COVID-19: to be or not to be; that is the diagnostic question

Abstract

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.

What Is Lost in Postgraduate Residency During COVID-19 Times?—a Resident Perspective on Diagnostic Error

“…In the diagnostic process, we tend to match the presenting clinical features to the illness scripts which we have developed within ourselves over a period of time. The situated cognition of pandemic 'intuitively' pushes us to fit the mimicking clinical features, and this subconscious blinding leads to diagnostic oversight of endemically prevalent respiratory conditions [4]. Similarly, blind anchoring to the pandemic outbreak protocol might prevent from exploring other genuine alternatives and escape from sense of uncertainty [5].…”

Atualização sobre a pandemia do COVID-19: uma revisão integrativa / Update on the COVID-19 pandemic: an integrative review

“…Devido à alta similaridade do vírus que acomete os morcegos com o SARS-CoV, acredita-se que essa espécie de animal seja um potencial reservatório natural da doença. Além disso, comenta-se que cobras e pangolins são animais suspeitos de serem hospedeiros intermediários, necessitando de mais investigações (RODRIGUEZ-MORALES et al, 2020;ZHENG, 2020 (COLEMAN et al, 2020;GUAN et al, 2020;GUO et al, 2020;NIKOLICH-ZUGICH et al, 2020;PATEL et al, 2020;SINGHAL, 2020;WU et al, 2020;ZHENG, 2020 (GOYAL et al, 2020;GUAN et al, 2020;ISER et al, 2020;NIKOLICH-ZUGICH et al, 2020;RODRIGUEZ-MORALES et al, 2020;SINGHAL, 2020;WU et al, 2020;ZHENG, 2020).…”

“…As manifestações clínicas conhecidas são febre (temperatura axilar ≥ 37,5°) e tosse (ambos os mais comuns), além de desconforto na faringe, cefaleia, fadiga, mialgia, dispneia, conjuntivite, dor no peito, hemoptise, produção de escarro, rinorreia, dor abdominal, diarreia, náusea, vômito, confusão mental e anorexia. Estudos também mostram que a infecção nos recém-nascidos, lactentes e crianças é mais branda do que nos adultos (GOYAL et al, 2020;GUAN et al, 2020;ISER et al, 2020;NIKOLICH-ZUGICH et al, 2020;RODRIGUEZ-MORALES et al, 2020;SINGHAL, 2020;ZHENG, 2020 GARNETT; BRUUN, 2020;GUO et al, 2020;NIKOLICH-ZUGICH et al, 2020;PITITTO;FERREIRA, 2020;RODRIGUEZ-MORALES et al, 2020;SINGHAL, 2020;YANG et al, 2020;ZHENG, 2020 COLEMAN et al, 2020;GUO et al, 2020;ISER et al, 2020).…”

“…Há evidências de que, sintomas inespecíficos como a perda do olfato (anosmia) e a perda do paladar (ageusia) podem representar a primeira ou a única manifestação da doença e não são acompanhadas por obstrução nasal ou outros sintomas rinológicos. Ademais, até o momento, não se sabe o tempo ou se há a recuperação completa destas disfunções sensoriais(COLEMAN et al, 2020;ISER et al, 2020;VAIRA et al, 2020). , determinando, assim, quais pacientes necessitam de observações adicionais da equipe médica.…”

Therapeutic Options for COVID-19: A Review

“…The most common clinical manifestations of COVID-19 include fever, cough, fatigue, dyspnea, sore throat, and headache. Multi-systemic symptoms like anosmia, diarrhea, and vomiting have also been reported [1]. The most common patterns on chest CT imaging in these patients include ground-glass opacity (56.4%) and bilateral patchy shadowing (51.8%).…”