Differentials

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Travel history to mainland China (particularly Wuhan City or Hubei Province), or any other affected location, in the last 14 days. 

Signs and symptoms are similar to other coronavirus infections so may be difficult to differentiate. Travel history is key. 

The situation is evolving rapidly; see our COVID-19 topic for further information.

INVESTIGATIONS

Real-time reverse transcription polymerase chain reaction (RT-PCR): positive for SARS-CoV-2 RNA.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Patients have lower incidence of comorbidities compared with MERS.

Clinical features are similar; however, patients are less likely to present with haemoptysis (1% of patients with SARS) or dyspnoea (42% of patients with SARS).[8]

Usually less aggressive than MERS as reflected by the lower mortality rate.[113]

INVESTIGATIONS

RT-PCR: positive for SARS-CoV RNA.[96][114]

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Seasonal outbreak during winter.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

INVESTIGATIONS

RT-PCR: negative for MERS coronavirus (MERS-CoV) RNA.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Seasonal outbreak during winter.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

INVESTIGATIONS

RT-PCR: positive for influenza A or B viral RNA.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Close contact with infected birds (e.g., farmer or visitor to a live market in endemic areas) or living in an area where avian influenza is endemic.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

INVESTIGATIONS

RT-PCR: positive for H5N1 viral RNA.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Close contact with infected birds (e.g., farmer or visitor to a live market in endemic areas) or living in an area where avian influenza is endemic. Up until now, the epidemic has been geographically focused in China.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

INVESTIGATIONS

RT-PCR: positive for H7-specific viral RNA.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Common cause of lower respiratory tract infection in children <1 year of age.

Seasonal outbreak during winter.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

INVESTIGATIONS

RT-PCR: positive for RSV RNA.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

INVESTIGATIONS

Blood or sputum culture, or multiplex RT-PCR testing: positive for causative organism (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Moraxella catarrhalis).

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lack of travel history to or from the Middle East (or country where there is an ongoing outbreak) in the preceding 14 days.

No close contact with a symptomatic traveller from the Middle East or a suspected or confirmed case of MERS in the preceding 14 days.

Differentiating MERS from community-acquired respiratory tract infections is not possible from signs and symptoms.

Unlikely to cause serious illness in young, healthy patients.

INVESTIGATIONS

Nasopharyngeal virus culture or RT-PCR: positive for causative organism (e.g., parainfluenza viruses, adenoviruses, rhinoviruses, enteroviruses, human metapneumovirus) or viral RNA.

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