Table of Contents

    Topic review

    General Symptoms with COVID-19

    Subjects: Pathology
    View times: 210
    Submitted by: Jacek Baj
    (This entry belongs to Entry Collection "COVID-19 ")

    Definition

    Coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become an epidemiological threat and a worldwide concern. SARS-CoV-2 has spread to 210 countries worldwide and more than 3,000,000 confirmed cases and 228,513 deaths have been reported, while the number of both confirmed and fatal cases is continually increasing. COVID-19 is a viral disease that can affect every age group – from infants to the elderly – resulting in a wide spectrum of various clinical manifestations. COVID-19 might present different degrees of severity – from mild or even asymptomatic carriers, even to fatal cases. The most common complications include pneumonia and acute respiratory distress syndrome. Fever, dry cough, muscle weakness, and chest pain are the most prevalent and typical symptoms of COVID-19. However, patients might also present atypical symptoms that can occur alone, which might indicate the possible SARS-CoV-2 infection. The aim of this paper was to review and summarize all of the findings regarding clinical manifestations of COVID-19 patients and those include respiratory, neurological, olfactory and gustatory, gastrointestinal, ophthalmic, dermatological, cardiac, and rheumatologic manifestations, as well as specific symptoms in pediatric patients.

    1. Introduction

    The majority of patients with COVID-19 present common symptoms that include fever, shortness of breath, cough (either with or without sputum), sore throat, nasal congestion, dizziness, chills, muscle ache, arthralgia, weakness, fatigue or myalgia, chest tightness, excessive mucus production with expectoration, hemoptysis, and dyspnea[1][2][3][4][5][6][7]. Even though fever is not the only initial clinical manifestation of SARS-CoV-2 infection, it is considered to be critical[8][9]. Fever, cough, and fatigue are the three most prevalent symptoms in COVID-19 patients[10][11]. Other less characteristic symptoms include headache, diarrhea, abdominal pain, vomiting, chest pain, rhinorrhoea, or pharyngalgia[12][13][14][15]. Approximately 90% of the patients present more than one symptom[16][17]. An approximate proportion of severe versus common cases of COVID-19 is estimated to 1:4[18]. It is suggested that an early onset of shortness of breath constitutes a poor prognostic factor for patients. Among 81 fatal cases of patients from Wuhan, the most common cause of death was a respiratory failure (46.91%), followed by septic shock (19.75%), multiple organ failure (16.05%), and cardiac arrest (8.64%). Rarer death causes were acute coronary syndrome, malignant arrhythmia, or disseminated intravascular coagulation (DIC)[19]. Zhou et al. reported a case of a COVID-19 patient with a spontaneous pneumomediastinum and subcutaneous emphysema[20]. Clinical characteristics might differ between critically ill and non-critically ill patients[21][22].

    2. Radiological Findings

    The majority of patients show bilateral pneumonia and only a small percentage of COVID-19 patients show unilateral pneumonia. The most frequent computed tomography (CT) findings are bilateral patchy shadows and ground-glass opacities (GGO); multilobe involvement and focal lesions (patches, stripes, or nodules) are also very characteristic[23][24][25][26]. Less characteristic CT findings include centrilobular nodules, tree-in-bud sign, cystic change, pleural effusion, interstitial fibrosis, or lymphadenopathy. CT examinations show that lesions are more likely to be localized in the periphery than in the center of the lungs and the lesions are more patchy than oval[27][28]. Other CT findings include either pure GGO or GGO with reticular and/or interlobular septal thickening, GGO with consolidation, or pure consolidation[29][30]. Less common, but still characteristic, CT findings include ground-glass followed by irregular or halo sign, air bronchogram, bronchovascular bundle thickening, grid-form shadow, and hydrothorax[23]. Ground glass-like shadows, fibrous stripes, patchy shadow, and pleural thickening are observed both in common-type and severe or critical-type patients, independent to the severity of the COVID-19 course[31]. Single or multiple lobes of a single lung or both lungs (without a characteristic pattern) can be affected; interestingly, some of the studies showed that severe critical-type patients exhibit lesions primarily in the right lung[32].

