COVID-19 Diagnostics

Imagine you are in the hospital. A patient comes to you and you suspect this patient has COVID-19. What should you do? In this article, I am going to explain the diagnostic tools used to diagnose COVID-19

If you haven't read the article on the pathophysiology of COVID-19, please go check it from the link below as this will help you understand many details here.

https://curiosnerd.blogspot.com/2020/04/updated-how-people-die-from-corona.html

1- Check vitals

If the patient is:
 hypotensive ---> it could be a septic shock (due to cytokines storm explained in the previous article)
hypertensive ---> doesn't signify anything but it is not good because hypertensive patients are at high risk to develop serious complication due to the infection

Look for tachycardia ---> sign of hypoxemia

Look for respiratory rate ---> if more than 20 ---> again it could be due to hypoxia

Check temperature ---> if high --> sign of inflammation --> probably due to COVID-19

2- Do a physical exam

 Auscultation 

Listen to any high breath sounds --> sign of pneumonia
Wheezing ---> bronchoconstriction
Crackles ---> alveolar edema that is causing alveoli to collapse --> pneumonia

3- Nasopharyngeal swab
Nasopharyngeal Swab Procedure - YouTube

4- Do reverse-transcriptase PCR (a tests that detect the presence of the viral genetic material in the swab) (GOLD STANDARD)

 Reverse transcription PCR: Principle, Procedure, Application ...


5- Serology 

In this test, we are looking for antibodies produced by the body against the virus (IgM) It is one of the most sensitive tests but it has a disadvantage. The problem is that it takes at least a week to create antibodies against the virus, so the patient may have acute symptoms but the patient hasn't yet synthesized antibodies against the virus. This is called the window period.
B-cell receptor - Wikiwand

6- Labs

 Viral infections usually lead to lymphocytosis.

 Due to direct damage on the kidney or as a result of the multi-organ failure explained in the last article ---> you may find signs of kidney failure ---> increased urea and creatinine.

 You may find elevated liver enzymes (by the same mechanism as kidney) ---> increased ALT and AST

 As a result of the cytokine storm (explained in the previous article) ----> the patient may have DIC
 ---> elevated PT, PTT, D-Dimers, 
Decreased fibrinogen, thrombomodulin, protein C

7- Imaging

 Check for

Bilateral opacities
Chest X-ray: multiple bilateral opacities and reticular pattern in ...

Check for consolidation
Left lower lobe consolidation | Radiology Case | Radiopaedia.org

I hope that helped you!

Comments

  1. UnknownJune 7, 2020 at 2:31 AM

    A very fine explanation to a layman like me. But still it pains me
    that we are not able to find medicine.

    ReplyDelete
    Replies
    1. Youssef Refaat RaoofJune 7, 2020 at 2:53 AM

      Normally, it is very hard to treat viral infection. It is not that easy to find an anti-viral since the life cycle of a virus is more complex than bacteria. However, the best approach is vaccination which is approaching. By the end of 2020/beginning of 2021, a new vaccine will be available in the market. In the meantime, we should keep at home, and wait till something happens. Fingers crossed!

      Delete

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