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Clinical and radiological differentiation of COVID-19 pneumonia from non-COVID-19 atypical pneumonia
1Department of Chest Diseases, Izmir Katip Celebi University Atatürk Research and Training Hospital, İzmir, Türkiye
2Department of Radiology, Izmir Katip Celebi University Atatürk Research and Training Hospital, İzmir, Türkiye
Eurasian Journal of Pulmonology 2022; 24(3): 153-160 DOI: 10.14744/ejp.2022.2008
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BACKGROUND AND AIM: Atypical pneumonia involves viral and some bacterial microorganisms in etiology. As Coronavirus 2019 (COVID-19) is newly identified, the differences between coronavirus and other microorganisms causing atypical pneumonia have not been fully expressed yet. We aimed to make a clinical comparison of cases with COVID-19 and atypical pneumonia.

METHODS: “Non-COVID-19 atypical pneumonia” (non-COVID) group included patients with both radiological and clinical confirmation of atypical pneumonia by radiologists and clinicians. Patients with a positive polymerase chain reaction test formed “COVID-19 pneumonia” (COVID) group. Demographics, radiological, laboratory, and clinical features were recorded retrospectively.

RESULTS: A total of 177 patients (46 non-COVID and 131 COVID) were included. The mean age of the COVID group was significantly lower (p=0.040). Ground-glass density and peripheral involvement were more common in thoracic computed tomography of patients with COVID-19 (p=0.017 and p=0.019). Fever and fatigue in COVID (p<0.001 and p=0.040) and shortness of breath and gastrointestinal complaints in non-COVID group were significantly higher as presenting symptoms (p<0.001 and p=0.031). In biochemical tests, impairment in liver function tests in COVID-19 (p<0.001), impairment in kidney function tests, increased C-reactive protein (CRP) and procalcitonin (PCT) in non-COVID-19 patients were more common (p=0.003, p=0.042, and p=0.023, respectively). Serum PCT, CRP, and lymphocyte levels were significantly lower in cases with COVID-19 (p<0.001, p=0.048, and p=0.016). There was no significant difference in the prognosis of both groups (p=0.556).

CONCLUSIONS: With COVID-19 pandemic, there has been an increase in atypical pneumonia cases in which viral strains play a role. Symptomatic, laboratory, and radiological differences between two groups detected in our study may help in differential diagnosis especially in winter when atypical pneumonia is more common.