Clinical Presentation
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Ocular and atypical manifestations Ocular manifestations are also common (Meduri 2020). In a case series from China, 12/38 patients (32%, more common in severe cases) had ocular manifestations consistent with conjunctivitis, including conjunctival hyperemia, chemosis, epiphora, or increased secretions. Two patients had positive PCR results from conjunctival swabs (Wu 2020). The retina can also be affected, as has been shown using optical coherence tomography (OCT), a non-invasive imaging technique that is useful for demonstrating subclinical retinal changes. Twelve adult patients showed hyper-reflective lesions at the level of the ganglion cell and inner plexiform layers more prominently at the papillomacular bundle in both eyes. Since their initial report, the authors have extended their findings to more than 150 patients, demonstrating an absence of blood flow within the retinal lesions of “many” patients (Marinho 2020). However, in another study of 25 patients with severe or critical disease in a study from Brazil, only three (12%) manifested convincing retinal changes (micro-hemorrhages, flame-shaped hemorrhage and nerve fiber layer infarcts). These retinal changes were likely secondary to clinical intercurrences or co-morbidities (Lani-Louzada 2020). Other new and sometimes puzzling clinical presentations have emerged (and will emerge) in the current pandemic. There are case reports of non-specific symptoms, especially in the elderly population, underlining the need for extensive testing in the current pandemic (Nickel 2020).
Laboratory findings The most evident laboratory findings in the first large cohort study from China (Guan 2020) are shown in Table 2. On admission, lymphocytopenia was present in 83,2% of the patients, thrombocytopenia in 362%, and leukopenia in 33,7%. In most patients, C-reactive protein was elevated to moderate levels; less common were elevated levels of alanine aminotransferase and D-dimer. Most patients have normal procalcitonin on admission.
COVID Reference ENG 006.9
