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Masood W, Ahmad S, Khan NA, Shakir A, Rokni GR, Gold MH, Cockerell CJ, Schwartz RA, Goldust M. Pathobiology of Cutaneous Manifestations Associated with COVID-19 and Their Management. Viruses 2022; 14:1972. [PMID: 36146777 PMCID: PMC9500986 DOI: 10.3390/v14091972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has been a rising concern since its declaration as a pandemic by the World Health Organization on 11 March 2020. Recently, its association with multiple underlying organs has been identified that includes cardiac, renal, gastrointestinal, nervous systems, and cutaneous manifestations. Cutaneous COVID-19 findings have been supposedly classified into the following categories: vesicular (varicella-like), papulo-vesiculsar, chilblains-like ("COVID toes") maculopapular, and urticarial morphologies. In this review, we aim to focus on the proposed pathophysiology behind the various dermatological manifestations associated with COVID-19 and their associated management. We also included prevalence and clinical features of the different COVID-19-related skin lesions in our review. A comprehensive narrative review of the literature was performed in PubMed databases. Data from case reports, observational studies, case series, and reviews till June 2022 were all screened and included in the review.
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Affiliation(s)
- Waniyah Masood
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi 75271, Pakistan
| | - Shahzaib Ahmad
- Department of Medicine, Mayo Hospital Lahore, King Edward Medical University Lahore, Lahore 54000, Pakistan
| | - Noor Ayman Khan
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi 75271, Pakistan
| | - Amaima Shakir
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi 75271, Pakistan
| | - Ghasem Rahmatpour Rokni
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 48175866, Iran
| | - Michael H. Gold
- Gold Skin Care Center, Nashville, TN 37215, USA
- Tennessee Clinical Research Center, Nashville, TN 37215, USA
| | - Clay J. Cockerell
- Departments of Dermatology and Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Cockerell Dermatopathology, Dallas, TX 75235, USA
| | | | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany
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2
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Carmona-Rivera C, Zhang Y, Dobbs K, Markowitz TE, Dalgard CL, Oler AJ, Claybaugh DR, Draper D, Truong M, Delmonte OM, Licciardi F, Ramenghi U, Crescenzio N, Imberti L, Sottini A, Quaresima V, Fiorini C, Discepolo V, Lo Vecchio A, Guarino A, Pierri L, Catzola A, Biondi A, Bonfanti P, Poli Harlowe MC, Espinosa Y, Astudillo C, Rey-Jurado E, Vial C, de la Cruz J, Gonzalez R, Pinera C, Mays JW, Ng A, Platt A, Drolet B, Moon J, Cowen EW, Kenney H, Weber SE, Castagnoli R, Magliocco M, Stack MA, Montealegre G, Barron K, Fink DL, Kuhns DB, Hewitt SM, Arkin LM, Chertow DS, Su HC, Notarangelo LD, Kaplan MJ. Multicenter analysis of neutrophil extracellular trap dysregulation in adult and pediatric COVID-19. JCI Insight 2022; 7:160332. [PMID: 35852866 PMCID: PMC9534551 DOI: 10.1172/jci.insight.160332] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Dysregulation in neutrophil extracellular trap (NET) formation and degradation may play a role in the pathogenesis and severity of COVID-19; however, its role in the pediatric manifestations of this disease, including multisystem inflammatory syndrome in children (MIS-C) and chilblain-like lesions (CLLs), otherwise known as “COVID toes,” remains unclear. Studying multinational cohorts, we found that, in CLLs, NETs were significantly increased in serum and skin. There was geographic variability in the prevalence of increased NETs in MIS-C, in association with disease severity. MIS-C and CLL serum samples displayed decreased NET degradation ability, in association with C1q and G-actin or anti-NET antibodies, respectively, but not with genetic variants of DNases. In adult COVID-19, persistent elevations in NETs after disease diagnosis were detected but did not occur in asymptomatic infection. COVID-19–affected adults displayed significant prevalence of impaired NET degradation, in association with anti-DNase1L3, G-actin, and specific disease manifestations, but not with genetic variants of DNases. NETs were detected in many organs of adult patients who died from COVID-19 complications. Infection with the Omicron variant was associated with decreased NET levels when compared with other SARS-CoV-2 strains. These data support a role for NETs in the pathogenesis and severity of COVID-19 in pediatric and adult patients.
