Musculoskeletal involvement of COVID-19: review of imaging

Ramani, Santhoshini Leela; Samet, Jonathan D.; Franz, Colin K.; Hsieh, Christine; Nguyen, Cuong; Horbinski, Craig; Deshmukh, Swati

doi:10.1007/s00256-021-03734-7

Cited by 115 publications

(145 citation statements)

References 50 publications

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“…While myalgia is a common clinical feature of COVID-19, other musculoskeletal symptoms during the pandemic have rarely been described as early complaints. However, there are recent reports of COVID-19 infection and a number of neuromuscular and rheumatological complications related to the course of the disease, including myositis, neuropathy, arthropathy, and soft tissue abnormalities (21). In our study, although myalgia was among the most common complaints of 56.8% in COVID-19 patients, no specific distinction was observed for the disease.…”

Section: Discussioncontrasting

confidence: 69%

Covid-19 Hastalarında Başvuru Şikayetleri

Şahin

Ocak²,

Demiral³

et al. 2021

Konuralp Tıp Dergisi

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The aim of this study is to profile the complaints in the disease application using a symptom survey in patients presenting with the suspicion of COVID-19 disease and to determine the disease-specific and descriptive characteristics of the initial symptoms in those who were diagnosed with the disease. Methods: In this cross-sectional study, symptoms at first admission were questioned in adult patients who applied to the Covid Outpatient Clinic between 21 December 2020 -22 January 2021. A total of 43 complaints were analyzed in PCR test positive and negative patients. Results: 273 (62.0%) first application and 167 (38.0%) control applications were included in the study. The PCR test was positive in 16.5% of the first admissions. The most common complaints in the first admissions with positive PCR test were fatigue (73.0%), headache (64.9%), pain (32.2%), cough (56.8%), sore throat (51.4%), loss of appetite (45.9%) while 15.9% of them were asymptomatic. Odd's rates of significant complaints for PCR positivity were calculated as 2.607 for fever, 2.724 for anorexia, 2.051 for cough, 2.594 for loss of smell, and 2.243 for loss of strength. Conclusions: COVID-19 is a disease that affects many organs and systems. Comparing the admission symptoms with the PCR test results will contribute to the recognition of the disease at the initial stage. Fever, anorexia, cough, loss of smell and loss of strength were found to be the distinguishing complaints of PCR positivity in our study.

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Section: Discussioncontrasting

confidence: 69%

Covid-19 Hastalarında Başvuru Şikayetleri

Şahin

Ocak²,

Demiral³

et al. 2021

Konuralp Tıp Dergisi

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“…Meaning In this study, SARS-CoV-2 was associated with an immune-mediated myopathy. [38] 153 (382) [8] 233 (376) [16] 210.5 (262) [14] 97 (103) [10] Last, median (IQR) [No. of patients with data] 164 (392) [38] 315 (273) [8] 171 (609) [16] 58 (206) [14] 175 (567) [10] Highest, median (IQR) [No.…”

Section: Key Pointsmentioning

confidence: 99%

“…[38] 153 (382) [8] 233 (376) [16] 210.5 (262) [14] 97 (103) [10] Last, median (IQR) [No. of patients with data] 164 (392) [38] 315 (273) [8] 171 (609) [16] 58 (206) [14] 175 (567) [10] Highest, median (IQR) [No. of patients with data] 600 (748) [38] 359 (583) [9] 694 (706) [16] 808 (1374) [14] 485 (885) [11] Creatine…”

