Atypical presentation of COVID-19; an observational retrospective study
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(2020) 20:870
RESEARCH ARTICLE
Open Access
Atypical presentation of COVID-19; an observational retrospective study Maryam Haghighi-Morad1, Ilad Alavi Darazam2, Hooman Bahrami-Moltagh1, Maryam Amerifar1, Nasim Zamani3,4 and Hossein Hassanian-Moghaddam3,4*
Abstract Background: COVID-19 infection may present with atypical signs and symptoms and false negative polymerase chain reaction (PCR) tests predisposing healthy people and health care workers to infection. The aim of the current study is to evaluate the features of atypical presentations in COVID-19 infection in a referral center in Tehran, Iran. Methods: Hospital database of inpatients admitted to Loghman Hakim hospital between February 20th and May 11th, 2020 was reviewed and all patients with final diagnosis of COVID-19 infection were evaluated for their presenting symptoms. Patients with chief complaints of “fever”, “dyspnea”, and/or “cough” as typical presentations of COVID-19 were excluded and those with other clinical presentations were included. Results: Nineteen patients were included with a mean age of 51 ± 19 years, of whom, 17 were males (89%). Median [IQR] Glasgow coma scale (GCS) was 14 [13, 15]. Almost 10 had referred with chief complaint of methanol poisoning and overdose on substances of abuse. Only 8 cases (42%) had positive COVID-19 test. Nine (47%) needed invasive mechanical ventilation, of whom, two had positive COVID-19 test results (p = ns). Eight patients (42%) died with three of them having positive PCRs. Conclusions: In patients referring to emergency departments with chief complaint of poisoning (especially poisonings that can result in dyspnea including substances of abuse and toxic alcohols), gastrointestinal, and constitutional respiratory symptoms, attention should be given not to miss possible cases of COVID-19. Keywords: COVID-19, Infection, Atypical, Signs, Symptoms, False negative
Background During the recent months, the outbreak of a novel coronavirus disease (COVID-19) led to a global health crisis. Iran was one of the first countries with phase 3 transmission aligned with Japan, South Korea, and Italy [1]. Until May 8th, over 3 million cases of the disease were reported worldwide with over 105,000 cases originating from Iran, making this country among the first 10 * Correspondence: [email protected] 3 Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4 Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Avenue, Tehran, Iran Full list of author information is available at the end of the article
countries affected by COVID-19 [2]. The gold standard for diagnosis of this coronavirus is application of reverse transcription polymerase chain reaction (PCR) [1]. The problem with this gold standard is lack of available sensitive kits to measure it in a timely manner. Typical presentation of febrile illness as well as respiratory complications may alarm health care providers (HCPs)
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