https://doi.org/10.4081/ejtm.2022.10731
COVID-19 patients at referral to hospital during the first peak of disease: Common clinical findings including myalgia and fatigue
Submitted: 11 July 2022
Accepted: 3 August 2022
Published: 12 August 2022
Accepted: 3 August 2022
Abstract Views: 1066
PDF: 741
HTML: 9
HTML: 9
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The wide range of manifestations and clinical symptoms of COVID-19 has made it a unique disease. Investigating the epidemiology of different clinical manifestations of this disease in patients referred to medical centers is one of the most effective steps in adopting a suitable diagnostic and treatment approach. These findings also provide a basis for comparing the evolution of the virus and its clinical manifestations over time and at different peaks of the disease. Therefore, the present study was aimed at investigating common clinical findings at the time of referral in patients with COVID-19 in Afzalipour Hospital, Kerman, during the first peak of the disease. This descriptive-analytical cross-sectional study was performed on hospitalized patients diagnosed with COVID-19, between March 2020 and June 2020. The patients were included in the study by census method, and the research variables related to demographic indicators, disease course and clinical symptoms were extracted from the patients' medical records, and then subjected to statistical analysis. In this study, a total of 210 patients were examined, consisted mainly of male patients (59.5%). The mean age was found to be 53.95 ± 19.55 years. Also, 20.3% of patients needed admission in the intensive care unit. In addition, 1% of patients were infected in February 2020, 24% in March 2020, 47.4% in April 2020 and 27.4% in May 2020. The mean onset of symptoms until hospitalization was also found as 6.51 days. The most common clinical symptoms included shortness of breath (75.7%), dry cough (52.9%), fever (50.5%), myalgia (45.7%) and fatigue (41.9%). Fever at admission time was significantly more common in ages less than 50 years (p=0.034). Our study showed that the most common clinical symptoms were shortness of breath, dry cough, fever, myalgia and fatigue. No statistically significant difference was found in common symptoms between men and women. Among the common clinical symptoms, only fever at admission time was observed to be significantly higher in those under 50 years of age.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91-98.
DOI: https://doi.org/10.1016/j.jare.2020.03.005
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733.
DOI: https://doi.org/10.1056/NEJMoa2001017
Yan Y, Chang L, Wang L. Laboratory testing of SARS-CoV, MERS-CoV, and SARS-CoV-2 (2019-nCoV): Current status, challenges, and countermeasures. Rev Med Virol. 2020;30(3):e2106.
DOI: https://doi.org/10.1002/rmv.2106
Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130-137.
DOI: https://doi.org/10.1111/resp.13196
Alipoor SD, Jamaati H, Tabarsi P, Mortaz E. Immunopathogenesis of Pneumonia in COVID-19. Tanaffos. 2020;19(2):79-82.
Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, Wang Z, Li J, Li J, Feng C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-374.
DOI: https://doi.org/10.1007/s11427-020-1643-8
Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, Hu Y, Tao ZW, Tian JH, Pei YY, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-269.
DOI: https://doi.org/10.1038/s41586-020-2008-3
Wu CR, Yin WC, Jiang Y, Xu HE. Structure genomics of SARS-CoV-2 and its Omicron variant: drug design templates for COVID-19. Acta Pharmacol Sin. 2022:1-13.
DOI: https://doi.org/10.1038/s41401-021-00851-w
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-1207.
DOI: https://doi.org/10.1056/NEJMoa2001316
Ahmed W, Angel N, Edson J, Bibby K, Bivins A, O'Brien JW, Choi PM, Kitajima M, Simpson SL, Li J, et al. First confirmed detection of SARS-CoV-2 in untreated wastewater in Australia: A proof of concept for the wastewater surveillance of COVID-19 in the community. Sci Total Environ. 2020;728:138764.
DOI: https://doi.org/10.1016/j.scitotenv.2020.138764
Tiwari A, Phan N, Tandukar S, Ashoori R, Thakali O, Mousazadesh M, Dehghani MH, Sherchan SP. Persistence and occurrence of SARS-CoV-2 in water and wastewater environments: a review of the current literature. Environ Sci Pollut Res Int. 2021:1-11.
DOI: https://doi.org/10.1007/s11356-021-16919-3
Gu J, Han B, Wang J. COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission. Gastroenterology. 2020;158(6): 1518-1519.
DOI: https://doi.org/10.1053/j.gastro.2020.02.054
Peng L, Liu J, Xu W, Luo Q, Deng K, Lin B, Gao Z. 2019 Novel Coronavirus can be detected in urine, blood, anal swabs and oropharyngeal swabs samples. MedRxiv. 2020.