Section: Key Pointsmentioning

confidence: 99%

Association Between SARS-CoV-2 Infection and Immune-Mediated Myopathy in Patients Who Have Died

et al. 2021

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IMPORTANCE Myalgia, increased levels of creatine kinase, and persistent muscle weakness have been reported in patients with COVID-19.OBJECTIVE To study skeletal muscle and myocardial inflammation in patients with COVID-19 who had died. DESIGN, SETTING, AND PARTICIPANTSThis case-control autopsy series was conducted in a university hospital as a multidisciplinary postmortem investigation. Patients with COVID-19 or other critical illnesses who had died between March 2020 and February 2021 and on whom an autopsy was performed were included. Individuals for whom informed consent to autopsy was available and the postmortem interval was less than 6 days were randomly selected. Individuals who were infected with SARS-CoV-2 per polymerase chain reaction test results and had clinical features suggestive of COVID-19 were compared with individuals with negative SARS-CoV-2 polymerase chain reaction test results and an absence of clinical features suggestive of COVID-19. MAIN OUTCOMES AND MEASURES Inflammation of skeletal muscle tissue was assessed by quantification of immune cell infiltrates, expression of major histocompatibility complex (MHC) class I and class II antigens on the sarcolemma, and a blinded evaluation on a visual analog scale ranging from absence of pathology to the most pronounced pathology. Inflammation of cardiac muscles was assessed by quantification of immune cell infiltrates. RESULTS Forty-three patients with COVID-19 (median [interquartile range] age, 72 [16] years; 31 men [72%]) and 11 patients with diseases other than COVID-19 (median [interquartile range] age, 71 [5] years; 7 men [64%]) were included. Skeletal muscle samples from the patients who died with COVID-19 showed a higher overall pathology score (mean [SD], 3.4 [1.8] vs 1.5 [1.0]; 95% CI, 0-3; P < .001) and a higher inflammation score (mean [SD], 3.5 [2.1] vs 1.0 [0.6]; 95% CI, 0-4; P < .001). Relevant expression of MHC class I antigens on the sarcolemma was present in 23 of 42 specimens from patients with COVID-19 (55%) and upregulation of MHC class II antigens in 7 of 42 specimens from patients with COVID-19 (17%), but neither were found in any of the controls. Increased numbers of natural killer cells (median [interquartile range], 8 [8] vs 3 [4] cells per 10 high-power fields; 95% CI, 1-10 cells per 10 high-power fields; P < .001) were found. Skeletal muscles showed more inflammatory features than cardiac muscles, and inflammation was most pronounced in patients with COVID-19 with chronic courses. In some muscle specimens, SARS-CoV-2 RNA was detected by reverse transcription-polymerase chain reaction, but no evidence for a direct viral infection of myofibers was found by immunohistochemistry and electron microscopy. CONCLUSIONS AND RELEVANCEIn this case-control study of patients who had died with and without COVID-19, most individuals with severe COVID-19 showed signs of myositis ranging from mild to severe. Inflammation of skeletal muscles was associated with the duration of illness and was more pronounced than cardiac inflammation. Det...

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“…Other less common variants include the Miller Fisher syndrome (characterized by opthalmoplegia, ataxia, areflexia), pure motor or pure sensory variants, bilateral facial palsies, the pharyngeal-cervical-brachial motor variant, and others[ 140 ]. MRI can reveal thickening of the affected nerve roots and avid contrast enhancement of the conus medullaris and cauda equina, with preferential enhancement of the ventral nerve roots[ 141 ]. The fact that viral RNA has not been identified on cerebrospinal fluid analysis in affected patients suggests that injury occurs via an immune-mediated mechanism, such as molecular mimicry or antibody precipitation, rather than by direct viral insult[ 142 ].…”

Section: Extrapulmonary Manifestationsmentioning

confidence: 99%

Imaging in the COVID-19 era: Lessons learned during a pandemic

Sidéris

Nikolakea²,

Karanikola³

et al. 2021

WJR

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The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.

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Musculoskeletal involvement of COVID-19: review of imaging

Cited by 115 publications

References 50 publications

Covid-19 Hastalarında Başvuru Şikayetleri

Covid-19 Hastalarında Başvuru Şikayetleri

Association Between SARS-CoV-2 Infection and Immune-Mediated Myopathy in Patients Who Have Died

Imaging in the COVID-19 era: Lessons learned during a pandemic

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