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Giancotti R, Lomoio U, Puccio B, Tradigo G, Vizza P, Torti C, Veltri P, Guzzi PH. The Omicron XBB.1 Variant and Its Descendants: Genomic Mutations, Rapid Dissemination and Notable Characteristics. BIOLOGY 2024; 13:90. [PMID: 38392308 PMCID: PMC10886209 DOI: 10.3390/biology13020090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
The SARS-CoV-2 virus, which is a major threat to human health, has undergone many mutations during the replication process due to errors in the replication steps and modifications in the structure of viral proteins. The XBB variant was identified for the first time in Singapore in the fall of 2022. It was then detected in other countries, including the United States, Canada, and the United Kingdom. We study the impact of sequence changes on spike protein structure on the subvariants of XBB, with particular attention to the velocity of variant diffusion and virus activity with respect to its diffusion. We examine the structural and functional distinctions of the variants in three different conformations: (i) spike glycoprotein in complex with ACE2 (1-up state), (ii) spike glycoprotein (closed-1 state), and (iii) S protein (open-1 state). We also estimate the affinity binding between the spike protein and ACE2. The market binding affinity observed in specific variants raises questions about the efficacy of current vaccines in preparing the immune system for virus variant recognition. This work may be useful in devising strategies to manage the ongoing COVID-19 pandemic. To stay ahead of the virus evolution, further research and surveillance should be carried out to adjust public health measures accordingly.
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Affiliation(s)
- Raffaele Giancotti
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Ugo Lomoio
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Barbara Puccio
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | | | - Patrizia Vizza
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Carlo Torti
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Pierangelo Veltri
- Department of Computer Engineering, Modelling, Electronics and System, University of Calabria, 87036 Rende, Italy
| | - Pietro Hiram Guzzi
- Department of Surgical and Medical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Ică OM, Mitroi G, Ianoşi SL, Tutunaru CV, Leru PM, Matei D, Avramescu ET, Tănasie CA, Mitroi IB, Neagoe CD, Cazacu SM. Defining the short-term and long-term skin manifestations of COVID-19: insights after more than three years of the pandemic. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:291-304. [PMID: 37867347 PMCID: PMC10720941 DOI: 10.47162/rjme.64.3.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/22/2023] [Indexed: 10/24/2023]
Abstract
AIM This review aimed to assess the impact of coronavirus disease 2019 (COVID-19) on skin health to establish a classification of the skin lesions that occur most frequently during the disease and whether a particular category of skin damage is more likely to occur both in the short term and in the long term. METHODS We conducted a literature search of the PubMed database. Ultimately, 109 articles were included in this review. The exact phrases∕syntax and connectors used for the database search∕query were as follows: "Coronavirus and skin", "COVID-19 and skin", "SARS-CoV-2 and skin", "Coronavirus cutaneous manifestations", "COVID-19 cutaneous manifestations", "SARS-CoV-2 cutaneous manifestations", "Coronavirus dermatology", "SARS-CoV-2 and dermatology", "COVID-19 and dermatology", "COVID-19 and skin eruption", "Coronavirus and skin rash", "COVID-19 and hair", "Coronavirus and hair", "Coronavirus and nails", "SARS-CoV-2 and hair", and "SARS-CoV-2 and nails". Only articles with abstracts referring strictly to cutaneous manifestations of COVID-19 were chosen. Articles without abstracts were not considered. RESULTS We established six of the most frequently reported clinical patterns associated with COVID-19 and their probability of occurring during COVID-19 disease evolution based on the current literature reports. We did not identify the particular types of skin lesions that are most prone to long-term persistence; most such cases are rare, and no conclusion can be drawn based on them. CONCLUSIONS Apart from classified COVID-19-related skin disorders, this pandemic has been a challenge for dermatologists and a wide range of cutaneous side effects related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treatments have been reported. We are aware of other polymorphic clinical presentations, with novel data being reported periodically, but the pathophysiological mechanisms and evolution are largely unknown.
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Affiliation(s)
- Oana Maria Ică
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - George Mitroi
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Simona Laura Ianoşi
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristina Violeta Tutunaru
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Polliana Mihaela Leru
- Department of Family Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Matei
- Department of Medical Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Cornelia Andreea Tănasie
- Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Iulia Bianca Mitroi
- Medical Student, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Carmen Daniela Neagoe
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Sergiu Marian Cazacu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
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Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity. Adv Skin Wound Care 2023; 36:137-141. [PMID: 36812078 DOI: 10.1097/01.asw.0000911988.75204.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To describe the observed patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process. METHODS This retrospective observational cohort study included adults who were COVID-19 positive with purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury. Patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were compiled by review of the electronic health record. The wounds were described by location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and periwound condition (intact). RESULTS A total of 26 patients were included in the study. Purpuric/violaceous wounds were found predominantly on White (92.3%) men (88.0%) aged 60 to 89 years (76.9%) with a body mass index 30 kg/m2 or higher (46.1%). The majority of wounds were located on the sacrococcygeal (42.3%) and fleshy gluteal regions (46.1%). CONCLUSIONS Wounds were heterogeneous in appearance (poorly defined violaceous skin discoloration of acute onset), and the patient population had clinical characteristics similar to acute skin failure (eg, concomitant organ failures and hemodynamic instability). Additional larger population-based studies with biopsies may assist in finding patterns related to these dermatologic changes.
