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COVID-19 can suddenly become severe: a case series from Tokyo, Japan
Keiji Nakamura1, Satoshi Ide1, Sho Saito1
1Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Insights
Relative bradycardia, a slower heart rate, was observed in all 11 COVID-19 patients. This finding may help differentiate coronavirus disease from bacterial pneumonia, especially when fever persists.
Area of Science:
- Infectious Diseases
- Cardiology
- Pulmonology
Background:
- Coronavirus disease (COVID-19) has become a global health concern since its emergence in late 2019.
- Early identification and differentiation of COVID-19 from other respiratory illnesses are crucial for effective patient management.
Purpose of the Study:
- To report on 11 cases of COVID-19 presenting with relative bradycardia.
- To explore the potential of relative bradycardia as a distinguishing clinical sign for COVID-19.
Main Methods:
- Case series of 11 hospitalized patients diagnosed with COVID-19.
- Clinical data collection including symptom presentation, disease severity, and treatment interventions.
- Analysis of patient outcomes based on disease classification (mild, moderate, severe, critical).
Main Results:
- All 11 COVID-19 patients exhibited relative bradycardia.
- Three mild and three moderate COVID-19 cases showed spontaneous improvement.
- Severe and critical cases received lopinavir/ritonavir; critical cases required mechanical ventilation and ECMO.
- Critical COVID-19 patients experienced prolonged high fever and rapid respiratory decline.
Conclusions:
- Relative bradycardia may serve as a useful indicator to distinguish COVID-19 from bacterial community-acquired pneumonia.
- A fever lasting longer than 7 days in COVID-19 patients may signal potential sudden worsening of their condition.
Abstract:
Since the initial report of coronavirus disease (COVID-19) from the City of Wuhan, China in December 2019, there have been multiple cases globally. Reported here are 11 cases of COVID-19 at this hospital; all of the patients in question presented with relative bradycardia. The severity of the disease was classified into four grades. Of the patients studied, 3 with mild COVID-19 and 3 with moderate COVID-19 improved spontaneously. Lopinavir/ ritonavir was administered to 3 patients with severe COVID-19 and 2 with critical COVID-19. Both patients with critical COVID-19 required mechanical ventilation and extracorporeal membrane oxygenation. Both patients with critical COVID-19 had a higher fever that persisted for longer than patients with milder COVID-19. The respiratory status of patients with critical COVID-19 worsened rapidly 7 days after the onset of symptoms. Relative bradycardia may be useful in distinguishing between COVID-19 and bacterial community-acquired pneumonia. In patients who have had a fever for > 7 days, the condition might worsen suddenly.
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