    3. Laboratory Findings

    Generally, COVID-19 patients tend to have normal or decreased white blood cell counts, lymphopenia, or thrombocytopenia[33][34]. Zhang et al. showed that patients with high leukocyte count (>10 × 10^9/L), higher neutrophil count (>7 × 10^9/L), and lower lymphocyte count (<0.4 × 10^9/L) are much more prone to severe COVID-19 pneumonia and composite endpoint (which was the admission to an intensive care unit, mechanical ventilation, or death)[35]. Besides, higher levels of C-reactive protein (>150 mg/L) and increased D-dimer levels (>1 mg/L) are also strongly associated with an increased risk of COVID-19 pneumonia and the composite endpoint. Additional laboratory indicators of increased risk are higher alanine aminotransferase (ALT) activity (>80 U/L), higher aspartate aminotransferase (AST) activity (>80 U/L), higher α—hydroxybutyrate dehydrogenase activity (>540 U/L), higher lactate dehydrogenase activity (>720 U/L), higher creatine kinase activity (>600 U/L), and lower total protein level (<60 g/L). So far, researchers have not observed a significant statistical association between altered platelet counts and creatinine levels with an increased risk of COVID-19-related pneumonia. As opposed to numerous studies, Zhang et al. showed that COVID-19 pneumonia and composite endpoint are associated with leukocytosis rather than leukopenia[35]. However, the abovementioned results differ among COVID-19 patients. Du et al. observed that the majority of COVID-19 patients (81.2%) had lowered eosinophil count and many patients had decreased hemoglobin and hematocrit, as well as decreased activated partial prothrombin time (APTT) and increased prothrombin time (PT)[19]. Among studied patients, 22.4% had increased procalcitonin levels and elevated levels of blood urea nitrogen or serum creatinine. It is still speculated whether eosinophilopenia might constitute a prognostic factor for COVID-19 patients. Some patients present progressive lymphopenia with a concurrent progressive neutrophilia[36]. However, among the most common reported laboratory findings, those of the highest prevalence include elevated levels of C-reactive protein and erythrocyte number, as well as increased myohemoglobin, liver enzymes, and muscle enzymes[10]. Additionally, patients with a severe course of COVID-19 usually have elevated D-dimer levels, increased procalcitonin, increased leukocyte number, and lymphocytopenia[37][38]. In some cases, lymphocytes and white blood cell levels might remain within physiological ranges. The decrease in the number of lymphocytes is generally observed in the CD4+ subpopulation. No significant changes are stated in the case of CD8+ and B cell subpopulations[39]. Further, interleukin 10 (IL-10), interleukin 6 (IL-6), interleukin 1 (IL-1), interleukin 2R (IL-2R), and tumor necrosis factor alpha (TNF-α) levels might exceed the upper limit in COVID-19 patients[40][41][42][43]. Chemokines, such as interferon gamma-induced protein 10 (IP-10) and monocyte chemoattractant protein 1 (MCP1), are also overexpressed during the course of COVID-19[41].

