Lookout for non-typical COVID symptoms

Non-typical presentations or manifestations of infection with COVID-19 should not be overlooked and have important implications for a widespread testing programme according to Swiss doctors writing in the BMJ.

Severe acute respiratory illness with fever and respiratory symptoms, such as cough and shortness of breath, are the well accepted symptoms, they say, but other symptoms are increasingly being recognised.

Case series report gastrointestinal symptoms in 2–40% of patients and diarrhoea can be the initial manifestation of infection. The virus has been detected in stool samples indicating that faecal-oral transmission could pose a problem, they say.

Taste or olfactory disorders were noted in up to 53% of the cases in a small cohort from Italy and these symptoms are being recognised more widely.

Recent case series from China and the USA describe other neurological symptoms among patients with COVID-19, including ischaemic or haemorrhagic stroke, dizziness, headache, musculoskeletal disturbance, altered mental state, Guillain-Barré syndrome, or acute necrotising encephalopathy.

Cardiovascular events that have been associated with COVID-19 in preliminary observations include myocardial injury, myocarditis and myopericarditis with reduced systolic function, cardiac arrhythmias, heart failure, and misdiagnosis as acute coronary syndrome.

Finally, ocular manifestations such as red eyes and swollen conjunctiva, and increased secretions, were reported in up to 32% of infected patients in a Chinese case series.

According to the authors: ‘Risk of transmission by people with few or no symptoms remains to be quantified. Testing strategies that exclude patients with few symptoms are likely to miss a substantial proportion of cases.’

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