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Affiliation(s)
- Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID); and
| | | | | | - Clifton L. Dalgard
- Department of Anatomy, Physiology & Genetics, School of Medicine, and the American Genome Center, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Andrew J. Oler
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, Maryland, USA
| | - Dillon R. Claybaugh
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | | | | | | | | | - Ugo Ramenghi
- Department of Public Health and Pediatric Sciences and
| | - Nicoletta Crescenzio
- Pediatric Hematology, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Luisa Imberti
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Sottini
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Virginia Quaresima
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Fiorini
- Centro di Ricerca Emato-oncologica AIL, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Discepolo
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Biondi
- Department of Pediatrics, University of Milano-Bicocca, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, San Gerardo Hospital–University of Milano-Bicocca, Monza, Italy
| | - Maria C. Poli Harlowe
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Roberto del Rio, Santiago, Chile
| | | | | | - Emma Rey-Jurado
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cecilia Vial
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | - Javiera de la Cruz
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ricardo Gonzalez
- Pediatric Intensive Care Unit, Hospital Exequiel Gonzalez Cortés, Santiago, Chile
| | - Cecilia Pinera
- Infectious Diseases Unit, Hospital Dr. Exequiel González Cortés, Región Metropolitana, Chile
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Jacqueline W. Mays
- National Institute of Dental and Craniofacial Research (NIDCR), NIH, Bethesda, Maryland, USA
| | - Ashley Ng
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew Platt
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, Maryland, USA
| | | | | | - Beth Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - John Moon
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | | | | | - Mary Magliocco
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID; and
| | - Michael A. Stack
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID; and
| | - Gina Montealegre
- Division of Clinical Research, NIAID, NIH, Bethesda, Maryland, USA
| | - Karyl Barron
- Division of Clinical Research, NIAID, NIH, Bethesda, Maryland, USA
| | - Danielle L. Fink
- Applied/Developmental Research Directorate, Frederick and National Laboratory for Cancer Research, National Cancer Institute (NCI), NIH, Frederick, Maryland, USA
| | - Douglas B. Kuhns
- Applied/Developmental Research Directorate, Frederick and National Laboratory for Cancer Research, National Cancer Institute (NCI), NIH, Frederick, Maryland, USA
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Daniel S. Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, Maryland, USA
| | - Helen C. Su
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID); and
| | | | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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3
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Yin H, Lu L. Chilblain-like acral lesions. Eur J Intern Med 2022; 100:119-120. [PMID: 35331594 DOI: 10.1016/j.ejim.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Hanlin Yin
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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4
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Carmona-Rivera C, Zhang Y, Dobbs K, Markowitz TE, Dalgard CL, Oler AJ, Claybaugh DR, Draper D, Truong M, Delmonte OM, Licciardi F, Ramenghi U, Crescenzio N, Imberti L, Sottini A, Quaresima V, Fiorini C, Discepolo V, Lo Vecchio A, Guarino A, Pierri L, Catzola A, Biondi A, Bonfanti P, Poli Harlowe MC, Espinosa Y, Astudillo C, Rey-Jurado E, Vial C, de la Cruz J, Gonzalez R, Pinera C, Mays JW, Ng A, Platt A, Drolet B, Moon J, Cowen EW, Kenney H, Weber SE, Castagnoli R, Magliocco M, Stack MA, Montealegre G, Barron K, Hewitt SM, Arkin LM, Chertow DS, Su HC, Notarangelo LD, Kaplan MJ. Multicenter analysis of neutrophil extracellular trap dysregulation in adult and pediatric COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.24.22271475. [PMID: 35262093 PMCID: PMC8902885 DOI: 10.1101/2022.02.24.22271475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dysregulation in neutrophil extracellular trap (NET) formation and degradation may play a role in the pathogenesis and severity of COVID-19; however, its role in the pediatric manifestations of this disease including MIS-C and chilblain-like lesions (CLL), otherwise known as "COVID toes", remains unclear. Studying multinational cohorts, we found that, in CLL, NETs were significantly increased in serum and skin. There was geographic variability in the prevalence of increased NETs in MIS-C, in association with disease severity. MIS-C and CLL serum samples displayed decreased NET degradation ability, in association with C1q and G-actin or anti-NET antibodies, respectively, but not with genetic variants of DNases. In adult COVID-19, persistent elevations in NETs post-disease diagnosis were detected but did not occur in asymptomatic infection. COVID-19-affected adults displayed significant prevalence of impaired NET degradation, in association with anti-DNase1L3, G-actin, and specific disease manifestations, but not with genetic variants of DNases. NETs were detected in many organs of adult patients who died from COVID-19 complications. Infection with the Omicron variant was associated with decreased levels of NETs when compared to other SARS-CoV-2 strains. These data support a role for NETs in the pathogenesis and severity of COVID-19 in pediatric and adult patients. Summary NET formation and degradation are dysregulated in pediatric and symptomatic adult patients with various complications of COVID-19, in association with disease severity. NET degradation impairments are multifactorial and associated with natural inhibitors of DNase 1, G-actin and anti-DNase1L3 and anti-NET antibodies. Infection with the Omicron variant is associated with decreased levels of NETs when compared to other SARS-CoV-2 strains.