    The entry is from 10.3390/jcm9061753

    References

    1. Lei, S.; Jiang, F.; Su, W.; Chen, C.; Chen, J.; Mei, W.; Zhan, L.Y.; Jia, Y.; Zhang, L.; Liu, D.; et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020, 21, 100331.
    2. Guan, W.-J.; Ni, Z.-Y.; Hu, Y.; Liang, W.-H.; Ou, C.-Q.; He, J.-X.; Liu, L.; Shan, H.; Lei, C.-L.; Hui, D.S.; et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. 2020, 382, 1708–1720.
    3. Xie, J.; Tong, Z.; Guan, X.; Du, B.; Qiu, H. Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China. JAMA Netw. Open 2020, 3, e205619.
    4. Wang, Z.; Chen, X.; Lu, Y.; Chen, F.; Zhang, W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci. Trends 2020, 14, 64–68.
    5. Kim, E.S.; Chin, B.S.; Kang, C.K.; Kim, N.J.; Kang, Y.M.; Choi, J.-P.; Oh, D.H.; Kim, J.-H.; Koh, B.; Kim, S.E.; et al. Clinical Course and Outcomes of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Preliminary Report of the First 28 Patients from the Korean Cohort Study on COVID-19. J. Korean Med. Sci. 2020, 35, e142.
    6. Tu, H.; Tu, S.; Gao, S.; Shao, A.; Sheng, J. Current epidemiological and clinical features of COVID-19; a global perspective from China. J. Infect. 2020.
    7. Shi, F.; Yu, Q.; Huang, W.; Tan, C. 2019 Novel Coronavirus (COVID-19) Pneumonia with Hemoptysis as the Initial Symptom: CT and Clinical Features. Korean J. Radiol. 2020, 21, 537–540.
    8. Chaolin Huang; Yeming Wang; Xingwang Li; Lili Ren; Jianping Zhao; Yi Hu; Li Zhang; Guohui Fan; Jiuyang Xu; Xiaoying Gu; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020, 395, 497-506, 10.1016/s0140-6736%2820%2930183-5.
    9. Tu, Y.-F.; Chien, C.-S.; Yarmishyn, A.; Lin, Y.-Y.; Luo, Y.-H.; Lin, Y.-T.; Lai, W.-Y.; Yang, D.-M.; Chou, S.-J.; Yang, Y.-P.; et al. A Review of SARS-CoV-2 and the Ongoing Clinical Trials. Int. J. Mol. Sci. 2020, 21, 2657.
    10. Leiwen Fu; Bingyi Wang; Tanwei Yuan; Xiaoting Chen; Yunlong Ao; Thomas Fitzpatrick; Peiyang Li; Yiguo Zhou; Yi-Fan Lin; Qibin Duan; et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. Journal of Infection 2020, 80, 656-665, 10.1016/j.jinf.2020.03.041.
    11. Pengfei Sun; Shuyan Qie; Zongjian Liu; Jizhen Ren; Kun Li; Jianing Xi; Clinical characteristics of hospitalized patients with SARS‐CoV‐2 infection: A single arm meta‐analysis. Journal of Medical Virology 2020, 92, 612-617, 10.1002/jmv.25735.
    12. Guo-Qing Qian; Nai-Bin Yang; Feng Ding; Ada Hoi Yan Ma; Z -Y Wang; Yue-Fei Shen; Chun-Wei Shi; Xiang Lian; Jin-Guo Chu; Lei Chen; et al. Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series. QJM 2020, null, null, 10.1093/qjmed/hcaa089.
    13. Xiao-Wei Xu; Xiao-Xin Wu; Xian-Gao Jiang; Kai-Jin Xu; Ling-Jun Ying; Chun-Lian Ma; Shi-Bo Li; Hua-Ying Wang; Sheng Zhang; Hai-Nv Gao; et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series.. BMJ 2020, 368, m606, .
    14. Bobin Mi; Lang Chen; Yuan Xiong; Hang Xue; Wu Zhou; Guohui Liu; Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients. The Journal of Bone and Joint Surgery-American Volume 2020, 102, 750-758, 10.2106/jbjs.20.00390.
    15. Jian Wu; Jun Liu; Xinguo Zhao; Chengyuan Liu; Wei Wang; Dawei Wang; Wei Xu; Chunyu Zhang; Jiong Yu; Bin Jiang; et al. Clinical Characteristics of Imported Cases of Coronavirus Disease 2019 (COVID-19) in Jiangsu Province: A Multicenter Descriptive Study. Clinical Infectious Diseases 2020, null, null, 10.1093/cid/ciaa199.
