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Wettasinghe I, Puthra S, Sugathapala HA, Mendis S. Rapidly Progressive, Symmetrical, Acute Cutaneous Necrosis of Bilateral Lower Limbs: A Rare Presentation of Polyarteritis Nodosa. Cureus 2024; 16:e58649. [PMID: 38770516 PMCID: PMC11103124 DOI: 10.7759/cureus.58649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Acute cutaneous necrosis is a rare presentation of polyarteritis nodosa (PAN). In this study, we report a presentation with symmetrical cutaneous necrosis of the lower limbs, which ascended upward at a rapid rate. A 47-year-old man presented with a fever of one day and pain in the feet for six days. He had no history of claudication. Upon examination, he was febrile, and subtle bluish discoloration was observed on the sole of his foot. There was a bilateral stocking-type paresthesia up to the ankle joint. His blood pressure on admission was 210/120 mmHg. Eight hours later, the pain subsided, but a left-sided foot drop was noted along with the paresthesia extending up both feet to approximately 10 cm above the medial malleolus. The feet turned black, and dark discoloration spread rapidly upward over the next 16 hours, and the skin became necrosed. A clinical diagnosis of vasculitis was established, and the patient received IV methylprednisolone at a daily dosage of 1 g for three days, effectively stopping the advancement of necrosis. This was followed by treatment with IV cyclophosphamide. A conclusive diagnosis of PAN was made, and the patient underwent wound debridement. After three months of physiotherapy, a successful skin graft was performed. Prompt identification of the underlying etiology is crucial to prevent the advancement of necrosis and save the limbs. When vasculitis is suspected, ruling out infectious causes is essential before starting early immunosuppressive treatment.
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Affiliation(s)
| | - Shiran Puthra
- Internal Medicine, Colombo South Teaching Hospital, Colombo, LKA
| | | | - Suresh Mendis
- Internal Medicine, Colombo South Teaching Hospital, Colombo, LKA
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2
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Li Y, Han L, Li P, Ge J, Xue Y, Chen L. Potential network markers and signaling pathways for B cells of COVID-19 based on single-cell condition-specific networks. BMC Genomics 2023; 24:619. [PMID: 37853311 PMCID: PMC10583333 DOI: 10.1186/s12864-023-09719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
To explore the potential network markers and related signaling pathways of human B cells infected by COVID-19, we performed standardized integration and analysis of single-cell sequencing data to construct conditional cell-specific networks (CCSN) for each cell. Then the peripheral blood cells were clustered and annotated based on the conditional network degree matrix (CNDM) and gene expression matrix (GEM), respectively, and B cells were selected for further analysis. Besides, based on the CNDM of B cells, the hub genes and 'dark' genes (a gene has a significant difference between case and control samples not in a gene expression level but in a conditional network degree level) closely related to COVID-19 were revealed. Interestingly, some of the 'dark' genes and differential degree genes (DDGs) encoded key proteins in the JAK-STAT pathway, which had antiviral effects. The protein p21 encoded by the 'dark' gene CDKN1A was a key regulator for the COVID-19 infection-related signaling pathway. Elevated levels of proteins encoded by some DDGs were directly related to disease severity of patients with COVID-19. In short, the proteins encoded by 'dark' genes complement some missing links in COVID-19 and these signaling pathways played an important role in the growth and activation of B cells.
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Affiliation(s)
- Ying Li
- School of Mathematics and Statistics, Henan University of Science and Technology, Luoyang, 471023, China
- Longmen Laboratory, Luoyang, 471003, Henan, China
| | - Liqin Han
- School of Mathematics and Statistics, Henan University of Science and Technology, Luoyang, 471023, China
- Longmen Laboratory, Luoyang, 471003, Henan, China
| | - Peiluan Li
- School of Mathematics and Statistics, Henan University of Science and Technology, Luoyang, 471023, China.
- Longmen Laboratory, Luoyang, 471003, Henan, China.
| | - Jing Ge
- Shanghai Immune Therapy Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200032, China
| | - Yun Xue
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, 471023, China
| | - Luonan Chen
- Key Laboratory of Systems Biology, Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 201100, China.
- Key Laboratory of Systems Health Science of Zhejiang Province, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, 310000, China.
- School of Life Science and Technology, ShanghaiTech University, Shanghai, 201100, China.
- West China Biomedical Big Data Center, Med-X Center for Informatics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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3
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Tilak K, Joung K, Apath M. Evolving Skin Rash as a Rare Cutaneous Manifestation in a Pediatric Patient With COVID-19 Infection. Cureus 2022; 14:e26477. [PMID: 35919370 PMCID: PMC9339118 DOI: 10.7759/cureus.26477] [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: 06/30/2022] [Indexed: 11/28/2022] Open
Abstract
COVID-19 has been one of the common infections that have affected numerous children across the world in the last two years. The clinical manifestations of this virus are varied, ranging from being asymptomatic to affecting multiple organ systems. There is a lot of ongoing research to find out the different manifestations that this infection can have in both adults and children. As with any viral illness, skin is one of the most commonly affected organs, and many viral illnesses can present with a rash. In our case, we found it interesting that our patient who tested positive for COVID-19 had a rash that began on the day of her initial presentation and evolved over time as the disease progressed, and hence, we thought it was important to highlight this rare case presentation as a cutaneous finding in children with COVID-19 infection.
