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

• Published in: BMC infectious diseases Vol. 21; no. 1; pp. 127 - 12
• Main Authors: Yang, Zhiqi, Chen, Xiaofeng, Huang, Ruibin, Li, Shengkai, Lin, Daiying, Yang, Zhijian, Sun, Hongfu, Liu, Guorui, Qiu, Jinming, Tang, Yanyan, Xiao, Jianning, Liao, Yuting, Wu, Xianheng, Wu, Renhua, Chen, Xiangguang, Dai, Zhuozhi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.01.2021; BioMed Central; BMC
• Subjects: Adult; Age; Asymptomatic; Asymptomatic Infections; Cell number; Chi-square test; China - epidemiology; Computed tomography; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - diagnostic imaging; COVID-19 - epidemiology; CT imaging; CT imaging negative; Disease transmission; Features; Female; Hospital patients; Hospitalization; Humans; Infections; Infectious diseases; Lung - diagnostic imaging; Lungs; Lymphocytes; Male; Medical imaging; Middle Aged; Neutrophils; Patient Readmission; Patients; Pneumonia; Radiography, Thoracic; Re-detectable positive; Retrospective Studies; Ribonucleic acid; RNA; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statistical tests; Statistics; Tomography, X-Ray Computed; Viral diseases; China; COVID-19; CT imaging negative; Asymptomatic; Features; Re-detectable positive
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05751-8

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. 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. 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. 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.