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Zambrano-Mericq MJ, Lam JM. Erythema nodosum associated with COVID19 infection: A pediatric case report and review of the literature. Pediatr Dermatol 2023; 40:166-170. [PMID: 35918301 PMCID: PMC9539322 DOI: 10.1111/pde.15096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/09/2022] [Indexed: 01/25/2023]
Abstract
Erythema nodosum (EN) is a common panniculitis characterized by tender erythematous nodules predominantly on the pretibial area and represents a hypersensitivity reaction to multiple triggers. COVID19 infection and vaccination have been associated with EN in the adult population. We report a pediatric case of EN following COVID19 infection and review the literature on COVID19 infection and COVID19 immunization-related EN.
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Affiliation(s)
| | - Joseph M Lam
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Chersi F, Conforti C, Zalaudek I, di Meo N. Lichen Striatus Post-COVID-19 Infection: Clinical and Dermoscopic Presentations. Dermatol Pract Concept 2023; 13:dpc.1301a6. [PMID: 36892345 PMCID: PMC9946117 DOI: 10.5826/dpc.1301a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Filippo Chersi
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Nicola di Meo
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy
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Coronavirus Disease 2019 (COVID-19). BIOLOGY 2022; 11:biology11081250. [PMID: 36009877 PMCID: PMC9404726 DOI: 10.3390/biology11081250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
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Barbachowska A, Gozdowska J, Piotrowska-Kownacka D, Sawicka M, Dęborska-Materkowska D, Skolimowska E, Durlik M. Extrapulmonary Manifestations of SARS-CoV-2: A Report of 3 Cases and a Literature Review. Ann Transplant 2022; 27:e935874. [PMID: 35941813 PMCID: PMC9375514 DOI: 10.12659/aot.935874] [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: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND COVID-19 disease, caused by the SARS-CoV-2 virus, has been one of the greatest challenges in modern medicine. It is mostly known to affect the pulmonary system, leading to pneumonia and acute respiratory distress syndrome, but there is a growing body of evidence of extrapulmonary manifestations of COVID-19 disease. CASE REPORT This article presents 3 cases of various extrapulmonary symptoms of COVID-19 disease and a literature review of similar clinical cases. Two patients had a medical history of living-donor kidney transplantation, and 1 patient was a kidney donor. We present symptoms, diagnostic processes, laboratory and imaging results, and treatment approach. Patient 1 was 29-year-old woman with new-onset diabetes mellitus due to SARS-CoV-2, which required temporary insulin treatment. Patient 2 was a 34-year-old man with fever, chronic fatigue, back pain, and abdominal pain. Imagining showed acalculous cholecystitis, epiploic appendagitis of the right colic flexure, and inflammation of pericardial fat pad in the left cardiophrenic angle. Coagulopathy due to COVID-19 was the most probable cause of the described processes. Therapeutic doses of low-molecular-weight heparin were administered. Patient 3 was a 68-year-old male kidney donor who had painless, nodular, reddening lesions on both shins, accompanied by itching on both shins and recurrent fever. The diagnosis of erythema nodosum during COVID-19 was made. After treatment with low-molecular-weight heparin, significant decreases of symptoms were observed. CONCLUSIONS We conclude that SARS-CoV-2 infection can have a varied course and can involve other systems and organs. Physicians should be aware of possible extrapulmonary symptoms associated with infection with this virus. Correct diagnosis is a prerequisite for proper treatment and prevention of unexpected complications.
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Affiliation(s)
- Aleksandra Barbachowska
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Monika Sawicka
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Dęborska-Materkowska
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Skolimowska
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Sadeghi S, Amini Z, Goodarzi A. A comparative review on mucocutaneous reactions caused by Covid-19 infection versus Covid-19 vaccination. Exp Dermatol 2022; 31:1122-1127. [PMID: 35657119 PMCID: PMC9348341 DOI: 10.1111/exd.14620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/27/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
The prevalence and severity of mucocutaneous manifestations in Covid-19 infection are generally higher than those reported in Covid vaccines. Therefore, comparing the mucocutaneous reactions of the Covid-19 infection and vaccination is necessary to enhance our knowledge about such reactions and guide us to evaluate the risk of infection or vaccination. A thorough literature search was conducted on PubMed, Google Scholar, and EBSCO (LISTA), and 2069 articles were downloaded. After screening, 11 studies remained for the final review. The literature review revealed that the prevalence and severity of postvaccine mucocutaneous adverse reactions have been less common compared to Covid-19 infection. Postvaccine adverse reactions primarily occurred after the first dose administration and such reactions were manageable with antihistamines and corticosteroids administration. This comparative analysis highlights the frequency and potential severity of mucocutaneous reactions due to Covid-19 infection and Covid-19 vaccination. It also affirmed that potentially critical (serious) mucocutaneous reactions are more likely to occur in Covid-19 infection compared to Covid vaccination. Moreover, postvaccine reactions predominantly happened after the first dose and were reported to be non-life-threatening, self-manageable and with a lower incidence of potentially critical events. It was also concluded that the incidence of mucocutaneous reactions decreased in the following doses. Hence, given the low rate of such reactions following Covid-19 vaccination, vaccines have a lower risk of mucocutaneous reactions occurrence than Covid-19 infection. Further, due to the limited number of studies, we recommend that large-scale trials evaluate such reactions comparing various types of Covid-19 vaccines in healthy individuals and those with autoimmune skin disorders.
