Pulmonary and Extra-Pulmonary Clinical Manifestations of COVID-19

Abstract

The severe acute respiratory syndrome coronavirus−2 (SARS-CoV-2) has been recently identified as the culprit of the highly infectious, outbreak named coronavirus disease 2019 (COVID-19) in China. Now declared a public health emergency, this pandemic is present in more than 200 countries with over 14 million cases and 600,000 deaths as of July 18, 2020. Primarily transmitted through the respiratory tract, the most common clinical presentations of symptomatic individuals infected with SARS-CoV-2 include fever, dyspnea, cough, fatigue, and sore throat. In advanced cases, patients may rapidly develop respiratory failure with acute respiratory distress syndrome, and even progress to death. While it is known that COVID-19 manifests similarly to the 2003 Severe Acute Respiratory Syndrome (SARS) and the 2012 Middle East Respiratory Syndrome (MERS), primarily affecting the pulmonary system, the impact of the disease extends far beyond the respiratory system and affects other organs of the body. The literature regarding the extrapulmonary manifestations (cardiovascular, renal, hepatic, gastrointestinal, ocular, dermatologic, and neurological) of COVID-19 is scant. Herein, we provide a comprehensive review of the organ-specific clinical manifestations of COVID-19, to increase awareness about the various organs affected by SARS-CoV-2 and to provide a brief insight into the similarities and differences in the clinical manifestations of COVID-19 and the earlier SARS and MERS.

Hyperinflammation in Two Severe Acute Respiratory Syndrome Coronavirus 2-Infected Adolescents Successfully Treated With the Interleukin-1 Inhibitor Anakinra and Glucocorticoids

“…Notably, in the adult population, COVID-19 disease is mainly dominated by fever and pneumonia, with severe cases showing cytokine storm that leads to ARDS (2, 3), whereas in our pediatric patients, there was no lung involvement. Nevertheless, COVID-19 can also result in several extrapulmonary manifestations such as thrombotic complications and myocardial, kidney, gastrointestinal, hepatocellular, neurologic, cutaneous, and ocular injury (6,7).…”

“…Direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and dysregulation of immune responses might contribute to these extrapulmonary manifestations (6,7). Hyperinflammation in SARS-CoV-2infected pediatric patients has been described as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (8) or as Kawasaki-like disease (9) or as multisystem inflammatory syndrome in children (MIS-C) (10) but is still little known, and optimal management has to be defined.…”

Coronavirus Disease (COVID-19) Caused by (SARS-CoV-2) Infections: A Real Challenge for Human Gut Microbiota

“…Up to September 4, 2020, the top three countries with the highest number of infected cases are represented by the US, Brazil, and India (Shah et al, 2020). A comprehensive list of pulmonary and extrapulmonary manifestations of the COVID-19 has been reported (Aziz et al, 2020;Gandhi et al, 2020;Johnson et al, 2020;Perisetti et al, 2020c). The pulmonary symptoms included fever, cough, chest tightness, fatigue, shortness of breath, hypoxemia, anosmia, nasal congestion, inflammatory storms, and viral pneumonia.…”

Gastrointestinal Endoscopy in the Era of COVID-19

“…The Centers for Disease Control and Prevention (CDC) added multiple symptoms as a part of the COVID-19 presentation, which also includes gastrointestinal (GI) manifestations such as nausea, vomiting, dysgeusia, pancreatitis, hepatitis, colitis, etc. (6)(7)(8)(9)(10). Additionally, the virus has also been shown to be present in GI secretions.…”