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COVID 19 a great impersonator , masquerading as UTI

The current coronavirus disease 2019 (COVID-19) pandemic is a challenge for doctors in triaging patients in emergency rooms. The ER is divided into COVID and Non- COVID group for separating and treating them. We found a potentially dangerous overlap of classical urinary symptoms and COVID-19. After a patient was primarily triaged as an urosepsis case and then subsequently diagnosed with COVID-19, we focused on an increase in urinary frequency as a symptom of COVID-19. We have identified many patients as COVID 19 with symptoms of fever and increased urinary frequency in OPD. Increased Urinary frequency may be secondary to viral cystitis due to underlying COVID-19 disease. We propose
consideration of urinary frequency as an to-suspect symptom in patients to increase awareness during the current COVID-19 pandemic to prevent fatal implications of misinterpreting urological symptoms.

A case with suspected urinary sepsis was admitted to the emergency department of the hospital. The patient reported fever, shivering, flank pain, urgency, and increased urinary frequency as initial symptoms. The patient was admitted and treatment started for kidney infection. Initial urine analysis via urine sediment and urine culture demonstrated no signs of infection. The patient developed shortness of breath and decreased oxygen saturation next day. The patient had underlying co-morbidities like diabetes mellitus, hypertension and cardiac disease. The patient’s naso-pharyngeal swab RT-PCR turned positive and CT chest showed signs of COVID 19 infection. We henceforth suspect COVID 19 in all patients
presenting as urosepsis.

German researchers identified higher urinary frequency as an additional symptom of COVID 19 infection independent of acute renal injury or urinary tract infection in a small series of hospitalized patients. Since urinary frequency along with clinical signs such as fever and positive laboratory results for inflammatory markers may be misinterpreted as urosepsis, knowledge of this finding is important for understanding during the current COVID-19
pandemic. Further research is warranted to understand the molecular mechanisms leading to urinary frequency, potentially attributed to viral cystitis in COVID 19 infected patients, and to determine its prognostic value COVID-19 has a strong binding affinity to ACE2 receptors. Therefore, organs with high ACE2 receptor expression are at higher risk for COVID-19.Bladder urothelium is a high-risk group for viral invasion with a high ACE2 expression rate. Urinary symptoms may occur as a result of bladder mucosal damage. Patients with documented COVID-19 develop urinary frequency of ≥ 13 episodes/24 h and nocturia ≥ 4 episodes/night. We call this COVID-19 associate cystitis (CAC). It is therefore hypothesized that CAC is caused by increased inflammatory cytokines that are released into the urine and/or expressed in the bladder.

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