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Affiliation(s)
- Sara Sadeghi
- Department of Pediatrics, Division of DermatologyUniversity of Calgary, Alberta Children's HospitalCalgaryAlbertaCanada
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of Medicine, Iran University of Medical SciencesTehranIran
| | - Zeynab Amini
- School of Biology and Environmental ScienceQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of Medicine, Iran University of Medical SciencesTehranIran
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Varol F, Can YY, Sahin E, Durak C, Kilic A, Sahin C, Gursoy F, Akin T. The role of treatment with plasma exchange therapy in two pediatric toxic epidermal necrolysis cases related to
COVID
‐19. J Clin Apher 2022; 37:516-521. [PMID: 35792366 PMCID: PMC9350357 DOI: 10.1002/jca.21997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Fatih Varol
- Department of Pediatric Intensive Care University of Health Sciences Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital Istanbul Turkey
| | - Yasar Yusuf Can
- Department of Pediatric Intensive Care University of Health Sciences Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital Istanbul Turkey
| | - Ebru Sahin
- Department of Pediatric Intensive Care University of Health Sciences Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital Istanbul Turkey
| | - Cansu Durak
- Department of Pediatric Intensive Care University of Health Sciences Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital Istanbul Turkey
| | - Aziz Kilic
- Department of Pediatrics Ankara University Faculty of Medicine Ankara Turkey
| | - Ceyhan Sahin
- Department of Pediatric Surgery University of Health Sciences Umraniye Training and Research Hospital Istanbul Turkey
| | - Fatima Gursoy
- Department of Pathology University of Health Sciences Umraniye Training and Research Hospital Istanbul Turkey
| | - Tugba Akin
- Department of Dermatology Konya Numune State Hospital Konya Turkey
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Ahmed SMA, Olajide T, Albsheer KMIA, Danjuma SN. Erythema multiforme as a presentation of COVID-19: Case Illustrated format. IDCases 2022; 28:e01512. [PMID: 35611052 PMCID: PMC9119717 DOI: 10.1016/j.idcr.2022.e01512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/12/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
COVID-19 is now an established morbidity across races, regions and clinical risks around the world. From its first detection in Wuhan city-China in 2019 to the recent breakthrough of approved vaccines, that are determinants and deterrents and gradually becoming apparent. The phenotype of its presentation however is both variable and challenging especially. For those presenting with unique skin dermatosis such as erythema multiforme. Case report Our case is on a 36 year- old gentleman who presented to the hospital complaining, initially of only urticarial rash (later established to be erythema multiform), which improved with symptomatic treatment. He was discharged, only to be re-admitted a week later with exacerbation of the former cutaneous manifestation, accompanied by fever and gastrointestinal symptoms. He ultimately made complete recovery and was discharged home.
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11
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Diamanti E, Föhr J, Papageorgiou A, Herbst M, Jahn S. Immunologie in der dermatologischen Praxis – wieviel, warum, wann? AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1699-5440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ZusammenfassungDie Haut als Grenzorgan zum Körperäußeren realisiert viele immunologische Abwehrfunktionen. Folglich sind Immunologie und Dermatologie eng miteinander verknüpft. Die Diagnostik immunologischer Hauterkrankungen und deren Immuntherapie, labormedizinische Analysen, Hyposensibilisierung – Begegnungen mit der Immunologie finden auch in einer dermatologischen Praxis im Alltag nahezu ständig statt. Ziel dieser Arbeit ist es, praxisnah aufzuzeigen, wie uns Dermatologen die Immunologie in unserer Fachdisziplin helfen kann.
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Affiliation(s)
| | - Julia Föhr
- Dermatologische Facharztpraxis Dr. Herbst & Kollegen, Darmstadt
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg
| | | | - Matthias Herbst
- Dermatologische Facharztpraxis Dr. Herbst & Kollegen, Darmstadt
| | - Sigbert Jahn
- Dermatologische Facharztpraxis Dr. Herbst & Kollegen, Darmstadt
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12
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Manji KP, Mwaniki G, Simba AA, Makani J. Erythema multiforme in a young adult following COVID-19 infection and vaccination in Tanzania. BMJ Case Rep 2022; 15:15/5/e247168. [PMID: 35606031 PMCID: PMC9174760 DOI: 10.1136/bcr-2021-247168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We report the case of a young female adult in her early 20s, who had COVID-19 infection for 8 weeks and COVID-19 vaccination 4 weeks prior to presentation with an extensive rash associated with erythema multiforme, resembling varicella zoster on initial presentation. After initial acyclovir therapy with no improvement, systemic corticosteroid treatment dramatically resolved the patient’s skin rash.
