Directing COVID-19 Testing in Patients with Pneumonia

Differentiation of patients with COVID-19 infection from those with bacterial pneumonia can be difficult. The guidance below is provided to assist in deciding if a patient warrants COVID-19 testing. Patients with syndromes highly consistent with bacterial infection are unlikely to need COVID-19 testing while those presenting with an “atypical pneumonia” with features concerning for COVID-19 should always be placed in appropriate isolation and tested. Patients where the need for testing is unclear can be discussed with Infection Control (888-4646).

Indication COVID-19 Bacterial Pneumonia

Symptoms Fever, Cough, Shortness of Breath, Fever, Cough, Shortness of Breath, Viral prodrome (headache, myalgias, Purulent sputum nausea/vomiting/diarrhea)1 Lab Abnormalities Normal WBC or Lymphopenia Leukocytosis, bandemia common (occcasionally leukocytosis)2 Mild hepatitis Exposure Travel to affected Areas None Close contact with Confirmed or suspected case of COVID-19 Imaging Multifocal ground glass opacities, Lobar Infiltrate often bilateral, “atypical pneumonia”3

Procalcitonin Usually low4 Elevated

Treatment Supportive Cares Antibiotic Therapy Airborne, contact/droplet Isolation Precautions as appropriate for etiology

1 Chen, Guang, Di Wu, Wei Guo, Yong Cao, Da Huang, Hongwu Wang, Tao Wang et al. "Clinical and immunologic features in severe and moderate forms of Coronavirus Disease 2019." medRxiv (2020). 2 Liu, Huanhuan, Fang Liu, Jinning Li, Tingting Zhang, Dengbin Wang, and Weishun Lan. "Clinical and CT Imaging Features of the COVID-19 Pneumonia: Focus on Pregnant Women and Children." Available at SSRN 3546094 (2020). 3 Zhao, W., Zhong, Z., Xie, X., Yu, Q., & Liu, J. (2020). Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. American Journal of Roentgenology, 1-6. 4 Xu, Kaijin, Hongliu Cai, Yihong Shen, Q. Ni, Y. Chen, S. Hu, J. Li et al. "Management of corona virus disease-19 (COVID-19): the Zhejiang experience." Zhejiang da xue xue bao. Yi xue ban= Journal of Zhejiang University. Medical sciences 49, no. 1 (2020): 0.