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Affiliation(s)
- Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | | | - Tovah E. Markowitz
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, MD
- Axle Informatics, Bethesda, MD, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology & Genetics, School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD and The American Genome Center, USUHS, Bethesda, MD, USA
| | - Andrew J. Oler
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, MD
| | - Dillon R. Claybaugh
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | | | | | - Francesco Licciardi
- Department of Public Health and Pediatric Sciences, “Regina Margherita” Children’s Hospital, University of Turin, Turin, Italy
| | - Ugo Ramenghi
- Department of Public Health and Pediatric Sciences, “Regina Margherita” Children’s Hospital, University of Turin, Turin, Italy
| | - Nicoletta Crescenzio
- Pediatric Hematology, “Regina Margherita” Children Hospital, University of Turin, Turin, Italy
| | - Luisa Imberti
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Sottini
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Virginia Quaresima
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Fiorini
- Centro di Ricerca Emato-oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Valentina Discepolo
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Naples, Italy
| | - Andrea Biondi
- Department of Pediatrics, University of Milano-Bicocca, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, San Gerardo Hospital–University of Milano-Bicocca, Monza, Italy
| | - Maria Cecilia Poli Harlowe
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Roberto del Rio, Santiago, Chile
| | | | | | - Emma Rey-Jurado
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cecilia Vial
- Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina, Santiago, Chile
| | - Javiera de la Cruz
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ricardo Gonzalez
- Pediatric Intensive Care Unit, Hospital Exequiel Gonzalez Cortés, Santiago, Chile
| | - Cecilia Pinera
- Infectious Diseases Unit, Hospital Dr. Exequiel González Cortés, Región Metropolitana, Chile
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Jacqueline W. Mays
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA
| | - Ashley Ng
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew Platt
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | | | | | - Beth Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John Moon
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Edward W. Cowen
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD
| | | | | | | | | | | | | | - Karyl Barron
- Division of Clinical Research, NIAID, NIH, Bethesda, MD
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel S. Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, and Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Helen C. Su
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD, USA
| | | | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
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Jones OY, Yeralan S. Is Long COVID a State of Systemic Pericyte Disarray? J Clin Med 2022; 11:jcm11030572. [PMID: 35160024 PMCID: PMC8836446 DOI: 10.3390/jcm11030572] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 01/03/2023] Open
Abstract
The most challenging aspect of Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) or Long COVID remains for the discordance between the viral damage from acute infection in the recent past and susceptibility of Long COVID without clear evidence of post infectious inflammation or autoimmune reactions. In this communication we propose that disarray of pericytes plays a central role in emerge of Long COVID. We assume pericytes are agents with “Triple-A” qualities, i.e., analyze-adapt and advance, necessary for sustainability of host homeostasis. Based on this view, we further suggest Long COVID may provide a model system to integrate system theory and complex adaptive systems to explore a new class of maladies those are currently not well defined and with no remedies.
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Affiliation(s)
- Olcay Y. Jones
- Pediatric Rheumatology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Correspondence: (O.Y.J.); (S.Y.)
| | - Sencer Yeralan
- School of IT and Engineering, ADA University, Baku AZ1008, Azerbaijan
- Correspondence: (O.Y.J.); (S.Y.)
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Çakmak F, Demirbuga A, Demirkol D, Gümüş S, Torun SH, Kayaalp GK, Ömeroglu RE, Somer A, Uysalol M, Yıldız R, Ayaz NA. Nailfold capillaroscopy: A sensitive method for evaluating microvascular involvement in children with SARS-CoV-2 infection. Microvasc Res 2021; 138:104196. [PMID: 34097919 PMCID: PMC8190529 DOI: 10.1016/j.mvr.2021.104196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The hyperinflammatory state and the viral invasion may result in endothelial dysfunction in SARS-CoV-2 infection. Although a method foreseeing microvascular dysfunction has not been defined yet, studies conducted in patients diagnosed with COVID-19 have demonstrated the presence of endotheliitis. With this study, we aimed to investigate the microvascular circulation in patients diagnosed with COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by nailfold videocapillaroscopy (NVC). METHODS Thirty-one patients with SARS-CoV-2 infection, 25 of whom were diagnosed with COVID-19 and 6 with MIS-C and 58 healthy peers were included in the study. NVC was performed in eight fingers with 2 images per finger and 16 images were examined for the morphology of capillaries, presence of pericapillary edema, microhemorrhage, avascular area, and neoangiogenesis. Capillary length, capillary width, apical loop, arterial and venous width, and intercapillary distance were measured from three consecutive capillaries from the ring finger of the non-dominant hand. RESULTS COVID-19 patients showed significantly more capillary ramification (p < 0.001), capillary meandering (p = 0.04), microhemorrhage (p < 0.001), neoangiogenesis (p < 0.001), capillary tortuosity (p = 0.003). Capillary density (p = 0.002) and capillary length (p = 0.002) were significantly lower in the patient group while intercapillary distance (p = 0.01) was significantly longer compared with healthy volunteers. Morphologically, patients with MIS-C had a higher frequency of capillary ramification and neoangiogenesis compared with COVID-19 patients (p = 0.04). CONCLUSION Abnormal capillary alterations seen in COVID-19 and MIS-C patients indicate both similar and different aspects of these two spectra of SARS-CoV-2 infection and NVC appears to be a simple and non-invasive method for evaluation of microvascular involvement.
