Objective To identify the differential diagnoses of severe COVID‐19 and the distinguishing characteristics of critically ill COVID‐19 patients in Reunion Island to help improve the triage and management of patients in this tropical setting. Methods This retrospective observational study was conducted from 11 March to 4 May 2020 in the only intensive care unit (ICU) authorised to manage COVID‐19 patients in Reunion Island, a French overseas department located in the Indian Ocean region. All patients with unknown COVID‐19 status were tested by polymerase chain reaction (PCR) on ICU admission; those who tested negative were transferred to the COVID‐19‐free area of the ICU. Results Over the study period, 99 patients were admitted to our ICU. A total of 33 patients were hospitalised in the COVID‐19 isolation ward, of whom 11 were positive for COVID‐19. The main differential diagnoses of severe COVID‐19 were as follows: community‐acquired pneumonia, dengue, leptospirosis causing intra‐alveolar haemorrhage and cardiogenic pulmonary oedema. The median age of COVID‐19‐positive patients was higher than that of COVID‐19‐negative patients (71 [58–74] vs. 54 [46–63.5] years, P = 0.045). No distinguishing clinical, biological or radiological characteristics were found between the two groups of patients. All COVID‐19‐positive patients had recently travelled or been in contact with a recent traveller. Conclusions In Reunion Island, dengue and leptospirosis are key differential diagnoses of severe COVID‐19, and travel is the only distinguishing characteristic of COVID‐19‐positive patients. Our findings apply only to the particular context of Reunion Island at this time of the epidemic.
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