COVID-19: Pulmonary and Extra Pulmonary Manifestations

Abstract

Introduction: The coronavirus disease-2019 (COVID-19) pandemic has been the most significant event in 2020, with ~86.8 million cases and 1.88 million deaths worldwide. It is a highly infectious disease, wherein the virus (severe acute respiratory syndrome coronavirus 2) rapidly multiplies and spreads to all parts of the body. Therefore, COVID-19 is not only respiratory disease but also a multisystem disease. Many people, including physicians, incorrectly believe that the disease affects only the respiratory tract. In this study, we aimed to describe COVID-19 manifestations and the underlying pathophysiology to provide the readers with a better understanding of this disease to achieve good management and to control the spread of this disease.Methods: Secondary data were obtained from PubMed, Google Scholar, and Scopus databases. The keywords used for the search were as follows: COVID-19, COVID-19 pulmonary manifestations, COVID-19 extra pulmonary manifestations, and pathophysiology of COVID-19. We collected secondary data from systemic reviews, metaanalyses, case series, and case reports in the form of public data that was published on websites of the government, medical corporations, medical peer-reviewed journals, and medical academies, all of which were indexed in PubMed, Google Scholar, or Scopus. Our questions were as follows: Is COVID-19 a respiratory disease only? and What are the extrapulmonary manifestations of COVID-19?Results: From our data, we found that a patient with COVID-19 may be either asymptomatic or symptomatic. Symptomatic cases may have either pulmonary or extrapulmonary manifestations. Pulmonary manifestations occur as mild, moderate, or severe cases. In mild and moderate cases, extrapulmonary manifestations such as gastroenteritis, fever, or vomiting may present alone. Some of these cases may be missed for diagnosis, and the patient may receive symptomatic treatment without a COVID-19 diagnosis, leading to increased spread of the infection. Extrapulmonary manifestations may occur in severe and critical cases as complications of severe infections (high viral overload) or the cytokine storm, such as in acute kidney injury (AKI), heart failure (HF), and venous thromboembolic (VTE) manifestation.Conclusion: COVID-19 is not a respiratory disease alone; rather, it is a multisystem disease. Pulmonary and extrapulmonary manifestations should be considered for early diagnosis and to control the spread of the infection.

Post-acute sequelae of COVID-19: A metabolic perspective

“…In the lung, lipofibroblasts morph into myofibroblasts during the infection, which in turn are likely culprits in the dramatically enhanced profibrotic environment seen during viral exposure. In this context, the potent antifibrotic and anti-inflammatory factor adiponectin is reduced, while the proinflammatory adipokine leptin is enhanced ( Elrobaa and New, 2021 ). Many immune cells of the innate and adaptive immune system, including T cells, express leptin receptors, and may disproportionally respond to the viral challenge.…”

“…Leptin can also be reduced through the use of neutralizing antibodies, thereby curbing a disproportionate immune response. Both the PPARγ and the leptin pathway offer significant potential in the future, not only in the context of the acute viral response, but also in the context of the prolonged consequences associated with PASC ( Elrobaa and New, 2021 ; Tanowitz et al, 2017 ).…”

“…The source for the plasma viremia is still not fully defined and could reflect spillage from the pulmonary tissue into the vasculature, but there is evidence that SARS-CoV-2 can also directly infect endothelial cells ( Fajnzylber et al, 2020 ). Tissue studies have revealed evidence of endothelitis with perivascular inflammation and the extrapulmonary spread of SARS-CoV-2 to other organs ( Caccuri et al, 2021 ; Elrobaa and New, 2021 ). Some clues from a case study suggest that in at least a subset of patients, the extrapulmonary burden of SARS-CoV-2 may be attributed to a substantial fraction of the virus found in the body ( Li et al, 2021 ).…”

Progress and Challenges Toward Generation and Maintenance of Long-Lived Memory T Lymphocyte Responses During COVID-19

“…Activation of coagulation pathways as an immune response mechanism against SARS-CoV-2 infection is associated with the hyperactivation of proinflammatory cytokine production and multi organ failures ( 31 ). Importantly, some of the crucial cytokines such as CCL7, CXCL10, and IL-1 receptor antagonist are associated with the increased viral load, pulmonary dysfunction and damage, and mortality ( 32 , 33 ). Severe COVID-19 patients have been shown to exhibit higher levels of IL-2, IL-6, IL-10, IL-1, GSCF, MCP-1, TNF-α, and MIP1A ( 34 , 35 ).…”

SARS-CoV-2 triggered relapse of multiple sclerosis

“…SARS-CoV-2 infections not only affect the lungs but generally all organs including the central and peripheral nervous system (CNS, PNS) (neuro-COVID) [1] , [2] . The underlying pathophysiology for SARS-CoV-2 associated CNS disease is suspected to be immunogenic in the majority of the cases [3] .…”