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Does this patient have COVID-19? A practical guide for the internist
Lorenzo Bertolino1, Martina Vitrone1, Emanuele Durante-Mangoni2,3
1Department of Precision Medicine, Section of Internal Medicine, University of Campania 'L. Vanvitelli', Napoli, Italy.
Insights
Recognizing Coronavirus disease 2019 (COVID-19) requires internists to develop specific skills for differential diagnosis. Understanding the disease
Area of Science:
- Internal Medicine
- Infectious Diseases
- Clinical Diagnosis
Background:
- Coronavirus disease 2019 (COVID-19) presents a significant diagnostic challenge for physicians, particularly in differentiating it from other respiratory illnesses.
- The ongoing pandemic necessitates improved clinical approaches to accurately identify COVID-19 cases.
Purpose of the Study:
- To review key clinical features aiding in the differentiation of COVID-19 from other upper respiratory and influenza-like illnesses.
- To provide guidance for internists on recognizing COVID-19 in both outpatient and inpatient settings.
Main Methods:
- Review of clinical features and natural history of COVID-19.
- Consideration of diagnostic strategies in different clinical settings (outpatient vs. inpatient).
Main Results:
- COVID-19 often lacks specific signs and symptoms, making clinical diagnosis difficult.
- Knowledge of the disease's natural history can help contextualize common, unspecific symptoms.
Conclusions:
- Developing specific skills in recognizing COVID-19's 'semeiotic' is crucial for internists.
- A balanced clinical approach, informed by disease knowledge, is essential for managing patients with flu-like symptoms.
Abstract:
Coronavirus disease 2019 (COVID-19) is currently causing a pandemic and will likely persist in endemic form in the foreseeable future. Physicians need to correctly approach this new disease, often representing a challenge in terms of differential diagnosis. Although COVID-19 lacks specific signs and symptoms, we believe internists should develop specific skills to recognize the disease, learning its 'semeiotic'. In this review article, we summarize the key clinical features that may guide in differentiating a COVID-19 case, requiring specific testing, from upper respiratory and/or influenza-like illnesses of other aetiology. We consider two different clinical settings, where availability of the different diagnostic strategies differs widely: outpatient and inpatient. Our reasoning highlights how challenging a balanced approach to a patient with fever and flu-like symptoms can be. At present, clinical workup of COVID-19 remains a hard task to accomplish. However, knowledge of the natural history of the disease may aid the internist in putting common and unspecific symptoms into the correct clinical context.
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