Última revisión: 23 Feb 2023
Última actualización: 08 Dic 2022

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • fiebre
  • tos
  • disnea
  • sentido del olfato/gusto alterado

Otros factores de diagnóstico

  • fatiga
  • mialgia o artralgia
  • dolor de garganta
  • cefalea
  • rinorrea o congestión nasal
  • estornudos
  • expectoración
  • dolor de pecho/estrechez
  • malestar general
  • mareos
  • confusión o delirio
  • síntomas gastrointestinales
  • síntomas cutáneos
  • síntomas oculares
  • signos de neumonía o dificultad respiratoria aguda
  • hemoptisis
  • síntomas audio-vestibulares
  • lesiones de la mucosa oral

Factores de riesgo

  • contacto con el caso probable o confirmado
  • residir/trabajar en un lugar con alto riesgo de transmisión
  • edad avanzada
  • sexo masculino
  • grupo étnico
  • residencia en un centro de cuidados a largo plazo
  • presencia de comorbilidades
  • obesidad
  • enfermedad cardiovascular
  • diabetes
  • enfermedad respiratoria crónica
  • enfermedad renal crónica
  • hepatopatía crónica.
  • embarazo
  • tabaquismo
  • neoplasia maligna
  • enfermedad cerebrovascular
  • trastornos de salud mental
  • trasplante de órgano sólido o de células madre
  • discapacidades
  • demencia
  • inmunosupresión
  • Infección por VIH
  • inactividad física
  • trastornos de la hemoglobina
  • hipertensión
  • trastornos por consumo de sustancias
  • niños con ciertas afecciones subyacentes
  • deficiencia de vitamina D
  • uso de inhibidores de la bomba de protones
  • enfermedad autoinmune
  • enfermedad tiroidea
  • Enfermedad de Parkinson
  • gota
  • dislipidemia
  • cirugía
  • grupos sanguíneos A y B
  • Disbiosis intestinal
  • Factores ambientales

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • Reacción en cadena de la polimerasa de transcripción inversa en tiempo real (RT-PCR)
  • prueba rápida de antígenos
  • oximetría de pulso
  • GSA
  • hemograma completo (HC)
  • perfil metabólico completo (PMC)
  • pruebas de función tiroidea
  • nivel de glucemia
  • cribado de coagulación
  • biomarcadores cardíacos
  • proteína C-reactiva sérica
  • velocidad de sedimentación globular en suero
  • lactato deshidrogenasa en suero
  • nivel de interleucina (IL) en suero
  • procalcitonina sérica
  • nivel de ferritina en suero
  • amiloide sérico nivel A
  • creatina-cinasa y mioglobina en suero
  • cultivos de esputo y hemocultivos
  • radiografía de tórax

Pruebas diagnósticas que deben considerarse

  • Tomografía computarizada (TC) de tórax
  • ultrasonido de pulmón
  • serología

Algoritmo de tratamiento

Colaboradores

Consejeros especializados

Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Divulgaciones

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Divulgaciones

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

Robert Fowler, MDCM, MS (Epi), FRCP(C)

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Divulgaciones

RF declares that he has no competing interests.

Revisores por pares

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Divulgaciones

WAP declares that he has no competing interests.

Xin Zhang, MD, PhD

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China

Divulgaciones

XZ declares that he has no competing interests.

Ran Nir-Paz, MD

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Divulgaciones

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

Editores

Adam Mitchell

Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice

Divulgaciones

AM declares that he has no competing interests.

Irene Chiwele

Lead Section Editor, BMJ Best Practice

Divulgaciones

IC declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

Divulgaciones

JC declares that she has no competing interests.

Consejeros especializados: comorbilidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Divulgaciones

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare, virtual conference in November 2020 for which he received no fee.

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Head of MBChB

School of Medicine

University of Leeds

Leeds

UK

Divulgaciones

AL has been the principal applicant/co-applicant for a number of grants including: Engineering and Physical Sciences Research Council Research - Multiplexed AKI biomarker detection with a single molecule biosensor; Leeds Cares - A novel, non-invasive diagnostic approach to assess kidney transplant health through the targeted measurement of biomarkers of kidney injury and immune response in kidney transplant recipients at the Leeds Teaching Hospitals NHS Trust; Kidney Research Yorkshire - Use of enhanced technology to characterise haemodialysis treatment for acute kidney injury (AKI); Bringing It Home - Validation of a micro-sampling technique for measuring tacrolimus and creatinine remotely; and to fund a research nurse; British Renal Society - Renal function assessment with point of care creatinine in diverse populations (RAPID), and several NIHR grants including on a) Improving the quality of post-discharge care following AKI b) An investigation into the use of remote blood sample collection to reduce health inequalities in patients with mental health disorders c) A comparison of remote blood collection devices: a human factor use study d) Defining the characteristics for a novel automatic device to monitor urine output in catheterized patients e) Leeds Medtech and In-vitro Diagnostic Cooperative Grant Extension f) Surgical MedTech Co-operative for the 2019/20 proof-of-principle funding stream g) A pilot investigation into the use of beta-trace protein for residual renal function estimation in haemodialysis h) Application of functional MRI to improve assessment of chronic kidney disease (AFiRM study) i) SuperResPath-Renal: Quantitative super-resolution technology for a fast, decentralised clinical diagnosis of renal pathologies. AL is the co-author of a number of manuscripts including on extracorporeal treatments, AKI, kidney function testing prior to contrast-enhanced CT, plasma exchange and glucocorticoids in severe ANCA-associated vasculitis, COVID-19 rapid diagnostics, multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome, and on a summary of NICE guidance on CKD. AL is the author of several book chapters on nephrology and AKI. AL has received expenses for accommodation and travel for conferences at which he has given lectures, other than those delivered virtually. AL was a member of the AKI Scientific Program Committee for the ISN World Congress of Nephrology 2020-2021 and Chair of this same committee in 2021-2022.

Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

Divulgaciones

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, & Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

Divulgaciones

RAE has given lectures for non-promotional industry-led sessions on long COVID and provided consultancy for GSK, AstraZenica, Boehringer, and Chiesi, for individual payment and travel expenses totalling <£4000.

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Divulgaciones

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

Divulgaciones

SP declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

Divulgaciones

MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of an MRCP revision course.

Revisores por pares: comorbilidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Divulgaciones

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare, virtual conference in November 2020 for which he received no fee.

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

Divulgaciones

AA has received honorariums for giving lectures on behalf of Profile Pharma in 2021. AA is an expert committee member of the National Institute for Health and Care Excellence (NICE) quality standards committee on urinary tract infections in adults and Deputy chair of the British Geriatrics Society England Council and Ageing Specialty Research Lead CRN NWC. AA sits on advisory committees for the following research studies: VOICE2 (development and testing of communication skills training for hospital healthcare practitioners caring for people living with dementia), SWOP (social work in older people) and CFIN (cognitive frailty interdisciplinary network). AA has received research funding from the Liverpool CCG and Applied Research Collaborative. He is contributing to developing a heart failure pathway tool for the British Society for Heart Failure and has been invited to contribute to the European Union Geriatric Medicine conference (free conference registration) and British Society for Heart Failure conference (accommodation and travel expenses covered).

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