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Affiliation(s)
- Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Asuman Demirbuga
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Demet Demirkol
- Department of Pediatric Intensive Care Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Süheyla Gümüş
- Department of Pediatric Emergency Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gülşah Kavrul Kayaalp
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rukiye Eker Ömeroglu
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Metin Uysalol
- Department of Pediatric Emergency Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Raif Yıldız
- Department of Pediatric Emergency Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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7
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Sanghai N, Tranmer GK. COVID-toe - The Silent Symptom: Raising Awareness among Health Care Professionals and Community. Curr Mol Med 2021; 22:563-566. [PMID: 34645373 DOI: 10.2174/1566524021666211013121116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/10/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Nitesh Sanghai
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB R3E 0T5. Canada
| | - Geoffrey K Tranmer
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB R3E 0T5. Canada
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8
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Abstract
A multisystem inflammatory syndrome (MISC) can result from COVID-19 infection in previously healthy children and adolescents. It is potentially life threatening and is treated initially with intravenous immunoglobulin and aspirin but may require anti-inflammatory monoclonal antibody treatment in severe cases. SARS-CoV-2 infection can cause macrophage activation syndrome, chilblains, and flares of existing rheumatologic diseases. The pandemic has led to later presentation of some rheumatologic conditions as parents and patients have avoided health care settings. PubMed and Google scholar have been utilized to review the literature on the rheumatologic conditions resulting from COVID-19 and the current treatment options.
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Affiliation(s)
- Nivine El-Hor
- Department of Internal Medicine and Pediatrics, Children’s Hospital of Michigan, 4201 St. Antoine, UHC 5C, Detroit, MI 48201, USA
| | - Matthew Adams
- Division Chief for Pediatric Rheumatology, Department of Pediatrics, Wayne State University School of Medicine, Wayne Pediatrics, 400 Mack Avenue, Detroit, Michigan 48201, USA.
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9
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Shinkai K. JAMA Dermatology-The Year in Review, 2020. JAMA Dermatol 2021; 157:507-509. [PMID: 33760007 DOI: 10.1001/jamadermatol.2021.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kanade Shinkai
- Editor, JAMA Dermatology.,Department of Dermatology, University of California, San Francisco
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10
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Sachdeva M, Mufti A, Maliyar K, Lara-Corrales I, Salcido R, Sibbald C. A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses. Adv Skin Wound Care 2021; 34:348-354. [PMID: 34125725 DOI: 10.1097/01.asw.0000752692.72055.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.
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11
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Strauss SA, Seo C, Carrier M, Jetty P. From cellular function to global impact: the vascular perspective on COVID-19. Can J Surg 2021; 64:E289-E297. [PMID: 33978563 PMCID: PMC8327988 DOI: 10.1503/cjs.023820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
Since COVID-19 was declared a pandemic a year ago, our understanding of its effects on the vascular system has slowly evolved. At the cellular level, SARS-CoV-2 - the virus that causes COVID-19 - accesses the vascular endothelium through the angiotensin-converting enzyme 2 (ACE-2) receptor and induces proinflammatory and prothrombotic responses. At the clinical level, these pathways lead to thromboembolic events that affect the pulmonary, extracranial, mesenteric, and lower extremity vessels. At the population level, the presence of vascular risk factors predisposes individuals to more severe forms of COVID-19, whereas the absence of vascular risk factors does not spare patients with COVID-19 from unprecedented rates of stroke, pulmonary embolism and acute limb ischemia. Finally, at the community and global level, the fear of COVID-19, measures taken to limit the spread of SARS-CoV-2 and reallocation of limited hospital resources have led to delayed presentations of severe forms of ischemia, surgery cancellations and missed opportunities for limb salvage. The purpose of this narrative review is to present some of the data on COVID-19, from cellular mechanisms to clinical manifestations, and discuss its impact on the local and global surgical communities from a vascular perspective.