    16. Ruirui Wang; Min Pan; Xiumei Zhang; Xiaoyun Fan; Ming- Feng Han; Fengde Zhao; Manli Miao; Jing Xu; Minglong Guan; Xia Deng; et al. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China.. Int. J. Infect. 2020, 95, 421–428, .
    17. Yuxin Yan; Woo In Shin; Yoong Xin Pang; Yang Meng; Jianchen Lai; Chong You; Haitao Zhao; E. H. Lester; Tao Wu; Cheng Heng Pang; et al. The First 75 Days of Novel Coronavirus (SARS-CoV-2) Outbreak: Recent Advances, Prevention, and Treatment. International Journal of Environmental Research and Public Health 2020, 17, 2323, 10.3390/ijerph17072323.
    18. Sijia Tian; Nan Hu; Jing Lou; Kun Chen; Xuqin Kang; Zhenjun Xiang; Hui Chen; Dali Wang; Ning Liu; Dong Liu; et al. Characteristics of COVID-19 infection in Beijing. Journal of Infection 2020, 80, 401-406, 10.1016/j.jinf.2020.02.018.
    19. Yingzhen Du; Lei Tu; Pingjun Zhu; Mi Mu; Runsheng Wang; Pengcheng Yang; Xi Wang; Chao Hu; Rongyu Ping; Peng Hu; et al. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study. SSRN Electronic Journal 2020, 201, 1372–1379, 10.2139/ssrn.3546088.
    20. Changyu Zhou; Chen Gao; Yuanliang Xie; Maosheng Xu; COVID-19 with spontaneous pneumomediastinum. The Lancet Infectious Diseases 2020, 20, 510-510, 10.1016/s1473-3099(20)30156-0.
    21. Xiaobing Wang; Jun Fang; Yue Zhu; Liping Chen; Feng Ding; Rui Zhou; Liuqing Ge; Fan Wang; Qian Chen; Yongxi Zhang; et al. Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID-19) in a Fangcang Hospital. Clinical Microbiology and Infection 2020, null, null, 10.1016/j.cmi.2020.03.032.
    22. Iek Long Lo; Chon Fu Lio; Hou Hon Cheong; C I Lei; Tak Hong Cheong; Xu Zhong; Yakun Tian; Nin Ngan Sin; Evaluation of SARS-CoV-2 RNA shedding in clinical specimens and clinical characteristics of 10 patients with COVID-19 in Macau.. International Journal of Biological Sciences 2020, 16, 1698-1707, 10.7150/ijbs.45357.
    23. Yinghao Cao; Xiaoling Liu; Lijuan Xiong; Kailin Cai; Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis. Journal of Medical Virology 2020, null, null, 10.1002/jmv.25822.
    24. F Zheng; W Tang; H Li; Y-X Huang; Y-L Xie; Z-G Zhou; Clinical characteristics of 161 cases of corona virus disease 2019 (COVID-19) in Changsha.. Eur. Rev. Med Pharmacol. Sci. 2020, 24, 3404-3410, .
    25. WanBo Zhu; Kai Xie; Hui Lu; Lei Xu; Shusheng Zhou; Shiyuan Fang; Initial clinical features of suspected Coronavirus Disease 2019 in two emergency departments outside of Hubei, China. Journal of Medical Virology 2020, null, null, 10.1002/jmv.25763.
    26. Xi Xu; Chengcheng Yu; Jing Qu; Lieguang Zhang; Songfeng Jiang; Deyang Huang; Bihua Chen; Zhiping Zhang; Wanhua Guan; Zhoukun Ling; et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. European Journal of Nuclear Medicine and Molecular Imaging 2020, 47, 1275-1280, 10.1007/s00259-020-04735-9.
    27. Melina Hosseiny; Soheil Kooraki; Ali Gholamrezanezhad; Sravanthi Reddy; Lee Myers; Radiology Perspective of Coronavirus Disease 2019 (COVID-19): Lessons From Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome. American Journal of Roentgenology 2020, 214, 1078-1082, 10.2214/ajr.20.22969.
    28. Sheng-Qun Deng; Hong-Juan Peng; Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. Journal of Clinical Medicine 2020, 9, 575, 10.3390/jcm9020575.
    29. Fengxiang Song; Nannan Shi; Fei Shan; Zhiyong Zhang; Jie Shen; Hongzhou Lu; Yun Ling; Yebin Jiang; Yuxin Shi; Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology 2020, 295, 210-217, 10.1148/radiol.2020200274.
