COVID clinical presentation

By Dr Deepu Changappa Cheriamane

Clinical presentation

COVID-19 typically presents with systemic and/or respiratory manifestations. Some individuals infected with SARS-CoV-2 are asymptomatic and can act as carriers. Some also experience mild gastrointestinal or cardiovascular symptoms, although these are much less common. 

The full spectrum of clinical manifestation of COVID-19 remains to be determined. Symptoms and signs are non-specific:

Common

fever (85-90%)

cough (65-70%)

disturbed taste and smell (40-50%) 

fatigue (35-40%)

sputum production (30-35%)

shortness of breath (15-20%)

Less common

myalgia/arthralgia (10-15%)

headaches (10-36%)

sore throat (10-15%)

chills (10-12%)

pleuritic pain

Rare

nausea, vomiting, nasal congestion (<10%), diarrhea (<5%)

palpitations, chest tightness

hemoptysis (<5%)

confusion, seizures, paraesthesia, altered consciousness

stroke(most commonly cryptogenic)

COVID-19 sufferers have reported high rates of disturbances of smell and taste, including anosmia, hyposmia, ageusia, and dysgeusia. The numbers of patients affected vary and current evidence points more towards a neurological than a conductive cause of the olfactory dysfunction. 

Various reports suggest patients with the disease may have symptoms of conjunctivitis, and those affected, may have positive viral PCR in their conjunctival fluid. However a meta-analysis of over 1,100 patients found that conjunctivitis was only present in 1.1% cases. A small case series found conjunctivitis to be the only clinical manifestation in some patients with COVID-19.

Cutaneous lesions may also be seen, similar to many other viral infections. In a cohort of 88 patients, 20% developed skin disease, most commonly an erythematous rash. Most of the skin abnormalities were self-limited, resolving in a few days.

Pediatric

In the main, the clinical presentation in children with COVID-19 is milder than in adults. Symptoms are similar to any acute chest infection, encompassing most commonly pyrexia, dry cough, sore throat, sneezing, myalgia and lethargy. Wheezing has also been noted. Other less common (<10%) symptoms in children included diarrhea, lethargy, rhinorrhea and vomiting.

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Diagnostic tests