Atypical Presentation Of COVID-19 Research Articles

Divergent: Age, Frailty, and Atypical Presentations of COVID-19 in Hospitalized Patients.

BackgroundAlthough frailty has been associated with atypical manifestations of infections, little is known about COVID-19 presentations in hospitalized frail patients. We aimed to investigate the association between age, frailty, and clinical characteristics of COVID-19 in hospitalized middle-aged and older adults.MethodsLongitudinal observational study comprising 711 patients aged ≥50 years consecutively admitted to a university hospital dedicated to COVID-19 severe cases, between March and May 2020. We reviewed electronic medical records to collect data on demographics, comorbidities, COVID-19 signs/symptoms, and laboratory findings on admission. We defined frailty using the Clinical Frailty Scale (CFS=1-9; frail ≥5). We also documented in-hospital mortality. We used logistic regressions to explore associations between age, frailty, and COVID-19 signs/symptoms; and between typical symptoms (fever, cough, dyspnea) and mortality.ResultsParticipants had a mean age of 66±11 years, and 43% were female. Overall, 25% were frail, and 37% died. The most common COVID-19 presentations were dyspnea (79%), cough (74%), and fever (62%), but patients aged ≥65 years were less likely to have a co-occurrence of typical symptoms, both in the absence (OR=0.56; 95%CI=0.39-0.79) and in the presence of frailty (OR=0.52; 95%CI=0.34-0.81). In contrast, older age and frailty were associated with unspecific presentations, including functional decline, acute mental change, and hypotension. After adjusting for age, sex, and frailty, reporting fever was associated with lower odds of mortality (OR=0.70; 95%CI=0.50-0.97).ConclusionsAtypical COVID-19 presentations are common in frail and older hospitalized patients. Providers should be aware of unspecific disease manifestations during the management and follow-up of this population.

S1425 An Atypical Presentation of COVID-19 as Acute Pancreatitis

INTRODUCTION: While gastrointestinal manifestations of the novel coronavirus infection (COVID-19) viral infection is reported, the extent of organ involvement is unknown. Effect of the virus on the pancreas is unclear. We report a rare case of viral acute pancreatitis (AP) likely secondary to COVID-19 infection. CASE DESCRIPTION/METHODS: 34 year-old healthy hispanic male presented with epigastric pain, bilious vomiting and nausea for 5 days. He endorsed shortness of breath, cough, fever, chills and recent exposure to a known COVID-19 positive patient. He denied previous surgeries, medication or alcohol use. Vital signs were BP 156/90, HR 112, T103 F, R20 with 98% saturation on room air. Exam was pertinent for epigastric tenderness to palpation. As seen in Table 1, labs showed elevated lipase, transaminitis and acute kidney injury on admission. He was admitted to medicine for presumed COVID viral infection and started on ceftriaxone, azithromycin, hydroxychloroquine and IV fluids. Subsequent nasal swab was positive for SARS-COV-2 viral infection. On day 3, the patient complained of worsening abdominal pain, fever of 103.6 and elevation of lipase to 211, greater than 3 times ULN ( >200 U/L). Liver function enzymes, lipase and inflammatory peaked on day 5 with subsequent clinical improvement. Further investigations were negative for causes of AP including hypertriglyceridemia, hypocalcemia, gallstones, autoimmune pancreatitis, leading to diagnosis of exclusion of acute pancreatitis secondary to COVID-19 viral infection. Patient improved clinically with complete resolution of fever and abdominal pain on day 9, and was discharged with outpatient follow up. DISCUSSION: Although AP due to has been known to be caused by a few viruses (CMV, Mumps, and Influenza), the effect of COVID-19 on the pancreas is unclear. There are only four reports of AP attributed to COVID-19. While Wang et al. reported pancreatic injury in COVID-19 patients, the elevations in pancreatic enzymes were mild, and there were no signs of clinical AP. Our case features a patient with COVID-19 infection presenting with predominantly gastrointestinal symptoms that resolved on symptomatic management as the viral inflammatory response subsided. Possible mechanisms include virus affinity to ACE-2 receptors, expressed in pancreatic islet cells and cytotoxic injury from inflammatory response. By outlining this rare gastrointestinal manifestation of COVID-19, we hope to improve current clinical understanding.Table 1.: Laboratory values through hospital stay showing rising lipase, liver function tests and inflammatory markers

Atypical presentation of COVID-19 in hospitalised older adults.

