A novel coronavirus emerged in China in 2019, named as
SARS-CoV-2, become a pandemic. Scientists, Researchers and Health care
professionals are still learning about it. It is an endeavor to compile the
unusual/atypical symptoms, as far as possible, from different reputed sources.
It will help the health care personnel to remain aware of the possibility of
dealing with a COVID-19 patient, when patients present with symptoms, similar
to some other disease.
Fever,
Cough, Shortness of breath; these are what have become known as the classic,
tell-tale COVID-19 symptoms. However, there
can be additional non-specific, atypical symptoms or different, less common ones
that should alert the health care profession, the possibility of the infection. Those include, Sore throat, Diarrhea, Myalgia (muscle
aches, body aches), abdominal pain, loss of smell or taste, conjunctivitis, Tiredness
or fatigue.
At
present the definition of a COVID-19 Suspected Case:
|
Suspected Case Definitions
|
||
|
A. Symptoms +
Travel History |
B. Symptoms +
Epidemiologic Link |
C. Severe Symptoms
|
|
A patient with ALL of the
following:
|
A patient with ALL of the following:
·
any
acute respiratory illness
·
contact
of a confirmed or probable case of COVID-19 disease during the 14 days prior
to the onset of symptoms
|
A patient with ALL of the
following:
·
severe
acute respiratory infection
·
requires
hospitalization
·
no other
etiology that fully explains the clinical presentation
|
1.
Loss of smell
and taste has been reported with such a frequency in COVID-19 that some
medical professionals suggest to take it as a cardinal feature for diagnosis,
if, associated with features of respiratory infection, even common cold or
seasonal flu. According to Carol Yan, an otolaryngologist from the University
of California San Diego in the US, “if, you have smell and taste loss, you are
more than 10 times more likely to have COVID-19 infection than other causes of
infection."
The loss of smell reported to be so profound
that the patient starts nauseating just at the sight of food. He further says,
while the most common first sign of a COVID-19 infection remains fever, fatigue/loss
of smell and taste follow as other very common initial symptoms.
Based on the findings, UC San Diego
Health has included loss of smell and taste as a screening requirement for
visitors and staff, as well as a marker for testing patients who may be
positive for the virus. The original article was published in The Week on April 14, 2020 15:14 IST, can be accessed here.
2.
Abdominal
discomfort may be the presenting symptom in as many as 20 percent of
patients. Recent literature has revealed that as many as 20 percent of patients
present to the hospital with a digestive symptom, such as diarrhea, vomiting,
pain, accompanying their respiratory symptoms. And, roughly 5 percent show up
with an abdominal complaint alone.
This is where abdominal radiologists can
play an integral role, said industry experts in a recent article published in
the American Journal of Roentgenology. A team,
led by Abraham Dachman, M.D., professor of radiology and abdominal imaging
specialist with UChicago Medicine, shared three cases where patients were
referred for abdominal imaging and providers distinguished findings indicative
of COVID-19 infection in the lung base.
Axial CT of abdomen and pelvis shows
left basilar round airspace and ground-glass opacities (arrow). Appearance is
highly compatible with atypical infection such as coronavirus disease
(COVID-19) pneumonia.
3.
The
gastrointestinal presentation can delay the initiation of COVID-19
diagnostic workup. Notably, however, the first case of COVID-19 infection
confirmed in the United States reported a 2-day history of nausea and vomiting
on admission followed by loose stools in hospital on day 2, and COVID-19 viral
nucleic acids of loose stool and respiratory specimens were reported positive.
In a recent report from Hubei, China, 204 COVID-19-infected patients were
studied, and the authors reported that digestive symptoms are not uncommon in
patients with COVID-19. The original article, published in The Karger, can be
accessed here.
According to the WHO, digestive issues like diarrhea and nausea may be a more common symptom than previously thought.
4. Conjuctivitis: Several reports suggest
that SARS-CoV-2 can cause a mild
follicular conjunctivitis otherwise indistinguishable from other
viral causes, and possibly be transmitted by aerosol contact with conjunctiva.
However, at this point in the COVID-19 pandemic, practically any patient seen
by an ophthalmologist could be infected with SARS-CoV-2, regardless of
presenting diagnosis, risk factors, indication for visit or geographic
location. Updated on April 21, 2020, online by American Academy of
Ophthalmology, can be accessed here. Access
the Ocular manifestations of a hospitalized patient with confirmed 2019
novel coronavirus disease in The British Journal of Ophthalmology here.
5.
Malaise
and Confusion can be present in varied number of patients of COVID-19 are
some of the atypical symptoms, according to an article
published in The Lancet.
In
a study, the most common symptoms at onset of illness were fever (40 [98%] of
41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common
symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38),
haemoptysis (two [5%] of 39), and diarrhea (one [3%] of 38). More than half of
patients (22 [55%] of 40) developed dyspnoea.
