Introduction: COVID-19 is a viral, inflammatory disease with a rich semiological spectrum, making it a true systemic disease, hence the important role that internists can play in its management, especially in developing countries. We conducted a study to investigate the different extra-respiratory signs of COVID-19 in patients admitted to the Niamey General Reference Hospital (HGR). Methodology: This was a retrospective study during the first two waves of the epidemic in Niger. All patients diagnosed with COVID-19 by PCR and hospitalized at the General Reference Hospital (HGR) in Niamey were included. Extrapulmonary and paraclinical clinical signs were studied. Results: We recorded 205 patients hospitalized for COVID-19: 145 men (70.73%) and 60 women (29.27%). The mean age was 55.76 years [range: 12-103]. In total, 81 patients had at least one comorbidity (39.51%), of which the most frequent comorbidity was high blood pressure with 45 cases (21.95%), followed by diabetes (35 cases, 17.05%) and asthma (6 cases, 2.92%). The most frequent general sign was fever (n = 130; 63%), followed by asthenia (n = 73; 36%), and the extra respiratory functional signs were vomiting (7%), diarrhea (5%) and headache. For physical signs, neuropsychiatric disorders were the most frequent: 17 cases of consciousness disorder (8%), 11 cases of behavioral disorder (5%), 8 cases of temporospatial disorientation (4%), and 1 case of motor deficits. For cardiovascular signs, we found: 1 case of right heart failure secondary to pulmonary embolism and 1 case of sural venous thrombosis. In the biological assessment, the erythrocyte sedimentation rate (ESR) was elevated in 9 patients (82%), and the CRP elevated in 67 (74%), with 41 (45%) who had a CRP greater than or equal to 60 mg/L. There was hyperleukocytosis (especially neutrophilic), anemia, increased troponin levels, increase in AST, ALT and D-Dimer, creatinine and azotemia disturbances. Conclusion: The extra-respiratory semiology of COVID-19 is very rich, making it a systemic pathology requiring holistic management, hence the important role of the internist.
Al Mutair, A., Alhumaid, S., Alhuqbani, W.N., Zaidi, A.R.Z., Alkoraisi, S., Al-Subaie, M.F., et al. (2020) Clinical, Epidemiological, and Laboratory Characteristics of Mild-To-Moderate COVID-19 Patients in Saudi Arabia: An Observational Cohort Study. European Journal of Medical Research, 25, Article No. 61. https://doi.org/10.1186/s40001-020-00462-x
[3]
Ketfi, A., Touahri, R., Chabati, O., Chemali, S., Mahjoub, M., Gharnaout, M., et al. (2021) Severity Factors in Algerian Patients Hospitalized for COVID-19. La Tunisie Médicale, 99, 734-743.
[4]
Liu, Y., Yang, Y., Zhang, C., Huang, F., Wang, F., Yuan, J., et al. (2020) Clinical and Biochemical Indexes from 2019-Ncov Infected Patients Linked to Viral Loads and Lung Injury. Science China Life Sciences, 63, 364-374. https://doi.org/10.1007/s11427-020-1643-8
[5]
Tabata, S., Imai, K., Kawano, S., Ikeda, M., Kodama, T., Miyoshi, K., et al. (2020) Clinical Characteristics of COVID-19 in 104 People with SARS-CoV-2 Infection on the Diamond Princess Cruise Ship: A Retrospective Analysis. The Lancet Infectious Diseases, 20, 1043-1050. https://doi.org/10.1016/s1473-3099(20)30482-5
