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Colegio de Medicos y Cirujanos República de Costa Rica

2020, Número 629

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Rev Med Cos Cen 2020; 86 (629)


SARS CoV-2, manifestaciones clínicas y consideraciones en el abordaje diagnóstico de COVID- 19

Madrigal-Rojas JP, Quesada-Loría M, García-Sánchez M, Solano-Chinchilla A

Idioma: Español
Referencias bibliográficas: 34
Paginas: 13-21
Archivo PDF: 178.67 Kb.


RESUMEN

El mundo se enfrenta actualmente a un nuevo patógeno para el ser humano, un bcoronavirus denominado SARS-CoV-2, de posible origen animal y que ha generado una pandemia, que tiene como precedente a otros coronavirus, el SARS y el MERS.Este virus se transmite a través de gotas y fomites, donde una persona contagiada puede infectar en promedio de 2 a 3 personas más. La patología generada se le ha denominado Covid-19 que se manifiesta con sintomatología muy variable. Es una enfermedad respiratoria con un espectro amplio de severidad, desde una infección respiratoria superior sin complicaciones hasta un distress respiratorio agudo. Los síntomas preponderantes serán: fiebre, tos, disgeusia, hiposmia, disnea y fatiga. Los hallazgos de laboratorio son variables en el tiempo, siendo útil el uso combinado y seriado de marcadores como la proteína C reactiva, eritrosedimentación, ferritina, interleukina 6, dímero D entre otras. Desde el punto de vista radiológico, los hallazgos de TAC son muy sugestivos, pero hay limitantes logísticas y riesgo de transmisión, por lo cual el ultrasonido de tórax se ha convertido en el estudio de elección. En cuanto el diagnóstico y tamizaje es fundamental combinar los datos epidemiológicos, clínicos, radiológicos y de laboratorio. La reacción en cadena de polimerasa en tiempo real (RTPCR) es la prueba mas utilizada para el diagnóstico. Se necesita identificar y aislar de manera precoz las personas diagnosticadas y sus contactos. En el escenario de una pandemia se debe sospechar de Covid-19 en pacientes con infección respiratoria aguda grave (IRAG), neumonía bilateral con linfopenia, síndromes febriles sin causa y con síntomas “no respiratorios” de Covid, personas con hipoxemia silente y casos de síndrome hemofagocítico. La definición de caso ha evolucionado en el tiempo y es dinámica, las manifestaciones son muy diversas y el diagnóstico es complicado; por lo cual queda claro que enfrentar esta patología ha sido un reto para todo el personal de salud.


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