An integrated approach to the differential diagnosis of COVID-19 syndromes and symptoms

Abstract

COVID-19 is characterized by a variety of symptoms that are not pathognomonic (hyper-/hypothermia; acute intoxication syndrome; cough; sore throat; enlargement of submandibular lymph nodes; shortness of breath; dyspeptic syndrome; neurological symptoms; ageusia and anosmia, etc.), which determines the need for differential diagnosis. COVID-19 refers to acute respiratory infections, has common transmission routes and similar symptoms, simultaneous infection with other respiratory viruses is possible.

Symptoms of intoxication require differential diagnosis with other infections, cough and shortness of breath may be manifestations of cardiovascular diseases, ageusia and anosmia occur in respiratory viral infections and neurological diseases, skin manifestations are also not specific. Laboratory and radiation diagnostics in COVID-19 reveals frequent changes, which, however, are also not pathognomonic. The article discusses diseases that have similar manifestations to COVID-19.

The greatest difficulties in differential diagnosis are caused by combined conditions ― the development of COVID-19 in patients with cardiovascular diseases, cancer patients, with chronic diseases of the respiratory system and others. Crucial in the differential diagnosis is the conduct of a specific examination ― the determination of the SARS-CoV-2 antigen in smears from the nasopharynx and oropharynx by immunochemical methods.

Keywords

COVID-19 / syndromes / differential diagnosis

References

[1] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5

[2] Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China // Lancet. 2020. Vol. 395, N 10223. Р. 497–506. doi: 10.1016/S0140-6736(20)30183-5

[3] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513. doi: 10.1016/S0140-6736(20)30211-7

[4] Chen N., Zhou M., Dong X., et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study // Lancet. 2020. Vol. 395, N 10223. Р. 507–513. doi: 10.1016/S0140-6736(20)30211-7

[5] Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10): 929–936. doi: 10.1056/NEJMoa2001191

[6] Holshue M.L., DeBolt C., Lindquist S., et al. First case of 2019 novel coronavirus in the United States // N Engl J Med. 2020. Vol. 382, N 10. Р. 929–936. doi: 10.1056/NEJMoa2001191

[7] Solomon DA, Sherman AC, Kanjilal S. Influenza in the COVID-19 Era. JAMA. 2020;324(13):1342–1343. doi: 10.1001/jama.2020.14661

[8] Solomon D.A., Sherman A.C., Kanjilal S. Influenza in the COVID-19 Era // JAMA. 2020. Vol. 324, N 13. Р. 1342–1343. doi: 10.1001/jama.2020.14661

[9] Krati K, Rizkou J, Errami AA, Essaadouni L. Differential diagnosis of COVID-19 in symptomatic patients at the University Hospital Center Mohammed VI, Marrakesh. Pan Afr Med J. 2020;36:269. doi: 10.11604/pamj.2020.36.269.24558

[10] Krati K., Rizkou J., Errami A.A., Essaadouni L. Differential diagnosis of COVID-19 in symptomatic patients at the University Hospital Center Mohammed VI, Marrakesh // Pan Afr Med J. 2020. Vol. 36. Р. 269. doi: 10.11604/pamj.2020.36.269.24558

[11] Orlova NV. Gripp. Diagnostics, strategy of choosing antiviral drugs. Medicinskii Sovet. 2017;(20):80–86. (In Russ). doi: 10.21518/2079-701X-2017-20-80-86

[12] Орлова Н.В. Грипп. Диагностика, стратегия выбора противовирусных препаратов // Медицинский совет. 2017. № 20. С. 80–86. doi: 10.21518/2079-701X-2017-20-80-86

[13] Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667–678. doi: 10.1016/S2468-1253(20)30126-6

[14] Mao R., Qiu Y., He J.S., et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis // Lancet Gastroenterol Hepatol. 2020. Vol. 5, N 7. Р. 667–678. doi: 10.1016/S2468-1253(20)30126-6

[15] Lechien JR, Chiesa-Estomba CM, De Siati DR. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251–2261. doi: 10.1007/s00405-020-05965-1

[16] Lechien J.R., Chiesa-Estomba C.M., de Siati D.R. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study // Eur Arch Otorhinolaryngol. 2020. Vol. 277, N 8. Р. 2251–2261. doi: 10.1007/s00405-020-05965-1

[17] Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV-2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92(6):552–555. doi: 10.1002/jmv.25728

[18] Li Y.C., Bai W.Z., Hashikawa T. The neuroinvasive potential of SARS-CoV-2 may play a role in the respiratory failure of COVID-19 patients // J Med Virol. 2020. Vol. 92, N 6. Р. 552–555. doi: 10.1002/jmv.25728

[19] Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18–22. doi: 10.1016/j.bbi.2020.03.031

