Presenting Symptom Of COVID-19 Research Articles

Skin Manifestations as Early Presenting Symptom of COVID-19 in Acute Myeloid Leukemia

Coronavirus infection in 2019 (COVID-19) is an acute respiratory infection caused by a coronavirus, and it has been associated with various organ involvement. However, there are few examples of COVID-19's unusual appearance in newly diagnosed acute myeloid leukaemia (AML). Through two case reports and a literature review, this report aims to provide an overview of cutaneous characteristics in COVID-19 individuals. In this study, we present two patients with AML who developed a diffuse maculo

Fever in the ICU: A Predictor of Mortality in Mechanically Ventilated COVID-19 Patients.

Purpose:While fever may be a presenting symptom of COVID-19, fever at hospital admission has not been identified as a predictor of mortality. However, hyperthermia during critical illness among ventilated COVID-19 patients in the ICU has not yet been studied. We sought to determine mortality predictors among ventilated COVID-19 ICU patients and we hypothesized that fever in the ICU is predictive of mortality.Materials and Methods:We conducted a retrospective cohort study of 103 ventilated COVID-19 patients admitted to the ICU between March 14 and May 27, 2020. Final follow-up was June 5, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded.Results:103 patients were included, 40 survived and 63(61.1%) died. Deceased patients were older {66 years[IQR18] vs 62.5[IQR10], (p = 0.0237)}, more often male {48(68%) vs 22(55%), (p = 0.0247)}, had lower initial oxygen saturation {86.0%[IQR18] vs 91.5%[IQR11.5], (p = 0.0060)}, and had lower pH nadir than survivors {7.10[IQR0.2] vs 7.30[IQR0.2] (p < 0.0001)}. Patients had higher peak temperatures during ICU stay as compared to hospital presentation {103.3°F[IQR1.7] vs 100.0°F[IQR3.5], (p < 0.0001)}. Deceased patients had higher peak ICU temperatures than survivors {103.6°F[IQR2.0] vs 102.9°F[IQR1.4], (p = 0.0008)}. Increasing peak temperatures were linearly associated with mortality. Febrile patients who underwent targeted temperature management to achieve normothermia did not have different outcomes than those not actively cooled. Multivariable analysis revealed 60% and 75% higher risk of mortality with peak temperature greater than 103°F and 104°F respectively; it also confirmed hyperthermia, age, male sex, and acidosis to be predictors of mortality.Conclusions:This is one of the first studies to identify ICU hyperthermia as predictive of mortality in ventilated COVID-19 patients. Additional predictors included male sex, age, and acidosis. With COVID-19 cases increasing, identification of ICU mortality predictors is crucial to improve risk stratification, resource management, and patient outcomes.

Multiple Introductions Followed by Ongoing Community Spread of SARS-CoV-2 at One of the Largest Metropolitan Areas of Northeast Brazil.

Multiple epicenters of the SARS-CoV-2 pandemic have emerged since the first pneumonia cases in Wuhan, China, such as Italy, USA, and Brazil. Brazil is the third-most affected country worldwide, but genomic sequences of SARS-CoV-2 strains are mostly restricted to states from the Southeast region. Pernambuco state, located in the Northeast region, is the sixth most affected Brazilian state, but very few genomic sequences from the strains circulating in this region are available. We sequenced 101 strains of SARS-CoV-2 from patients presenting Covid-19 symptoms that reside in Pernambuco. Phylogenetic reconstructions revealed that all genomes belong to the B lineage and most of the samples (88%) were classified as lineage B.1.1. We detected multiple viral introductions from abroad (likely from Europe) as well as six local B.1.1 clades composed by Pernambuco only strains. Local clades comprise sequences from the capital city (Recife) and other country-side cities, corroborating the community spread between different municipalities of the state. These findings demonstrate that different from Southeastern Brazilian states where the epidemics were majorly driven by one dominant lineage (B.1.1.28 or B.1.1.33), the early epidemic phase at the Pernambuco state was driven by multiple B.1.1 lineages seeded through both national and international traveling.

In Reply: May Cooler Heads Prevail During a Pandemic: Stroke in COVID-19 Patients or COVID-19 in Stroke Patients?

In Reply: May Cooler Heads Prevail During a Pandemic: Stroke in COVID-19 Patients or COVID-19 in Stroke Patients?

Headache as a Prognostic Factor for COVID-19. Time to Re-evaluate

Headache occurs in only about 13% of patients within the cohort of presenting COVID-19 symptoms. The hypothesis that such a painful symptomatic picture could be considered a prognostic factor for COVID-19 positive evolution or its trend of severity, or the co-generation of hyposmia/anosmia and/or hypogeusia/ageusia, needs robust epidemiological data, punctual pathophysiological demonstrations, and a detailed comparative analysis on drug–drug interactions (DDIs).

