COVID-19 differential diagnosis

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Main article: COVID-19

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2];Syed Hassan A. Kazmi BSc, MD [3]

Overview

Coronavirus disease 2019 (COVID-19) should be differentiated from other diseases presenting with cough, fever, shortness of breath, and tachypnea.

Differentiating COVID-19 from other Diseases

Coronavirus disease 2019 (COVID-19) should be differentiated from other diseases presenting with cough, fever, shortness of breath, and tachypnea. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]

Diseases Diagnostic tests Physical Examination Symptoms Past medical History Other Findings
CT scan and MRI EKG Chest X-ray Tachypnea Tachycardia Fever Chest Pain Hemoptysis Dyspnea on Exertion Wheezing Chest Tenderness Nasalopharyngeal Ulceration Carotid Bruit
COVID-19
  • Chest CT findings include:
    • Bilateral ground-glass opacities
    • Crazy paving sign
    • Air space consolidation
    • Traction bronchiectasis
    • Vascular enlargement of the lesion
 -
  • Consolidation
  • Peripheral ground glass opacity
 ✔ ✔ ✔ ✔/- ✔ ✔ - ✔/- - -
  • Possible exposure to infected animals or persons
Influenza
  • Unilateral/bilateral ground glass opacities on chest CT
  • T wave flattening in the aVF and T wave inversion in lead III
  • ST-segment elevation in leads V1-V3 and ST-segment depression in the inferolateral lead distribution
  • Consolidation
 ✔/- ✔/- ✔ ✔/- - - - - ✔/- -
  • No history of flu vaccine
  • Exposure to individuals with same signs and symptoms
Pulmonary embolism
  • On CT angiography:
    • Intra-luminal filling defect
  • On MRI:
    • Narrowing of involved vessel
    • No contrast seen distal to obstruction
    • Polo-mint sign (partial filling defect surrounded by contrast)
 ✔ ✔ ✔ (Low grade) ✔ ✔ (In case of massive PE) ✔ - - - -
Congestive heart failure
  • Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
    • SV1 or SV2 + RV5 or RV6 ≥3.5 mV
    • Total QRS amplitude in each of the limb leads ≤0.8 mV
    • R/S ratio <1 in lead V4
 ✔ ✔ ✔ - - ✔ - - - -
Percarditis
  • ST elevation
  • PR depression
  • Large collection of fluid inside the pericardial sac (pericardial effusion)
  • Calcification of pericardial sac
 ✔ ✔ ✔ (Low grade) ✔ (Relieved by sitting up and leaning forward) - ✔ - - - -
  • May be clinically classified into:
    • Acute (< 6 weeks)
    • Sub-acute (6 weeks - 6 months)
    • Chronic (> 6 months)
Pneumonia ✔ ✔ ✔ ✔ - ✔ ✔ - - -
Vasculitis

Homogeneous, circumferential vessel wall swelling

✔ ✔ ✔ ✔ ✔ ✔ - ✔ ✔ ✔
Chronic obstructive pulmonary disease (COPD)
  • On CT scan:
  • On MRI:
    • Increased diameter of pulmonary arteries
    • Peripheral pulmonary vasculature attentuation
    • Loss of retrosternal airspace due to right ventricular enlargement
    • Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
 ✔ ✔ - - - ✔ ✔ - - -


Differentiating SARS-CoV-2, MERS-CoV and SARS-CoV




Type of Coronavirus Origins Family (Lineage) Receptor Incubation Period Genome size Clinical Features Transmission Epidemiology Cytokine Profile Imaging Findings Serological Testing
Fever Dry cough Dyspnea Rhinorrhea Sneezing Sore throat Diarrhea
SARS-CoV-2
  • Huanan seafood market, Wuhan, Hubei China (December 2019)
  • Betacoronaviridea, subgenus: Sarbecovirus (Lineage B)
  • ACE1/2
  • 1-14 days
  • 29.8 kB (> 80% nucleotide identity with SARS-CoV)
 ++ ++ ++ + + + -
  • Human to human transmission through close contact
  • 14380 confirmed cases
  • 17 deaths
  • Males > females
  • Mortality rate 2.7%
  • IL1B, IFNγ, IP10, and MCP1
  • GCSF, IP10, MCP1, MIP1A, and TNFα (ICU-admitted)
  • IL4 and IL10
  • On CT scan:
    • Bilateral ground-glass opacities
    • Peripheral localization and subpleural sparing
MERS-CoV
  • Saudi Arabia (September 2012)
  • Betacoronaviridea (Lineage C)
  • DPP4 (CD26)
  • 2-14 days
  • 29.9 kB
 ++ ++ ++ ++ ++ ++ +
  • Limited human to human transmission
  • Reservoirs:
    • Bats
    • Civets
    • Camels
  • 2494 confirmed cases
  • 858 deaths
  • Mortality rate of 34%
  • IFNγ, TNFα, IL15, and IL17
  • On CT scan:
    • Bilateral, subpleural and basilar infiltrates
    • Ground glass opacities
    • Organizing pneumonia-like pattern (subpleural and peribroncho-vascular)
SARS-CoV
  • Guangdong, Southern China (November 2002)
  • Betacoronaviridea (Lineage B)
  • ACE2
  • 2-7 days
  • 29.3 kB
 ++ ++ ++ ++ ++ ++ +
  • Human to human transmission through close contact
  • Reservoirs:
    • Bats
    • Civets
    • Camels
  • 8098 cases
  • 774 deaths
  • Mortality rate of about 10%
  • IL1B, IL6, IL12, IFNγ, IP10, and MCP1
  • On CT scan:
    • Airspace consolidation
    • Focal or multi-focal opacities

