronavirus emerged from Wuhan, china in December 2019. For decreasing the infection rate rapid, reliable diagnosis is need. Nasopharyngeal swab, sputum, saliva, other body fluid considered useful for COVID-19 detection. Currently nasopharyngeal swabbing, reverse transcription of extracted RNA, quantitative PCR are consider as major tests for detection of COVID-19. All these methods mentioned above have high risk of infection because trained staff are required. These methods also cause economic, logistic burden on health system. So the simple, less invasive, low risk method is require for detection. The non invasive method for specimen collection is saliva. The collection of saliva sample can be done by patient itself and this method is very economic and involve low risk of infection. The aim of these review is to analyses use of saliva for detection of

Salivary diagnostics and its implementation in diagnosis of COVID19

International Journal of Applied Dental Sciences

The coronavirus disease (COVID-19), epidemic started in Wuhan, caused by a novel coronavirus (SARS-CoV-2), has become a major public challenge around the world. Here, saliva diagnostic testing for COVID-19 is essential to controlling the global pandemic. The use of saliva has various advantages compared to collection of Nasopharyngeal swabs. The close contacts involved in swab collection have a risk to healthcare workers, and collection of saliva may reduce this risk. Presently, rapid testing is enchanting with the help of nasopharyngeal, oropharyngeal swab, bronchoalveolar lavage, sputum, urine, and blood. Saliva is demonstrating to be a capable non-invasive sample variety for the diagnosis of COVID-19, thus helping to detector the infection and prevent it from further spreading by prompt isolation. The saliva biomarkers have a potential to be an vital guide in COVID-19 diagnosis, making possible the development of sampling procedures. Salivary biomarkers connected with the improvement and evolution of COVID-19 could allow a well distinction among asymptomatic, mild, moderate or advanced disease.

Saliva in the Diagnosis of COVID-19: Review Article

2021

The use of saliva samples for the diagnosis of severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) provides several advantages over the use of nasopharyngeal (NP) swabs, such as comfort, ease of self-collection, less use of personal protective equipment, and protection of healthcare personnel from transmission. This review included current studies using saliva samples for the detection of SARS-CoV-2, comparing its sensitivity, cycle threshold, and specificity with those of NP swab. In the literature, the sensitivity rates of saliva samples in the diagnosis of SARS-CoV-2 ranged from 70% to 98%. Despite different opinions, we concluded that saliva is a reliable sample for the detection of SARS-CoV-2. However, studies with large samples and comparing different diagnostic methods are needed to reach precise and reliable results and include saliva collection in diagnostic guidelines.

Use of Saliva for Diagnosis and Monitoring the SARS-CoV-2: A General Perspective

Journal of Clinical Medicine

In this report, updated information and future perspectives about the use of saliva as a sample for laboratory analysis of the Covid-19 are highlighted. Saliva can be used for the direct detection of the SARS-CoV-2 virus, the quantification of the specific immunoglobulins produced against it, and for the evaluation of the non-specific, innate immune response of the patient. Moreover, a deeper knowledge of potential changes in the saliva proteome in this disease may allow the identification of new diagnostic and prognostic biomarkers, or even help our understanding of the mechanisms associated with the disease. With the development of appropriate sample collection and processing methods and the use of adequate assays, saliva can provide useful clinical information about the disease and could be potentially included in guidelines for sample collection for the diagnosis, disease management, and control of Covid-19.

Saliva as a Diagnostic Tool for Detection of Coronavirus: A Review

2020

We aimed in this literature review to demonstrate the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non-invasive diagnostic modality. The specimen can be easily obtained and tested from suspected individuals. Review of available literature in PubMed, Google Scholar, EBSCO, and Semantic Scholar was carried out using keywords and combination of “Coronavirus”, “saliva” and “diagnosis”. Of 1846 articles found, 110 were screened and included in this literature review. Currently, nasopharyngeal swab is the standard diagnostic tool as it has been reported to be accurate and sensitive towards detection of coronavirus. Testing of saliva specimens is now being considered to aid rapid detection, because saliva collection and its testing are relatively simple, cheap, and safe for both patients as well as healthcare professionals. Further research on this will be beneficial to control and contain the virus.

Saliva as a potential surrogate for detection of SARS-CoV-2 in the pediatric population and special care patients

Anais Da Academia Brasileira De Ciencias, 2022

The Advantages of Saliva Sampling Method for Diagnosis of COVID 19

2021

Several tests for many persons have to be conducted in order to control the pandemic and prevent the possibility of transmission of (Covid-19) to health care workers and other patients. The main aim of this study was to detect the importance of saliva sample for early diagnosis of Corona virus 2019 (COVID-19). Saliva sample considered as an alternative for diagnosis of COVID-19 as salivary gland found to express surface receptor angiotensin converting enzyme II, (ACE2) a receptor that plays a key role within the entry of SARS Corona Virus-2 (SARS-CoV-2) into the cell. The sample can be self-collected from the entrance of the oral cavity easily, in a way the risk of virus transmission to healthcare personnel can be minimized avoiding the use of protective equipment. There are several ways for collection of saliva, such as spitting out, directly from salivary duct gland and collection with sponge-like device. The analysis of Saliva can be used to detect oral cancer, dental caries, periodontal diseases, diabetes, breast cancer, and lung cancer. The saliva polymerase chain reaction (PCR) test demonstrated high sensitivity comparable performance to the current standard nasopharyngeal and throat swabs. In addition, saliva could be used for monitoring viral clearance, as it contains the highest live COVID-19 viruses and viral load during the first week.

