Atypical clinical presentation of COVID-19 infection in residents of a long-term care facility

Autor: Mylène Albrand, Stéphanie Miot, Jean Bousquet, Nadia Giacosa, Yves Rolland, Hubert Blain, Athanase Benetos
Přispěvatelé: Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Gérontopôle, Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse], Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Gériatrie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Berlin Institute of Health (BIH), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Humboldt-Universität zu Berlin, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Humboldt University Of Berlin, Herrada, Anthony
Rok vydání: 2020
Předmět:
Male
Pediatrics
Delayed Diagnosis
rRT-PCR
Testing for SARS-CoV-2
Disease
Polymerase Chain Reaction
Hypoxemia
MESH: Long-Term Care
MESH: Aged
80 and over
0302 clinical medicine
MESH: COVID-19
Medicine
Infection control
MESH: Skilled Nursing Facilities
030212 general & internal medicine
MESH: Aged
Aged
80 and over
[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology
[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology
Brief Report
MESH: Accidental Falls
3. Good health
MESH: Diarrhea
Diarrhea
COVID-19 Nucleic Acid Testing
Female
medicine.symptom
Presentation (obstetrics)
Long-term-care facility
MESH: Pandemics
medicine.medical_specialty
Health Personnel
Asymptomatic
MESH: COVID-19 Nucleic Acid Testing
03 medical and health sciences
Humans
MESH: SARS-CoV-2
Pandemics
Aged
Skilled Nursing Facilities
MESH: Humans
030214 geriatrics
SARS-CoV-2
business.industry
COVID-19
MESH: Polymerase Chain Reaction
Long-Term Care
MESH: Male
MESH: Delayed Diagnosis
Long-term care
MESH: Health Personnel
Delirium
Accidental Falls
business
MESH: Female
Zdroj: European Geriatric Medicine
European Geriatric Medicine, Elsevier, 2020, 11 (6), pp.1085-1088. ⟨10.1007/s41999-020-00352-9⟩
European Geriatric Medicine, 2020, 11 (6), pp.1085-1088. ⟨10.1007/s41999-020-00352-9⟩
ISSN: 1878-7657
1878-7649
Popis: Key summary points Aim To assess the magnitude of the infection in residents from—and staff working in—a long-term-care facility (LTCF) 7 days after the identification of one resident with confirmed COVID-19 infection and the clinical presentation of the infected residents. Findings Two weeks after the first case, 50.9% of residents and 27.5% of the workers were tested positive for SARS-CoV-2. Diarrhea, fall, delirium, and hypothermia can be initial symptoms of COVID-19 in LTCF residents. Message The rapid dissemination of a COVID-19 infection in a LTCF may be due to a delay in the diagnosis of the first case, whose presentation could be atypical in residents.
Purpose To assess the magnitude of the infection in residents from—and staff working in—a long-term-care facility (LTCF) 7 days after the identification of one resident with confirmed COVID-19 infection and to assess the clinical presentation of the infected residents. Methods All residents and staff members of a LTCF were tested for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction on nasopharyngeal swab. Residents were studied clinically 4 weeks after the first COVID diagnosis. Results Thirty-eight of the 79 residents (48.1%) tested positive for SARS-CoV-2. Respiratory symptoms were preceded by diarrhea (26.3%), a fall (18.4%), fluctuating temperature with hypothermia (34.2%) and delirium in one resident. Respiratory symptoms, including cough and oxygen desaturation, appeared after those initial symptoms or as the first sign in 36.8% and 52.2%, respectively. At any time of the disease, fever was observed in 65.8%. Twelve deaths occurred among the COVID-19 residents. Among the 41 residents negative for SARS-CoV-2, symptoms included cough (21.9%), diarrhea (7.3%), fever (21.9%), hypothermia (9.7%), and transient hypoxemia (9.8%). No deaths were observed in this group. 27.5% of the workers were also COVID-19 positive. Conclusion The rapid dissemination of the COVID-19 infection may be explained by the delay in the diagnosis of the first cases due to atypical presentation. Early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents earlier and test for SARS-CoV-2 symptomatic and asymptomatic staff and residents earlier to implement appropriate infection control practices.
Databáze: OpenAIRE
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