References

  1. ↑ Brenes-Salazar JA (2014). "Westermark's and Palla's signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era". J Emerg Trauma Shock. 7 (1): 57–8. doi:10.4103/0974-2700.125645. PMC 3912657. PMID 24550636.
  2. ↑ "CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics".
  3. ↑ Bĕlohlávek J, Dytrych V, Linhart A (2013). "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism". Exp Clin Cardiol. 18 (2): 129–38. PMC 3718593. PMID 23940438.
  4. ↑ "Pulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health".
  5. ↑ Ramani GV, Uber PA, Mehra MR (2010). "Chronic heart failure: contemporary diagnosis and management". Mayo Clin. Proc. 85 (2): 180–95. doi:10.4065/mcp.2009.0494. PMC 2813829. PMID 20118395.
  6. ↑ Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL (2008). "Symptom distress and quality of life in patients with advanced congestive heart failure". J Pain Symptom Manage. 35 (6): 594–603. doi:10.1016/j.jpainsymman.2007.06.007. PMC 2662445. PMID 18215495.
  7. ↑ Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ (2009). "Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology". Eur. J. Heart Fail. 11 (2): 130–9. doi:10.1093/eurjhf/hfn013. PMC 2639415. PMID 19168510.
  8. ↑ Takasugi JE, Godwin JD (1998). "Radiology of chronic obstructive pulmonary disease". Radiol. Clin. North Am. 36 (1): 29–55. PMID 9465867.
  9. ↑ Wedzicha JA, Donaldson GC (2003). "Exacerbations of chronic obstructive pulmonary disease". Respir Care. 48 (12): 1204–13, discussion 1213–5. PMID 14651761.
  10. ↑ Nakawah MO, Hawkins C, Barbandi F (2013). "Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome". J Am Board Fam Med. 26 (4): 470–7. doi:10.3122/jabfm.2013.04.120256. PMID 23833163.
  11. ↑ Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK (2010). "Pericardial disease: diagnosis and management". Mayo Clin. Proc. 85 (6): 572–93. doi:10.4065/mcp.2010.0046. PMC 2878263. PMID 20511488.
  12. ↑ Bogaert J, Francone M (2013). "Pericardial disease: value of CT and MR imaging". Radiology. 267 (2): 340–56. doi:10.1148/radiol.13121059. PMID 23610095.
  13. ↑ Gharib AM, Stern EJ (2001). "Radiology of pneumonia". Med. Clin. North Am. 85 (6): 1461–91, x. PMID 11680112.
  14. ↑ Schmidt WA (2013). "Imaging in vasculitis". Best Pract Res Clin Rheumatol. 27 (1): 107–18. doi:10.1016/j.berh.2013.01.001. PMID 23507061.
  15. ↑ Suresh E (2006). "Diagnostic approach to patients with suspected vasculitis". Postgrad Med J. 82 (970): 483–8. doi:10.1136/pgmj.2005.042648. PMC 2585712. PMID 16891436.
  16. ↑ Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW (1975). "The electrocardiogram in acute pulmonary embolism". Prog Cardiovasc Dis. 17 (4): 247–57. PMID 123074.
  17. ↑ Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML (2013). "Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease". COPD. 10 (1): 62–71. doi:10.3109/15412555.2012.727918. PMID 23413894.
  18. ↑ Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H (2012). "Electrocardiogram in pneumonia". Am. J. Cardiol. 110 (12): 1836–40. doi:10.1016/j.amjcard.2012.08.019. PMID 23000104.
  19. ↑ Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA, Brunner-La Rocca HP, van Paassen P, Cohen Tervaert JW, Heymans S (2015). "Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis". Int. J. Cardiol. 199: 170–9. doi:10.1016/j.ijcard.2015.06.087. PMID 26209947.
  20. ↑ Dennert RM, van Paassen P, Schalla S, Kuznetsova T, Alzand BS, Staessen JA, Velthuis S, Crijns HJ, Tervaert JW, Heymans S (2010). "Cardiac involvement in Churg-Strauss syndrome". Arthritis Rheum. 62 (2): 627–34. doi:10.1002/art.27263. PMID 20112390.
  21. ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html. Missing or empty |title= (help)
  22. ↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
  23. ↑ Ison, M. G.; Campbell, V.; Rembold, C.; Dent, J.; Hayden, F. G. (2005). "Cardiac Findings during Uncomplicated Acute Influenza in Ambulatory Adults". Clinical Infectious Diseases. 40 (3): 415–422. doi:10.1086/427282. ISSN 1058-4838.