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Affiliation(s)
- Shira A Strauss
- From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier)
| | - Chanhee Seo
- From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier)
| | - Marc Carrier
- From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier)
| | - Prasad Jetty
- From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier)
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12
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Sancho-Shimizu V, Brodin P, Cobat A, Biggs CM, Toubiana J, Lucas CL, Henrickson SE, Belot A, Tangye SG, Milner JD, Levin M, Abel L, Bogunovic D, Casanova JL, Zhang SY. SARS-CoV-2-related MIS-C: A key to the viral and genetic causes of Kawasaki disease? J Exp Med 2021; 218:212029. [PMID: 33904890 PMCID: PMC8080850 DOI: 10.1084/jem.20210446] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) emerged in April 2020 in communities with high COVID-19 rates. This new condition is heterogenous but resembles Kawasaki disease (KD), a well-known but poorly understood and clinically heterogenous pediatric inflammatory condition for which weak associations have been found with a myriad of viral illnesses. Epidemiological data clearly indicate that SARS-CoV-2 is the trigger for MIS-C, which typically occurs about 1 mo after infection. These findings support the hypothesis of viral triggers for the various forms of classic KD. We further suggest that rare inborn errors of immunity (IEIs) altering the immune response to SARS-CoV-2 may underlie the pathogenesis of MIS-C in some children. The discovery of monogenic IEIs underlying MIS-C would shed light on its pathogenesis, paving the way for a new genetic approach to classic KD, revisited as a heterogeneous collection of IEIs to viruses.
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Affiliation(s)
- Vanessa Sancho-Shimizu
- Department of Paediatric Infectious Diseases and Virology, Imperial College London, London, UK.,Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Petter Brodin
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Aurélie Cobat
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, Necker Hospital for Sick Children, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Catherine M Biggs
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Julie Toubiana
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.,Pasteur Institute, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Carrie L Lucas
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT
| | - Sarah E Henrickson
- Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alexandre Belot
- Centre International de Recherche en Infectiologie, University of Lyon, Institut National de la Santé et de la Recherche Médicale, U1111, Université Claude Bernard, Lyon 1, Le Centre National de la Recherche Scientifique, UMR5308, Lyon, France.,National Reference Center for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE), Pediatric Nephrology, Rheumatology, Dermatology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | | | - Stuart G Tangye
- Garvan Institute of Medical Research, Darlinghurst, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Joshua D Milner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Michael Levin
- Department of Paediatric Infectious Diseases and Virology, Imperial College London, London, UK.,Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, Necker Hospital for Sick Children, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Dusan Bogunovic
- Center for Inborn Errors of Immunity, Precision Immunology Institute, Mindich Child Health and Development Institute, Department of Microbiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, Necker Hospital for Sick Children, Paris, France.,University of Paris, Imagine Institute, Paris, France.,Howard Hughes Medical Institute, New York, NY
| | - Shen-Ying Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale, Necker Hospital for Sick Children, Paris, France.,University of Paris, Imagine Institute, Paris, France
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13
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Wong SW, Fan BE, Huang W, Chia YW. ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:425-430. [PMID: 34100519 DOI: 10.47102/annals-acadmedsg.202175] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thromboembolic events in the acute setting. However, the abnormal thrombotic diathesis is not known to persist into the recovery phase of COVID-19 infection. We described 3 cases of ST-segment elevation myocardial infarction in healthy male patients who recovered from COVID-19 with no prior cardiovascular risk factors. They shared features of elevated von Willebrand factor antigen, factor VIII and D-dimer level. One patient had a borderline positive lupus anticoagulant. Intravascular ultrasound of culprit vessels revealed predominantly fibrotic plaque with minimal necrotic core. Clot waveform analysis showed parameters of hypercoagulability. They were treated with dual antiplatelet therapy, angiotensin-converting-enzyme inhibitor, beta blocker and statin. These cases highlight the strong thrombogenic nature of COVID-19 that persisted among patients who recovered from infection. Several suspected mechanisms could explain the association between vascular thrombosis in the convalescent period (endothelial dysfunction, hypercoagulability, systemic inflammatory response and vasculopathy). Additional studies on "long COVID" are essential for identifying endotheliopathy and thrombotic sequalae.