Mortality of Patients with Cancer Presenting with Symptoms of COVID-19 With vs Without Detectable SARS-CoV-2: A Nationwide Prospective Cohort Study

Background: This nationwide prospective cohort reports on the outcome of patients with cancer presenting COVID-19 symptoms with or without detectable SARS-COV2 on RT-PCR and/or specific CT-scan imaging.Methods: This prospective study was conducted in 23 Cancer Centers and hospitals. Inclusion criteria were :1) confirmed diagnosis of solid or hematologic cancer in treatment and 2) clinical symptoms of COVID-19. COVID-19 infection was defined as: 1) detectable SARS-CoV2 on RT-PCR (repeated twice if negative first) and/or specific CT-scan imaging if undocumented SARS-COV-2 on RT-PCR. The primary endpoint was death at day-28 after COVID-19 test, in patients with (COVID-19 positive group) or without (COVID-19 negative group) documented COVID-19.Findings: From March 1st 2020 to May 21st 2020, 1230 cancer patients with suspicion of COVID-19, including 1162 (94·5%) matching inclusion criteria were included. 425 (36·6%) [including 155 [13·3%] with diagnosis on CT-scan only], and 737 (63·4%) were in the COVID-19+ and COVID-19- groups respectively. Deaths within 28 days after COVID-19 diagnosis occurred in 116/425 (27·8%) of COVID-19+ patients, and in 118/737 (16·3%) of COVID-19 negative patients (p100 mg/L vs 35/203 (17·4%) of other patients died before day 28 (pInterpretation: Patients with cancer presenting COVID-19 symptoms with or without detectable SARS-COV-2 by RT-PCR are both at high risk of early mortality. COVID-19 is reported as the cause of death in 50% of the COVID-19 positive patients with cancer.Trial Registration: This trial is registered with ClinicalTrials.gov, number NCT04363632Funding Statement: This work was supported by LYRICAN (INCA-DGOS-INSERM-12563), the French National Research Agency [LabEx DEvweCAN (ANR-10-LABX0061)], RHU4-DEPGYN (ANR-18-RHUS-0009), INCA&DGOS (NetSARC, RREPS, RESOS), INCA (InterSARC), European commission (EURACAN-EC739521), Fondation ARC, PIA Institut Convergence François Rabelais PLAsCAN (17-CONV-0002), La Ligue contre le Cancer, La Ligue de L’Ain contre le Cancer. This work was partly supported by an unrestricted grant from Astra Zeneca. Declaration of Interests: The authors have declared no potential conflicts of interest.Ethics Approval Statement: Local approval of the Data Protection Officer of Centre Léon Bérard, the sponsoring center, was obtained in accordance with French national and European laws and directives. The coordinating center complies with the MR-004 French data protection authority (CNIL) requirements (project reference: R201-004-040).

Letter: May Cooler Heads Prevail During a Pandemic: Stroke in COVID-19 Patients or COVID-19 in Stroke Patients?

To the Editor: Along with the novel coronavirus (COVID-19) pandemic comes a growing public fear of its severe complications and possible central nervous system involvement.1 Neurointerventionalists in COVID-19 prevalent regions raised an alarm toward an increased risk of acute large-vessel-occlusion stroke in COVID-19 patients. It has been proposed that large-vessel stroke could be the presenting symptom of COVID-19 in younger patients.2 This has brought upon heightened fear and anxiety among younger adults. Yet, the scientific literature lacks evidence supporting a higher risk of stroke with COVID-19 in mildly symptomatic patients, or providing a causal link between COVID-19 and large-vessel stroke in younger adults. Systemic inflammation that may occur after severe COVID-19 infection promotes a prothrombotic state that may predispose to thrombotic events, including stroke. However, stroke as the presenting complaint of COVID-19 patients with otherwise mild or no systemic disease raises concerns over COVID-19 being a bystander given its high prevalence in reporting regions.2 In a report of 5 patients younger than 50 yr, 2 of whom were underscored for having no stroke comorbidities, stroke was described as a presenting symptom of young COVID-19 patients.2 This led to a robust news coverage to alarm young healthy adults of stroke secondary to COVID-19. We find this alarm unfounded. Stroke is less common, but not rare, in young adults. The findings presented remain anecdotal and lack the methodological and statistical rigor to claim that COVID-19 infection increases stroke risk in the youth or that stroke could be the presenting symptom of COVID-19. In fact, our Stroke Thrombectomy and Aneurysm Registry reports that 12% of 5000 patients undergoing thrombectomy are younger than 50 yr.3,4 Of young adults, 47% had no stroke comorbidity. Similarly, 8% of patients from the stroke thrombectomy trials were under 50 yr.5 Therefore, anecdotal reports of small case series of stroke in younger adults with COVID-19 do not reach the threshold, to date, to raise public fear among young adults. Although sounding early alarms during outbreaks may prevent delayed responses to novel threats, sufficient evidence is required to limit unnecessary burdens of the alarm itself on the healthcare system and public. Efforts to increase stroke awareness are always commended to avoid delay in patient presentation; however, in times of uncertainty and anxiety, it is critical to minimize misinformation that can have profound ramifications, even if it were well intended. Physicians are encouraged to seek sound medical evidence during care for patients and news appearances. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