  24. ↑ Jeyanathan T, Overgaard C, McGeer A (April 2013). "Cardiac complications of influenza infection in 3 adults". CMAJ. 185 (7): 581–4. doi:10.1503/cmaj.110807. PMC 3626810. PMID 23549966.
  25. ↑ Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z (February 2020). "Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China". JAMA. doi:10.1001/jama.2020.1585. PMID 32031570 Check |pmid= value (help).
  26. ↑ Pan F, Ye T, Sun P, Gui S, Liang B, Li L, Zheng D, Wang J, Hesketh RL, Yang L, Zheng C (February 2020). "Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia". Radiology: 200370. doi:10.1148/radiol.2020200370. PMID 32053470 Check |pmid= value (help).
  27. ↑ Shi, Heshui; Han, Xiaoyu; Jiang, Nanchuan; Cao, Yukun; Alwalid, Osamah; Gu, Jin; Fan, Yanqing; Zheng, Chuansheng (2020). "Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study". The Lancet Infectious Diseases. doi:10.1016/S1473-3099(20)30086-4. ISSN 1473-3099.
  28. ↑ Lee, Elaine Y P; Ng, Ming-Yen; Khong, Pek-Lan (2020). "COVID-19 pneumonia: what has CT taught us?". The Lancet Infectious Diseases. doi:10.1016/S1473-3099(20)30134-1. ISSN 1473-3099.
  29. ↑ Chan, Jasper Fuk-Woo; Kok, Kin-Hang; Zhu, Zheng; Chu, Hin; To, Kelvin Kai-Wang; Yuan, Shuofeng; Yuen, Kwok-Yung (2020). "Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan". Emerging Microbes & Infections. 9 (1): 221–236. doi:10.1080/22221751.2020.1719902. ISSN 2222-1751.
  30. ↑ Lu, Roujian; Zhao, Xiang; Li, Juan; Niu, Peihua; Yang, Bo; Wu, Honglong; Wang, Wenling; Song, Hao; Huang, Baoying; Zhu, Na; Bi, Yuhai; Ma, Xuejun; Zhan, Faxian; Wang, Liang; Hu, Tao; Zhou, Hong; Hu, Zhenhong; Zhou, Weimin; Zhao, Li; Chen, Jing; Meng, Yao; Wang, Ji; Lin, Yang; Yuan, Jianying; Xie, Zhihao; Ma, Jinmin; Liu, William J; Wang, Dayan; Xu, Wenbo; Holmes, Edward C; Gao, George F; Wu, Guizhen; Chen, Weijun; Shi, Weifeng; Tan, Wenjie (2020). "Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding". The Lancet. doi:10.1016/S0140-6736(20)30251-8. ISSN 0140-6736.
  31. ↑ Ajlan, Amr M.; Ahyad, Rayan A.; Jamjoom, Lamia Ghazi; Alharthy, Ahmed; Madani, Tariq A. (2014). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings". American Journal of Roentgenology. 203 (4): 782–787. doi:10.2214/AJR.14.13021. ISSN 0361-803X.
  32. ↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
  33. ↑ "Coronavirus | Home | CDC".
  34. ↑ Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA (August 2018). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics". Eur Rev Med Pharmacol Sci. 22 (15): 4956–4961. doi:10.26355/eurrev_201808_15635. PMID 30070331.
  35. ↑ Xia S, Liu Q, Wang Q, Sun Z, Su S, Du L, Ying T, Lu L, Jiang S (December 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) entry inhibitors targeting spike protein". Virus Res. 194: 200–10. doi:10.1016/j.virusres.2014.10.007. PMID 25451066.
  36. ↑ Hajjar SA, Memish ZA, McIntosh K (2013). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV): a perpetual challenge". Ann Saudi Med. 33 (5): 427–36. doi:10.5144/0256-4947.2013.427. PMC 6074883. PMID 24188935.
  37. ↑ Memish ZA, Assiri AM, Al-Tawfiq JA (December 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications". Int. J. Infect. Dis. 29: 307–8. doi:10.1016/j.ijid.2014.10.002. PMID 25448335.
  38. ↑ Satija N, Lal SK (April 2007). "The molecular biology of SARS coronavirus". Ann. N. Y. Acad. Sci. 1102: 26–38. doi:10.1196/annals.1408.002. PMID 17470909.
  39. ↑ Bolles M, Donaldson E, Baric R (December 2011). "SARS-CoV and emergent coronaviruses: viral determinants of interspecies transmission". Curr Opin Virol. 1 (6): 624–34. doi:10.1016/j.coviro.2011.10.012. PMC 3237677. PMID 22180768.
  40. ↑ Fehr AR, Perlman S (2015). "Coronaviruses: an overview of their replication and pathogenesis". Methods Mol. Biol. 1282: 1–23. doi:10.1007/978-1-4939-2438-7_1. PMC 4369385. PMID 25720466.
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