Differential diagnosis for suspected cases of coronavirus disease 2019: a retrospective study

Abstract

Background Since December 2019, the coronavirus disease 2019 (COVID-19) has infected more than 12,322,000 people and killed over 556,000 people worldwide. However, Differential diagnosis remains difficult for suspected cases of COVID-19 and need to be improved to reduce misdiagnosis. Methods Sixty-eight cases of suspected COVID-19 treated in Wenzhou Central Hospital from January 21 to February 20, 2020 were divided into confirmed and COVID-19-negative groups based on the results of real-time reverse transcriptase polymerase chain reaction (RT-PCR) nucleic acid testing of the novel coronavirus in throat swab specimens to compare the clinical symptoms and laboratory and imaging results between the groups. Results Among suspected patients, 17 were confirmed to COVID-19-positive group and 51 were distinguished to COVID-19-negative group. Patients with reduced white blood cell (WBC) count were more common in the COVID-19-positive group than in the COVID-19-negative group (29.4% vs 3.9%, P = 0.003). Subsequently, correlation analysis indicated that there was a significant inverse correlation existed between WBC count and temperature in the COVID-19-positive patients (r = − 0.587, P = 0.003), instead of the COVID-19-negative group. But reduced lymphocyte count was no different between the two groups (47.1% vs 25.5%, P = 0.096). More common chest imaging characteristics of the confirmed COVID-19 cases by high-resolution computed tomography (HRCT) included ground-glass opacities (GGOs), multiple patchy shadows, and consolidation with bilateral involvement than COVID-19-negative group (82.4% vs 31.4%, P = 0.0002; 41.2% vs 17.6% vs P = 0.048; 76.5% vs 43.1%, P = 0.017; respectively). The rate of clustered infection was higher in COVID-19-positive group than COVID-19-negative group (64.7% vs 7.8%, P = 0.001). Through multiplex PCR nucleic acid testing, 2 cases of influenza A, 3 cases of influenza B, 2 cases of adenovirus, 2 cases of Chlamydia pneumonia, and 7 cases of Mycoplasma pneumoniae were diagnosed in the COVID-19-negative group. Conclusions WBC count inversely correlated with the severity of fever, GGOs, multiple patchy shadows, and consolidation in chest HRCT and clustered infection are common but not specific features in the confirmed COVID-19 group. Multiplex PCR nucleic acid testing helped differential diagnosis for suspected COVID-19 cases.

Severe infectious acute respiratory failure mimicking COVID‐19 in a healthy adolescent

“…Multiplex PCR tests have recently been reported to be useful for differentiating severe COVID‐19 from severe MPP that require antimicrobial therapy with or without anticoagulation treatment. 5 Multiplex PCR tests and the 16S rRNA gene analysis using bronchoalveolar lavage fluid were useful for confirming M. pneumoniae in our patient, which allowed us to initiate appropriate antimicrobial therapy.…”

Late diagnosis of respiratory syncytial virus and influenza co-infection during coronavirus disease 2019 pandemic: a case report

“…Performing multiplex PCR testing through sputum or throat swabs helps to distinguish different pathogens such as influenza A virus, influenza B virus, Adenovirus, RSV, Chlamydia pneumoniae and Mycoplasma pneumoniae from COVID-19 infection [ 14 ]. However, this method may be related to multiple factors such as quality of sampling, specimen preservation, and varying concentration of nasopharyngeal at different stages of the disease [ 15 ].…”

Association between Polygenetic Risk Scores of Low Immunity and Interactions between These Scores and Moderate Fat Intake in a Large Cohort

“…However, low WBC counts had an inverse relation with cancer risk in the present study. Recent studies have demonstrated that WBC counts are inversely correlated with fever and severity from coronavirus disease 2019 (COVID-19) infection in the chest damage showing by imaging analysis, including ground-glass opacities and multiple patchy shadows [ 42 , 43 ].…”