ðɛɹ ɪz sˌʌm kənsˈɜːn ðæt ðiːz kˈeɪsᵻz wɪð ɐdˈɪʃənəl sˈɪmptəmz mˈeɪ ɹᵻflˈɛkt ɐn ˌæsɚtˈeɪnmənt bˈaɪəs ɹˈæðɚ ðɐn bˌiːɪŋ ɐ tɹˈuː ɹˌɛpɹᵻzˈɛntˈeɪʃən ʌvðə klˈɪnɪkəl spˈɛktɹəm ʌvðə dɪzˈiːz.
There is some concern that these cases with additional symptoms may reflect an ascertainment bias rather than being a true representation of the clinical spectrum of the disease.