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WASHINGTON (AFP) – A Covid-19 nasal swab test ruptured the lining at the base of an American woman’s skull, causing cerebrospinal fluid to leak through her nose and put her at risk for brain infection, the researchers reported. doctors in a medical journal on Thursday (October 1).
The patient, who is 40, had a rare, undiagnosed condition and the test she received may have been performed incorrectly – an unlikely sequence of events that means the risk of nasal tests remains very low.
But healthcare professionals should be careful to follow the testing protocols closely, Jarrett Walsh, lead author of the paper that appeared in JAMA Otolaryngology-Head & Neck Surgery, told AFP.
People who have had extensive sinus or skull base surgery should consider requesting an oral test if available, he said.
“It underscores the need for proper training of those performing the test and the need for surveillance after the test is performed,” added Ear, Nose and Throat Specialist Dennis Kraus of Lenox Hill Hospital in New York, who was not involved in the paper.
Walsh, who practices at the University of Iowa Hospital, said the woman had undergone a nasal test prior to elective hernia surgery, and later noticed clear fluid leaking from one side of her nose.
She subsequently developed a headache, vomiting, stiff neck, and aversion to light, and was transferred to Walsh’s care.
“She had been cleaned previously for another procedure, on the same side, without any problem. She feels that maybe the second swab was not using the best technique, and that the input was a bit high,” he said.
In fact, the woman had been treated years earlier for intracranial hypertension, which means that the pressure of the cerebrospinal fluid that protects and nourishes the brain was too high.
Doctors at the time used a bypass to drain some of the fluid, and the condition resolved.
But it caused him to develop what’s called an encephalocele, or a defect at the base of the skull that caused the lining of the brain to protrude into the nose, where it was susceptible to rupture.
This went unnoticed until his new doctors reviewed the old scans, who performed surgery to repair the defect in July.
Since then he has made a full recovery.
Walsh said he believes the symptoms he developed were the result of irritation of the lining of the brain.
If the problem had not been treated, he could have developed a life-threatening brain infection from bacteria that made their way up his nose.
Most testing protocols require clinicians to follow the path of the floor of the nose, which is located above the roof of the mouth, rather than pointing the swab upward, or if they point at it, doing so very carefully.
Walsh said that while this likely occurred very little, it was a reminder of the need for high-quality training, given that hundreds of millions more tests will be conducted before the pandemic ends.
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