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).