[6]
Zhang, J., Dong, X., Cao, Y., Yuan, Y., Yang, Y., Yan, Y., et al. (2020) Clinical Characteristics of 140 Patients Infected with SARS-CoV-2 in Wuhan, China. Allergy, 75, 1730-1741. https://doi.org/10.1111/all.14238
[7]
Hussain, A., Kaler, J., Tabrez, E., Tabrez, S. and Tabrez, S.S.M. (2020) Novel COVID-19: A Comprehensive Review of Transmission, Manifestation, and Pathogenesis. Cureus, 12, e8184. https://doi.org/10.7759/cureus.8184
[8]
Masi, P., Hékimian, G., Lejeune, M., Chommeloux, J., Desnos, C., Pineton De Chambrun, M., et al. (2020) Systemic Inflammatory Response Syndrome Is a Major Contributor to Covid-19-Associated Coagulopathy: Insights from a Prospective Single-Center Cohort Study. Circulation, 142, 611-614. https://doi.org/10.1161/circulationaha.120.048925
[9]
Dhama, K., Khan, S., Tiwari, R., Sircar, S., Bhat, S., Malik, Y.S., et al. (2020) Coronavirus Disease 2019—COVID-19. Clinical Microbiology Reviews, 33, e00028-20. https://doi.org/10.1128/cmr.00028-20
[10]
Ye, L., Yang, Z., Liu, J., Liao, L. and Wang, F. (2020) Digestive System Manifestations and Clinical Significance of Coronavirus Disease 2019: A Systematic Literature Review. Journal of Gastroenterology and Hepatology, 36, 1414-1422. https://doi.org/10.1111/jgh.15323
[11]
Moussa Ounteini, A., Brah, S., Moussa, S., Maman, D., Andia, A.K., Yerima, S., et al. (2023) SARS-CoV-2 Infection at the General Reference Hospital of Niamey. Journal of Functional Ventilation and Pulmonology, 43, 1-64.
[12]
(2025) Le coronavirus (COVID-19). https://fr.statista.com/etude/71081/le-coronavirus-covid-19/
[13]
Yuki, K., Fujiogi, M. and Koutsogiannaki, S. (2020) COVID-19 Pathophysiology: A Review. Clinical Immunology, 215, Article ID: 108427. https://doi.org/10.1016/j.clim.2020.108427
[14]
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., et al. (2020) Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: A Descriptive Study. The Lancet, 395, 507-513. https://doi.org/10.1016/s0140-6736(20)30211-7
[15]
Lian, J., Jin, X., Hao, S., Cai, H., Zhang, S., Zheng, L., et al. (2020) Analysis of Epidemiological and Clinical Features in Older Patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clinical Infectious Diseases, 71, 740-747. https://doi.org/10.1093/cid/ciaa242
[16]
Zheng, S., Fan, J., Yu, F., Feng, B., Lou, B., Zou, Q., et al. (2020) Viral Load Dynamics and Disease Severity in Patients Infected with SARS-CoV-2 in Zhejiang Province, China, January-March 2020: Retrospective Cohort Study. BMJ, 369, m1443. https://doi.org/10.1136/bmj.m1443
[17]
Mallet, J., Massini, C., Dubreucq, J., Padovani, R., Fond, G. and Guessoum, S.B. (2022) Santé mentale et Covid: Toutes et tous concernés. Une revue narrative. Annales Médico-psychologiques, revue psychiatrique, 180, 707-712. https://doi.org/10.1016/j.amp.2022.07.019
[18]
Robillard, R., Daros, A.R., Phillips, J.L., Porteous, M., Saad, M., Pennestri, M., et al. (2021) Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study: Nouveaux symptômes psychiatriques émergents et détérioration des troubles mentaux préexistants durant la pandémie de la COVID-19: Une étude canadienne multisite. The Canadian Journal of Psychiatry, 66, 815-826. https://doi.org/10.1177/0706743720986786
[19]
