key: cord-0898325-nj5cs1s3
authors: Khatri, Prabin; Neupane, Aryan; Banjade, Ashish; Chhetri, Ashmita; Sharma, Dipesh; Chhetri, Pradip; Thapa, Pramila; Khadka, Nasatya; Karki, Saugat; Neupane, Srijana
title: Fever among COVID-19 Patients in a Tertiary Care Hospital of Western Nepal: A Descriptive Cross-sectional Study
date: 2021-10-31
journal: JNMA J Nepal Med Assoc
DOI: 10.31729/jnma.6422
sha: ccf718f8ef1a7e69f6994e93fbb68dc239944a2c
doc_id: 898325
cord_uid: nj5cs1s3

INTRODUCTION: COVID-19 has a wide spectrum of clinical presentation ranging from asymptomatic infection to acute respiratory distress syndrome and multi organ dysfunction. Data regarding this is scarce in our setting. This study aims to study the prevalence of fever in confirmed COVID-19 cases in a tertiary care hospital of western Nepal. METHODS: We conducted a descriptive cross-sectional study among patients admitted to COVID-19 wards and intensive care units of a tertiary care hospital. We enrolled patients from August 2020 to January 2021 and the study proposal was approved by the Institutional Review Committee (reference number: 069/20). Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and descriptive statistics. RESULTS: Among 206 cases of COVID-19, the most common symptom was fever 136 (66.1%) (95% Confidence Interval= 58.14.63-74.05). Sixty-seven (49.3%) of those with fever required intensive care units admission whereas 27 (19.9%) of patients with fever had mortality. Most common comorbidities in the patient having fever is Diabetes mellitus 41 (66.1%) followed by hypertension 20 (62.5%). CONCLUSIONS: Fever was the most common presenting complaint with high prevalence as compared to similar studies done in similar settings. We stress the importance of considering the presence of COVID-19 even in the absence of fever as many patients presented without fever.

transmission between human to human is due to close contact with the affected, mainly by inhalation of infected respiratory droplets. 1, 2 Nepal reported its first case of COVID-19 in January 2020. 3 COVID-19 has a wide spectrum of clinical presentations ranging from asymptomatic infection to acute respiratory distress syndrome (ARDS) and multiorgan dysfunction. Fever has been observed as the most common initial presenting complaint in COVID-19 along with cough, sore throat, myalgia, shortness of breath, headache, and loss of smell. Fever ranging from low to high-grade along with or without chills has been found in COVID-19 patients. 4 Different countries have reported variable clinical presentations and outcomes in patients with COVID-19. 5,6-12 So, we aimed to find out the prevalence of fever in COVID-19 cases in a tertiary care hospital of western Nepal.

We conducted a descriptive cross-sectional study in patients visiting outpatient departments or admitted to COVID-19 wards and intensive care units of Universal College of Medical Sciences (UCMS). Patients from August 2020 to January 2021 were enrolled after taking ethical approval from the Institutional Review Committee at UCMS (Ref No: 069/20). The patient aged more than 16 years with positive real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 and those who gave written consent were included in this study. Age more than 16yrs who did not give written consent were excluded from the study. Convenience sampling was done and the sample size was calculated as: Gastrointestinal symptoms in the form of diarrhea were reported by 13 (9.6%) and 3 (1.5%) out of 136 patients with fever (Table 2) . The frequency of co-morbidities in patient who had fever in COVID-19 (Table 3) . The characteristics of those requiring ICU and those not requiring ICU in relation to demographics, presenting complaints, and co-morbidities (Table 4) . Out of the total study population, 59.7% of the patients were <50 years of age and 40.3% were ≥ 50 years of age. This is comparable to a study done by Panthee, et al. which showed an age distribution of 49.4% and 50.6% respectively. 18 More than half (62.6 %) of the patients were male and 37.4% were female. Similar sex distribution was shown by a study conducted by Gupta, et al. 19 The reason for male predominance may be because of higher expression of ACE2 receptor in males than that in women. 20 Furthermore females have a reduced susceptibility to viral infections which could also be due to the protection from X chromosome and sex hormones. 21 Besides fever, shortness of breath (47.1%), cough (41.3%), and myalgia (34.4%) were the other common symptoms in our study. Bhandari, et al. reported cough (85.71%) to be the most common symptom followed by fever (78.57%), myalgia (64.28%), and dyspnea (28.57%) while Chen, et al. reported shortness of breath to be the 3rd most common presenting symptom (31%) behind fever (83%) and cough (82%). 5, 22 Shortness of breath was the second most common presenting symptom in our study. This may be because the majority of our sample size is from critical cases requiring ICU admission and fewer patients with milder symptoms seeking medical attention in this region due to fear of acquiring COVID-19 from hospitals. Myalgia during COVID-19

is thought to be due to the effect of proinflammatory cytokines on muscle tissue. TNF-α causes intensified breakdown of muscle proteins and Prostaglandin E 2 (PGE 2 ) can increase pain signaling. 23 Low i.e. 6.8% of the cases were without any symptoms. This is in contrast with the study reported by Mohan, et al. which showed 44.4% of cases showing no symptoms. 24 This study found that 47.1% of the total cases required admission in COVID-ICU. This is greater than the results shown by Gupta, et al. (16%) . 19 The reason behind this might be the fact that our study center was one of the only two COVID-19 dedicated tertiary centers and also a referral center in our region. This study cannot be generalized as it is a single centered study and being a tertiary referral center for COVID-19, most of the sample size was from severe form of cases, therefore creating a possibility of neglect of symptoms from milder forms. Not every symptom available in the literature could be included. Pre hospital use of antipyretics, which is a common practice in our community, may hamper studying the exact grade, duration, and pattern of fever. A larger sample and multicenter study are needed to address these issues.

Fever was the most common presenting complaint in our study with high prevalence as compared to similar studiesf done in similar settings. Nearly half of patients with fever required ICU admission. Fever is also common in those patients who had comorbidities. In such cases, other manifestations should be considered. Also we Free Full Text Articles are Available at www.jnma.com.np stress the importance of cosidering the presence of COVID-19 even in the absence of fever as many had no fever. We suggest giving emphasis on early diagnosis, identification of comorbid conditions, early isolation, and prompt treatment of all the COVID-19 cases to reduce transmission, morbidity, and mortality.

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