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Affiliation(s)
- Karim Premji Manji
- Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Mwaniki
- Family Medicine, Premier Care Clinic and Pharmacy, Dar es Salaam, Tanzania
| | - Alma Abu Simba
- History, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Julie Makani
- Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Battaglini D, Ball L, Robba C, Maiani S, Brunetti I, Benedetti L, Castellan L, Zona G, Pesce G, Rocco PRM, Pelosi P. Patients With Suspected Severe Adverse Reactions to COVID-19 Vaccination Admitted to Intensive Care Unit: A Case Report. Front Med (Lausanne) 2022; 9:823837. [PMID: 35372434 PMCID: PMC8972056 DOI: 10.3389/fmed.2022.823837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022] Open
Abstract
Background Several cases of adverse reactions following vaccination for coronavirus disease 2019 (COVID-19) with adenoviral vector vaccines or mRNA-based vaccines have been reported to date. The underlying syndrome has been named “vaccine-induced immune thrombotic thrombocytopenia” (VITT) or “thrombosis with thrombocytopenia syndrome (TTS)” with different clinical manifestations. Methods We report the clinical course of five patients who had severe adverse reactions to COVID-19 vaccines, either with VITT/TTS, abdominal or pulmonary thrombosis after adenoviral vaccines, or Stevens' Johnson syndrome because of mRNA vaccination, all of whom required admission to the intensive care unit (ICU). Conclusions All patients with severe or life-threatening suspected reaction to different types of COVID-19 vaccination required ICU admission. A prompt evaluation of early symptoms and individualized clinical management is needed to improve outcomes.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
- *Correspondence: Denise Battaglini
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Simona Maiani
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Luana Benedetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Children (DINOGMI), University of Genoa, Genoa, Italy
- UO Clinica Neurologica, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lucio Castellan
- Department of Radiology and Neuroradiology, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Gianluigi Zona
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Children (DINOGMI), University of Genoa, Genoa, Italy
- Department of Neurosurgery, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Giampaola Pesce
- UOSD Laboratorio Diagnostico di Autoimmunologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Università di Genova, Genoa, Italy
| | - Patricia R. M. Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Akuffo-Addo E, Nicholas MN, Joseph M. COVID-19 Skin Manifestations in Skin of Colour. J Cutan Med Surg 2022; 26:189-197. [PMID: 34663122 PMCID: PMC8950713 DOI: 10.1177/12034754211053310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.
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Affiliation(s)
- Edgar Akuffo-Addo
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, ON, Canada
| | - Mathew N. Nicholas
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Marissa Joseph
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Women’s College Hospital, Toronto, ON, Canada
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15
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Gambichler T, Boms S, Susok L, Dickel H, Finis C, Abu Rached N, Barras M, Stücker M, Kasakovski D. Cutaneous findings following COVID-19 vaccination: review of world literature and own experience. J Eur Acad Dermatol Venereol 2022; 36:172-180. [PMID: 34661927 PMCID: PMC8656409 DOI: 10.1111/jdv.17744] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/29/2021] [Indexed: 12/11/2022]
Abstract
There is growing evidence that not only the novel coronavirus disease (COVID-19) but also the COVID-19 vaccines can cause a variety of skin reactions. In this review article, we provide a brief overview on cutaneous findings that have been observed since the emerging mass COVID-19 vaccination campaigns all over the world. Unspecific injection-site reactions very early occurring after the vaccination are most frequent. Type I hypersensitivity reactions (e.g. urticaria, angio-oedema and anaphylaxis) likely due to allergy to ingredients may rarely occur but can be severe. Type IV hypersensitivity reactions may be observed, including delayed large local skin lesions ("COVID arm"), inflammatory reactions in dermal filler or previous radiation sites or even old BCG scars, and more commonly morbilliform and erythema multiforme-like rashes. Autoimmune-mediated skin findings after COVID-19 vaccination include leucocytoclastic vasculitis, lupus erythematosus and immune thrombocytopenia. Functional angiopathies (chilblain-like lesions, erythromelalgia) may also be observed. Pityriasis rosea-like rashes and reactivation of herpes zoster have also been reported after COVID-19 vaccination. In conclusion, there are numerous cutaneous reaction patterns that may occur following COVID-19 vaccination, whereby many of these skin findings are of immunological/autoimmunological nature. Importantly, molecular mimicry exists between SARS-CoV-2 (e.g. the spike-protein sequences used to design the vaccines) and human components and may thus explain some COVID-19 pathologies as well as adverse skin reactions to COVID-19 vaccinations.
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Affiliation(s)
- T. Gambichler
- Department of DermatologyRuhr‐University BochumBochumGermany
- Department of DermatologyChristian Hospital UnnaUnnaGermany
| | - S. Boms
- Department of DermatologyChristian Hospital UnnaUnnaGermany
| | - L. Susok
- Department of DermatologyRuhr‐University BochumBochumGermany
| | - H. Dickel
- Department of DermatologyRuhr‐University BochumBochumGermany
| | - C. Finis
- Department of DermatologyRuhr‐University BochumBochumGermany
| | - N. Abu Rached
- Department of DermatologyRuhr‐University BochumBochumGermany
| | - M. Barras
- Department of DermatologyRuhr‐University BochumBochumGermany
| | - M. Stücker
- Department of DermatologyRuhr‐University BochumBochumGermany
| | - D. Kasakovski
- European Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheimGermany
- Division of Vascular Oncology and MetastasisGerman Cancer Research Center Heidelberg (DKFZ‐ZMBH Alliance)HeidelbergGermany
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16
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Robustelli Test E, Sena P, Locatelli AG, Carugno A, di Mercurio M, Moggio E, Gambini DM, Arosio MEG, Callegaro A, Morotti D, Gianatti A, Vezzoli P. RNAscope in situ hybridization and RT-PCR for detection of SARS-CoV-2 in chilblain-like lesions: A clinical, laboratory and histopathological study. Pediatr Dermatol 2022; 39:77-83. [PMID: 34989043 DOI: 10.1111/pde.14903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of chilblain-like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS-CoV-2 infection has not been unequivocally established. METHODS In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1 June 2020. RESULTS The mean age was 14.2 years, and 21 patients (78%) experienced mild systemic symptoms a median of 28 days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients - 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT-PCR for SARS-CoV-2 showing only 1 positive. Histopathological examinations of 7 skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS-CoV-2 RNA in skin biopsies, both with real-time polymerase chain reaction (RT-PCR) and RNAscope in situ hybridization (ISH). LIMITATIONS Limited number of cases, unavailability of laboratory confirmation of COVID-19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. CONCLUSIONS These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN-I or complement-mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.
