BMC Infectious Diseases (Jan 2021)

Atypical presentations of coronavirus disease 2019 (COVID-19) from onset to readmission

  • Zhiqi Yang,
  • Xiaofeng Chen,
  • Ruibin Huang,
  • Shengkai Li,
  • Daiying Lin,
  • Zhijian Yang,
  • Hongfu Sun,
  • Guorui Liu,
  • Jinming Qiu,
  • Yanyan Tang,
  • Jianning Xiao,
  • Yuting Liao,
  • Xianheng Wu,
  • Renhua Wu,
  • Xiangguang Chen,
  • Zhuozhi Dai

DOI
https://doi.org/10.1186/s12879-020-05751-8
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 12

Abstract

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Abstract Background To investigate the CT imaging and clinical features of three atypical presentations of coronavirus disease 2019 (COVID-19), namely (1) asymptomatic, (2) CT imaging-negative, and (3) re-detectable positive (RP), during all disease stages. Methods A consecutive cohort of 79 COVID-19 patients was retrospectively recruited from five independent institutions. For each presentation type, all patients were classified into atypical vs. typical groups (i.e., asymptomatic vs.symptomatic, CT imaging-negative vs. CT imaging-positive, and RP and non-RP,respectively). The chi-square test, Student’s t test, and Kruskal-Wallis H test were performed to compare CT imaging and clinical features of atypical vs. typical patients for all three presentation categories. Results In our COVID-19 cohort, we found 12.7% asymptomatic patients, 13.9% CT imaging-negative patients, and 8.9% RP patients. The asymptomatic patients had fewer hospitalization days (P=0.043), lower total scores for bilateral lung involvement (P< 0.001), and fewer ground-glass opacities (GGOs) in the peripheral area (P< 0.001) than symptomatic patients. The CT imaging-negative patients were younger (P=0.002), had a higher lymphocyte count (P=0.038), had a higher lymphocyte rate (P=0.008), and had more asymptomatic infections (P=0.002) than the CT imaging-positive patients. The RP patients with moderate COVID-19 had lower total scores of for bilateral lung involvement (P=0.030) and a smaller portion of the left lung affected (P=0.024) than non-RP patients. Compared to their first hospitalization, RP patients had a shorter hospitalization period (P< 0.001) and fewer days from the onset of illness to last RNA negative conversion (P< 0.001) at readmission. Conclusions Significant CT imaging and clinical feature differences were found between atypical and typical COVID-19 patients for all three atypical presentation categories investigated in this study, which may help provide complementary information for the effective management of COVID-19.

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