BackgroundIt is increasingly recognised that older patients may not present with typical symptoms of COVID-19.AimsThis study aims to evaluate the incidence, characteristics and clinical outcome of older adults with atypical presentations of COVID-19.MethodsA retrospective analysis of adults ≥ 65 years with confirmed COVID-19 admitted to our institution between 1 March and 24 April 2020 was performed. Patients were categorised into typical or atypical groups based on primary presenting complaint in the community.ResultsOne hundred twenty-two patients (mean age 81 ± 8 years; 62 male) were included. Seventy-three (60%) were categorised into the typical group and 49 (40%) into the atypical group. In the atypical group, common presenting complaints were fall in 18 (36%), reduced mobility or generalised weakness in 18 (36%) and delirium in 11 (22%). Further assessment by paramedics and on admission found 32 (65%) to have typical features of COVID-19, fever being the most common, and 22 (44%) were hypoxic. This subset had worse outcomes than those in the typical group with a mortality rate of 50% versus 38%, respectively, although this was not statistically significant (P = 0.27). No significant difference in mortality or length of hospital stay between the groups was demonstrated.ConclusionOlder patients with atypical presentation of COVID-19 in the community are equally susceptible to poor outcomes. Early detection may improve outcomes and limit community transmission. Primary care practitioners should be vigilant and consider prompt onward referral.

COVID-19 in Nursing Homes: Calming the Perfect Storm.

The pandemic of viral infection with the severe acute respiratory syndrome coronavirus-2 that causes COVID-19 disease has put the nursing home industry in crisis. The combination of a vulnerable population that manifests nonspecific and atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a "perfect storm" in our country's nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal. J Am Geriatr Soc 68:2153-2162, 2020.

Lung base CT findings in COVID-19 adult patients presenting with acute abdominal complaints: case series from a major New York City health system.

ObjectiveTo describe demographic, clinical, and lung base CT findings in COVID-19 patients presenting with abdominal complaints.MethodsIn this retrospective study, 76 COVID-19 patients who underwent abdominal CT for abdominal complaints from March 1 to April 15, 2020, in a large urban multihospital Health System were included. Those with positive abdominal CT findings (n = 14) were then excluded, with 62 patients undergoing final analysis (30M/32F; median age 63 years, interquartile range (IQR) 52–75 years, range 30–90 years). Demographic and clinical data were extracted. CT lung base assessment was performed by a cardiothoracic radiologist. Data were compared between discharged and hospitalised patients using Wilcoxon or Fisher’s exact tests.ResultsThe majority of the population was non-elderly (56.4%, < 65 years) and most (81%) had underlying health conditions. Nineteen percent were discharged and 81% were hospitalised. The most frequent abdominal symptoms were pain (83.9%) and nausea/vomiting/anorexia (46.8%). Lung base CT findings included ground-glass opacities (95.2%) in a multifocal (95.2%) and peripheral (66.1%) distribution. Elevated laboratory values (when available) included C-reactive protein (CRP) (97.3%), D-dimer (79.4%), and ferritin (68.8% of males and 81.8% of females). Older age (p = 0.045), hypertension (p = 0.019), and lower haemoglobin in women (p = 0.042) were more frequent in hospitalised patients. There was no difference in lung base CT findings between discharged and hospitalised patients (p > 0.165).ConclusionsCOVID-19 patients can present with abdominal symptoms, especially in non-elderly patients with underlying health conditions. Lung base findings on abdominal CT are consistent with published reports. Radiologists should be aware of atypical presentations of COVID-19.Key Points• COVID-19 infected patients can present with acute abdominal symptoms, especially in non-elderly patients with underlying health conditions, and may frequently require hospitalisation (81%).• There was no difference in lung base CT findings between patients who were discharged and those who were hospitalised.• Lung base CT findings included multifocal and peripheral ground-glass opacities, consistent with published reports.

A Cautionary Tale of an Atypical Presentation of COVID-19 in the Geriatric Population

A Cautionary Tale of an Atypical Presentation of COVID-19 in the Geriatric Population

The atypical presentation of COVID-19 as gastrointestinal disease: key points for primary care.