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Affiliation(s)
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Erica Moggio
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marco Enrico Giovanni Arosio
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Denise Morotti
- Pathology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Pamela Vezzoli
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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17
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Ooi R, Lim SLX, Ooi SZY, Bennett A. Representing Black, Asian and Minority Ethnic Skin in Dermatology Education Amidst the COVID-19 Pandemic: An Evaluation of an E-learning Resource. Cureus 2021; 13:e20738. [PMID: 35111430 PMCID: PMC8790939 DOI: 10.7759/cureus.20738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/06/2022] Open
Abstract
Background Recently published literature has shed light on the lack of representation and exposure to Black, Asian and Minority Ethnic (BAME) skin types in dermatology education and training. This may lead to diagnostic uncertainty and impact the overall quality of care delivered. Thus, this paper discusses the design and development of an e-learning resource as an innovative solution to address this educational need during the pandemic. Methods A focus group was conducted to assess the learning needs of trainees on cutaneous manifestations of BAME patients. An e-learning resource was created using instructional design, educational and multimedia principles such as the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model and Gagne’s nine steps. The e-learning was disseminated to trainees across a one-month period. Feedback on the content and relevance of the e-learning was collected on the completion of the module. Results Overall, 84% (n=42) of trainees reported that the module improved their confidence and knowledge acquisition of common skin conditions in BAME skin types (p<0.0001 when compared to pre-course confidence). 94% (n=47) of trainees agreed or strongly agreed that the e-learning met their learning needs as an educational tool. Of 50 trainees, the results show that trainees agreed or strongly agreed that the resource was accessible (94%, n=47), reusable (94%, n=47) and promotes a sustainable way of teaching in dermatology (96%, n=48). Conclusion A well-structured virtual learning module can be an effective tool to deliver teaching remotely whilst complying with public health measures to prevent the spread of COVID-19. This e-learning also highlights the need for further BAME representation in published dermatological resources.
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18
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Khosravi M. A Possible Type IV Hypersensitivity Reaction to Older Antiepileptic Drugs During and After Recovery from COVID-19 Infection. PHARMACOPSYCHIATRY 2021; 55:58-59. [PMID: 34758492 DOI: 10.1055/a-1678-7429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nearly two years after the onset of the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers face new and unexpected complications. Although accelerating the vaccination process in recent months has reduced the incidence and mortality of the COVID-19 infection, the general population (particularly vulnerable groups) remains at risk of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Over the last two months, Iran has encountered the fifth wave of the COVID-19 pandemic, i. e., the B.1.617.2 (Delta) variant of the SARS-CoV-2, with faster infectiousness and higher severity and mortality among hospitalized patients 1. Although fever, cough, and expectoration are the most common clinical features of COVID-19, recent studies have indicated an increasing number of skin manifestation reports in the disease. Besides, there is growing evidence that underlying SARS-CoV-2 infection may increase the risk of adverse drug reactions 2. However, the enduring concern in our medical centers in recent days is a raised incidence of Stevens-Johnson syndrome (SJS) in recovered COVID-19 patients following monotherapy with older antiepileptic drugs (0.004 vs. 0.0008% - i. e., 5 times higher than the pre-COVID-19 period) 3. It is worth noting that these patients did not have any history of SJS/toxic epidermal necrolysis (TEN) or additional etiopathogenic factors, including infections, genetic factors (particularly HLA-B*1502 allele), and malignancy. Furthermore, for many years before developing the COVID-19 and recovering from it, they had been treated with the above drugs without showing any cutaneous hypersensitivity reactions. These observational findings raise two important questions: (i) Could a history of the COVID-19 infection be a potential risk factor for type IV hypersensitivity reactions to older antiepileptic drugs? (ii) If so, what are its mechanisms of action?
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19
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Farajzadeh S, Khalili M, Dehghani S, Babaie S, Fattah M, Abtahi-Naeini B. Top 10 acral skin manifestations associated with COVID-19: A scoping review. Dermatol Ther 2021; 34:e15157. [PMID: 34628708 PMCID: PMC8646918 DOI: 10.1111/dth.15157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
COVID‐19‐associated cutaneous manifestations are one of the most important and relatively common extra‐respiratory presentations of SARS‐COV‐2 infection. The exact identification and classification of these lesions can facilitate the accurate diagnosis and treatment. There are several case reports and small case series which describe cutaneous lesions in hands and feet. Currently, there is no scoping review about acral skin manifestations associated with COVID‐19. This paper covers the COVID‐related acral skin manifestations in 10 entities including acral papulo‐vesicular eruption, acral urticarial lesion, acral non‐inflammatory purpura and necrosis, acro‐ischemia associated COVID‐19, acral vasculitis, chilblain‐like lesion (COVID Toe), acral erythema multiform (EM) like lesion, hand and foot skin lesions associated with multisystem inflammatory syndrome in children (MISC), acral peeling conditions and red half‐moon nail sign. Future studies should focus on exact investigation of etiologies of these lesions including role of immune senescence, environment, gender, immunogenetics and relation of these lesion with major organ involvements.
