2019 Coronavirus Disease Extra-pulmonary Signs: A Multisystem Illness
Keywords:
COVID-19, SARS-CoV-2, 2019-nCoVAbstract
Introduction
The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV- 2), has been recently declared a pandemic by the World Health Organization. Apart from acute respiratory manifestations, SARS-CoV-2 may also adversely affect other organ systems. To date, however, there is a very limited understanding of the manifestations and management of COVID-19 related conditions outside of the pulmonary system. This study provides an overview of the current literature about the extra pulmonary manifestations of COVID-19 that may affect the renal, cardiovascular, gastrointestinal, hematological, hematopoietic, neurological, or reproductive systems. This study also describes the current understanding of the extra pulmonary manifestations caused by COVID-19 to improve the management and prognosis of patients with COVID-19.
Materials and Methods
A total number of 200 hospitalized patients with COVID-19 disease were retrospectively evaluated for extra-pulmonary manifestations findings or complications. These patients had undergone various imaging studies, blood examinations during the course of hospital stay. The data reviewed using the institutional PACS, database system over a period of four months (August to November 2020).
Results
Among the 200 patients (males and females), 175 of them had extra-pulmonary complications. Various extra-pulmonary findings such as acute kidney injury, renal failure, cytokinase strome, acute myocardial injury, congestive cardiac failure, pulmonary thromboembolism, gastrointestinal, neurological complications were observed.
Inclusion and Exclusion Criteria
All retrospective clinical studies, case series, and case reports with data on extra-pulmonary manifestations in COVID-19 that were published from the end of December 2019 till the end of February 2021 were included. Studies that did not mention extra pulmonary manifestations were excluded.
Literature Search
The review was based on publications available on PubMed and data collected by the World Health Organization (WHO). Search terms used were ‘novel coronavirus 2019 (2019-nCoV)’, ‘SARS- CoV-2’, or ‘COVID-19’ combined with ‘asymptomatic’, ‘gastro intestinal’, ‘cardiac’, ‘neurological’, ‘hepatic’, ‘hematological’, ‘renal’, ‘psychiatric’, ‘hematological’, and ‘atypical’.
References
Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020; 91(1): 157-160. doi: 10.23750/abm.v91i1.9397
World Health Organizaion (WHO). Report of the WHO-China joint mission on corona virus disease 2019 (COVID-19). 2020. Web site. https://www.who.int/publications/i/item/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19). Accessed March 3, 2021.
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020; 20(5): 533- 534. doi: 10.1016/S1473-3099(20)30120-1
Guan WJ, Ni Z-y, Hu Y, Liang W, He J-x, Liu L, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382: 1708-1720. doi: 10.1056/NEJMoa2002032
Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of Covid-19 in New York City. N Engl J Med. 2020; 382: 2372-2374. doi: 10.1056/NEJMc2010419 Shi S,
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clini-cal features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497-506. doi: 10.1016/S0140- 6736(20)30183-5
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epide-miological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lan-cet. 2020; 395: 507-513. doi: 10.1016/S0140-6736(20)30211-7
Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibi-tors in patients with Covid-19. N Engl J Med. 2020; 382: 1653-1659. doi: 10.1056/NEJMsr2005760
Ye M, Wysocki J, William J, Soler MJ, Cokic I, Batlle D. Glomer-ular localization and expression of angiotensin-converting enzyme 2 and angiotensin-converting enzyme: implications for albuminuria in diabetes. J Am Soc Nephrol. 2006; 17: 3067-3075. doi: 10.1681/ ASN.2006050423
Kuba K, Imai Y, Ohto-Nakanishi T, Penninger JM. Trilogy of ACE2: A peptidase in the renin-angiotensin system, a SARS recep-tor, and a partner for amino acid transporters. Pharmacol Ther. 2010; 128: 119-128. doi: 10.1016/j.pharmthera.2010.06.003
Strawn WB, Ferrario CM, Tallant EA. Angiotensin-(1-7) reduc-es smooth muscle growth after vascular injury. Hypertension. 1999; 33: 207-211. doi: 10.1161/01.hyp.33.1.207
Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chonget M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. J Am Med Assoc. 2020; 323: 1612-1614. doi: 10.1001/jama.2020.4326
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region — case series. N Engl J Med. 2020; 382: 2012-2022. doi: 10.1056/NEJMoa2004500
Lippi G, Plebani M, Henry BM. Thrombocytopenia is associat-ed with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020; 506: 145- 148. doi: 10.1016/j. cca.2020.03.022
Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. ST-segment elevation in patients with Covid-19 — a case series. N Engl J Med. 2020; 382(25): 2478-2480. doi: 10.1056/ NEJMc2009020
Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of car-diac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020; 5(7): 802-810. doi: 10.1001/ jamacardio.2020.0950
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregula-tion of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020; 71(15): 762-768. doi: 10.1093/cid/ ciaa248
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020; 135: 2033-2040. doi: 10.1182/blood.2020006000
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation param-eters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18: 844-847. doi: 10.1111/jth.14768
Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous throm-boembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020; 18: 1421-1424. doi: 10.1111/jth.14830
Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gom-mers DAMPJ, Kant KM, et al. Incidence of thrombotic compli-cations in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191: 145-147. doi: 10.1016/j.thromres.2020.04.013
Robson SC, Shephard EG, Kirsch RE. Fibrin degradation product D-dimer induces the synthesis and release of biologi-cally active IL-1β, IL-6 and plasminogen activator inhibitors from monocytes in vitro. Br J Haematol. 1994; 86: 322-326. doi: 10.1111/ j.1365-2141.1994.tb04733.x
Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Ser-gentanis TN, Politou M, et al. Hematological findings and com-plications of COVID-19. Am J Hematol. 2020; 95: 834-847. doi: 10.1002/ajh.25829
Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan Submit your article to this journal | https://openventio.org/submit-manuscript/ Chawla AR et al GB, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020; 95(6): E131-E134. doi: 10.1002/ ajh.25774
Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kum-merlen C, et al. Neurologic features in severe SARS-CoV-2 in-fection. N Engl J Med. 2020; 382(23): 2268-2270. doi: 10.1056/ NEJMc2008597
Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020; 70: 124. doi: 10.1016/j.sleep.2020.04.019
Kawohl W, Nordt C. COVID-19, unemployment, and sui-cide. Lancet Psychiatry. 2020; 7: 389-390. doi: 10.1016/S2215- 0366(20)30141-3
Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatry. 2020; 52: 102066. doi: 10.1016/j.ajp.2020.102066
Gunnell D, Appleby L, Arensman E, Hawton K, John A, Ka-pur N, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. 2020; 7: 468-471. doi: 10.1016/S2215- 0366(20)30171-1
World Health Organization (WHO). Occupational safety and health in public health emergencies: A manual for protecting health workers and responders. Web sites. https://www.who.int/ publications/i/item/9789241514347. Accessed on 21 July 2020.
Wong SF, Chow KM, Leung TN. Pregnancy and perinatal out-comes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004; 191: 292-297. doi: 10.1016/j.ajog.2003.11.019
Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: Report of two cases and review of the literature. J Microbiol Immunol Infect. 2019; 52: 501-503. doi: 10.1016/j.jmii.2018.04.005
Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urti-carial eruption in COVID-19 infection. J Eur Acad Dermatol Vene-reol. 2020; 34(6): e244-e245. doi: 10.1111/jdv.16472
Estebanez A, Perez-Santiago L, Silva E, Guillen-Climent S, García-Vázquez A, Ramón MD. Cutaneous manifestations in CO-VID-19: A new contribution. J Eur Acad Dermatol Venereol. 2020 doi: 10.1111/jdv.16474
Marzano AV, Genovese G, Fabbrocini G, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol. 2020; 34(6): e250-e251. doi: 10.1016/j.jaad.2020.04.044
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