The CoviD-19 saga: “CoviD Toes” and other atypical symptoms

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It has already been suggested that those infected with the virus may be asymptomatic or develop flu-like symptoms such as fever, cough, fatigue, and shortness of breath. Fever may not even develop, or develop much later. Less commonly, sneezing, runny nose or sore throat may be seen. Gastrointestinal symptoms such as nausea, vomiting and diarrhea have been observed in varying percentages.

For a recap on CoviD-19’s symptomatology read: The CoviD-19 Saga: Symptomatology and Virology. As the weeks progressed, new studies surface about the signs and symptoms of CoviD-19 and some can be considered atypical.

Atypical Symptoms: Loss of Taste and Smell

Traditional education in healthcare teach typical presentations of illnesses. But it is duly noted that there will always be a frequent occurrence of atypical presentations – “atypical” because they lack the usual signs and symptoms characterizing a particular condition or diagnosis. In older adults, “atypical” presentations are actually quite common. For example, a change in behavior or functional ability is often the only sign of a new, potentially serious illness. Failure to recognize atypical presentations may lead to worse outcomes, missed diagnoses, and missed opportunities for treatment of common conditions.

In this article we will talk about the reported atypical symptoms of CoviD-19, while it’s early to consider some to be definitive diagnostic criteria, it’s imperative that they are known as they could very much save lives. One atypical symptom, according to a new study published on 12 April in the International Forum of Allergy and Rhinology has found that smell and taste loss appear to be common initial symptoms in patients with mild infections. The study suggests that it should be considered upon screening. Most will recover chemosensory function within weeks paralleling resolution of other disease‐related symptoms.

Pink Eye (Conjunctivitis), Skin rashes and CoviD Toes

The new coronavirus can also lead to “pink eye.” Ophthalmologists have said pink eye may be a rare sign of CoviD-19, What’s more, reports from China suggested that the eyes could be a source of infection for the coronavirus where the virus can replicate. But it’s still unclear how infectious these coronavirus eye samples are.

There was another case in Italy, in which a CoviD-19 patient had detectable levels of infectious viral particles in her eyes, long after the infection had cleared from her nose, healthcare professionals continued to take eye swabs daily. Though the woman’s pink eye cleared on the 20th day she was at the hospital, they found the virus lingered up to the 21st day. For the next couple of days, the virus was undetectable in both the nose and the eyes. But on day 27, they detected the virus once more in her eyes.

It is now speculated that SARS‐CoV‐2 may be detected in the tears and secretions in patients with conjunctivitis – The possibility of eye infection and the ocular route as a potential infection source should be considered and further examined, and protection should be carried out. These findings highlight one of the preventive measures stated in fighting against the spread of CoviD-19, which is avoiding touching the face and eyes.

Besides anosmia (loss of smell) and pink eye, another condition possibly linked to the coronavirus has captured researchers’ attention. Dubbed “CoviD toes” by the dermatology community. It looks like “purple lesions” on feet or hands. But because “CoviD toes” may appear before or without other coronavirus symptoms, dermatologists believe it should be a criterion for testing. Another report published in the Journal of the American Academy of Dermatology found that one patient in Thailand with a confirmed case of COVID-19 developed a skin rash called petechiae, which are tiny, circular patches that aren’t raised. The patient was originally misdiagnosed with dengue fever, which commonly causes petechiae, only to later be diagnosed with CoviD-19.

While it’s very common for viral infections to cause rashes, it’s also a relatively common general symptom and it could simply be caused by a simple skin irritation. That is why we need to know every detail of a patient’s condition, or else we could suspect a case for another, and panic must be alleviated as much as possible.

Guillain Barre Syndrome

Physicians in China reported what they believe is the first case of CoviD-19 initially presenting as acute Guillain-Barré syndrome (GBS). GBS is typically a rare disorder in which your body’s immune system attacks your nerves. Weakness and tingling in your extremities are usually the first symptoms and it’s also rapid in onset.

The patient was a 61-year-old woman returning home from Wuhan during the pandemic. Based on the Lancet there is no conclusive evidence (yet) for the causal relationship of GBS and SARS-CoV-2. The patient developed respiratory symptoms 7 days after onset of GBM – therefore it is prudent to consider alternative explanations – like GBM of unknown causes and nosocomial SARS-CoV-2 infection developing separately in the patient.

There’s a gray area in this study that we should acknowledge. This single report suggests possibility of SARS CoV-2 causing GBM. This is also not conclusive as more data is needed. Yet this must heighten the vigilance of all our healthcare workers, even if they’re not in the infectious ward. Not to cause alarm but we should never downplay the possibility that CoviD-19 patients can not only be found in the Infectious ward but in Neuro and Pedia wards as well.

Malaise, Disorientation, Exhaustion

A case report on a Washington nursing home, nearly one-third of the residents tested positive for the coronavirus, but half had no symptoms, and a few patients had unusual symptoms like malaise, a general sense of discomfort, illness, or uneasiness. According to the CDC, severe confusion or an inability to wake up or be alert can be warning signs and people who experience those symptoms, especially with other critical signs like bluish lips, trouble breathing, or chest pain, should seek help immediately.

It’s true that a minority of cases do not develop noticeable symptoms at any point in time and these asymptomatic carriers tend not to get tested – unfortunately their role in transmission is not yet fully known, however, preliminary evidence suggest that they may contribute to the spread of the disease.

Sneezing is still debated on its link to the coronavirus, but it must be noted that sneezing alone is much more likely another malady, such as allergies or a cold, and not a cause of alarm. The pandemic’s effect led to quarantines and social distancing, and these can also cause added stress and anxiety. It’s good to note that psychological factors could result in similar symptoms, so it’s important not to panic if you feel tired or uneasy. If you have a family member, friend, colleague who feel some sort of unease in this dire times, lend them a hand, assure them that it’s going to be okay. Maybe they need someone to talk to, be present. Some things don’t need to be physical to be felt.

Sometimes the least we do, is the most help they will get. Continue to stay informed and stay safe.

REFERENCES:

Atypical Symptoms: Loss of Taste and Smell

Pink Eye (Conjunctivitis), Skin rashes and CoviD Toes

Guillain Barre Syndrome

Malaise, Disorientation, Exhaustion

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