6.
Headaches and dizziness may also be signs of the
viral infection: According to the study in The Lancet, about 8 percent
of COVID-19 patients reported headaches. Dizziness has also been reported in
some cases – frequent dizzy spells or very severe or abrupt bouts of dizziness
could indicate a more serious health risk, according to the Cleveland Clinic.
7.
Chills or muscle aches occasionally accompany
COVID-19. Aches and chills can be symptoms of many illnesses, including the
flu, but coronavirus patients have reported them. It's not clear how prevalent
these symptoms are, but about 11 percent of people studied reported chills, and
14 percent reported muscle aches, according to the WHO report.
8.
Runny nose is rarely a sign of coronavirus: It
is more indicative of allergies or a cold. A minority of COVID-19
patients experience nasal congestion or a runny nose – less than 5 percent of
people experience these symptoms, according to the WHO report.
9.
Acute
myocarditis is thought to be a possible complication associated with
COVID-19. While, it is required to closely monitor such patients for the
complication, medical profession should keep in mind to test for the COVID-19,
whenever other symptoms or epidemiologic link is available. Laboratory testing,
including troponin levels, in individuals with recent symptoms of an acute
illness should be performed to guarantee appropriate identification and prompt
isolation of patients at risk of COVID-19 and eventually to reduce further
transmission. The article published in JAMA Network on March 27, 2020, can
be accessed here.
10.
Necrotizing
encephalopathy: A woman who tested positive for COVID-19 developed a rare
brain disease known as acute necrotizing encephalopathy, a condition that can
be triggered by viral infections like influenza
and herpes.
At
this point, the brain damage "has yet to be demonstrated as a result of
COVID-19 infection," according to a case report published March 31 in the
journal Radiology.
However, as the novel coronavirus continues to spread, "clinicians and
radiologists should be watching for this presentation among patients presenting
with COVID-19 and altered mental status," the authors wrote.
The
original article published online by the Radiological Society of North America
on Mar 31, 2020 can be accessed here.
11.
Asymptomatic
(subclinical): Now-a-days, a large number of asymptomatic (in
pre-clinical/pre-symptomatic stage) patients are seen positive for COVID-19;
many are also seen with mild symptoms (easily ignored). Many more asymptomatic
contacts are also positive for COVID-19. It
may go up to 80%. Another study suggests that the number can be between
5% and 80%.
In those mild cases,
the predominant CT in Lungs can be diagnostic, with the findings of
ground-glass opacification, consolidation, bilateral involvement, and
peripheral and diffuse distribution. Notably, in Shi and colleagues' study, the
asymptomatic (subclinical) group of patients showed early CT changes,
supporting what was first observed in a familial cluster with COVID-19
pneumonia. Published on February 24th,
2020 in The Lancet can be accessed here.
12.
Atypical symptoms of COVID‑19 can be more common
in immune-suppressed or immune-compromised patients. They may present with the
symptoms of COVID‑19; neutropenic sepsis and pneumonitis may be difficult to
differentiate at initial presentation. Medical profession has to keep in mind
to screen and triage all those patients to assess, whether they are known,
suspected to have COVID‑19, or have been in contact with someone with confirmed
infection. In that case, COVID-19
rapid guidance from National Institute for Health & Care Excellence,
updated on April 17, 2020, can be followed.
Atypical symptoms in COVID-19: the
many guises of a common culprit: COVID-19 exhibits a diverse range of
clinical presentations. Whilst classical respiratory symptoms of a dry cough
have been underscored, these may be preceded by atypical symptoms. More
generally, it is important not to neglect other disease manifestations, since
they may represent alternative modes of viral dissemination.
In critically ill patients, evidence of
raised inflammatory markers suggests that cytokine storm syndrome occurs in
COVID-19 and may underlie some atypical presentations. Notably, the elderly and
those with multiple co-morbidities are severely affected by COVID-19, and
atypical symptoms in these susceptible groups warrant further investigation.
More Readings at:
1.
Published
on Mar 31st, 2020, 23:28 IST in The Business Insider, India; 10
coronavirus symptoms you may not be aware of, from malaise and dizziness to
digestive issues.
2. Published on 1st April, 2020 in The ScienceAlert; Some COVID-19 Symptoms Are Turning Out to Be Atypical. Here's What We Know So Far
3. Published on 05 April 2020 in thebmj in a letter to the Editor, under caption, “Atypical symptoms in COVID-19: the many guises of a common culprit.”
4. Published on April 17th, 2020 in Medscape: Unusual Presentations of COVID-19: 'Our Ignorance Is Profound'
(A Paradip Port Trust Hospital Document)
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