DOI: https://doi.org/10.1101/2020.02.21.20026179
Liu M, Wang T, Zhou Y, Zhao Y, Zhang Y, Li J. Potential Role of ACE2 in Coronavirus Disease 2019 (COVID-19) Prevention and Management. J Transl Int Med. 2020;8(1):9-19.
DOI: https://doi.org/10.2478/jtim-2020-0003
Xu J, Chu M, Zhong F, Tan X, Tang G, Mai J, Lai N, Guan C, Liang Y, Liao G. Digestive symptoms of COVID-19 and expression of ACE2 in digestive tract organs. Cell Death Discov. 2020;6:76.
DOI: https://doi.org/10.1038/s41420-020-00307-w
Hirano T, Murakami M. COVID-19: A New Virus, but a Familiar Receptor and Cytokine Release Syndrome. Immunity. 2020;52(5):731-733.
DOI: https://doi.org/10.1016/j.immuni.2020.04.003
Gaibani P, Viciani E, Bartoletti M, Lewis RE, Tonetti T, Lombardo D, Castagnetti A, Bovo F, Horna CS, Ranieri M, et al. The lower respiratory tract microbiome of critically ill patients with COVID-19. Sci Rep. 2021;11(1):10103.
DOI: https://doi.org/10.1038/s41598-021-89516-6
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
Larsen JR, Martin MR, Martin JD, Kuhn P, Hicks JB. Modeling the Onset of Symptoms of COVID-19. Front Public Health. 2020;8:473.
DOI: https://doi.org/10.3389/fpubh.2020.00473
Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020;70(9):311-322.
DOI: https://doi.org/10.33588/rn.7009.2020179
Wong SH, Lui RN, Sung JJ. Covid-19 and the digestive system. J Gastroenterol Hepatol. 2020;35(5):744-748.
DOI: https://doi.org/10.1111/jgh.15047
Huang Y, Pinto MD, Borelli JL, Mehrabadi MA, Abrihim H, Dutt N, Lambert N, Nurmi EL, Chakraborty R, Rahmani AM, et al. COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler: Looking for Clarity in the Haze of the Pandemic. medRxiv. 2021.
DOI: https://doi.org/10.1101/2021.03.03.21252086
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831-1833.e1833.
DOI: https://doi.org/10.1053/j.gastro.2020.02.055
Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, Zhang L, Lin R, Liu J, Ding Z, et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol. 2020;115(6):916-923.
DOI: https://doi.org/10.14309/ajg.0000000000000664
Marasco G, Lenti MV, Cremon C, Barbaro MR, Stanghellini V, Di Sabatino A, Barbara G. Implications of SARS-CoV-2 infection for neurogastroenterology. Neurogastroenterol Motil. 2021;33(3):e14104.
DOI: https://doi.org/10.1111/nmo.14104
Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-773.
DOI: https://doi.org/10.14309/ajg.0000000000000620
Gulen M, Satar S. Uncommon presentation of COVID-19: Gastrointestinal bleeding. Clin Res Hepatol Gastroenterol. 2020;44(4):e72-e76.
DOI: https://doi.org/10.1016/j.clinre.2020.05.001
Barrett LF, Lo KB, Stanek SR, Walter JW. Self-limited gastrointestinal bleeding in COVID-19. Clin Res Hepatol Gastroenterol. 2020;44(4):e77-e80.
DOI: https://doi.org/10.1016/j.clinre.2020.06.015
Sakr Y, Giovini M, Leone M, Pizzilli G, Kortgen A, Bauer M, Tonetti T, Duclos G, Zieleskiewicz L, Buschbeck S, et al. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Ann Intensive Care. 2020;10:124.
DOI: https://doi.org/10.1186/s13613-020-00741-0
Page EM, Ariëns RAS. Mechanisms of thrombosis and cardiovascular complications in COVID-19. Thromb Res. 2021;200:1-8.
DOI: https://doi.org/10.1016/j.thromres.2021.01.005
McFadyen JD, Stevens H, Peter K. The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications. Circ Res. 2020;127(4): 571-587.
DOI: https://doi.org/10.1161/CIRCRESAHA.120.317447
Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34(5):e212-e213.
DOI: https://doi.org/10.1111/jdv.16387
Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017-1032.
DOI: https://doi.org/10.1038/s41591-020-0968-3
Carfì A, Bernabei R, Landi F. Persistent Symptoms in Patients After Acute COVID-19. Jama. 2020;324(6):603-605.
DOI: https://doi.org/10.1001/jama.2020.12603
Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, Gibbs KW, Erickson HL, Steingrub JS, Smithline HA, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(30):993-998.
