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Atypical presentations of coronavirus disease 2019 (COVID-19) from onset to readmission
Zhiqi Yang1, Xiaofeng Chen1, Ruibin Huang2
1Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, 514031, People's Republic of China.
Insights
This study analyzed atypical coronavirus disease 2019 (COVID-19) presentations, including asymptomatic, CT imaging-negative, and re-detectable positive (RP) cases. Findings reveal significant differences in CT imaging and clinical features between atypical and typical COVID-19 patients.
Area of Science:
- Radiology
- Infectious Diseases
- Pulmonology
Background:
- Coronavirus disease 2019 (COVID-19) presents with diverse clinical and imaging manifestations.
- Atypical presentations, including asymptomatic, CT imaging-negative, and re-detectable positive (RP) cases, require further investigation.
- Understanding these atypical forms is crucial for comprehensive disease management.
Purpose of the Study:
- To investigate the computed tomography (CT) imaging and clinical features of three atypical COVID-19 presentations.
- To compare these atypical presentations (asymptomatic, CT imaging-negative, RP) with typical COVID-19 cases.
- To identify differences that may aid in managing COVID-19.
Main Methods:
- Retrospective analysis of 79 COVID-19 patients from five institutions.
- Classification of patients into atypical (asymptomatic, CT imaging-negative, RP) versus typical (symptomatic, CT imaging-positive, non-RP) groups.
- Statistical comparison of CT imaging and clinical features using chi-square, t-tests, and Kruskal-Wallis H tests.
Main Results:
- Atypical presentations constituted 12.7% asymptomatic, 13.9% CT imaging-negative, and 8.9% RP patients.
- Asymptomatic patients showed shorter hospital stays and less lung involvement.
- CT imaging-negative patients were younger with higher lymphocyte counts; RP patients had reduced lung involvement and shorter recovery times.
Conclusions:
- Significant differences in CT imaging and clinical features exist between atypical and typical COVID-19 patients.
- These findings offer complementary information for effective COVID-19 management.
- Further research into atypical COVID-19 presentations can refine diagnostic and therapeutic strategies.
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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