KUALA LUMPUR: It is safe to undergo nasal (or nasopharyngeal) swab test for Covid-19, say medical experts.
The concern and their reassurance come in the wake of a recent article published in a medical journal that said a Covid-19 nasal swab test had ruptured the lining at the base of a woman's skull in the United States, causing cerebrospinal fluid to leak from her nose and putting her at risk of brain infection.
Malaysian Public Health Physicians' Association president Datuk Dr Zainal Ariffin Omar said it was an isolated and extremely rare case.
He said people should not panic or be afraid to take the swab test.
"The patient (in the case) had an underlying health condition. Nasal swab is safe. People must not be over-alarmed. Talk to medical professionals and trust them (in undergoing the test)," he told the New Straits Times.
The case was published in the paper, "Cerebrospinal Fluid Leak (CSF) After Nasal Swab Testing for Coronavirus Disease 2019", which appeared in the JAMA Otolaryngology Head and Neck Surgery journal on Oct 1.
It was reported that the woman had an undiagnosed rare condition and the test might not have been carried out properly.
Professor Dr G. Jayakumar, who is a professor of Community and Occupational Medicine at the Faculty of Medicine in Melaka Manipal Medical College, said the study was done among a population group and did not represent a consensus statement from a reputed medical body.
"I wouldn't pay much attention to it as it (the case) may be a late complication. The basic preventive measures still hold good."
The paper stated that the case of iatrogenic CSF leak from nasal swab testing for Covid-19 illustrated that prior surgical intervention, or pathology that distorts normal nasal anatomy may increase the risk of adverse events associated with nasal testing for respiratory pathogens, including Covid-19.
It said, therefore, that one should consider alternative methods to nasal screening in patients with known prior skull base defects, history of sinus or skull base surgery, or predisposing conditions to skull base erosion.
Jarrett Walsh, a senior author of the paper, who practises at the University of Iowa Hospital, told AFP that the patient's case showed that healthcare professionals should take care to follow testing protocols closely.
He said people who have had extensive sinus or skull base surgery should consider requesting oral testing if available.
Ear, nose and throat specialist Dennis Kraus of Lenox Hill Hospital in New York told AFP that the report highlighted the need to provide adequate training to those performing the test.
Walsh said the woman had gone for a nasal test ahead of an elective hernia surgery and later noticed clear fluid coming out of one side of her nose.
She subsequently developed headache, vomiting, neck stiffness and aversion to light, and was transferred to Walsh's care.
The patient, Walsh said, had been treated years earlier for intracranial hypertension, which meant that the pressure from cerebrospinal fluid that protects and nourishes the brain was too high.
Doctors at the time used a shunt to drain some of the fluid and the condition resolved. But it caused her to develop an encephalocele, or a defect at the base of the skull, which made the brain's lining protrude into the nose where it was susceptible to rupture.
This went unnoticed until old scans were reviewed by her new doctors, who carried out surgery to repair the defect in July. She has since fully recovered, AFP reported.