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14
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Ortega-Quijano D, Fernandez-Nieto D, Jimenez-Cauhe J, Cortes-Cuevas JL, Marcos-Mencia D, Rodriguez-Dominguez M, Segurado-Miravalles G, Fernandez-Guarino M, Jaen-Olasolo P. Association between COVID-19 and chilblains: a case-control study. J Eur Acad Dermatol Venereol 2021; 35:e359-e361. [PMID: 33651424 PMCID: PMC8013508 DOI: 10.1111/jdv.17195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Affiliation(s)
- D Ortega-Quijano
- Servicio de Dermatología. Hospital, Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Dermatología Pedro Jaen, Madrid, Spain
| | - D Fernandez-Nieto
- Servicio de Dermatología. Hospital, Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Jimenez-Cauhe
- Servicio de Dermatología. Hospital, Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J L Cortes-Cuevas
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Marcos-Mencia
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - G Segurado-Miravalles
- Servicio de Dermatología. Hospital, Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Dermatología Pedro Jaen, Madrid, Spain
| | - M Fernandez-Guarino
- Servicio de Dermatología. Hospital, Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Dermatología Pedro Jaen, Madrid, Spain
| | - P Jaen-Olasolo
- Servicio de Dermatología. Hospital, Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Grupo de Dermatología Pedro Jaen, Madrid, Spain
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15
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Ulloa JH, Figueroa V, Cifuentes JS, Pinto P, Lurie F. The Impact of COVID-19 on Vascular Surgery Practice: A Systematic Review. Vasc Endovascular Surg 2021; 55:601-611. [PMID: 33657926 DOI: 10.1177/1538574421998212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND COVID-19 is characterized by a pulmonary interstitial compromise which can require intensive care unit (ICU) and mechanical ventilation. Covid patients develop a wide range of pathologies. This study aims to identify the impact of COVID-19 in diseases commonly treated by vascular surgeons. METHODS Four conditions were selected: venous thromboembolism (VTE), pulmonary embolism (PE), peripheral arterial disease (PAD), and microangiopathy. A systematic review of the literature using PRISMA guidelines was. RESULTS Out of 1195 papers reviewed for conditions in COVID-19 patients relevant to routine vascular surgery practice, 43 papers were included and analyzed. Venous thrombosis was found to be the most common COVID-19 associated pathology with a cumulative incidence of 25% at 7 days and 48% at 14 days. Additionally, D-dimer levels proved to be a good predictor, even in the early stages of the disease with a sensitivity of 85%, specificity of 88.5% and a negative predictive value of 94.7%. Patients in the ICU demonstrated a significantly higher risk of developing VTE, even when receiving pharmacologic thromboprophylaxis. Although evidence of arterial thrombosis was less common (1% to 16.3%), its consequences were typically more serious, including limb loss and death even in young individuals (OR = 25, 95% CI). Finally, microangiopathy has a wide spectrum of clinical presentations from retinal microangiopathy to other more severe manifestations such as myocardial injury, pulmonary compromise and potential multiple organ dysfunction syndrome. CONCLUSIONS Although the pathophysiological pathway by which COVID-19 produces thrombosis is not completely clear, the incidence of both arterial and venous thrombosis is increased. D-dimer screening should be done in all COVID-19 patients, as a predictor of thrombotic complications.
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Affiliation(s)
| | - Valentin Figueroa
- 173061Hospital Universitario de la Fundacion Santa Fe de Bogota, Bogotá, Colombia
| | | | - Paula Pinto
- 27991Universidad de los Andes, Bogota, Colombia
| | - Fedor Lurie
- 92661Jobst Vascular Institute, Toledo, OH, USA.,University of Michigan, Ann Arbor, MI, USA
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16
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Iba T, Warkentin TE, Thachil J, Levi M, Levy JH. Proposal of the Definition for COVID-19-Associated Coagulopathy. J Clin Med 2021; 10:jcm10020191. [PMID: 33430431 PMCID: PMC7827226 DOI: 10.3390/jcm10020191] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
Thrombotic events are common complications in COVID-19 patients that include both thrombus formation in large vessels and the microvasculature of the lung and other organs. COVID-19-associated coagulopathy (CAC) and disseminated intravascular coagulation (DIC) have similarities and differences, and whether CAC is a form of DIC is the subject of debate. Reported mechanisms of CAC include activated coagulation, endotheliopathy, up-regulated innate and adaptive immunity, and activated complement system. Although the clinical features and laboratory findings of CAC and DIC seem different, there are fundamental similarities that should be considered. Basically, the pathological findings of COVID-19 fall within the scope of the definition of DIC, i.e., systemic activation of coagulation caused by or resulting from the microvascular damage. Therefore, we suggest that although CAC differs from usual infection-associated DIC, its various features indicate that it can be considered a thrombotic phenotype DIC. This review summarizes the current knowledge about CAC including differences and similarities with sepsis-associated DIC.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Correspondence: ; Tel.: +81-3-3813-3111
| | - Theodore E. Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester M13 9WL, UK;
| | - Marcel Levi
- Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-Metabolic Programme-NIHR UCLH/UCL BRC, London NW1 2BU, UK;
| | - Jerrold H. Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
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17
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Abstract
The first cases of coronavirus disease 2019 (COVID-19) in Iran were detected on February 19, 2020. Soon the entire country was hit with the virus. Although dermatologists were not immediately the frontline health care workers, all aspects of their practice were drastically affected. Adapting to this unprecedented crisis required urgent appropriate responses. With preventive measures and conserving health care resources being the most essential priorities, dermatologists, as an integral part of the health system, needed to adapt their practices according to the latest guidelines. The spectrum of the challenges encompassed education, teledermatology, lasers, and other dermatologic procedures, as well as management of patients who were immunosuppressed or developed drug reactions and, most importantly, the newly revealed cutaneous signs of COVID-19. These challenges have paved the way for new horizons in dermatology.