DOI: https://doi.org/10.15585/mmwr.mm6930e1
McElvaney OJ, McEvoy NL, McElvaney OF, Carroll TP, Murphy MP, Dunlea DM, O NC, Clarke J, O'Connor E, Hogan G, et al. Characterization of the Inflammatory Response to Severe COVID-19 Illness. Am J Respir Crit Care Med. 2020;202(6):812-821.
DOI: https://doi.org/10.1164/rccm.202005-1583OC
Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-e440.
DOI: https://doi.org/10.1016/S2352-3026(20)30145-9
Alsofayan YM, Althunayyan SM, Khan AA, Hakawi AM, Assiri AM. Clinical characteristics of COVID-19 in Saudi Arabia: A national retrospective study. J Infect Public Health. 2020;13(7):920-925.
DOI: https://doi.org/10.1016/j.jiph.2020.05.026
de Souza WM, Buss LF, Candido DDS, Carrera JP, Li S, Zarebski AE, Pereira RHM, Prete CA, Jr., de Souza-Santos AA, Parag KV, et al. Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil. Nat Hum Behav. 2020;4(8):856-865.
DOI: https://doi.org/10.1038/s41562-020-0928-4
Khoshnood RJ, Ommi D, Zali A, Ashrafi F, Vahidi M, Azhide A, Shirini D, Sanadgol G, Khave LJ, Nohesara S. Epidemiological characteristics, clinical features, and outcome of COVID-19 patients in northern Tehran, Iran; a cross-sectional study. Adv J Emerg Med. 2020;127(104378): 10.1016.
Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, Mirahmadizadeh A, Lotfi M, Shirazi Yeganeh B, Dorrani Nejad A, Hemmati A, Ebrahimi M, Moghadami M. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020;20(1):427.
DOI: https://doi.org/10.1186/s12879-020-05128-x
Scully EP, Haverfield J, Ursin RL, Tannenbaum C, Klein SL. Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol. 2020;20(7):442-447. doi: 10.1038/s41577-020-0348-8.
DOI: https://doi.org/10.1038/s41577-020-0348-8
Griesbeck M, Ziegler S, Laffont S, Smith N, Chauveau L, Tomezsko P, Sharei A, Kourjian G, Porichis F, Hart M, et al. Sex Differences in Plasmacytoid Dendritic Cell Levels of IRF5 Drive Higher IFN-α Production in Women. J Immunol. 2015;195(11):5327-5336.
DOI: https://doi.org/10.4049/jimmunol.1501684
Mauvais-Jarvis F. Aging, Male Sex, Obesity, and Metabolic Inflammation Create the Perfect Storm for COVID-19. Diabetes. 2020;69(9):1857-1863.
DOI: https://doi.org/10.2337/dbi19-0023
Peckham H, de Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, Rosser EC, Webb K, Deakin CT. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020;11(1):6317.
DOI: https://doi.org/10.1038/s41467-020-19741-6
Sobhani S, Aryan R, Kalantari E, Soltani S, Malek N, Pirzadeh P, Yarahmadi A, Aghaee A. Association between Clinical Characteristics and Laboratory Findings with Outcome of Hospitalized COVID-19 Patients: A Report from Northeast Iran. Interdiscip Perspect Infect Dis. 2021;2021:5552138.
DOI: https://doi.org/10.1101/2021.01.23.21250359
Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626-638.
DOI: https://doi.org/10.1038/nri.2016.90
Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, Satlin MJ, Campion TR, Jr., Nahid M, Ringel JB, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372-2374.
DOI: https://doi.org/10.1056/NEJMc2010419
Brandal LT, MacDonald E, Veneti L, Ravlo T, Lange H, Naseer U, Feruglio S, Bragstad K, Hungnes O, Ødeskaug LE, et al. Outbreak caused by the SARS-CoV-2 Omicron variant in Norway, November to December 2021. Euro Surveill. 2021;26(50).
DOI: https://doi.org/10.2807/1560-7917.ES.2021.26.50.2101147
da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, Farias de Oliveira T, Campos Alcântara R, Monteiro Arnozo G, Rodrigues da Silva Filho E, Galdino Dos Santos AG, Oliveira da Cunha EJ, Salgueiro de Aquino SH, et al. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr. 2021;133(7-8):377-382.
DOI: https://doi.org/10.1007/s00508-020-01760-4
Javanian M, Bayani M, Shokri M, Sadeghi-Haddad-Zavareh M, Babazadeh A, Yeganeh B, Mohseni S, Mehraeen R, Sepidarkish M, Bijani A, et al. Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study. Rom J Intern Med. 2020;58(3):161-167.