[20] Wu Y., Xu X., Chen Z., et al. Nervous system involvement after infection with COVID-19 and other coronaviruses // Brain Behav Immun. 2020. Vol. 87. Р. 18–22. doi: 10.1016/j.bbi.2020.03.031

[21] Wollina U, Karadağ AS, Rowland-Payne C, et al. Cutaneous signs in COVID-19 patients: a review. Dermatol Ther. 2020;33(5):e13549. doi: 10.1111/dth.13549

[22] Wollina U., Karadağ A.S., Rowland-Payne C., et al. Cutaneous signs in COVID-19 patients: a review // Dermatol Ther. 2020. Vol. 33, N 5. Р. e13549. doi: 10.1111/dth.13549

[23] Suchonwanit P, Leerunyakul K, Kositkuljorn C. Cutaneous manifestations in COVID-19: lessons learned from current evidence. J Am Acad Dermatol. 2020;83(1):e57–e60. doi: 10.1016/j.jaad.2020.04.094

[24] Suchonwanit P., Leerunyakul K., Kositkuljorn C. Cutaneous manifestations in COVID-19: lessons learned from current evidence // J Am Acad Dermatol. 2020. Vol. 83, N 1. Р. e57–e60. doi: 10.1016/j.jaad.2020.04.094

[25] Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71–77. doi: 10.1111/bjd.19163

[26] Galván Casas C., Català A., Carretero Hernández G., et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases // Br J Dermatol. 2020. Vol. 183, N 1. Р. 71–77. doi: 10.1111/bjd.19163

[27] El Hachem M, Diociaiuti A, Concato C, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34(11):2620–2629. doi: 10.1111/jdv.16682

[28] El Hachem M., Diociaiuti A., Concato C., et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection // J Eur Acad Dermatol Venereol. 2020. Vol. 34, N 11. Р. 2620–2629. doi: 10.1111/jdv.16682

[29] Gianotti R, Veraldi S, Recalcati S, et al. Cutaneous clinico-pathological findings in three COVID-19-positive patients observed in the metropolitan area of Milan, Italy. Acta Derm Venereol. 2020; 100(8):adv00124. doi: 10.2340/00015555-3490

[30] Gianotti R., Veraldi S., Recalcati S., et al. Cutaneous clinico-pathological findings in three COVID-19-positive patients observed in the metropolitan area of Milan, Italy // Acta Derm Venereol. 2020. Vol. 100, N 8. Р. adv00124. doi: 10.2340/00015555-3490

[31] Feng Z, Diao B, Wang R, et al. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly decimates human spleens and lymph nodes. medRxiv. 2020. doi: 10.1101/2020.03.27.20045427

[32] Feng Z., Diao B., Wang R., et al. The novel severe acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) directly decimates human spleens and lymph nodes // medRxiv. 2020. doi: 10.1101/2020.03.27.20045427

[33] Millan-Oñate J, Millan W, Mendoza LA, et al. Successful recovery of COVID-19 pneumonia in a patient from Colombia after receiving chloroquine and clarithromycin. Ann Clin Microbiol Antimicrob. 2020;19(1):16. doi: 10.1186/s12941-020-00358-y

[34] Millan-Oñate J., Millan W., Mendoza L.A., et al. Successful recovery of COVID-19 pneumonia in a patient from Colombia after receiving chloroquine and clarithromycin // Ann Clin Microbiol Antimicrob. 2020. Vol. 19, N 1. Р. 16. doi: 10.1186/s12941-020-00358-y

[35] Román GC, Spencer PS, Reis J, et al. WFN Environmental Neurology Specialty Group. The neurology of COVID-19 revisited: a proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries. J Neurol Sci. 2020;414:116884. doi: 10.1016/j.jns.2020.116884

[36] Román G.C., Spencer P.S., Reis J., et al. WFN Environmental Neurology Specialty Group. The neurology of COVID-19 revisited: a proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries // J Neurol Sci. 2020. Vol. 414. Р. 116884. doi: 10.1016/j.jns.2020.116884

[37] Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75(18): 2352–2371. doi: 10.1016/j.jacc.2020.03.031

[38] Driggin E., Madhavan M.V., Bikdeli B., et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic // J Am Coll Cardiol. 2020. Vol. 75, N 18. Р. 2352–2371. doi: 10.1016/j.jacc.2020.03.031

[39] Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020;5(6):529–530. doi: 10.1016/S2468-1253(20)30084-4

[40] Bangash M.N., Patel J., Parekh D. COVID-19 and the liver: little cause for concern // Lancet Gastroenterol Hepatol. 2020. Vol. 5, N 6. Р. 529–530. doi: 10.1016/S2468-1253(20)30084-4

[41] Ghayda RA, Lee J, Lee JY, et al. Correlations of clinical and laboratory characteristics of COVID-19: a systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(14):5026. doi: 10.3390/ijerph17145026