Since the SARS-CoV2 outbreak in Wuhan, China, in late 2019, the world has been ravaged by a roaring pandemic. Unlike coronavirus SARS-CoV that caused the severe acute respiratory syndrome (SARS) outbreak in 2002, SARS-CoV2 has proven to be more contagious and difficult to control. A key challenge is that the disease presentation can be very variable: patients in the early phase of infection may be asymptomatic, have subclinical symptoms, or atypical symptoms of COVID-19. This, compounded with the lack of easily accessible diagnostic tests, makes it challenging to diagnose COVID-19 in the community. The most common symptoms of patients with COVID-19 are fever (72–88%) and cough (68–83%).1,2 A sore throat may be present in 14–61% of patients, and dyspnoea is usually seen in severe cases and is less frequent (11–19%).1,2 Other non-specific symptoms such as myalgia, headaches, rhinorrhoea, anosmia, ageusia, nasal congestion, conjunctivitis, and haemoptysis have been reported but are comparatively infrequent. However, of significant concern is the atypical presentation of gastrointestinal (GI) symptoms. Early experience in Wuhan illustrated how a cluster outbreak occurred from a single index patient being mistakenly admitted to surgical services for abdominal pain. This resulted in nosocomial spread to 10 healthcare workers and four other patients, all presenting with abdominal symptoms of diarrhoea, nausea, and loss of appetite.3 Non-bloody diarrhoea …

Atypical Presentation of COVID-19: Acute Renal Failure.

Coronavirus disease (COVID-19) emerged in Wuhan, China, in December 2019 and rapidly became a global pandemic, with the number of confirmed infections worldwide reaching 1 million by the start of April 2020 and 3 million less than a month later. COVID-19 can be encountered with different clinical presentations. We present the case of a patient with COVID-19 in the etiology presenting with acute renal failure.

COVID-19: to be or not to be; that is the diagnostic question.

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.

Beyond the lung involvement in COVID-19 patients.

Since COVID-19 spread all over the world becoming a pandemic illness, researchers have better characterized route of virus transmissibility and clinical signs and symptoms of the disease. Since viral transmission occurs through the droplets emitted during coughing or sneezing, the lungs are primarily affected. However, SARS-CoV-2 can affect several human organs due to high expressions of ACE2 receptor which is the main viral target, and the virus may affect not only higher and lower respiratory tracts, but also heart, kidney, gastro enteric tract, liver, pancreas, nervous system and skin. This review focuses on extra pulmonary involvement underlying atypical presentation of COVID-19. There is a great body of evidence concerning several human organ abnormalities associated to the SARS-CoV-2, enough to consider COVID-19 as a multisystemic and polyhedral disease.

Atypical presentation of Covid-19 – Peripheral arterial thrombosis

The present ongoing pandemic of Coronavirus Disease 2019 (COVID-19) has been viewed to be typically affecting the respiratory system chiefly the lungs parenchyma, but it has been more and more evident that severe acute respiratory syndrome coronavirus-2 is not exclusive to his single system. Here, we report a rare case of a 55-year-old female presented with the left brachial thrombus as an atypical presentation of COVID-19.

Acute pancreatitis in a patient with COVID-19: A case report

Introduction: The world is in the middle of the COVID-19 global pandemic. Case load is rising on exponential rate and we have already crossed 20 million mark. Typical presenting feature of COVID-19 is asymptomatic/mild or symptoms/acute respiratory illness and death. Gastrointestinal (GI) manifestations are common like loose stools, nausea, and abdominal pain. Case Report: A case of a 19-year-old girl without previous comorbidities presented with typical symptoms of COVID-19. During hospital stay she developed abdominal pain and diagnosed severe pancreatitis. All common causes of acute pancreatitis were ruled out by doing relevant investigations. Her pancreatitis was severe and required percutaneous drainage of necrotic material. She was discharged after prolonged hospital stay even after her negative COVID test. Conclusion: Atypical presentation of COVID-19 is increasing with increasing case load. Abdominal pain in a patient with COVID should be evaluated for acute pancreatitis and be treated accordingly to lessen morbidity and mortality.

Covid-19 påvist hos eldre kvinne med akutt funksjonssvikt

BACKGROUND Atypical presentation of illness (by onset of delirium and falls) in older patients is highly prevalent, but little information is available on atypical presentations of elderly patients with COVID-19. CASE PRESENTATION A woman in her late eighties was admitted after falling in her own home, complaining of dizziness and confusion. She had no obvious respiratory symptoms. The working diagnosis was exacerbation of chronic dizziness due to dehydration or possibly a urinary tract infection. Further investigations revealed that she had COVID-19. By then the patient had been treated by several healthcare workers who − at that stage − were not wearing protective equipment. Consequently, quarantine measures had to be implemented. INTERPRETATION This case illustrates an atypical presentation of COVID-19 amongst older people and the consequences of delayed detection. Paying attention to atypical presentations in older people and appropriate treatment and infection control measures are essential for geriatric care and for public health.