Clinical manifestation
COVID-19 is an acute respiratory disease. It is present in mild,
moderate, and severe forms which, affects all groups of people but it is
mostly seen in adults (10). Children usually are asymptomatic or
manifest mild gastrointestinal symptoms (3, 12). Adults are symptomatic
featuring 3 common symptoms of fever, dry cough, and myalgia. Other
symptoms including chills, shortness of breath, chest pain, malaise,
fatigue, headache, nasal congestion, rhinorrhea (3, 10, 17) and GI
symptoms such as nausea, abdominal pain and diarrhea (18) and dyspnea
which is a sign of disease progression (4), has been reported within
less than a week. During the second and third weeks of symptomatic
infection, signs of pneumonia have been discovered within 75% of
patients. On physical examination patients based on the severity of the
disease have various findings, ranging from normal findings to
respiratory distress, tachycardia, and fever. There has been no specific
diagnostic laboratory findings but among the tests, elevated levels of
Aspartate aminotransferase (AST), Alanine aminotransferase (ALT),
lactate dehydrogenase (LDH), C-reactive protein (CRP), and lactate (19,
20) have been found alongside a leukopenia consisting of neutropenia and
lymphopenia which is a criteria of poor prognosis (10, 15). Imaging
studies with computed tomography (CT) has been used as a complementary
diagnostic tool as well and findings are usually seen, 10 days after
onset of the symptoms (21). These studies revealed a range of findings
from no findings in a few cases to unilateral and bilateral pulmonary
engagement (22). Increased bilateral para hilar infiltration and
ill-defined irregular patchy consolidations with increased thickening of
reticular or interlobular septa were seen (3, 23). Bilateral peripheral
Grand glass opacities (24) may also be seen in CT images (25). In some
cases some uncommon findings such as small bilateral pleural effusions
and mediastinal lymphadenopathy was also detected (21).