S2229 Gastrointestinal Bleeding Following Routine Endoscopy: An Unusual Presentation of COVID-19 Infection

INTRODUCTION: Presenting symptoms of COVID-19 include fever, cough, dyspnea, nausea, and diarrhea. COVID-19 has been associated with coagulopathy; however, there have been little to no reports of bleeding as the presenting symptom. We present a case of immediate and delayed bleeding after routine gastric biopsy, a normally rare occurrence, as the initial presentation of COVID-19. CASE DESCRIPTION/METHODS: A 53 year-old male with history of hypertension, diabetes, and severe psoriasis presented for an outpatient esophagogastroduodenoscopy (EGD) with gastric mapping. He denied NSAID, aspirin, or SSRI use and had no history of cirrhosis. The gastric mucosa was noted to have erythematous changes suggestive of inflammation. After the initial biopsies were completed, bleeding was noted in the lesser curvature of the stomach from three biopsy sites requiring intervention. Hemostasis was achieved with epinephrine and hemostatic clipping. He had an episode of desaturation during procedure, but did not require supplemental oxygen after recovery from sedation. He was started on a pantoprazole drip and transferred to the emergency department. On admission, his review of systems were negative. Physical exam was unremarkable; vitals were within normal limits including a 97% oxygen saturation on room air. Labs included: hemoglobin 8.9, WBC 3.9, platelet 160K, lymphocyte count of 0.87, PT 10.9, and INR 0.92. His course was notable for new and persistent fevers, patchy opacities on chest X-ray, increasing oxygen requirements despite broad spectrum antibiotics, and melena with worsening anemia requiring two blood transfusions. EGD on hospital day (HD) 3 was notable for a large amount of clotted red blood with food in the gastric fundus and body and a small ulceration. On HD 4, he became hemodynamically unstable with oxygen desaturations to 70% and bilateral consolidations on chest X-ray. COVID-19 testing was positive. He was transferred to the medical ICU and intubated. His ICU course was notable for continued melena requiring two blood transfusions. Repeat EGD on HD 5 noted no bleeding or stigmata of bleeding. He had no further episodes of melena but eventually expired due to complications of COVID-19 infection. DISCUSSION: Clinically significant bleeding after EGD with biopsy requiring transfusion and hospitalization is rare. The patient described above has few risk factors associated with bleeding. His significant gastrointestinal bleeding was likely a result of a dysregulated coagulation associated with COVID-19 infection.

Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults.

BackgroundFrailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification.ObjectiveTo assess how frailty affects presenting COVID-19 symptoms in older adults.DesignObservational cohort study of hospitalised older patients and self-report data for community-based older adults.SettingAdmissions to St Thomas’ Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application.SubjectsHospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020.MethodsMultivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19.ResultsHospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath.ConclusionsThis is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

A Review of the Importance of Atypical Otorhinolaryngological Symptoms in the Screening of COVID-19 Patients.

While the world is fighting against the newly emerged highly contagious coronavirus strain, new evolving ideas regarding symptoms and investigations are reverberating among health care professionals to combat the public health emergency. The study aims to review various presenting symptoms of COVID-19 especially the unusual one and analyzing the importance of olfactory and taste disturbances. 20 studies published recently in the last 1 year were analyzed and discussed for insights into the unusual presentation of symptoms in COVID-19 patients. All the findings and statements in this review regarding the pandemic are based on published information as listed in the references. Most research articles initially focused on fever and respiratory symptoms. Later gastrointestinal symptoms were also taken into consideration. Only 5 studies from the literature have mentioned any smell and taste disturbances after SARS-CoV-2 infection to date. So changing trends can be seen in publications and recognizing these symptoms has important to timely combat this disease. The majority of corona virus-infected patients suffer from mild to moderate severity of the disease. Much hyped up symptoms of the respiratory tract may not be shown by a greater number of patients. So the need of the hour especially in developing and densely populated nations is to recognize unusual symptoms of COVID-19 especially its influence over smell and taste sensation to prevent any delay or misdiagnosis.

