Of late, doctors are noticing changes in clinical presentation of COVID-19 patients and radiological findings in young patients that have led them to analyse the variations when compared to last year.
As COVID-19 cases continue to surge, health officials and doctors have been noting that a significant number of patients are now in the lower age group. They were reporting with variations in clinical presentation, early onset of complications and changes in lung findings.
E. Theranirajan, Dean, Rajiv Gandhi Government General Hospital, said clinical presentations remained the same in most patients. However, there were certain variations in radiological findings. “In some patients, the lung presentation included nodular patterns with bilateral involvement. We have seen CT scans with such variations as opposed to our earlier findings of ground glass opacities. We have taken samples for biopsy, and our teams are analysing such CT findings,” he said.
Patients were turning up with multiple symptoms, said K. Narayanasamy, Director of the Government Corona Hospital that has 480 patients at present. “Earlier, we mostly had people with fever, cough and body ache. Now, many are showing additional symptoms of vomiting, diarrhoea and abdominal pain,” he said.
The hospital saw several patients aged between 20 and 45 with breathlessness as many of them preferred home isolation and came in late as symptoms progressed. “We are analysing atypical features in CT scans,” he said.
At the Government Kilpauk Medical College Hospital, doctors found certain variations in presentation. “In cases of mild fever, there is aggravation of symptoms in three or four days. There are many persons with swab negative results but positive CT findings. There is sudden deterioration in the condition of patients. As far as CT findings are concerned, we do find some variations such as bilateral involvement, nodular appearances and involvement of the whole lungs as compared to earlier ground glass opacities, unilateral and peripheral involvement. We are studying such findings,” Dean P. Vasanthamani said.
Lung issues
R. Jayanthi, Dean, Government Medical College Hospital, Omandurar Estate, said they were seeing more patients aged 30 onwards than before. The hospital has 300 patients. She pointed out that many were clinically symptomatic. “Some patients with breathlessness easily move on to intense lung involvement. However, the percentage of lung involvement shown in a CT scan does not correlate in such cases. Such patients desaturate readily,” she said.
In some patients, there is radiologically minimal involvement of the lungs which is disproportionate to their symptoms. The variants may be among the reasons. “Mutations can cause properties to change,” she said.
More symptoms
K. R. Vijay Chakkaravarthy, head of department, Critical Care Unit, Kumaran Hospitals and Appasamy Hospitals, said, “Last year, many patients came in with fever and sore throat, while some had loose stools and abdominal pain. Now, the proportion of people with loose stools and abdominal pain is a little more compared to last year. They mistake it for common diarrhoea. So, someone having these symptoms should suspect COVID-19. I have come across patients in whom the first manifestation of COVID-19 was a heart attack or stroke.”
Earlier, hypoxia and breathlessness occurred during the second week from the onset of symptoms but now patients were developing these complications in three to five days.
“We find some variations radiologically too. Though there are several patients with ground glass opacities, there is an increase in the number of patients in whom CT scan found nodular changes. This was rare last year. This is important considering treatment response. They might need prolonged oxygen support,” Dr. Chakkaravarthy added.
