A US woman underwent a COVID-19 nasal swab test and got her brain’s lining punctured instead, as reported by doctors in a medical journal on Thursday.
According to medical experts, the patient who is in her 40s, and reportedly had an undiagnosed rare condition, suffered a life-threatening infection probably due to the COVID-19 test conducted on her may have been carried out improperly.
It must be noted, chances of such critical damage are rare and unfortunate, but her case reaffirms health care professionals should take care to follow testing protocols closely, Jarrett Walsh, senior author of the paper that appeared in JAMA Otolaryngology-Head & Neck Surgery, told AFP.
Walsh said that this particular case is a warning to healthcare professionals all around the world.
He further added that people who suffer extensive sinus or have been through skull-base surgery should be cautious enough to request for an oral testing instead of a nasal swab if available.
Dennis Kraus, an ENT specialist of Lenox Hill Hospital in New York who wasn’t involved in the paper, claims, “It underscores the necessity of adequate training of those performing the test and the need for vigilance after the test has been performed.”
The woman had gone for a nasal test before an elective hernia surgery, and later noticed clear fluid coming out of one side of her nose, said Walsh, a practicing doctor at the University of Lowa Hospital.
The lady who subsequently developed a headache, followed by vomiting, neck stiffness, and unable to bear the light, was transferred to Walsh’s care.
“She had been swabbed previously for another procedure, same side, no problems at all. She feels like maybe the second swab was not using the best technique and that the entry was a little bit high,” he said.
Dr. Suresh Naruka, ear, nose and throat specialist at Apollo Hospitals, New Delhi, explained to Healthwire: “The roof of nose is connected to the brain with a layer of thin bone which separates the nose from the brain is known as the base skull, and if someone tries to push it harsh during the swab test then it may increase the chance of the bone to break.
So, incidents like this can occur if the base skull is weak or thin. Some patients might have a defect in the base skull or nasal cavity, and if the test is not done properly or by mistakenly the stick goes inside the brain through the defect, can rupture the brain layers and fluid can come out.”
Dr. Naruka added: “Therefore especially patients with nasal cavity or any other defect must be very careful while going for a swab test. These tests should be conducted under the proper guidance of the specialist or ENT’s and if required they should get a CT scan done before the test of such patients.
The children and the older patients are at risk of these incidents as they have a weak and thin base skull. So strict safety measures should be taken while the nasal swab tests are conducted because there can be a life-threatening risk of brain infection from bacteria that can travel up the nose”.
The lady, in fact, also had a history of intracranial hypertension which means that the pressure from the cerebrospinal fluid that protects and nourishes the brain was too high.
This 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.
When the old scans were reviewed by her new doctors, they carried out the surgery to repair the defect. Since then she was fully recovered.
Walsh said that the symptoms she developed were the result of irritation to the lining of the brain.
If this problem hadn’t been treated on time, the bacteria could have traveled up the nose, or the air could have entered the skull and placed excess pressure on the brain, leading to a potentially life-threatening brain infection.
Most of the testing protocols call for healthcare professionals to follow the path of the floor of the nose, which lies above the roof of the mouth, rather than pointing the swab up — or if they point it up, they must do so with great care.
This recent case exemplifies that COVID-19 tests even if expertly performed can lead to complications if the patient has undergone any prior surgery or underlying condition that may have altered the structure and strength of their nasal passage or skull.
Dr. Walsh said that though this incident has been a very rare occurrence, it is definitely a reminder of the need for high-quality training, given that hundreds of millions more tests will have to be done before the pandemic is over.