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Sperry B, Joseph J, Yglesias B. COVID-19-Induced Hypercoagulability: A Case Report. Cureus 2022; 14:e22155. [PMID: 35308749 PMCID: PMC8920298 DOI: 10.7759/cureus.22155] [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: 02/12/2022] [Indexed: 11/26/2022] Open
Abstract
We report a case of atherothrombotic microembolism in a 53-year-old male diagnosed with coronavirus disease 2019 (COVID-19) prior to hospital admission. Upon admission, Day 9 after diagnosis, he presented with COVID-19 pneumonia and mottling of the lower extremities. The patient was treated with anticoagulation therapy. The lower extremity angiogram showed a patent posterior tibial artery and a patent peroneal artery. Despite initial anticoagulation therapy, toe and transmetatarsal amputations were required. However, a below-the-knee amputation was subsequently required due to continued worsening and extension of mottling. Unfortunately, the patient ultimately expired from cardiopulmonary arrest before any other surgical intervention could be done.
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5
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Fitero A, Bungau SG, Tit DM, Endres L, Khan SA, Bungau AF, Romanul I, Vesa CM, Radu AF, Tarce AG, Bogdan MA, Nechifor AC, Negrut N. Comorbidities, Associated Diseases, and Risk Assessment in COVID-19-A Systematic Review. Int J Clin Pract 2022; 2022:1571826. [PMID: 36406478 PMCID: PMC9640235 DOI: 10.1155/2022/1571826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
It is considered that COVID-19's pandemic expansion is responsible for the particular increase in deaths, especially among the population with comorbidities. The health system is often overwhelmed by the large number of cases of patients addressing it, by the regional limitation of funds, and by the gravity of cases at subjects suffering from this pathology. Several associated conditions including diabetes, cardiovascular illnesses, obesity, persistent lung condition, neurodegenerative diseases, etc., increase the mortality risk and hospitalization of subjects suffering from COVID-19. The rapid identification of patients with increased risk of death from the SARS-CoV-2 virus, the stratification in accordance with the risk and the allocation of human, financial, and logistical resources in proportion must be a priority for health systems worldwide.
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Affiliation(s)
- Andreea Fitero
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Laura Endres
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Shamim Ahmad Khan
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | | | - Ioana Romanul
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Andrei-Flavius Radu
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | | | - Mihaela Alexandra Bogdan
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, Bucharest 011061, Romania
| | - Nicoleta Negrut
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
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Aslan A, Aslan C, Zolbanin NM, Jafari R. Acute respiratory distress syndrome in COVID-19: possible mechanisms and therapeutic management. Pneumonia (Nathan) 2021; 13:14. [PMID: 34872623 PMCID: PMC8647516 DOI: 10.1186/s41479-021-00092-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/20/2021] [Indexed: 02/07/2023] Open
Abstract
COVID-19 pandemic is a serious concern in the new era. Acute respiratory distress syndrome (ARDS), and lung failure are the main lung diseases in COVID-19 patients. Even though COVID-19 vaccinations are available now, there is still an urgent need to find potential treatments to ease the effects of COVID-19 on already sick patients. Multiple experimental drugs have been approved by the FDA with unknown efficacy and possible adverse effects. Probably the increasing number of studies worldwide examining the potential COVID-19 related therapies will help to identification of effective ARDS treatment. In this review article, we first provide a summary on immunopathology of ARDS next we will give an overview of management of patients with COVID-19 requiring intensive care unit (ICU), while focusing on the current treatment strategies being evaluated in the clinical trials in COVID-19-induced ARDS patients.
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Affiliation(s)
- Anolin Aslan
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
| | - Cynthia Aslan
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naime Majidi Zolbanin
- Experimental and Applied Pharmaceutical Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Reza Jafari
- Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Shafa St., Ershad Blvd., P.O. Box: 1138, Urmia, 57147, Iran. .,Hematology, Immune Cell Therapy, and Stem Cell Transplantation Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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Abstract
Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome-coronavirus-2 virus that led to a pandemic. Acute manifestations of COVID-19 include fever, cough, dyspnea, respiratory failure, pneumonitis, anosmia, thromboembolic events, cardiogenic shock, renal injury, ischemic strokes, encephalitis, and cutaneous eruptions, especially of hands or feet. Prolonged symptoms, unpredictable recoveries, and chronic sequelae (long COVID) sometimes emerge even for some people who survive the initial illness. Sequelae such as fatigue occasionally persist even for those with only mild to moderate cases. There is much to learn about postacute COVID-19 dyspnea, anosmia, psychosis, thyroiditis, cardiac arrhythmia, and/or multisystem inflammatory response syndrome in children. Determining prognoses is imprecise. Examining patient databases about those who have survived COVID-19 is warranted. Multidisciplinary teams are assessing such disease databases to better understand longer-term complications and guide treatment.
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Cutaneous manifestations of coronavirus disease 2019 - review of literature and case reports. Postepy Dermatol Alergol 2021; 38:943-947. [PMID: 35125998 PMCID: PMC8802969 DOI: 10.5114/ada.2020.95958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
Primary clinical manifestations of coronavirus disease are respiratory tract infections, ranging from an asymptomatic carrier state to severe interstitial pneumonia. The most common symptoms are fever, dry cough, fatigue, nausea, diarrhea, and loss of smell or taste. Recent reports indicate the possibility of several nonspecific dermatological symptoms. These include urticaria, maculopapular lesions, vascular lesions involving petechiae, purpura and livedo reticularis. The onset of cutaneous lesions may precede full-blown COVID-19 or remain the only manifestation of the disease (especially in young patients). Focusing on dermatological symptoms may be crucial for preventing the spread of SARS-CoV-2. However, unambiguous assessment of cutaneous manifestations of COVID-19 requires more research and case studies conducted by dermatologists.
