COVID-19, a Real Internal Medicine Pathology Due to Its Semiological Richness: Experience of the Niamey General Reference Hospital in Niger

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.