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Affiliation(s)
- Maryam Daneshpazhooh
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - HamidReza Mahmoudi
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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Nuno-Gonzalez A, Magaletsky K, Feito Rodríguez M, Mayor Ibarguren A, Beato MJ, Ruiz Bravo E, Herranz Pinto P. Palmoplantar erythrodysesthesia: a diagnostic sign of COVID-19. J Eur Acad Dermatol Venereol 2020; 35:e247-e249. [PMID: 33289937 DOI: 10.1111/jdv.17074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/15/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A Nuno-Gonzalez
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain.,Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain
| | - K Magaletsky
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain.,Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain
| | - M Feito Rodríguez
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain.,Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain
| | - A Mayor Ibarguren
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain.,Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain
| | - M J Beato
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - E Ruiz Bravo
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - P Herranz Pinto
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain.,Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain
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19
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McMurray JC, May JW, Cunningham MW, Jones OY. Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis-A Critical Review of Its Pathogenesis and Treatment. Front Pediatr 2020; 8:626182. [PMID: 33425823 PMCID: PMC7793714 DOI: 10.3389/fped.2020.626182] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
MIS-C is a newly defined post-viral myocarditis and inflammatory vasculopathy of children following COVID-19 infection. This review summarizes the literature on diagnosis, parameters of disease severity, and current treatment regimens. The clinical perspective was analyzed in light of potential immunopathogenesis and compared to other post-infectious and inflammatory illnesses of children affecting the heart. In this paradigm, the evidence supports the importance of endothelial injury and activation of the IL-1 pathway as a common determinant among MIS-C, Kawasaki disease, and Acute Rheumatic fever.
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Affiliation(s)
- Jeremy C. McMurray
- Department of Pediatrics, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, United States
| | - Joseph W. May
- Department of Pediatrics, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, United States
- Division of Pediatric Cardiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, United States
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Madeleine W. Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Olcay Y. Jones
- Department of Pediatrics, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, United States
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Division of Pediatric Rheumatology, WRNMMC, Bethesda, MD, United States
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20
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Type I Interferon Signature in Chilblain-Like Lesions Associated with the COVID-19 Pandemic. Dermatopathology (Basel) 2020; 7:57-63. [PMID: 33291622 PMCID: PMC7768511 DOI: 10.3390/dermatopathology7030010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022] Open
Abstract
Contemporarily to the new SARS-CoV-2 mediated COVID-19 pandemic, a rise in patients with acral chilblain lesions has been described. They manifest late after mild disease or asymptomatic exposure to SARS-CoV-2. Their pathogenic evolution is currently unknown. In biopsies from three patients with acral partially ulcerating chilblain lesions that occurred associated to the COVID-19 pandemic, we analysed the expression of type I interferon induced proteins and signal transduction kinases. Histology demonstrated perivascular and periadnexal lymphohistiocytic infiltrates and endothelial dominated MxA-staining, as well as pJAK1 activation. Our findings demonstrate induction of the type I IFN pathway in lesional sections of COVID-19-associated chilblain-like lesions. This may indicate a local antiviral immune activation status associated with preceding exposure to SARS-CoV-2.
