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Patient case: Coronavirus Infection

Discussion

A 42-year-old man presents to the emergency department with a five-day history of fever, fatigue, cough, and shortness of breath. He initially had mild flu-like symptoms, including a sore throat and muscle aches, but his condition worsened over the past two days, with increasing difficulty breathing. He has no significant medical history but works in a crowded office environment. He reports that a colleague recently tested positive for COVID-19.

On examination, his temperature is 38.2°C (100.8°F), respiratory rate is 24 breaths per minute, and oxygen saturation is 91% of room air. Auscultation of his lungs reveals bilateral crackles. A nasopharyngeal swab is sent for RT-PCR testing, which confirms infection with SARS-CoV-2. A chest X-ray shows patchy infiltrates consistent with viral pneumonia.

The patient is admitted for close monitoring and supportive care. He receives supplemental oxygen, antipyretics for fever, and intravenous fluids. Over the next week, his respiratory symptoms gradually improve, and he is discharged with instructions for home isolation and follow-up. He fully recovers within three weeks.

Questions
1. What is the most likely diagnosis in this patient?

a) Influenza

b) Bacterial pneumonia

c) COVID-19 (SARS-CoV-2 infection)

d) Tuberculosis

2. Which clinical feature suggests a more severe form of COVID-19?

a) Sore throat and mild fatigue

b) Cough with no shortness of breath

c) Oxygen saturation of 91% and respiratory distress

d) Fever resolving within 24 hours

3. What is the most appropriate initial management for this patient?

a) Broad-spectrum antibiotics

b) Supportive care with oxygen therapy and monitoring

c) Immediate mechanical ventilation

d) High-dose corticosteroids in all cases

4. How is COVID-19 most commonly transmitted?

a) Contaminated food and water

b) Respiratory droplets and close contact

c) Mosquito bites

d) Blood transfusion

Reveal answers

Answers

1. Answer: c) COVID-19 (SARS-CoV-2 infection)

The patient’s symptoms, recent exposure, and RT-PCR confirmation strongly suggest COVID-19. While influenza can present similarly, the worsening shortness of breath and chest X-ray findings are more consistent with COVID-19 pneumonia.

2. Answer: c) Oxygen saturation of 91% and respiratory distress

Low oxygen levels and difficulty breathing indicate moderate to severe COVID-19, which requires hospitalization and close monitoring. Mild cases typically present with only upper respiratory symptoms.

3. Answer: b) Supportive care with oxygen therapy and monitoring

Management of moderate COVID-19 focuses on oxygen supplementation, fever control, and monitoring for worsening respiratory failure. Mechanical ventilation is reserved for critically ill patients.

4. Answer: b) Respiratory droplets and close contact

COVID-19 spreads primarily through respiratory droplets from infected individuals, especially in crowded or poorly ventilated areas. Hand hygiene and mask use help prevent transmission.

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