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Affiliation(s)
- Saeedeh Farajzadeh
- Pediatric Dermatology Department, Kerman university of Medical Science, Kerman, Iran
| | - Maryam Khalili
- Pediatric Dermatology Department, Kerman university of Medical Science, Kerman, Iran
| | - Shakiba Dehghani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Babaie
- Department of Pediatric Intensive Care Unit, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Fattah
- Department of Dermatology, Sulaimani Center for Skin Disease Treatment, Sulaimani, Iraq
| | - Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Hsu HT, Su HA, Chen YC. Erythema nodosum, after Medigen vaccination against COVID-19? J Formos Med Assoc 2021; 121:723-724. [PMID: 34656402 PMCID: PMC8501263 DOI: 10.1016/j.jfma.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Hui-Te Hsu
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsuan-An Su
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Chia Chen
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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21
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Fernández-Lázaro D, Garrosa M. Identification, Mechanism, and Treatment of Skin Lesions in COVID-19: A Review. Viruses 2021; 13:1916. [PMID: 34696346 PMCID: PMC8540564 DOI: 10.3390/v13101916] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a multisystem disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), that primarily causes respiratory symptoms. However, an increasing number of cutaneous manifestations associated with this disease have been reported. The aim of this study is to analyze the scientific literature on cutaneous manifestations associated with SARS-CoV-2 by means of a narrative literature review until June 2021. The search was conducted in the following electronic databases: Medline (PubMed), SciELO, and Cochrane Library Plus. The most common cutaneous manifestations in patients with COVID-19 are vesicular eruptions, petechial/purpuric rashes, acral lesions, liveoid lesions, urticarial rash, and maculopapular-erythematous rash. These manifestations may be the first presenting symptoms of SARS-CoV-2 infection, as is the case with acral lesions, vesicular eruptions, and urticaria. In relation to severity, the presence of liveoid lesions may be associated with a more severe course of the disease. Treatment used for dermatological lesions includes therapy with anticoagulants, corticosteroids, and antihistamines. Knowledge of the dermatologic manifestations associated with SARS-CoV-2 contributes to the diagnosis of COVID-19 in patients with skin lesions associated with respiratory symptoms or in asymptomatic patients. In addition, understanding the dermatologic lesions associated with COVID-19 could be useful to establish a personalized care plan.
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Affiliation(s)
- Diego Fernández-Lázaro
- Department of Cellular Biology, Histology and Pharmacology, Faculty of Health Sciences, University of Valladolid, Campus of Soria, 42004 Soria, Spain
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
| | - Manuel Garrosa
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Area of Histology, Faculty of Medicine, Institute of Neurosciences of Castile and Leon (INCYL), University of Valladolid, 47005 Valladolid, Spain
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22
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Mehta H, Handa S, Malhotra P, Patial M, Gupta S, Mukherjee A, Chatterjee D, Takkar A, Mahajan R. Erythema nodosum, zoster duplex and pityriasis rosea as possible cutaneous adverse effects of Oxford-AstraZeneca COVID-19 vaccine: report of three cases from India. J Eur Acad Dermatol Venereol 2021; 36:e16-e18. [PMID: 34547126 PMCID: PMC8657518 DOI: 10.1111/jdv.17678] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Patial
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gupta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Mukherjee
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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23
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Pratt M, Mahmood F, Kirchhof MG. Pharmacologic Treatment of Idiopathic Chilblains (Pernio): A Systematic Review. J Cutan Med Surg 2021; 25:530-542. [PMID: 33653127 PMCID: PMC8474327 DOI: 10.1177/1203475421995130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 12/23/2022]
Abstract
Idiopathic chilblains is a cold-induced inflammatory condition that causes significant morbidity. When preventative measures alone are inadequate, oral nifedipine is generally recommended as first-line pharmacologic therapy. Given the natural course of this spontaneously remitting/relapsing condition, controls are needed to critically appraise studies and determine the value of treatments. We report a systematic review of placebo-controlled or comparative therapeutic trials for the treatment of idiopathic chilblains. Our search of PubMed, Embase, and Cochrane databases, identified 11 studies that met our inclusion criteria for a combined study population n = 576. Therapies included nifedipine, pentoxifylline, tadalafil, topical glyceryl trinitrate (GTN), topical minoxidil, diltiazem, corticosteroids, and vitamin D. There was moderate evidence to support the use of nifedipine and pentoxifylline in the treatment of severe or refractory cases of idiopathic chilblains, while other therapies had inadequate evidence or nonsignificant results compared to placebo.