[42] Ghayda R.A., Lee J., Lee J.Y., et al. Correlations of clinical and laboratory characteristics of COVID-19: a systematic review and meta-analysis // Int J Environ Res Public Health. 2020. Vol. 17, N 14. Р. 5026. doi: 10.3390/ijerph17145026

[43] Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5(5):428–430. doi: 10.1016/S2468-1253(20)30057-1

[44] Zhang C., Shi L., Wang F.S. Liver injury in COVID-19: management and challenges // Lancet Gastroenterol Hepatol. 2020. Vol. 5, N 5. Р. 428–430. doi: 10.1016/S2468-1253(20)30057-1

[45] Guan WJ, Ni ZY, Hu Y, et al. China Medical Treatment Expert Group for COVID-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi: 10.1056/NEJMoa2002032

[46] Guan W.J., Ni Z.Y., Hu Y., et al. China medical treatment expert group for COVID-19. Clinical characteristics of Coronavirus Disease 2019 in China // N Engl J Med. 2020. Vol. 382, N 18. Р. 1708–1720. doi: 10.1056/NEJMoa2002032

[47] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3

[48] Zhou F., Yu T., Du R., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study // Lancet. 2020. Vol. 395, N 10229. Р. 1054–1062. doi: 10.1016/S0140-6736(20)30566-3

[49] Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in wuhan, China. JAMA Intern Med. 2020; 180(7):934–943. doi: 10.1001/jamainternmed.2020.0994

[50] Wu C., Chen X., Cai Y., et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in wuhan, China // JAMA Intern Med. 2020. Vol. 180, N 7. Р. 934–943. doi: 10.1001/jamainternmed.2020.0994

[51] Valeri AM, Robbins-Juarez SY, Stevens JS, et al. Presentation and outcomes of patients with ESKD and COVID-19. J Am Soc Nephrol. 2020;31(7):1409–1415. doi: 10.1681/ASN.2020040470

[52] Valeri A.M., Robbins-Juarez S.Y., Stevens J.S., et al. Presentation and outcomes of patients with ESKD and COVID-19 // J Am Soc Nephrol. 2020. Vol. 31, N 7. Р. 1409–1415. doi: 10.1681/ASN.2020040470

[53] Akalin E, Azzi Y, Bartash R, et al. COVID-19 and kidney transplantation. N Engl J Med. 2020;382(25):2475–2477. doi: 10.1056/NEJMc2011117

[54] Akalin E., Azzi Y., Bartash R., et al. COVID-19 and kidney transplantation // N Engl J Med. 2020. Vol. 382, N 25. Р. 2475–2477. doi: 10.1056/NEJMc2011117

[55] Rismanbaf A, Zarei S. Liver and kidney injuries in COVID-19 and their effects on drug therapy; a letter to editor. Arch Acad Emerg Med. 2020;8(1):e17. doi: 10.22037/aaem.v8i1.590

[56] Rismanbaf A., Zarei S. Liver and kidney injuries in COVID-19 and their effects on drug therapy; a letter to editor // Arch Acad Emerg Med. 2020. Vol. 8, N 1. Р. e17. doi: 10.22037/aaem.v8i1.590

[57] Dai WC, Zhang HW, Yu J, et al. ct imaging and differential diagnosis of COVID-19. Can Assoc Radiol J. 2020;71(2):195–200. doi: 10.1177/0846537120913033

[58] Dai W.C., Zhang H.W., Yu J., et al. CT imaging and differential diagnosis of COVID-19 // Can Assoc Radiol J. 2020. Vol. 71, N 2. Р. 195–200. doi: 10.1177/0846537120913033

[59] Duzgun SA, Durhan G, Demirkazik FB, et al. COVID-19 pneumonia: the great radiological mimicker. Insights Imaging. 2020;11(1):118. doi: 10.1186/s13244-020-00933-z

[60] Duzgun S.A., Durhan G., Demirkazik F.B., et al. COVID-19 pneumonia: the great radiological mimicker // Insights Imaging. 2020. Vol. 11, N 1. Р. 118. doi: 10.1186/s13244-020-00933-z

[61] Petrovichev VS, Melekhov AV, Sayfullin MA, et al. Computed tomography for coronavirus infection: differential diagnosis on clinical examples. Archiv of Internal Medicine. 2020;10(5):357–371. (In Russ). doi: 10.20514/2226-6704-2020-10-5-357-371

[62] Петровичев В.С., Мелехов А.В., Сайфуллин М.А., и др. Компьютерная томография при коронавирусной инфекции: дифференциальный диагноз на клинических примерах // Архивъ внутренней медицины. 2020. Т. 10, № 5. С. 357–371. doi: 10.20514/2226-6704-2020-10-5-357-371

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