Clinical Features, Diagnosis, and Treatment of COVID-19 in Hospitalized Patients: A Systematic Review of Case Reports and Case Series

Abstract

Introduction: The 2019 novel coronavirus (COVID-19) has been declared a public health emergency worldwide. The objective of this systematic review was to characterize the clinical, diagnostic, and treatment characteristics of hospitalized patients presenting with COVID-19. Methods: We conducted a structured search using PubMed/Medline, Embase, and Web of Science to collect both case reports and case series on COVID-19 published up to April 24, 2020. There were no restrictions regarding publication language. Results: Eighty articles were included analyzing a total of 417 patients with a mean age of 48 years. The most common presenting symptom in patients who tested positive for COVID-19 was fever, reported in up to 62% of patients from 82% of the analyzed studies. Other symptoms including rhinorrhea, dizziness, and chills were less frequently reported. Additionally, in studies that reported C-reactive protein (CRP) measurements, a large majority of patients displayed an elevated CRP (60%). Progression to acute respiratory distress syndrome (ARDS) was the most common complication of patients testing positive for COVID-19 (21%). CT images displayed ground-glass opacification (GGO) patterns (80%) as well as bilateral lung involvement (69%). The most commonly used antiviral treatment modalities included, lopinavir (HIV protease inhibitor), arbidiol hydrochloride (influenza fusion inhibitor), and oseltamivir (neuraminidase inhibitor). Conclusions: Development of ARDS may play a role in estimating disease progression and mortality risk. Early detection of elevations in serum CRP, combined with a clinical COVID-19 symptom presentation may be used as a surrogate marker for the presence and severity of the disease. There is a paucity of data surrounding the efficacy of treatments. There is currently not a well-established gold standard therapy for the treatment of diagnosed COVID-19. Further prospective investigations are necessary.

Olfactory and gustatory dysfunction in COVID‐19 patients: A meta‐analysis study

“…COVID-19 is known for causing acute respiratory syndrome with nonspecific presenting symptoms characterized by fever, cough, chills, dyspnea, myalgia, and sore throat (Tahvildari et al, 2020). However, COVID-19 can also cause loss of smell (anosmia) and loss of taste (ageusia) early in the disease.…”

Recent Advances in Pathophysiology, Drug Development and Future Perspectives of SARS-CoV-2

“…The immune response in SARS-CoV-2 patients occurs in two phases: Initially, when the disease is moderate, the immune cells eliminate the virus by producing primary cytokines, which may be beneficial for eliminating the virus but results in inflammation. During the second phase of more severe cases, SARS-CoV-2 patients exhibit significantly high cytokine levels or hyper-inflammation, and in some cases, the lungs become damaged (Figure 4; Azin et al, 2020;Shih-Hwa et al, 2020). Patients in this stage develop ARDS, and worsening damage to the lungs is a major challenge.…”

“…et al, 2020;. A high level of IL-6 can suppress normal cell activation (Azin et al, 2020). Thus, a cytokine storm may help with the suppression of T-cells in SARS-CoV-2 patients (Puja et al, 2020).…”

Features of patients that died for COVID-19 in a Hospital in the south of Mexico: A observational cohort study

“…Shortness of breath, fever and dry cough were the most prevalent symptoms in our sample. Fever and cough had been reported as the most prevalent symptoms in several studies, including the Mexican population and severe cases (5,10,15,(17)(18)(19)). On the other hand, the third most prevalent symptom varies widely; for instance, a review found dyspnea prevalence of 53 -80%, and a series of fatal cases found in 70.6% (5,17).…”

“…The copyright holder for this this version posted September 23, 2020. ; https://doi.org/10.1101/2020.09.21.20199117 doi: medRxiv preprint hypertension compared with diabetes (8,10). Nonetheless, in other populations hypertension has a much higher prevalence compared to diabetes (5,18). In two meta-analyses from the same work group (20,21), hypertension and diabetes were associated with poor outcomes in COVID-19.…”