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Affiliation(s)
- Michelle Pratt
- Division of Dermatology, Department of Medicine, University of
Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Farhan Mahmood
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, K1H 8L1,
Ottawa, Ontario, Canada
| | - Mark G. Kirchhof
- Division of Dermatology, Department of Medicine, University of
Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, K1H 8L1,
Ottawa, Ontario, Canada
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24
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Herbst M, Diamanti E, Papageorgiou A, Jahn S. Toxische epidermale Nekrolyse (TEN) – durch, verstärkt durch oder parallel zu einer SARS-CoV-2-Infektion? AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1545-8708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ZusammenfassungDie Coronavirus-Pandemie ist auch im Alltag einer dermatologischen Praxis allgegenwärtig. Wir berichten über einen 55-jährigen Patienten, der sich mit einer toxisch-epidermalen Nekrolyse (TEN) vorstellte. Auf intensive Nachfrage ergab sich zunächst, dass er direkten Kontakt zu einer Person mit gesichertem Nachweis einer SARS-CoV-2-Infektion gehabt hatte, also K1-Kontakt war. Sein Corona-Test war zunächst jedoch 2-mal negativ. Dies veranlasste entsprechende Vorsichtsmaßnahmen bei der stationären Aufnahme des Patienten, die sich als richtig erwiesen, da der dritte PCR-Test nunmehr positiv war und die stattgehabte Infektion später in einem Antikörper-Test bei ihm und der Kontaktperson bestätigt wurde. Die TEN war möglicherweise durch Amoxicillin oder Metronidazol ausgelöst worden und wurde unter stationären Bedingungen erfolgreich mit hoch dosierten systemischen Steroiden und adäquater topischer Behandlung therapiert. Die Hauterkrankung heilte ad integrum ab.
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Affiliation(s)
| | | | | | - Sigbert Jahn
- Dermatologische Praxis Dr. Herbst und Kollegen, Darmstadt
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25
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Farinazzo E, Dianzani C, Zalaudek I, Conforti C, Grabbe S, Goldust M. Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes. Clin Cosmet Investig Dermatol 2021; 14:991-997. [PMID: 34385830 PMCID: PMC8354337 DOI: 10.2147/ccid.s325552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/24/2021] [Indexed: 01/01/2023]
Abstract
The incidence of coronavirus disease 2019 (COVID-19)-related skin manifestations has progressively grown, in parallel with the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. The available evidence indicates that cutaneous signs are heterogeneous and can be divided as follows: a) erythematous rashes, b) lesions of vascular origin, c) vesicular rashes, d) urticarial rashes, and e) acute generalized exanthematous pustulosis (AGEP), erythema multiforme (EM) and other polymorphic/atypical reactions. Most cutaneous manifestations appear simultaneously or after respiratory and/or systemic symptoms such as fever, even if rarely urticaria has been reported as the first sign of the disease. It has been proposed that erythematous and vesicular rashes, as well as urticaria, are the result of immunological activation against Sars-CoV-2, similarly to other viral exanthems; alternatively, reactivation or co-infection of herpesviruses and drug hypersensitivity represent possible etiologic diagnosis that has to be considered. Regarding lesions of vascular origin, ischemic ones are the result of systemic hypercoagulability established in severe infections, whereas chilblains seem to be linked to the type I-interferon massively produced to halt virus replication. AGEP is triggered by drugs, whereas EM could represent a delayed immune response to the virus or a hypersensitivity reaction to drugs elicited by the inflammatory process built to fight the infection. A further pathogenic hypothesis is that the virus, or its particles detected in the skin (particularly in endothelium and eccrine glands), could be responsible for certain skin reactions, including chilblains and EM. From the available data, it appears that chilblains are correlated with younger age and less severe disease, while ischemic manifestations occur in the elderly with severe infection. In conclusion, larger studies are needed to confirm the suggested pathogenetic mechanisms of COVID-19-related skin reactions and to determine the potential prognostic significance of each one.
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Affiliation(s)
- Eleonora Farinazzo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Caterina Dianzani
- Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Rome, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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26
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Bouabdella S, Benkaraache M, Almheirat Y, Zizi N, Dikhaye S. Erythema multiforme eruption due to SARS-COV 2: Case report. Ann Med Surg (Lond) 2021; 68:102591. [PMID: 34336192 PMCID: PMC8312051 DOI: 10.1016/j.amsu.2021.102591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction and importance: The COVID-19 is a global pandemic that is now responsible for more than 3 million deaths around the world. Its cutaneous manifestations in patients are being increasingly reported. This case brings additional data implementing the knowledge on the dermatological signs during COVID-19. Case presentation We report a new pattern with erythema multiforme (EM) lesions in a healthy patient with COVID-19 infection and no other medical background. Clinical discussion We are facing challenging times in Dermatology. New information and cutaneous manifestations possibly related to COVID‐19 are emerging every day. There are only a few case reports describing EM in patients with COVID-19. Conclusion We suggest that this EM might be another pattern of exanthem associated with COVID‐19 infection. Further studies are needed to evaluate whether these lesions are associated with the virus, the drug intake or any other conditions. The covid-19 is a global pandemic that is responsible for millions of deaths. •Cutaneous manifestations of COVID-19 are emerging every day. •Erythema multiforme is a new pattern of exanthem associated with COVID‐19 infection.
