Clinical manifestations of COVID‐19: An overview of 102 systematic reviews with evidence mapping

Abstract

Objective Coronavirus disease 2019 (COVID‐19) has rapidly spread worldwide, but there is so far no comprehensive analysis of all known symptoms of the disease. Our study aimed to present a comprehensive picture of the clinical symptoms of COVID‐19 using an evidence map. Methods We systematically searched MEDLINE via PubMed, Web of Science, Embase, and Cochrane library from their inception to March 16, 2021. We included systematic reviews reporting the clinical manifestations of COVID‐19 patients. We followed the PRISMA guidelines, and the study selection, data extraction, and quality assessment were done by two individuals independently. We assessed the methodological quality of the studies using AMSTAR. We visually presented the clinical symptoms of COVID‐19 and their prevalence. Results A total of 102 systematic reviews were included, of which, 68 studies (66.7%) were of high quality, 19 studies (18.6%) of medium quality, and 15 studies (14.7%) of low quality. We identified a total of 74 symptoms including 17 symptoms of the respiratory system, 21 symptoms of the neurological system, 10 symptoms of the gastrointestinal system, 16 cutaneous symptoms, and 10 ocular symptoms. The most common symptoms were fever (67 studies, ranging 16.3%–91.0%, pooled prevalence: 64.6%, 95%CI, 61.3%–67.9%), cough (68 studies, ranging 30.0%–72.2%, pooled prevalence: 53.6%, 95%CI, 52.1%–55.1%), muscle soreness (56 studies, ranging 3.0%–44.0%, pooled prevalence: 18.7%, 95%CI, 16.3%–21.3%), and fatigue (52 studies, ranging 3.3%‐58.5%, pooled prevalence: 29.4%, 95%CI, 27.5%–31.3%). The prevalence estimates for COVID‐19 symptoms were generally lower in neonates, children and adolescents, and pregnant women than in the general populations. Conclusion At least 74 different clinical manifestations are associated with COVID‐19. Fever, cough, muscle soreness, and fatigue are the most common, but attention should also be paid to the rare symptoms that can help in the early diagnosis of the disease.

Cutaneous vasculitis: Lessons from COVID-19 and COVID-19 vaccination

“…The enveloped RNA virus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the etiologic agent, which primarily affects the respiratory tract leading to general symptoms like fever, fatigue, anosmia, and dysgeusia, while respiratory symptoms are variable in severity ranging from cough and rhinorrhea to dyspnea, pneumonia, or acute respiratory distress syndrome. However, evidence about the involvement of other organs and systems is increasing; in fact, knowledge about the neurological, gastrointestinal, and ocular manifestations of SARS-CoV-2 infection is deepening (21,22). Similarly, cutaneous signs of COVID-19 are continuously reported and attempts at classifications are already available in the literature, together with the first prevalence estimations in which dermatologic manifestations would place between 1.8 and 20.4% of the COVID-19 patients (23, 24).…”

Efficacy and safety of aniseed powder for treating gastrointestinal symptoms of COVID-19: a randomized, placebo-controlled trial

“…As the pandemic has progressed and new variants have emerged, there is increasing awareness of the extrapulmonary manifestations of the disease. Over 70 different clinical manifestations have been identified, of which 10 are gastrointestinal ( Luo et al, 2022 ).…”

“…The presence of gastrointestinal (GI) symptoms may precede pulmonary involvement ( Jin et al, 2020 ; Poggiali et al, 2020 ). Anorexia (12.9%), diarrhea (8.1%), nausea (6.7%), constipation (5.5%), melena (5.3%), abdominal pain (3.7%) and heartburn (3.6%) are estimated to be the most common ( Luo et al, 2022 ). While the overall prevalence is probably less than 20% and may not differ from the general population prevalence rates for neonates, children or pregnant women ( Zeng et al, 2022 ), GI manifestations appear to be associated with an increased risk of COVID-19 severity, especially the presence of abdominal pain ( Menon et al, 2021 ; Zeng et al, 2022 ).…”

A review of the main genetic factors influencing the course of COVID-19 in Sardinia: the role of human leukocyte antigen-G

“…Various clinical outcomes have been described among COVID-19 patients since the outbreak. While some patients remain asymptomatic, others may develop respiratory or multiorgan failure with potentially lethal outcomes ( 31 , 32 ).…”