Saliva, a relevant alternative sample for SARS-CoV2 detection

medRxiv, 2020

Background: Currently, COVID-19 diagnosis relies on quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) from nasopharyngeal swab (NPS) specimens, but NPSs present several limitations. The simplicity, low invasive and possibility of self-collection of saliva imposed this specimen as a relevant alternative for SARS-CoV-2 detection. However, the discrepancy of saliva test results compared to NPSs made of its use controversial. Here, we proposed to assess Salivettes, as a standardized saliva collection device, and to compare SARS-CoV-2 positivity on paired NPS and saliva specimens. Methods: A total of 303 individuals randomly selected among those investigated for SARS-CoV-2 were enrolled, including 30 (9.9%) patients previously positively tested using NPS (follow-up group), 90 (29.7%) mildly symptomatic and 183 (60.4%) asymptomatic. Results: The RT-qPCR revealed a positive rate of 11.6% (n=35) and 17.2% (n=52) for NPSs and saliva samples, respectively. The sensitivity...

Saliva as an alternate specimen source for the diagnosis of coronavirus disease 2019 in symptomatic patients using cepheid xpert xpress SARS-CoV-2

Biomedical and Biotechnology Research Journal (BBRJ), 2020

Background: Rapid and accurate SARS-CoV-2 diagnostic testing is essential for controlling the ongoing coronavirus disease 2019 (COVID-19) pandemic. The current gold standard for COVID-19 diagnosis is real-time reverse transcription-polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 from nasopharyngeal swab (NPS) specimens. The objective of this study is to assess saliva specimens for the diagnosis of COVID-19 using the GeneXpert® Xpress SARS-CoV-2 assay. Materials and Methods: In June 2020, we prospectively simultaneously collected saliva samples and a standard NPS from 60 patients meeting case definition of COVID-19 in the Emergency Department and from inpatients in Rashid Hospital at Dubai Health Authority during the outbreak of COVID-19. Real-time RT-PCR using the Cepheid Xpert Xpress SARS-CoV-2 was performed, and the results of the two specimens were compared. Results: A total of 60 paired NPS and saliva specimens were tested. An analysis of the agreement between the two...

Saliva: a diagnostic option and a transmission route for 2019-nCoV

Evidence-Based Dentistry, 2020

Data sources This review included 13 clinical studies (observational or clinical trial) which reported results of studies of the 2019 novel coronavirus (2019-nCoV). The other 62 referenced papers were of different types (eg, reviews, WHO protocols, letter to editor etc). Study selection The study selected trials, reviews, and in-vitro research assessing the critical aspects of saliva as an easily accessible and early-stage diagnostic source, and also an entry route for 2019

Saliva is not a useful diagnostic specimen in children with Coronavirus Disease 2019

Clinical Infectious Diseases, 2020

Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions

INTRODUCTION: Molecular diagnostics for SARS-CoV-2 infection characteristically involves the sampling of the throat or nasopharyngeal swab (NPS). However, these procedures are invasive, require necessary skills for sample collection, cause patient discomfort, and are non-conducive for extensive scale testing. Saliva is increasingly being suggested as an alternate diagnostic sample in SARS-CoV-2 infection. OBJECTIVES: This scoping review was done with the objective of exploring the evidence on the role of saliva as an alternate diagnostic sample in SARS-CoV-2 condition. METHODS: Thorough search of the literature in major databases was undertaken in June 2020 using free text and MESH terms, followed by PRISMA to identify 17 studies for data extraction. RESULTS AND CONCLUSIONS: Evidence was summarised for study characteristics, salivary sampling characteristics, viral load, and longevity of virus in saliva. The literature supports that saliva offers a simple sample collection method compared to techniquesensitive NPS and has the advantage of point-of-care testing for initial screening in community or hospital-based setup. The additional highlights of this review are heterogeneity in the current literature and the gaps in methodology. Therefore, a robust study design to generate higher levels of evidence has been proposed.

Saliva is a reliable and accessible source for the detection of SARS-CoV-2

International Journal of Infectious Diseases, 2021

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Saliva is Auspicious Non-Obtrusive Sample for Observing and Contamination Control in Cases Having Coronavirus Disease

2020

The 2019-novel-coronavirus was recognized in oneself gathered salivation of 93.8% (12/13) of patients. Sequential spit viral burden observing commonly demonstrated a declining pattern. Live infection was distinguished in salivation by viral culture. Our current research was conducted at Lahore General Hospital, Lahore from April to July 2020. In 2009, risky intense respiratory illness coronavirus produced an overwhelming worldwide flareup with a case-casualty pace of 12%. In April 2020, the SARS-CoV-like coronavirus, the Covid-19, has advanced in Punjab Province of Pakistan, and has spread quickly in territory Pakistan and to different pieces of the world. Salivation is very auspicious non-obtrusive example for determination, observing, and contamination control in cases having Coronavirus disease.