Haryalchi, K., Heidarzadeh, A., Abedinzade, M., Olangian-Tehrani, S. and Ghazanfar Tehran, S. (2021) The Importance of Happy Hypoxemia in Covid-19. Anesthesiology and Pain Medicine, 11, e111872. https://doi.org/10.5812/aapm.111872
[20]
Busana, M., Gasperetti, A., Giosa, L., Forleo, G.B., Schiavone, M., Mitacchione, G., et al. (2021) Prevalence and Outcome of Silent Hypoxemia in Covid-19. Minerva Anestesiologica, 87, 325-333. https://doi.org/10.23736/s0375-9393.21.15245-9
[21]
Dhont, S., Derom, E., Van Braeckel, E., Depuydt, P. and Lambrecht, B.N. (2020) The Pathophysiology of ‘Happy’ Hypoxemia in Covid-19. Respiratory Research, 21, Article No. 198. https://doi.org/10.1186/s12931-020-01462-5
[22]
Richardson, S., Hirsch, J.S., Narasimhan, M., Crawford, J.M., McGinn, T., Davidson, K.W., et al. (2020) Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA, 323, 2052-2059. https://doi.org/10.1001/jama.2020.6775
[23]
Lin, S., Kantor, R. and Clark, E. (2021) Coronavirus Disease 2019. Clinics in Geriatric Medicine, 37, 509-522. https://doi.org/10.1016/j.cger.2021.05.001
[24]
McCranor, B.J., Kim, M.J., Cruz, N.M., Xue, Q., Berger, A.E., Walston, J.D., et al. (2014) Interleukin-6 Directly Impairs the Erythroid Development of Human TF-1 Erythroleukemic Cells. Blood Cells, Molecules, and Diseases, 52, 126-133. https://doi.org/10.1016/j.bcmd.2013.09.004
[25]
Lazarian, G., Quinquenel, A., Bellal, M., Siavellis, J., Jacquy, C., Re, D., et al. (2020) Autoimmune Haemolytic Anaemia Associated with COVID‐19 Infection. British Journal of Haematology, 190, 29-31. https://doi.org/10.1111/bjh.16794
[26]
Angileri, F., Légaré, S., Marino Gammazza, A., Conway de Macario, E., Macario, A.J.L. and Cappello, F. (2020) Is Molecular Mimicry the Culprit in the Autoimmune Haemolytic Anaemia Affecting Patients with Covid-19? British Journal of Haematology, 190, e92-e93. https://doi.org/10.1111/bjh.16883
[27]
Taneri, P.E., Gómez-Ochoa, S.A., Llanaj, E., Raguindin, P.F., Rojas, L.Z., Roa-Díaz, Z.M., et al. (2020) Anemia and Iron Metabolism in COVID-19: A Systematic Review and Meta-Analysis. European Journal of Epidemiology, 35, 763-773. https://doi.org/10.1007/s10654-020-00678-5
[28]
Connors, J.M. and Levy, J.H. (2020) COVID-19 and Its Implications for Thrombosis and Anticoagulation. Blood, 135, 2033-2040. https://doi.org/10.1182/blood.2020006000
[29]
Berkman, S.A. and Tapson, V.F. (2021) COVID-19 and Its Implications for Thrombosis and Anticoagulation. Seminars in Respiratory and Critical Care Medicine, 42, 316-326. https://doi.org/10.1055/s-0041-1722992
[30]
García de Guadiana‐Romualdo, L., Morell‐García, D., Rodríguez‐Fraga, O., Morales‐Indiano, C., María Lourdes Padilla Jiménez, A., Gutiérrez Revilla, J.I., et al. (2021) Cardiac Troponin and COVID‐19 Severity: Results from BIOCOVID Study. European Journal of Clinical Investigation, 51, e13532. https://doi.org/10.1111/eci.13532
[31]
Oikonomou, E., Paraskevas, T. and Velissaris, D. (2022) Cardiac Biomarkers Alterations in Patients with SARS-CoV-2 Infection. Romanian Journal of Internal Medicine, 60, 6-13. https://doi.org/10.2478/rjim-2021-0037
[32]
Burtey, S. and Sallée, M. (2021) Les atteintes rénales de la COVID-19. Néphrologie & Thérapeutique, 17, 203-207. https://doi.org/10.1016/j.nephro.2021.06.002
