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?:abstract
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OBJECTIVE To identify the differential diagnoses of severe COVID-19 and the distinguishing characteristics of critically ill COVID-19 patients in Reunion Island to help improve the triage and management of patients in this tropical setting. METHODS This retrospective observational study was conducted from 11 March to 4 May 2020 in the only intensive care unit (ICU) authorized to manage COVID-19 patients in Reunion Island, a French overseas department located in the Indian Ocean region. All patients with unknown COVID-19 status were tested by polymerase chain reaction (PCR) on ICU admission; those who tested negative were transferred to the COVID-19-free area of the ICU. RESULTS Over the study period, 99 patients were admitted to our ICU. A total of 33 patients were hospitalized in the COVID-19 isolation ward, of whom 11 were positive for COVID-19. The main differential diagnoses of severe COVID-19 were: community-acquired pneumonia, dengue, leptospirosis causing intra-alveolar hemorrhage, and cardiogenic pulmonary edema. The median age of COVID-19-positive patients was higher than that of COVID-19-negative patients (71 [58 - 74] vs. 54 [46 - 63.5] years, p=0.045). No distinguishing clinical, biological, or radiological characteristics were found between the two groups of patients. All COVID-19-positive patients had recently traveled or been in contact with a recent traveler. CONCLUSIONS In Reunion Island, dengue and leptospirosis are key differential diagnoses of severe COVID-19, and travel is the only distinguishing characteristic of COVID-19-positive patients. Our findings apply only to the particular context of Reunion Island at this time of the epidemic.
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