Molecular detection of SARS-CoV-2 in formalin-fixed, paraffin-embedded specimens
JCI INSIGHT
Authors: Liu, Jun; Babka, April M.; Kearney, Brian J.; Radoshitzky, Sheli R.; Kuhn, Jens H.; Zeng, Xiankun
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of human coronavirus disease 2019 (COVID-19), emerged in Wuhan, China, in December 2019. The virus rapidly spread globally, resulting in a public health crisis including almost 5 million cases and 323,256 deaths as of May 21, 2020. Here, we describe the identification and evaluation of commercially available reagents and assays for the molecular detection of SARS-CoV-2 in infected FFPE cell pellets. We identified a suitable rabbit polyclonal anti-SARS-CoV spike protein antibody and a mouse monoclonal anti-SARS-CoV nucleocapsid protein (NP) antibody for cross-detection of the respective SARS-CoV-2 proteins by IHC and immunofluorescence assay (IFA). Next, we established RNAscope in situ hybridization (ISH) to detect SARS-CoV-2 RNA. Furthermore, we established a multiplex FISH (mFISH) to detect positive-sense SARS-CoV-2 RNA and negative-sense SARS-CoV-2 RNA (a replicative intermediate indicating viral replication). Finally, we developed a dual staining assay using IHC and ISH to detect SARS-CoV-2 antigen and RNA in the same FFPE section. It is hoped that these reagents and assays will accelerate COVID-19 pathogenesis studies in humans and in COVID-19 animal models.
False-positive SARS-CoV-2 serology in 3 children with Kawasaki disease
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Authors: To, Kelvin K. W.; Chua, Gilbert T.; Kwok, Ka Li; Wong, Joshua S. C.; Au, Dennis Chi Yu; Lam, Yuen Yu; Wong, Wilfred H. S.; Ho, Marco H. K.; Chan, Godfrey C. F.; Chui, Celine S. L.; Li, Xue; Tung, Keith T. S.; Wong, Rosa S.; Tso, Winnie W. Y.; Wong, Ian C. K.; Wong, Christina S. M.; Fong, Carol H. Y.; Chan, Kwok Hung; Yuen, Kwok Yung; Ip, Patrick; Kwan, Mike Y. W.
Abstract
Background: Kawasaki disease (KD) is an acute febrile and eruptive disease with systemic vasculitis predominantly affecting young East Asian children. Recent reports showed that children with KD-like disease from KD low prevalence regions had positive SARS-CoV-2 serology despite a negative SARS-CoV-2 polymerase chain reaction (PCR) in respiratory samples. Objectives: To describe 3 pediatric Kawasaki Disease patients with false positive SARS-CoV-2 serology. Study design: We retrospectively recruited children with KD diagnosed during the COVID-19 outbreak in Hong Kong. Clinical characteristics and laboratory test results including SARS-CoV-2 PCR results were retrieved. We performed a microparticle-based immunoassay for the detection of IgG against nucleoprotein (NP) and spike protein receptor binding domain (RBD), and a microneutralization assay for the detection of neutralizing antibodies. Results: Three Chinese children with typical KD were identified. They had no epidemiological links with COVID-19 patients and tested negative for SARS-CoV-2 NPA PCR. Theywere treated with IVIG and aspirin, and were discharged without complications. Subsequently 2 of them were tested positive against anti-RBD and anti-NP antibodies and 1 was tested positive against anti- RBD antibodies. However, microneutralization assay showed that neutralizing antibodies were absent, suggesting a false-positive IgG result. Conclusion: Detection of neutralizing antibodies is recommended to confirm previous SARS-CoV-2 infection in IgGpositive but PCR-negative patients. (C) 2020 The Author(s). Published by Elsevier Inc.