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Kartikasari U, Djajalaksana S, Martini H. Acute limb ischemia in a patient with Covid-19 pneumonia: a case report. J Thromb Thrombolysis 2021; 52:974-979. [PMID: 33797021 PMCID: PMC8016154 DOI: 10.1007/s11239-021-02434-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has emerged as a pandemic across the world. Hypercoagulability status in COVID-19 is one of the causes of complication from severe COVID-19 with a high risk of arterial thrombosis. Acute Limb Ischemia is a vascular emergency caused by sudden decrease in the arterial perfusion. We report the case of a 53-year-old male patient with COVID-19 Pneumonia, diagnosed with Acute Limb Ischemia. From clinical examination, which included anamnesis, physical examination, and laboratory results as well as chest X-rays, a suspicion of Acute Limb Ischemia was found in a patient with COVID-19 pneumonia. The SARS-CoV-2 real time PCR examination showed positive results. In this patient, the diagnosis of Acute Limb Ischemia with Covid-19 Pneumonia was established through a multidisciplinary approach covering the fields of pulmonology, cardiology, and thoracic and cardiovascular surgery.
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Affiliation(s)
- Ulfah Kartikasari
- Dr Saiful Anwar General Hospital, Malang, Indonesia.
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Brawijaya University, Dr Saiful Anwar General Hospital, Malang, Indonesia.
| | - Susanthy Djajalaksana
- Dr Saiful Anwar General Hospital, Malang, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Brawijaya University, Dr Saiful Anwar General Hospital, Malang, Indonesia
| | - Heny Martini
- Dr Saiful Anwar General Hospital, Malang, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University, Dr Saiful Anwar General Hospital, Malang, Indonesia
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10
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Abstract
Many skin manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection reflect activation of cutaneous and systemic immune responses involving effector pathways of both the innate and adaptive arms of the immune system. This article reviews evidence from the recent clinical and scientific literature that informs the current understanding of the consequences of coronavirus disease 2019 (COVID-19)-induced immune cell activation, as relevant to dermatology. Topics include the clinical consequences of autoantibody production in patients with COVID-19, immunologic evidence for chilblains as a manifestation of SARS-CoV-2 infection, and the relationship between type I interferons and COVID-19 disease severity.
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Affiliation(s)
- Antonia E Gallman
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA; Medical Scientist Training Program, University of California, San Francisco, 513 Parnassus Avenue, Room HSE1001A, San Francisco, CA 94143, USA
| | - Marlys S Fassett
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA; Department of Dermatology, University of California, San Francisco, 513 Parnassus Avenue, Room HSE1001E, San Francisco, CA 94143, USA.
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11
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Abstract
Coronavirus disease 2019 (COVID-19), an emergent disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the globe since its discovery in December 2019. Although first appreciated to cause pneumonia, numerous organ systems are now known to be involved. The objective of this article is to review the broad spectrum of cutaneous manifestations reported in association with SARS-CoV-2 infection. The most commonly reported cutaneous manifestations associated with COVID-19 infection include pernio (chilblain)-like acral lesions, morbilliform (exanthematous) rash, urticaria, vesicular (varicella-like) eruptions, and vaso-occlusive lesions (livedo racemosa, retiform purpura). It is important to consider SARS-CoV-2 infection in the differential diagnosis of a patient presenting with these lesions in the appropriate clinical context, as cutaneous manifestations may be present in otherwise asymptomatic individuals, or present before developing other symptoms of infection. With increased access to diagnostic testing, we are beginning to understand the utility and limitations of currently available assays.
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Affiliation(s)
- Ritesh Agnihothri
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, 3rd Floor, San Francisco, CA 94115, USA
| | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, 3rd Floor, San Francisco, CA 94115, USA.
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13
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Schwartz RA, Lambert WC. COVID-19-specific skin changes related to SARS-CoV-2: Visualizing a monumental public health challenge. Clin Dermatol 2021; 39:374-379. [PMID: 34517995 PMCID: PMC7849605 DOI: 10.1016/j.clindermatol.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The novel coronavirus SARS-CoV-2 has caused coronavirus disease-2019, known as COVID-19, now a pandemic stressing millions of individuals worldwide. COVID-19 is a systemic respiratory infection that may have dermatologic signs and systemic sequelae, a devastating public health challenge with parallels to the two great influenza pandemics of the last century. Skin lesions linked with COVID-19 have been grouped into six categories, with three distinct indicative patterns: vesicular (varicella-like), vasculopathic, and chilblains-like (including “COVID toes” and “COVID fingers”) plus the following three less suggestive patterns: dermatitic, maculopapular, and urticarial morphologies. Vasculopathic changes are the most concerning, in some patients, reflecting a devastating blood clotting dysfunction. We discuss the ways to detect, prevent, and treat COVID-19, keeping in mind the context of possible cutaneous markers of COVID-19 to enhance detection.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, Pathology, Medicine, Pediatrics, Rutgers New Jersey Medical School, Medical Sciences Building H-576, 185 South Orange Avenue, Newark, New Jersey 07103, USA.
