Severely ill patients most often in the first week after the onset of dyspnea and/or hypoxemia, severe cases can rapidly progress to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis and coagulation dysfunction and multi-organ failure. Very few patients may also have central nervous system involvement and ischemic necrosis of limbs, etc. It is worth noting that patients with severe and critical diseases may have low to moderate fever during the course of the disease, or even no obvious fever. In addition to the above symptoms, multi-systemic manifestations may also occur: changes in the sense of smell, taste, some patients with the first symptom of smell, loss of taste or loss of smell, the World Health Organization (WHO) has listed the loss of smell or taste as a new symptom of the new coronavirus infection. Loss of smell is a potential screening symptom that can help detect suspected cases or guide quarantine protection Therefore, it is recommended that patients with new, sudden onset loss of smell be considered as potentially infected with novel coronavirus. Digestive SymptomsNew coronavirus infected patients may show a variety of digestive symptoms, even as the first symptom, which needs to attract the attention of medical workers, early recognition, and appropriate protection and disinfection work. New coronavirus pneumonia-related digestive system symptoms can be manifested as decreased appetite, nausea, vomiting, diarrhea, abdominal pain, liver enzyme abnormalities, etc. Severe patients may experience gastrointestinal bleeding. Diarrhea is the most common, and the number, duration and severity of diarrhea have been reported inconsistently, and it has been reported in the literature that diarrhea can be used as an independent risk factor for predicting severe disease. Ocular SymptomsPatients with neocoronavirus may have ocular symptoms, mainly conjunctivitis, with a prevalence of 0.8% to 31.6%.
The main ocular symptoms in neocoronavirus-infected patients are eye pain, itchiness, foreign body sensation, tearing, and excessive ocular discharge, which is mainly characterized by conjunctival congestion and conjunctival edema. Ocular symptoms may appear 1 to 7 days before fever or respiratory symptoms, or after fever and other symptoms. Neurologic symptoms Although patients with neocoronary pneumonia mainly present with respiratory symptoms, they may be accompanied by a variety of neurologic symptoms during the course of the disease, and some patients may even present with neurologic symptoms as the first symptom without typical respiratory symptoms. Patients with severe neocoronary pneumonia are more susceptible to ischemic stroke, which may further contribute to the poor prognosis of these patients, and some may die from stroke. The key to treatment is to prevent progression to severe disease in patients with mild disease.
Patients with neocoronaryngitis who present with acute ischemic stroke manifestations should be treated by experienced neurologists and infectious disease physicians*** who should be involved in the management of the disease, depending on the possible etiology. For patients with a combined hypercoagulable tendency (abnormally high D-dimer), it has been suggested that low molecular heparin anticoagulation should be given while weighing the risk of intracranial hemorrhage, but whether anticoagulation can reduce the risk of ischemic stroke needs to be further investigated. The electroencephalogram of some patients with neocoronaryngitis may show abnormal epileptiform discharges or slow-wave activity. When patients with neocoronaryngitis present with unexplained disturbances of consciousness, confusion or altered mental status, disturbances in arousal, and abnormal paroxysmal movements (myoclonus), the electroencephalogram may be used as part of the adjunctive diagnostic process to assist in clarifying the cause of the condition.
Guillain-Barre syndrome induced by novel coronavirus infection may manifest as acute inflammatory demyelinating polyneuropathy, acute motor axonal neuropathy, and Miller-Fisher syndrome characterized by acute oculomotor paralysis, gait ****jigger disorders, and diminished tendon reflexes. Skin manifestations in patients with neocoronary pneumonia are predominantly found on the trunk and extremities. Among the early cutaneous manifestations of neocoronary pneumonia, erythema and papules were the most common manifestations (36.4%), followed by papules (34.7%), and vascular lesions (15.3%) including petechiae, ecchymosis, purpura, frostbite appearance with Raynaud's phenomenon, cherry hemangiomas, and purplish-red papules on the limbs, and urticaria (9.7%).
In addition, it can also manifest as a chickenpox-like rash or even a scaly rash. The most prominent phenomenon in severe cases or advanced cases is "COVID toe", i.e., frostbite-like lesions, preferably on the extremities, the lesions are initially reddish maculopapular, similar to frostbite. 1 week or so, the color of the lesions gradually deepen to purple and flatten, which can be relieved on its own, and there is no Raynaud's phenomenon on the affected fingers (toes).
These lesions may be painful, sometimes itchy, sometimes asymptomatic, and may be the only symptom or late manifestation of novel coronavirus infection. Other manifestations have been reported as oral ulcers with gingivitis and blisters.