Confusion as the Presenting Symptom of COVID-19 in Elderly Patients

Elderly individuals with chronic medical conditions are at particular risk for COVID-19, intensive care unit admission, and death. The authors of this

Prevalence and prognostic value of Delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study

BackgroundDelirium may be one of the presenting symptoms of COVID-19, complicating diagnosis and care of elderly patients with dementia. We aim to identify the prevalence and prognostic significance of delirium as the sole onset manifestation of COVID-19.MethodsThis is a retrospective single-centre study based on review of medical charts, conducted during the outbreak peak (March 27-April 18, 2020) in a Lombard dementia facility, including 59 elderly subjects with dementia and laboratory-confirmed COVID-19.FindingsOf the 59 residents, 57 (96⋅6%) tested positive (mean age: 82⋅8; women: 66⋅7%). Comorbidities were present in all participants, with 18/57 (31⋅6%) having three or more concomitant diseases. Delirium-Onset COVID-19 (DOC) was observed in 21/57 (36⋅8%) subjects who were chiefly older (mean age: 85⋅4 y/o) and with multiple comorbidities. Eleven/21 DOC patients (52⋅4%) had hypoactive delirium, while hyperactive delirium occurred in ten/21 (47⋅6%). Lymphopenia was present in almost all subjects (median: 1⋅3 × 109/L). Overall mortality rate was 24⋅6% (14/57) and dementia severity per se had no impact on short-term mortality due to COVID-19. DOC was strongly associated with higher mortality (p<0⋅001). Also, DOC and male gender were independently associated with increased risk of mortality (OR: 17⋅0, 95% CI: 2⋅8–102⋅7, p = 0⋅002 and 13⋅6, 95% CI: 2⋅3–79⋅2, p = 0⋅001 respectively).InterpretationDelirium occurrence in the elderly with dementia may represent a prodromal phase of COVID-19, and thus deserves special attention, especially in the presence of lymphopenia. Hypoxia and a severe inflammatory state may develop subsequently. DOC cases have higher short-term mortality rate.FundingNone.

Seizure as the presenting symptom of COVID-19: A retrospective case series

BackgroundCoronavirus Disease 2019 (COVID-19) has rapidly become a global pandemic, with over 1.8 million confirmed cases worldwide to date. Preliminary reports suggest that the disease may present in diverse ways, including with neurological symptoms, but few published reports in the literature describe seizures in patients with COVID-19. ObjectiveThe objective of the study was to characterize the risk factors, clinical features, and outcomes of seizures in patients with COVID-19. MethodsThis is a retrospective case series. Cases were identified through a review of admissions and consultations to the neurology and neurocritical care services between April 1, 2020 and May 15, 2020. SettingThe study setting was in a tertiary care, safety-net hospital in Boston, MA. ParticipantsPatients presenting with seizures and COVID-19 during the study period were included in the study. ResultsSeven patients met inclusion criteria (5 females, 71%). Patients ranged in age from 37 to 88 years (median: 75 years). Three patients had a prior history of well-controlled epilepsy (43%), while 4 patients had new-onset seizures, including 2 patients with prior history of remote stroke. Three patients had no preceding symptoms of COVID-19 prior to presentation (57%), and in all cases, seizures were the symptom that prompted presentation to the emergency department, regardless of prior symptoms of COVID-19. ConclusionsProvoking factors for seizures in patients with COVID-19 may include metabolic factors, systemic illness, and possibly direct effects of the virus. In endemic areas with community spread of COVID-19, clinicians should be vigilant for the infection in patients who present with seizures, which may precede respiratory symptoms or prompt presentation to medical care. Early testing, isolation, and contact tracking of these patients can prevent further transmission of the virus.

The impact of COVID-19 on people with diabetes in Brazil

The present study aims at identifying main barriers faced by people living with diabetes in Brazil during the COVID-19 pandemic. MethodsIn a convenience sampling study, data were collected from 1701 individuals, aged 18 or above; 75.54% female participants; 60.73% T1D and 30.75% T2D, between April 22nd and May 4th, using an anonymous and untraceable survey containing 20 multiple choice questions (socio-demographic; health status and habits of life during COVID-19 pandemic). Relationship between variables was established using the multiple correspondence analysis technique. Results95.1% of respondents reduced their frequency of going outside of their homes; among those who monitored blood glucose at home during the pandemic (91.5%), the majority (59.4%) experienced an increase, a decrease or a higher variability in glucose levels; 38.4% postponed their medical appointments and/or routine examinations; and 59.5% reduced their physical activity. T1D, the youngest group, was more susceptible to presenting COVID-19 symptoms despite not being testing; whilst the T2D group had higher frequency of comorbidities that are additional risk factors for COVID-19 severity. ConclusionsThis study provides a first hand revelation of the severity of COVID-19 on individuals with diabetes in Brazil. Their habits were altered, which impacted their glycemia, potentially increasing the risk of poor outcomes and mortality if infected by SARS-CoV-2, and of acute and chronic diabetes complications.