| | - W Clark Lambert
- Dermatology, Pathology, Medicine, Pediatrics, Rutgers New Jersey Medical School, Medical Sciences Building H-576, 185 South Orange Avenue, Newark, New Jersey 07103, USA
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Al Ali A, Al-Shidhani S, Al-Balushi F, Alhinai M, Al-Azri AR, Al Lawati SAL, Al Ghailani F, Al Riyami R. Cutaneous Manifestations of COVID-19: An Experience From Oman. Cureus 2021; 13:e16667. [PMID: 34513344 PMCID: PMC8412209 DOI: 10.7759/cureus.16667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: To identify the cutaneous manifestations in COVID-19 disease in Oman. Methods: The study was conducted in two phases with initial cross-sectional data collection with subsequent telemedical investigations of late skin manifestations including confirmed COVID-19 patients evaluated at Al-Nahdha Hospital and local health centers in Muscat from March 22 to June 2, 2020. Results: The total number of patients included in the study was 374. Cutaneous manifestations were observed in 1.87% (n=7) of patients at presentation with an additional 1.6% (n=5) on follow-up. The types of skin reactions included maculopapular rash (n=6), urticaria (n=2), transient pruritic erythema (n=1), pruritic palmoplantar erythema (n=1), pustular eruption (n=1) and flare-up of atopic dermatitis (n=1). Conclusions: The low percentage of skin lesions is not contradicting previous data and it might just reflect under-reporting of skin rash in the context of the presence of more severe symptoms in our sample population. Skin lesions can still be utilized to treat patients as suspected cases until proven otherwise as it can be a silent clue in asymptomatic patients.
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Affiliation(s)
| | | | | | - Mohammed Alhinai
- Internal Medicine, Gastroenterology, Al-Nahdha Hospital, Muscat, OMN
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Biswal JK, Mohanty SK, Behera SN, Swain SK, Sahoo AK. Acute Limb Ischemia: A Catastrophic COVID-19 Sequel Leading to Amputation. Cureus 2021; 13:e16456. [PMID: 34466301 PMCID: PMC8396422 DOI: 10.7759/cureus.16456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 12/13/2022] Open
Abstract
A positive-sense single-stranded ribonucleic acid (RNA) virus causes the novel coronavirus illness 2019 (COVID-19). COVID-19 symptoms range from mild to moderate to severe and very severe. Fever, cough, headache, anosmia, ageusia, body ache, and diarrhoea are mild to moderate grade symptoms, whereas systemic involvements (pneumonia, myocarditis, stroke, and other coagulation abnormalities) are more serious. Except for a few patients who have mild complaints of cough and shortness of breath, the majority of patients are recuperating entirely from the viral infection. Patients with severe to very severe illnesses experience significant lung damage and fibrosis. These are the patients who are more likely to experience extrapulmonary complications after COVID-19. The disease's aberrant presentation may be related to systemic involvement and a hypercoagulable condition with micro and macro-angiopathy. Acute limb ischemia is one of the symptoms of the hypercoagulable condition. Its presentation can be in the form of chilblains, bullae, acral cyanosis, bruising, blood blisters, dry gangrene, or life-threatening acute limb ischemia. Unfortunately, most patients have to undergo amputation due to a delay in presentation or rapidly progressing disease. Here we present a case series of two COVID-19 infected patients who were initially discharged from the hospital after proper treatment but developed acute limb ischemia within the home isolation period and their treatment strategy.
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Affiliation(s)
| | | | | | | | - Ashok Kumar Sahoo
- Surgery, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND.,Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
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16
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Sarkar R, Bhargava S, Mendiratta V. Virology and Etiopathogenesis of COVID-19 with Special Reference to Cutaneous Implications. Indian J Dermatol 2021; 66:231-236. [PMID: 34446945 PMCID: PMC8375542 DOI: 10.4103/ijd.ijd_467_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning “crown.” It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India
| | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Vibhu Mendiratta
- Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India
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Ekholm M, Kahan T. The Impact of the Renin-Angiotensin-Aldosterone System on Inflammation, Coagulation, and Atherothrombotic Complications, and to Aggravated COVID-19. Front Pharmacol 2021; 12:640185. [PMID: 34220496 PMCID: PMC8245685 DOI: 10.3389/fphar.2021.640185] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/07/2021] [Indexed: 12/20/2022] Open
Abstract
Atherosclerosis is considered a disease caused by a chronic inflammation, associated with endothelial dysfunction, and several mediators of inflammation are up-regulated in subjects with atherosclerotic disease. Healthy, intact endothelium exhibits an antithrombotic, protective surface between the vascular lumen and vascular smooth muscle cells in the vessel wall. Oxidative stress is an imbalance between anti- and prooxidants, with a subsequent increase of reactive oxygen species, leading to tissue damage. The renin-angiotensin-aldosterone system is of vital importance in the pathobiology of vascular disease. Convincing data indicate that angiotensin II accelerates hypertension and augments the production of reactive oxygen species. This leads to the generation of a proinflammatory phenotype in human endothelial and vascular smooth muscle cells by the up-regulation of adhesion molecules, chemokines and cytokines. In addition, angiotensin II also seems to increase thrombin generation, possibly via a direct impact on tissue factor. However, the mechanism of cross-talk between inflammation and haemostasis can also contribute to prothrombotic states in inflammatory environments. Thus, blocking of the renin-angiotensin-aldosterone system might be an approach to reduce both inflammatory and thrombotic complications in high-risk patients. During COVID-19, the renin-angiotensin-aldosterone system may be activated. The levels of angiotensin II could contribute to the ongoing inflammation, which might result in a cytokine storm, a complication that significantly impairs prognosis. At the outbreak of COVID-19 concerns were raised about the use of angiotensin converting enzyme inhibitors and angiotensin receptor blocker drugs in patients with COVID-19 and hypertension or other cardiovascular comorbidities. However, the present evidence is in favor of continuing to use of these drugs. Based on experimental evidence, blocking the renin-angiotensin-aldosterone system might even exert a potentially protective influence in the setting of COVID-19.