    30. Chih-Cheng Lai; Tzu-Ping Shih; Wen-Chien Ko; Hung-Jen Tang; Po-Ren Hsueh; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents 2020, 55, 105924, 10.1016/j.ijantimicag.2020.105924.
    31. Jiaojiao Chu; Nan Yang; Yanqiu Wei; Huihui Yue; Fengqin Zhang; Jianping Zhao; Li He; Gaohong Sheng; Peng Chen; Gang Li; et al. Clinical characteristics of 54 medical staff with COVID‐19: A retrospective study in a single center in Wuhan, China. Journal of Medical Virology 2020, 92, 807-813, 10.1002/jmv.25793.
    32. Israel Júnior Borges Do Nascimento; Nensi Cacic; Hebatullah Mohamed Abdulazeem; Thilo Caspar Von Groote; Umesh Jayarajah; Ishanka Weerasekara; Morteza Abdar Esfahani; Vinicius Tassoni Civile; Ana Marušić; Ana Jeroncic; et al. Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. Journal of Clinical Medicine 2020, 9, 941, 10.3390/jcm9040941.
    33. Kui Liu; Yuan-Yuan Fang; Yan Deng; Wei Liu; Mei-Fang Wang; Jing-Ping Ma; Wei Xiao; Ying-Nan Wang; Min-Hua Zhong; Cheng-Hong Li; et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chinese Medical Journal 2020, 133, 1025-1031, 10.1097/cm9.0000000000000744.
    34. Mary A Lake; What we know so far: COVID-19 current clinical knowledge and research. Clinical Medicine 2020, 20, 124-127, 10.7861/clinmed.2019-coron.
    35. Gemin Zhang; Jie Zhang; Bowen Wang; Xionglin Zhu; Qiang Wang; Shiming Qiu; Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis.. Respiratory Research 2020, 21, 74-10, 10.1186/s12931-020-01338-8.
    36. Guangming Ye; Zhenyu Pan; Yunbao Pan; Qiaoling Deng; Liangjun Chen; Jin Li; Yirong Li; Xinghuan Wang; Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation.. J. Infect. 2020, 80, e14–e17, .
    37. Yosra A. Helmy; Mohamed Fawzy; Ahmed Elaswad; Ahmed Sobieh; Scott P. Kenney; Awad A. Shehata; The COVID-19 Pandemic: A Comprehensive Review of Taxonomy, Genetics, Epidemiology, Diagnosis, Treatment, and Control. Journal of Clinical Medicine 2020, 9, 1225, 10.3390/jcm9041225.
    38. Jin-Jin Zhang; Xiang Dong; Yi-Yuan Cao; Ya-Dong Yuan; Yi-Bin Yang; You-Qin Yan; Cezmi A. Akdis; Ya-Dong Gao; Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy 2020, null, null, 10.1111/all.14238.
    39. Chuan Qin; Luoqi Zhou; Ziwei Hu; Shuoqi Zhang; Sheng Yang; Yu Tao; Cuihong Xie; Ke Ma; Ke Shang; Wei Wang; et al. Dysregulation of Immune Response in Patients with COVID-19 in Wuhan, China. SSRN Electronic Journal 2020, null, null, 10.2139/ssrn.3541136.
    40. Ling Mao; Huijuan Jin; Mengdie Wang; Yu Hu; Shengcai Chen; Quanwei He; Jiang Chang; Candong Hong; Yifan Zhou; David Wang; et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China.. JAMA Neurol. 2020, null, null, .
    41. Zhongliang Wang; Bohan Yang; Qianwen Li; Lu Wen; Ruiguang Zhang; Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China. Clinical Infectious Diseases 2020, null, null, 10.1093/cid/ciaa272.
    42. Piercarlo Sarzi-Puttini; Valeria Giorgi; Silvia Sirotti; Daniela Marotto; Sandro Ardizzone; Giuliano Rizzardini; Spinello Antinori; Massimo Galli; COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome?. Clin. Exp. Rheumatol. 2020, 38, 337–342, .
    43. Guang Chen; Di Wu; Wei Guo; Yong Cao; Da Huang; Hongwu Wang; Tao Wang; Xiaoyun Zhang; Huilong Chen; Haijing Yu; et al. Clinical and immunologic features in severe and moderate forms of Coronavirus Disease 2019. J. Clin. Investig. 2020, 130, 2620–2629, 10.1101/2020.02.16.20023903.
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