Kinetics IgM and IgG SARS-CoV-2 in Recovery Patients with Negative Evaluation RT-PCR

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Introduction
Coronavirus disease (COVID-19) is one of major problem in human respiratory system.In late December 2019, a case of patients was admitted to hospital with initial symptoms like pneumonia. 1 The pathogenesis of COVID-19 infections is as follow. 2In the last December 2019 five patients were hospitalized with acute respiratory syndrome and one of the patient died. 3e China National Health Commission reported that first 17 deaths until January 2020.A total 1975 cases were confirmed COVID-19 infected in China with a total 56 deaths. 4CDC reported first case human to human transmission of COVID-19 on January 30, 2020. 5VID-19 is an infectious disease caused by the SARS-CoV-2 Virus.SARS-CoV-2 are a positivesense, single stranded RNA (ssRNA) virus with genome length from 20-32 kb and about 125 nm in diameter that belongs to the Coronaviridae family. 6The mortality rate of SARS-CoV-2 a novel beta coronavirus is about 3.4% but SARS-CoV-2 has potentially higher transmission than another Coronavirus. 7e diagnosis of COVID-19 is dependent on clinical symptoms, CT imaging and some All tests were performed according to the product manual.
The figure 3a and 3b showed that the IgM level rate increase slightly at first and than decrease after the number of week form serological detected.In contrast, IgG level increase were higher than IgM overtimes.The limitations this study should be mentioned.
Result this study need to be further the validated by studies in a lerge data of subject.The antibodies study need more sensitive method for detection comprehensive antibodies level.

Conclusion
The

Datt
et al MEDICAL AND HEALTH SCIENCE JOURNAL 2023 AUGUST, VOL 07 (01) Page 52 of 56 laboratory result.Although some clinical manifestations and laboratory result have indicated to lead as a COVID-19 disease, that not unique to SARS-CoV-2 infection.The rapid and accurate diagnostic of COVID-19 is needed to rapid and good management, accurate public surveillance, prevention and control disease.Real-time reverse transcriptase polymerase chain reaction (RT-PCR) has been gold standard for diagnosis SARS-CoV-2. 8Patients with COVID-19 infection have a mild disease and recover quickly after good clinical management.Some COVID-19 patients develop more severe disease, multiple organ failure and death in the short time. 7Previous study reported that massive inflammatory responses induce the overinflammation of T cells and be severe infection in SARS-CoV-2 pathogenesis. 9Serological examination of Covid 19 in survivors is not only helps identify affected cases but can provide important information regarding Covid-19 immunity to infected groups.In SARS-CoV-2 infection, specific IgG antibodies increase and reach a peak at 4 months after the onset of the disease and then decrease after 16 months. 10Antibody level are generally regarded as protective, detrimental affected, as antibody dependent enhancement (ADE), hypothesis of SAR-CoV-2 infection. 11It is still on investigation whether ADE play a role in pathogenesis of COVID-19.A study showed that patients in severity case with COVID-19 had higher total SARS-CoV-2 antibody titers compared mild patients SARS-CoV-2 infection. 12However, weather higher neutralizing antibody (Nab) titers are associated with more lung manifestations to elucidated.Serological method another way to laboratory diagnostic, can diagnose disease by detecting antibody.Estimated decrease antibody to know antibodies circulated in the body.The aim this study to investigate the diagnostic value of serological method and the kinetic variance of IgG and IgM antibodies in patients with RT-PCR negative Methods Design and Subject Criteria A total 19 patients were diagnosed by real-time PCR testing.After isolation the subject we informed to be subject in this study.Patients who agree with informed consent we included to this study.The patients were followed up level of IgG and IgM after negative result 1 month, 2 months and and 4 months after negative realtime-PCR testing.Demographic information and symptoms we got from patient interview.The diagnosis of COVID-19 and evaluation patients is based on report Health Office (Dinas Kesehatan Provinsi) Bengkulu Province, Indonesia.The study was ethical approved by Health Research Ethics Comitte of the Faculty of Medicine and Health Sciences Universitas Bengkulu, by numbers 189/UN30.14.9/LT/2020.SARS-CoV-2 RNA Detection A total of 19 patients were diagnosed with realtime PCR testing.Diagnosis of COVID-19 using the RT-qPCR method using a sore throat swab in the nasopharynx.The examination used primers and probes targeting NP and the SARS-CoV-2 open reading frame1b gene according to World Health Organization (WHO) guidelines. 13Throat swab specimens were collected from all patients and samples were stored in viral transport media for laboratory testing.Datt et al MEDICAL AND HEALTH SCIENCE JOURNAL 2023 AUGUST, VOL 07 (01) Page 53 of 56 Serology Testing The specific IgG and IgM of SARS-CoV-2 were detected by IFA (Immuno fluorosence assay) used serum.The reagent used is COVID-19 IgG and IgM from (Frendcov, Nanoentech, Nanoentek America, Inc, USA).The catridge utilizas microfluicidics lateral flow technology where the analyte of interest in the sample forms immune complexes while moving through the fluidics pathway in the catridge.A well-mixed sample of 35 µL is transferred to the sample inlet of a single use frend COVID-19 total ab catridge.The catridge is then placed into the frend system, which is programmed to begin analysis once the sample has reacted with the reagents.IgM and IgG if present in the sample will bind to SARS-CoV-2 nucleocapsid fluorescent beads which then bind to the anti-IgM and anti-IgG in the test zone.

Table 1 .
Demographic and clinical symptoms level IgM and IgG level increase at first week and decrease after 12 weeks.IgM level lower than IgG level overtime.Quantitative IgG and IgM detection could be point of diagnosis and