DOI: https://doi.org/10.2478/rjim-2020-0013
Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, Liu L, Shan H, Lei C-l, Hui DS. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020;382(18):1708-1720.
DOI: https://doi.org/10.1056/NEJMoa2002032
Troitskaya LA, Plotnikova IA, Avakyan GG, Erokhina VA, Badalyan OL, Muraveva AV, Zelentsova VL, Khodko OK, Safarova ST, Shirokova EI, Rusina EA, Sanina NP, Terentev KV, Rachin AP. Neuropsychological evaluation of cognitive disorders in children after COVID-19. Eur J Transl Myol. 2022 Jul 15. doi: 10.4081/ejtm.2022.10685. Epub ahead of print.
DOI: https://doi.org/10.4081/ejtm.2022.10685
López-Viñas L, Vega-Villar J, Rocío-Martín E, García-García P, De La Rosa Santiago E, Galván-Román JM, Wix-Ramos R. Diaphragm impairment in patients admitted for severe COVID-19. Eur J Transl Myol. 2022 Jun 21;32(2):10460.
DOI: https://doi.org/10.4081/ejtm.2022.10460
Moghimi M, Jozpanahi M, Khodadadi K, Saeed SP, Pirsaraie SVA, Jalili N. Red cell distribution width, a predictive factor in immunocompromised patients with COVID-19: A comparison retrospective study between cancer and kidney transplant patients. Eur J Transl Myol. 2022 Jun 20;32(2):10582.
DOI: https://doi.org/10.4081/ejtm.2022.10582
Kouhpayeh H. Clinical features predicting COVID-19 mortality risk. Eur J Transl Myol. 2022 Apr 12. Epub ahead of print
DOI: https://doi.org/10.4081/ejtm.2022.10268
Finsterer J, Scorza FA, Scorza CA, Fiorini AC. Consider differentials before diagnosing COVID-19 associated polyradiculitis. Eur J Transl Myol. 2022 Jan 5. Online ahead of print
DOI: https://doi.org/10.4081/ejtm.2022.10111
Azizmohammadi S, Azizmohammadi S, Dahmardeh S, Hossein Azargashb, Shokouh SJH, Mohajeri-Iravani M, Mobasher M, Soleiman-Meigooni S, Zabihi M. Analysis of 239 ordinary and severe cases of COVID-19: Clinical features and treatment. Eur J Transl Myol. 2021 Jul 1;31(3):9579.
DOI: https://doi.org/10.4081/ejtm.2021.9579
Gholami N, Amzajerdi VS, Mehdioghli R, Heris HK, Kazempour MJ. Isolated hyperbilirubinemia as the manifestation of acute liver failure in a patient with acute myelogenous leukemia and COVID-19 infection. Eur J Transl Myol. 2021 Jul 1;31(3):9817.
DOI: https://doi.org/10.4081/ejtm.2021.9817
Doro M, Ferreira Marques Y, Cantarinho de Lima HF, De Oliveira Caccalano W, De Oliveira Nessi AA, Chagas Caperuto É, De Oliveira Alonso D, Leite Portella D. Physical activity and medication in Brazilians suffering with non-communicable diseases in quarantine by COVID-19. Eur J Transl Myol. 2021 Apr 29;31(2).
DOI: https://doi.org/10.4081/ejtm.2021.9772
Carraro U, Albertin G, Martini A, Giuriati W, Guidolin D, Masiero S, Kern H, Hofer C, Marcante A, Ravara B. To contrast and reverse skeletal muscle weakness by Full-Body In-Bed Gym in chronic COVID-19 pandemic syndrome. Eur J Transl Myol. 2021 Mar 26;31(1):9641.
DOI: https://doi.org/10.4081/ejtm.2020.9641
Moro T, Paoli A. When COVID-19 affects muscle: effects of quarantine in older adults. Eur J Transl Myol. 2020 Jun 17;30(2):9069. eCollection 2020 Jul 13.
DOI: https://doi.org/10.4081/ejtm.2020.9069
Angelini C, Siciliano G. Neuromuscular diseases and Covid-19: Advices from scientific societies and early observations in Italy. Eur J Transl Myol. 2020 Jun 22;30(2):9032. eCollection 2020 Jul 13
DOI: https://doi.org/10.4081/ejtm.2020.9032
How to Cite
Honarmand, A., Sheybani, F., Aflatoonian, E., & Saberinia, A. (2022). COVID-19 patients at referral to hospital during the first peak of disease: Common clinical findings including myalgia and fatigue. European Journal of Translational Myology, 32(3). https://doi.org/10.4081/ejtm.2022.10731
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.