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21
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D’Incan PM. Quoi de neuf en Clinique en 2020 ? Ann Dermatol Venereol 2020; 147:12S1-12S8. [DOI: 10.1016/s0151-9638(20)31101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Macy ML, Huetteman P, Kan K. Changes in Primary Care Visits in the 24 Weeks After COVID-19 Stay-at-Home Orders Relative to the Comparable Time Period in 2019 in Metropolitan Chicago and Northern Illinois. J Prim Care Community Health 2020; 11:2150132720969557. [PMID: 33174495 PMCID: PMC7675908 DOI: 10.1177/2150132720969557] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. METHODS We examined retrospective visit and billing data, regardless of payer, from 16 independent pediatric practices that utilize a common electronic medical record platform within an Accountable Care Organization of 252 pediatricians in 71 offices throughout metropolitan Chicago. We categorized visits as Well-Child and Immunization-Only (WC-IO) or Other types and identified visits with a telemedicine billing modifier. Diagnoses for Other visits were tallied and categorized using the Agency for Healthcare Research and Quality Clinical Classification System. We summarized counts of visits and the proportion of visits with a telemedicine billing modifier in one-week epochs for 2020 compared with 2019. RESULTS There were 102 942 total visits (72 030 WC-IO; 30 912 Other) in 2020 and 144 672 visits (80 578 WC-IO; 64 094 Other) in 2019. WC-IO visits in 2020 were half of 2019 visits at the start of the Illinois Stay-at-Home Order and returned greater than 90% of 2019 visits in 8 weeks. Other visit types have remained below 70% of 2019 visits. A telemedicine billing modifier peaked in mid-April (21% of all visits) and declined to <10% of all visits in June (Phase 2 reopening). The top 10 most common diagnoses differed between years. CONCLUSIONS Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.
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Affiliation(s)
- Michelle L. Macy
- Department of Pediatrics, Northwestern
University, Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL, USA
- Michelle L. Macy, Department of Pediatrics,
Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Ave,
Chicago, IL 60611, USA.
| | | | - Kristin Kan
- Department of Pediatrics, Northwestern
University, Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL, USA
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23
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Hayden MR. An Immediate and Long-Term Complication of COVID-19 May Be Type 2 Diabetes Mellitus: The Central Role of β-Cell Dysfunction, Apoptosis and Exploration of Possible Mechanisms. Cells 2020; 9:E2475. [PMID: 33202960 PMCID: PMC7697826 DOI: 10.3390/cells9112475] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was declared a pandemic by the WHO on 19 March 2020. This pandemic is associated with markedly elevated blood glucose levels and a remarkable degree of insulin resistance, which suggests pancreatic islet β-cell dysfunction or apoptosis and insulin's inability to dispose of glucose into cellular tissues. Diabetes is known to be one of the top pre-existing co-morbidities associated with the severity of COVID-19 along with hypertension, cardiocerebrovascular disease, advanced age, male gender, and recently obesity. This review focuses on how COVID-19 may be responsible for the accelerated development of type 2 diabetes mellitus (T2DM) as one of its acute and suspected long-term complications. These observations implicate an active role of metabolic syndrome, systemic and tissue islet renin-angiotensin-aldosterone system, redox stress, inflammation, islet fibrosis, amyloid deposition along with β-cell dysfunction and apoptosis in those who develop T2DM. Utilizing light and electron microscopy in preclinical rodent models and human islets may help to better understand how COVID-19 accelerates islet and β-cell injury and remodeling to result in the long-term complications of T2DM.
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Affiliation(s)
- Melvin R Hayden
- Departments of Internal Medicine, Endocrinology Diabetes and Metabolism, Diabetes and Cardiovascular Disease Center, University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA
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Baeck M, Peeters C, Herman A. Chilblains and COVID-19: further evidence against a causal association. J Eur Acad Dermatol Venereol 2020; 35:e2-e3. [PMID: 32866323 DOI: 10.1111/jdv.16901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/15/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Affiliation(s)
- M Baeck
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - C Peeters
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A Herman
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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25
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Fishman JA, Roberts MB, Zhang EW, Kumar D, Hirsch HH, Maggiore U. Case 29-2020: A 66-Year-Old Man with Fever and Shortness of Breath after Liver Transplantation. N Engl J Med 2020; 383:1168-1180. [PMID: 32937051 PMCID: PMC7510944 DOI: 10.1056/nejmcpc2004982] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jay A Fishman
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Matthew B Roberts
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Eric W Zhang
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Deepali Kumar
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Hans H Hirsch
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
| | - Umberto Maggiore
- From the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Massachusetts General Hospital, and the Departments of Medicine (J.A.F., M.B.R.) and Radiology (E.W.Z.), Harvard Medical School - both in Boston; the Division of Infectious Diseases and Transplant Center, University Health Network and University of Toronto, Toronto (D.K.); the Transplantation and Clinical Virology Unit, Department of Biomedicine, University Hospital Basel, Basel, Switzerland (H.H.H.); and the Nephrology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (U.M.)
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