An Atypical Presentation of Novel Coronavirus Disease 2019 (COVID-19)

Singhania, Namrata; Bansal, Saurabh; Singhania, Girish

doi:10.1016/j.amjmed.2020.03.026

Cited by 55 publications

(72 citation statements)

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“…Atypical presentations of other infectious diseases, such as delirium with urinary tract infections, have been well described in frail, older adults and long-term care residents. Case reports of atypical presentations of COVID-19 include delirium as a presenting symptom, 16 , 17 , 18 and a high prevalence of delirium has been reported among patients with COVID-19 in intensive care units. 19 A case-series of hospitalized patients from Wuhan, China with COVID-19 infection reported 7.5% experienced impaired consciousness or delirium.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility

Shi

Bakaev

Chen

et al. 2020

Journal of the American Medical Directors Association

124

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Objective To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. Design and Participants Retrospective cohort study (March 16, 2020 to May 8, 2020). Setting Academic long-term chronic care facility (Boston, MA). Participants Long-term care residents. Methods Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. Results Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%‒90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). Conclusions and Implications Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.

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Section: Discussionmentioning

confidence: 99%

Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility

Shi

Bakaev

Chen

et al. 2020

Journal of the American Medical Directors Association

124

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“…The virus was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the World Health Organization designated the disease as coronavirus disease 2019 (COVID- 19). The most common symptoms are respiratory, but gastrointestinal, neurological, and other atypical symptoms can also be seen, although these symptoms are rare [2]. Recent studies showed several coagulation abnormalities in patients with COVID-19, raising questions about appropriate management to prevent or treat thrombosis; this state has been termed COVID-19-associated coagulopathy (CAC) [3].…”

Section: Introductionmentioning

confidence: 99%

Current Overview on Hypercoagulability in COVID-19

Singhania

Bansal

Nimmatoori

et al. 2020

Am J Cardiovasc Drugs

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171

232

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The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC. Key Messages Venous thromboembolism (VTE) is common in COVID-19 patients, especially those in the intensive care unit. Prophylactic anticoagulation is recommended in all patients with COVID-19 unless contraindicated.

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“…While these issues are obviously important, our report is restricted to patients presenting with syncope and presyncope. Thus far, syncope has only been reported in the COVID‐19 literature as two isolated case reports and a case series of five patients 12,15,16 . The case reports describe two elderly patients; one presenting with syncope followed by altered mental status and the other with antecedent influenza like symptoms and syncope after a bowel movement.…”

Section: Discussionmentioning

confidence: 99%

Syncope and presyncope in patients with COVID‐19

Oates

Turagam

Musikantow

et al. 2020

Pacing Clinical Electrophis

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Introduction: Recent studies have described several cardiovascular manifestations of COVID-19 including myocardial ischemia, myocarditis, thromboembolism, and malignant arrhythmias. However, to our knowledge, syncope in COVID-19 patients has not been systematically evaluated. We sought to characterize syncope and/or presyncope in COVID-19. Methods: This is a retrospective analysis of consecutive patients hospitalized with laboratory-confirmed COVID-19 with either syncope or presyncope. This "study" group (n = 37) was compared with an age and gender-matched cohort of patients without syncope ("control") (n = 40). Syncope was attributed to various categories. We compared telemetry data, treatments received, and clinical outcomes between the two groups. Results: Among 1000 COVID-19 patients admitted to the Mount Sinai Hospital, the incidence of syncope/presyncope was 3.7%. The median age of the entire cohort was 69 years (range 26-89+ years) and 55% were men. Major comorbidities included hypertension, diabetes, and coronary artery disease. Syncopal episodes were categorized as (a) unspecified in 59.4% patients, (b) neurocardiogenic in 15.6% patients, (c) hypotensive in 12.5% patients, and (d) cardiopulmonary in 3.1% patients with fall versus syncope and seizure versus syncope in 2 of 32 (6.3%) and 1 of 33 (3.1%) patients, respectively. Compared with the "control" group, there were no significant differences in both admission and peak blood levels of d-dimer, troponin-I, and CRP in the "study" group. Additionally, there were no differences in arrhythmias or death between both groups. Conclusions: Syncope/presyncope in patients hospitalized with COVID-19 is uncommon and is infrequently associated with a cardiac etiology or associated with adverse outcomes compared to those who do not present with these symptoms.

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An Atypical Presentation of Novel Coronavirus Disease 2019 (COVID-19)

Abstract: Figure legendFigure 1 A, B, Computed tomography of chest showing groundglass densities present bilaterally, extending from the hilum, more prominent toward the periphery in the left upper lobe and middle lobe.

Cited by 55 publications

References 1 publication

Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility

Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility

Current Overview on Hypercoagulability in COVID-19

Syncope and presyncope in patients with COVID‐19

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