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Affiliation(s)
- M Ekholm
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - T Kahan
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
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18
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Abstract
Immune-related manifestations are increasingly recognized conditions in patients with COVID-19, with around 3,000 cases reported worldwide comprising more than 70 different systemic and organ-specific disorders. Although the inflammation caused by SARS-CoV-2 infection is predominantly centred on the respiratory system, some patients can develop an abnormal inflammatory reaction involving extrapulmonary tissues. The signs and symptoms associated with this excessive immune response are very diverse and can resemble some autoimmune or inflammatory diseases, with the clinical phenotype that is seemingly influenced by epidemiological factors such as age, sex or ethnicity. The severity of the manifestations is also very varied, ranging from benign and self-limiting features to life-threatening systemic syndromes. Little is known about the pathogenesis of these manifestations, and some tend to emerge within the first 2 weeks of SARS-CoV-2 infection, whereas others tend to appear in a late post-infectious stage or even in asymptomatic patients. As the body of evidence comprises predominantly case series and uncontrolled studies, diagnostic and therapeutic decision-making is unsurprisingly often based on the scarcely reported experience and expert opinion. Additional studies are required to learn about the mechanisms involved in the development of these manifestations and apply that knowledge to achieve early diagnosis and the most suitable therapy.
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19
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Fernandez-Nieto D, Hammerle J, Fernandez-Escribano M, Moreno-Del Real CM, Garcia-Abellas P, Carretero-Barrio I, Solano-Solares E, de-la-Hoz-Caballer B, Jimenez-Cauhe J, Ortega-Quijano D, Fernandez-Guarino M. Skin manifestations of the BNT162b2 mRNA COVID-19 vaccine in healthcare workers. 'COVID-arm': a clinical and histological characterization. J Eur Acad Dermatol Venereol 2021; 35:e425-e427. [PMID: 33783873 PMCID: PMC8251500 DOI: 10.1111/jdv.17250] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- D Fernandez-Nieto
- Dermatology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - J Hammerle
- Occupational Health Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - M Fernandez-Escribano
- Occupational Health Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - C M Moreno-Del Real
- Pathology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - P Garcia-Abellas
- Pathology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - I Carretero-Barrio
- Pathology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - E Solano-Solares
- Alergology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - B de-la-Hoz-Caballer
- Alergology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - J Jimenez-Cauhe
- Dermatology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - D Ortega-Quijano
- Dermatology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
| | - M Fernandez-Guarino
- Dermatology Department, Ramon y Cajal University Hospital, Instituto de investigación Sanitaria del Hospital Ramón y Cajal (Irycis), Madrid, Spain
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20
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Ingravallo G, Mazzotta F, Resta L, Sablone S, Cazzato G, Cimmino A, Rossi R, Colagrande A, Ferrante B, Troccoli T, Bonifazi E. Inflammatory Skin Lesions in Three SARS-CoV-2 Swab-Negative Adolescents: A Possible COVID-19 Sneaky Manifestation? Pediatr Rep 2021; 13:181-188. [PMID: 33918585 PMCID: PMC8167710 DOI: 10.3390/pediatric13020025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with various clinical manifestations, including skin lesions. In particular, during the COVID-19 pandemic lock-down period numerous chilblain-like lesions, mainly located on the feet, were observed in adolescents. The latter were often asymptomatic or associated with very mild respiratory symptoms. Here, we report three cases of acral nodular lesions in SARS-CoV-2 swab-negative adolescents with histological findings of chronic immune-mediated inflammation and immunohistochemical evidence of SARS-CoV-2 spike glycoproteins in endothelial cells and eccrine sweat glands. In one of these cases, the virus presence was confirmed by electron microscopy.
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Affiliation(s)
- Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari Aldo Moro, 11, 70124 Bari, Italy; (L.R.); (G.C.); (A.C.); (R.R.); (A.C.)
- Correspondence:
| | - Francesco Mazzotta
- Pediatric Dermatology and Surgery Outpatients Department, Azienda Sanitaria Locale Barletta-Andria-Trani, 76123 Andria, Italy; (F.M.); (B.F.); (T.T.)
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari Aldo Moro, 11, 70124 Bari, Italy; (L.R.); (G.C.); (A.C.); (R.R.); (A.C.)
| | - Sara Sablone
- Section of Forensic Medicine, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari Aldo Moro, 11, 70124 Bari, Italy; (L.R.); (G.C.); (A.C.); (R.R.); (A.C.)
| | - Antonietta Cimmino
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari Aldo Moro, 11, 70124 Bari, Italy; (L.R.); (G.C.); (A.C.); (R.R.); (A.C.)
| | - Roberta Rossi
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari Aldo Moro, 11, 70124 Bari, Italy; (L.R.); (G.C.); (A.C.); (R.R.); (A.C.)
| | - Anna Colagrande
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari Aldo Moro, 11, 70124 Bari, Italy; (L.R.); (G.C.); (A.C.); (R.R.); (A.C.)
| | - Beniamino Ferrante
- Pediatric Dermatology and Surgery Outpatients Department, Azienda Sanitaria Locale Barletta-Andria-Trani, 76123 Andria, Italy; (F.M.); (B.F.); (T.T.)
| | - Teresa Troccoli
- Pediatric Dermatology and Surgery Outpatients Department, Azienda Sanitaria Locale Barletta-Andria-Trani, 76123 Andria, Italy; (F.M.); (B.F.); (T.T.)