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Affiliation(s)
- Sara Bouabdella
- Department of Dermatology, Mohammed the VIth University Hospital of Oujda, Morocco
| | - Mounia Benkaraache
- Department of Dermatology, Mohammed the VIth University Hospital of Oujda, Morocco
| | - Yousef Almheirat
- Department of Dermatology, Mohammed the VIth University Hospital of Oujda, Morocco
| | - Nada Zizi
- Department of Dermatology, Mohammed the VIth University Hospital of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohamed the First University of Oujda, Morocco
| | - Siham Dikhaye
- Department of Dermatology, Mohammed the VIth University Hospital of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohamed the First University of Oujda, Morocco
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27
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Cutaneous Manifestations in SARS-CoV-2 Infection-A Series of Cases from the Largest Infectious Diseases Hospital in Western Romania. Healthcare (Basel) 2021; 9:healthcare9070800. [PMID: 34202233 PMCID: PMC8304390 DOI: 10.3390/healthcare9070800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: SARS-CoV-2 infection, which appeared as an isolated epidemic outbreak in December 2019, proved to be so contagious that, within 3 months, the WHO declared COVID-19 a pandemic. For one year (pre-vaccination period), the virus acted unhindered and was highly contagious, with a predominantly respiratory-oriented aggression. Although this lung damage, responsible for the more than 3,090,025 deaths, has provided sufficient data to facilitate the understanding of pathogenic mechanisms, other observation data, which meet the quality of emerging clinical aspects, such as rashes, remain without well-defined etiopathogenic support or a well-contoured clinical framework. (2) Methods and Results: We followed the occurrence of cutaneous manifestations in patients hospitalized during the second and third outbreak of SARS-CoV-2 in the main clinics of infectious diseases of our county, Timis, and recorded laboratory investigations and clinical evolution for five suggestive cases. (3) Conclusions: The presented cases, added to many other present and future clinical observations, will allow for better knowledge and understanding of SARS-CoV-2 infection, a requirement that has become a global priority for the entire medical and scientific community.
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Morris-Jones R. Cutaneous manifestations of infections: an update for general physicians. Clin Med (Lond) 2021; 21:174-176. [PMID: 34001567 DOI: 10.7861/clinmed.2021-0262] [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: 11/27/2022]
Abstract
Infection rashes can present in a number of different ways, some giving a reactive pattern in the skin to infection elsewhere in the body, while others reflect infection within the affected skin itself. Recognising the possible systemic symptoms, characteristic distribution and morphology of rashes can lead to a high degree of accuracy in making a clinical diagnosis in the clinic room/at the bedside that can be confirmed with a few simple laboratory tests.
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Yuen S. Dermatology services: The new normal post COVID-19. SKIN HEALTH AND DISEASE 2021; 1:e30. [PMID: 34235512 PMCID: PMC8250289 DOI: 10.1002/ski2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/04/2022]
Abstract
The article discusses the impact of COVID‐19 on the future of dermatology services. It will explore the changes dermatology services may need to follow to minimise disease transmission. This will include an integration of teledermatology into everyday practice, a shift in dermatology training, and change in dermoscopy technique.
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Affiliation(s)
- S Yuen
- Blizzard Institute Barts and The London School of Medicine and Dentistry London UK
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Ng SL, Ong YS, Khaw KY, Teh SP, Tan CS, Ming LC, Chan KG, Lee LH, Goh BH. Focused Review: Potential Rare and Atypical Symptoms as Indicator for Targeted COVID-19 Screening. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:189. [PMID: 33672384 PMCID: PMC7927030 DOI: 10.3390/medicina57020189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
The global pandemic of the coronavirus disease 2019 is a known consequence of infection of severe respiratory syndrome coronavirus-2 (SARS-CoV-2). It has affected nations worldwide with soaring number of cases daily. Symptoms such as fever, cough, and shortness of breath, diarrhea, nausea and vomiting are commonly presented in COVID-19 patients. This focused review aims to discuss these uncommon and atypical COVID-19 symptoms that may be presented which might affect neurological, cardiovascular, cutaneous and ocular systems and their possible mode of actions. Nonetheless, there are some cases of reported uncommon or atypical symptoms which may warrant healthcare professionals to be aware of, especially when in contact with patients. The knowledge and information concerning these symptoms might be able to provide additional cues for healthcare professional by subjecting patients to COVID-19 screening. Meanwhile, it might be able to further enhance the alertness and additional precautions being taken by healthcare personnel, which eventually lead to reduced risk of infections.
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Affiliation(s)
- Swee Li Ng
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Yong Sze Ong
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Kooi Yeong Khaw
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- Tropical Medicine & Biology Platform, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Siew Phooi Teh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310027, China
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia
| | - Long Chiau Ming
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
- International Genome Centre, Jiangsu University, Zhenjiang 212013, China
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
| | - Bey-Hing Goh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310027, China
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Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries. BIOLOGY 2021; 10:biology10010054. [PMID: 33451000 PMCID: PMC7828496 DOI: 10.3390/biology10010054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
The increasingly frequent cutaneous manifestations of coronavirus disease (COVID-19) remain to pose a problem to clinicians. Herein, we aimed to describe the clinical and pathological findings of skin lesions in patients with COVID-19. The case series, which was based on the International Dermatological Registry circulated to dermatologists worldwide, was conducted across organizations and societies belonging to five different countries. We documented 31 patients with dermatologic manifestations associated with COVID-19, including maculopapular rashes (16.10%), urticarial lesions (26.80%), pseudochilblains (22.60%), petechiae/purpura (6.50%), distal ischaemia and necrosis (6.50%), livedo racemosa (12.90%), and others (9.70%). Twenty-six cases (83.90%) were qRT-PCR-confirmed COVID-19 cases, two (6.50%) were serologically confirmed, while two others (9.7%) were suspected cases owing to previous contact with COVID-19-positive patients. Therefore, our findings indicate that a febrile rash or even a rash in an afebrile state in the early stages of the disease may be the only clinical manifestation of COVID-19. In the future, we recommend close monitoring of all patients with skin lesions not attributable to other causal factors; in the diagnostic perspective, clinicians should aim to confirm if the skin lesions are associated with COVID-19.
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