Neurological Manifestation of COVID-19 and the Enhanced Role of Physiatrists.

Neurological Manifestation of COVID-19 and the Enhanced Role of Physiatrists.

Early Symptoms of Patients With COVID-19 in Family Medicine Centers in South India: A Retrospective Study

Introduction: A recent Cochrane review on the diagnostic accuracy of initial signs and symptoms of COVID-19 reported on the lack of evidence from studies conducted in community-based health-care settings. Since a broad spectrum of patients present to primary health-care services, testing for patients with noninfluenza-like illness and atypical presentations is debatable. Hence, there is an urgent need for documenting the early presenting symptoms of COVID-19 among patients seeking medical care in primary health-care settings. Aim: In this study, we aim to document the early symptoms of patients with COVID-19 and the proportion of asymptomatic infection in family medicine centers in South India. Design: This is a retrospective study of the early symptoms of patients who tested positive between June and December 2020. The data and clinical notes of patients were retrieved from the hospital information system. Setting: This study was undertaken by the Department of Family Medicine (DFM) in a private not-for-profit academic institution in South India. The DFM provides primary and secondary health-care services to nearly 1,50,000 patients from the local urban communities. Results: A total of 330 patients were tested for COVID-19 and the study included 94 patients who tested positive. Around 37% participants were asymptomatic. The commonest symptom was fever (58.6%), followed by tiredness/myalgia (48.3%), loss of taste or smell or appetite (43.1%), and cough or cold (37.9%). Most participants (78.2%) were hospitalized and the rest (21.8%) were home-quarantined. Only 5 (5.7%) of them died due to COVID-19 infection. Conclusion: The results of the study reiterates the role of social distancing, self-isolation, proper masking, and greater vaccination coverage as significant public health interventions.

COVID-19 Anosmia Reporting Tool: Initial Findings.

There is accumulating anecdotal evidence that anosmia and dysgeusia are associated with the COVID-19 pandemic. To investigate their relationship to SARS-CoV2 infection, the American Academy of Otolaryngology-Head and Neck Surgery developed the COVID-19 Anosmia Reporting Tool for Clinicians for the basis of this pilot study. This tool allows health care providers to confidentially submit cases of anosmia and dysgeusia related to COVID-19. We analyzed the first 237 entries, which revealed that anosmia was noted in 73% of patients prior to COVID-19 diagnosis and was the initial symptom in 26.6%. Some improvement was noted in 27% of patients, with a mean time to improvement of 7.2 days in this group (85% of this group improved within 10 days). Our findings suggest that anomia can be a presenting symptom of COVID-19, consistent with other emerging international reports. Anosmia may be critical in timely identification of individuals infected with SARS-CoV2 who may be unwittingly transmitting the virus.

Fever in the returning traveller : dual infection with SARS-CoV-2 and Plasmodium falciparum malaria

Background: More than 90% of the global 400 000 annual malaria deaths occur in Africa. The current SARS-CoV-2 pandemic has resulted in more than 830 000 deaths in its first 10 months. Case presentation: This case describes a patient who had travelled from Mozambique to Cape Town, presented with a mild febrile illness, and was diagnosed with both COVID-19 and uncomplicated Plasmodium falciparum malaria infection. She responded well to malaria treatment and had an uneventful COVID-19 admission. Her blood smear showed a low malaria parasitaemia and a relatively high gametocyte load. Conclusion: We postulate that her clinical course and abnormal smear could well be due to reciprocal disease-modifying effects of the infections. The presenting symptoms of COVID-19 may mimic endemic infectious diseases including malaria, tuberculosis, pneumocystis pneumonia and influenza thus there is a need for clinical vigilance to identify and treat such co-infections.

Dysphonia as the main presenting symptom of COVID-19: a case report

The spectrum of illness associated with COVID-19 is wide, ranging from asymptomatic infection to life-threatening respiratory failure. Herein, the authors are presenting a case in which the main symptoms expressed by a patient infected with SARS-CoV-2 were simultaneous gradual change of voice with loss of olfaction but without nasal obstruction.