| | - Ernesto Bonifazi
- Pediatric Dermatology, University of Bari Aldo Moro, 11, 70124 Bari, Italy;
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21
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McGonagle D, Bridgewood C, Ramanan AV, Meaney JFM, Watad A. COVID-19 vasculitis and novel vasculitis mimics. LANCET RHEUMATOLOGY 2021; 3:e224-e233. [PMID: 33521655 PMCID: PMC7832717 DOI: 10.1016/s2665-9913(20)30420-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COVID-19 has been occasionally linked to histologically confirmed cutaneous vasculitis and a Kawasaki-like vasculitis, with these entities generally having minimal or no lung involvement and a good prognosis. Unlike these vasculitis types, patients with severe COVID-19 pneumonia can develop cutaneous vasculitis-like lesions and systemic arterial and venous thromboemboli, including cryptogenic strokes and other vasculopathy features. Proposed underlying mechanisms for these severe manifestations have encompassed immune dysregulation, including an anti-phospholipid syndrome-like state, complement activation, viral dissemination with direct systemic endothelial infection, viral RNAaemia with immunothrombosis, clotting pathway activation mediated by hypoxaemia, and immobility. In this Viewpoint, we highlight how imaging and post-mortem findings from patients with COVID-19 indicate a novel thrombosis in the pulmonary venous territory distal to the alveolar capillary bed, a territory that normally acts as a clot filtration system, which might represent an unappreciated nidus for systemic microembolism. Additionally, we suggest that this mechanism represents a novel vasculitis mimic related to COVID-19 that might lead to cryptogenic strokes across multivessel territories, acute kidney injury with haematuria, a skin vasculitis mimic, intestinal ischaemia, and other organ ischaemic manifestations. This finding is supported by pathological reports of extensive pulmonary venular thrombosis and peripheral organ thrombosis with pauci-immune cellular infiltrates. Therefore, severe COVID-19 pneumonia with extensive pulmonary intravascular coagulopathy might help to explain the numerous systemic complications of COVID-19, in which the demonstration of direct organ infection has not adequately explained the pathology.
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Affiliation(s)
- Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals, Leeds, UK
| | - Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust and Bristol Medical School, University of Bristol, Bristol, UK
| | - James F M Meaney
- Department of Radiology, St James Hospital and The Thomas Mitchell Centre for Advanced Medical Imaging, Trinity College Dublin, Dublin, Ireland
| | - Abdulla Watad
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Department of Medicine B, Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Khattab K, Kempa AT, Atas R, Asani H, Ehab A. Peripheral ischemic limb necrosis (Acro-ischemia) associated with severe COVID-19 patients (COVID-19 limbs): A report of three cases. Lung India 2021; 38:S58-S60. [PMID: 33686981 PMCID: PMC8104337 DOI: 10.4103/lungindia.lungindia_470_20] [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] [Indexed: 01/05/2023] Open
Abstract
The association between severe coronavirus disease 2019 and hypercoagulable state was observed in many reports. This may be explained by the presence of hypoxia, severe systemic inflammatory response, immobilization due to intensive care unit (ICU) admission, and diffuse intravascular coagulation. We report three patients who were admitted to our respiratory ICU with acute severe respiratory distress syndrome (ARDS) requiring mechanical ventilation due severe acute respiratory syndrome coronavirus 2 infection, who developed severe limb ischemia during the course of the disease.
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Affiliation(s)
- Khaled Khattab
- Department of Pulmonary and Critical Care Medicine, Lowenstein Lung Center, Lowenstein, Germany
| | - Axel Tobias Kempa
- Department of Pulmonary and Critical Care Medicine, Lowenstein Lung Center, Lowenstein, Germany
| | - Riza Atas
- Department of Pulmonary and Critical Care Medicine, Lowenstein Lung Center, Lowenstein, Germany
| | - Harun Asani
- Department of Pulmonary and Critical Care Medicine, Lowenstein Lung Center, Lowenstein, Germany
| | - Ahmed Ehab
- Department of Pulmonary and Critical Care Medicine, Lowenstein Lung Center, Lowenstein, Germany; Department of Pulmonary Medicine, Mansoura University, Egypt
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23
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Baeck M, Herman A. COVID toes: where do we stand with the current evidence? Int J Infect Dis 2021; 102:53-55. [PMID: 33075530 PMCID: PMC7566763 DOI: 10.1016/j.ijid.2020.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Numerous of cases of chilblains have been observed, mainly in young subjects with no or mild symptoms compatible with COVID-19. The pathophysiology of these lesions is still widely debated and an association with SARS-CoV-2 infection remains unconfirmed. OBJECTIVES This paper focus on the unresolved issues about these COVID toes and in particular whether or not they are associated with COVID-19. ARGUMENTS The temporal link between the outbreak of chilblains and the COVID-19 pandemic is a first suggests a link between the two events. Positive anti-SARS-CoV/SARS-CoV-2 immunostaining on skin biopsy of chilblains seem to confirm the presence of the virus in the lesions, but lack specificity and must be interpreted with caution. Conversely, RT-PCR and anti-SARS-CoV-2 serology were negative in the majority of patients with chilblains. Therefore, SARS-CoV-2 infection can be excluded, with relative certainty, even after accounting for possible lower immunization in mild/asymptomatic patients and for some differences in sensitivity/specificity between the tests used. Some authors hypothesize that chilblains could be the cutaneous expression of a strong type I interferon (IFN-I) response. High production of IFN-I is suggested to be associated with early viral control and may suppress antibody response. However, the absence of other cutaneous or extracutaneous symptoms as observed in other interferonopathies raises unanswered questions. To date, a direct link between chilblains and COVID-19 still seems impossible to confirm. A more indirect association due to lifestyle changes induced by lockdown is a possible explanation. Improvement of chilblains when protective measures were adopted and after lifting of lockdown, support this hypothesis. CONCLUSION Conflicting current evidence highlights the need for systematic and repeated testing of larger numbers of patients and the need for valid follow-up data that take into consideration epidemic curves and evolution of lockdown measures.
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Affiliation(s)
- Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Anne Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
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24
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Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study. Biosci Rep 2020; 40:226985. [PMID: 33201172 PMCID: PMC7724688 DOI: 10.1042/bsr20203455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to simultaneously assess several potential predictors of outcome (co-morbidity, previous and in-hospital treatment, radiologic Brixia score) in patients with COVID-19. This retrospective cohort study included 258 consecutive patients with confirmed COVID-19 admitted to a medical ward at Montichiari Hospital, Brescia, Italy from February 28th to April 30rd, 2020. Patients had SARS-CoV-2 related pneumonia with respiratory failure, and were treated with hydroxychloroquine and lopinavir plus ritonavir. In some patients, additional treatment with tocilizumab, dexamethasone and enoxaparin was adopted. Outcomes (death or recovery) were assessed at the end of the discharge period or at the end of the follow-up (August 2020). During hospitalization, 59 patients died, while 6 died after discharge. The following variables were demonstrated to be associated with a worse prognosis: Radiologic Brixia score higher than 8, presence at baseline of hypertension, diabetes, chronic obstructive pulmonary disease, heart disease, cancer, previous treatment with ACE-inhibitors or anti-platelet drugs. Anticoagulant treatment during hospital admission with enoxaparin at a dose higher than 4000 U once daily was associated with a better prognosis. In conclusion, our study demonstrates that some co-morbidities and cardiovascular risk factors may affect prognosis. The radiologic Brixia score may be a useful tool to stratify the risk of death at baseline. Anticoagulant treatment with enoxaparin might be associated to a clinical benefit in terms of survival in patients with COVID-19.
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25
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Eslamifar Z, Behzadifard M, Soleimani M, Behzadifard S. Coagulation abnormalities in SARS-CoV-2 infection: overexpression tissue factor. Thromb J 2020; 18:38. [PMID: 33323111 PMCID: PMC7737414 DOI: 10.1186/s12959-020-00250-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022] Open
Abstract
Among the pathways and mediators that may be dysregulated in COVID-19 infection, there are proinflammatory cytokines, lymphocyte apoptosis, and the coagulation cascade. Venous and arterial thromboembolisms also are frequent in COVID-19 patients with the increased risk of some life-threatening complications such as pulmonary embolism, myocardial infarction, and ischemic stroke. In this regard, overproduction of proinflammatory cytokines such as IL-6, IL-1β, and TNF-α induce cytokine storms, increase the risk of clot formation, platelet activation, and multiorgan failure that may eventually lead to death among these patients. Surface S protein of SARS-CoV-2 binds to its target transmembrane receptor, named as angiotensin converting enzyme 2 (ACE2(, on various cells such as lymphocyte, alveolar cells, monocytes/macrophages, and platelets. Notably, the activation of the coagulation cascade occurs through tissue factor (TF)/FVIIa-initiated hemostasis. Accordingly, TF plays the major role in the activation of coagulation system during viral infection. In viral infections, the related coagulopathy multiple factors such as inflammatory cytokines and viral specific TLRs are involved, which consequently induce TF expression aberrantly. SARS-COV-2 may directly infect monocytes/ macrophages. In addition, TF expression/release from these cells may play a critical role in the development of COVID-19 coagulopathy. In this regard, the use of TF- VIIa complex inhibitor may reduce the cytokine storm and mortality among COVID-19 patients.
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Affiliation(s)
| | | | - Masoud Soleimani
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Saba Behzadifard
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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26
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Ciechanowicz P, Lewandowski K, Szymańska E, Kaniewska M, Rydzewska GM, Walecka I. Skin and gastrointestinal symptoms in COVID-19. PRZEGLAD GASTROENTEROLOGICZNY 2020; 15:301-308. [PMID: 33777269 PMCID: PMC7988824 DOI: 10.5114/pg.2020.101558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The first cases of coronavirus disease 2019 (COVID-19) were noted in December 2019 in Wuhan province, China. The World Health Organisation (WHO) announced the pandemic status on March 11, 2020. The manifestations of the disease are as follows: fever, cough, fatigue, anosmia and ageusia, dyspnoea, chest pain, muscle soreness, chills, sore throat, rhinitis, headache, gastrointestinal (GI) symptoms, and dermal lesions. AIM To evaluate the relationship between dermal lesions and GI symptoms in a group of COVID-19 patients. MATERIAL AND METHODS A group of 441 COVID-19 patients admitted to the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw between March 15th and June 15th, 2020. RESULTS Of 441 patients with confirmed SARS-CoV-2 infection, 255 (58.5%) experienced gastrointestinal (GI) symptoms: lack of appetite was reported in 124 (48.6%) cases, diarrhoea was noted in 109 (42.7%), abdominal pain in 95 (37.3%), vomiting in 37 (14.5%), and nausea in 32 (12.5%) cases. Eight (1.81%) patients had dermal lesions: erythematous macular lesions (2 patients - 25%), erythematous infiltrated lesions (2; 25%), erythematous infiltrated and exfoliative lesions (3; 37.5%), erythematous papular lesions (3; 37.5%), and erythematous oedematous lesions (2; 25%). All of those patients reported gastrointestinal symptoms during the hospitalisation. CONCLUSIONS The following study analyses possible causes of dermal lesions and their coexistence with GI symptoms. Several possible theories were taken into account, including the microbiota alterations and issue of drug-related complications.
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Affiliation(s)
- Piotr Ciechanowicz
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Konrad Lewandowski
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Elżbieta Szymańska
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Magdalena Kaniewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Grażyna M. Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Irena Walecka
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
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27
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Gąsecka A, Filipiak KJ, Jaguszewski MJ. Impaired microcirculation function in COVID-19 and implications for potential therapies. Cardiol J 2020; 27:485-488. [PMID: 33165898 DOI: 10.5603/cj.2020.0154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Aleksandra Gąsecka
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland.
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28
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de Lorenzo Alvarez A, Revilla Á, Corbalán T, Villar A, Espinel L, Martins J, Cubas A. Ischemic stroke and purpuric dermatitis as COVID-19-related complications in a peritoneal dialysis patient. CEN Case Rep 2020; 10:250-254. [PMID: 33205335 PMCID: PMC7671569 DOI: 10.1007/s13730-020-00553-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/31/2020] [Indexed: 12/18/2022] Open
Abstract
Patients on dialysis may have an elevated risk of severe coronavirus disease 2019 (COVID-19) and its complications due to their high prevalence of comorbidities. Here we describe the case of an 80-year-old male undergoing peritoneal dialysis with a moderate SARS-CoV-2 infection who developed a purpuric dermatitis and ischemic stroke after successful recovery from his bilateral pneumonia. Erythemato-papular lesions affecting trunk and lower limbs appeared 17 days after the onset of SARS-CoV-2 symptoms. These kind of lesions are an infrequent cutaneous manifestation of COVID-19. The pathology revealed a moderate purpuric dermatitis affecting superficial dermis and corticoesteroids were prescribed achieving complete resolution. Arterial thrombosis affecting cerebellar vermis emerged 30 days after the onset of COVID-19 symptoms. It occurred 5 days after withdrawal of antithrombotic prophylaxis that the patient received from his admission until 2 weeks after discharge. He completely recovered from his paresis and continued on his regular antiaggregation therapy. This is the first case report published of a patient with PD with such COVID-19-related complications. More experience is needed to determine the appropriate length of antithrombotic prophylaxis especially in high-risk individuals.
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Affiliation(s)
- Alberto de Lorenzo Alvarez
- Department of Nephrology, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, Getafe, 28905, Madrid, Spain.
| | | | - Teresa Corbalán
- Department of Radiology, Hospital Universitario de Getafe, Madrid, Spain
| | - Ana Villar
- Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain
| | - Laura Espinel
- Department of Nephrology, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, Getafe, 28905, Madrid, Spain
| | - Judith Martins
- Department of Nephrology, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, Getafe, 28905, Madrid, Spain
| | - Alfonso Cubas
- Department of Nephrology, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, Getafe, 28905, Madrid, Spain
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29
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Keihanian F, Bigdelu L. Cardiovascular Considerations in COVID19: A Comprehensive Review. Ther Clin Risk Manag 2020; 16:1089-1097. [PMID: 33204097 PMCID: PMC7667183 DOI: 10.2147/tcrm.s264377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID19) is spreading rapidly and there is now much concern regarding different aspects of public health. Underlying disorders like cardiovascular diseases can increase the mortality rate. Understanding cardiovascular complications, manifestations and management in COVID19 is a necessary need. In this comprehensive review, we evaluated different aspects of cardiovascular disorders or complications related to COVID19 infection.
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Affiliation(s)
- Faeze Keihanian
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Bigdelu
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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30
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Herman A, Peeters C, Verroken A, Tromme I, Tennstedt D, Marot L, Dachelet C, Gruson D, Hermans C, Baeck M. Evaluation of Chilblains as a Manifestation of the COVID-19 Pandemic. JAMA Dermatol 2020; 156:998-1003. [PMID: 32584377 DOI: 10.1001/jamadermatol.2020.2368] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance During the coronavirus disease 2019 (COVID-19) pandemic, several cases of chilblains have been reported. Objective To determine if chilblains are associated with COVID-19. Design, Setting, and Participants This monocentric case series was conducted at the Department of Dermatology at Cliniques universitaires Saint-Luc, a tertiary care hospital in Brussels, Belgium, between April 10 and April 17, 2020. We evaluated a total of 31 referred patients who had recently developed chilblains. Main Outcomes and Measures Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on nasopharyngeal swabs for all patients and in skin biopsy specimens for 22 patients. Blood samples from all patients were tested for specific anti-SARS-CoV-2 immunoglobulin (Ig) M and IgG antibodies. All patients had extended blood analyses. Histologic (22 patients) and immunofluorescence examinations (15 patients) were performed on the skin biopsy specimens. Results The 31 patients were generally in good health; most were teenagers or young adults, and 19 were women. Histopathologic analysis of skin biopsy specimens (22 patients) confirmed the diagnosis of chilblains and showed occasional lymphocytic or microthrombotic phenomena. Immunofluorescence analyses showed vasculitis of small-diameter vessels in 7 patients. In all patients, SARS-CoV-2 RNA remained undetected by RT-PCR on nasopharyngeal swabs and in biopsy samples of the skin lesions. The IgM and IgG antibody titers were negative for SARS-CoV-2 in all patients (<1.0 arbitrary unit/mL). No significant abnormalities in blood test results were suggestive of systemic disease. Antinuclear antibody titers were low in 7 patients and higher in 1 patient. Conclusions and Relevance Chilblains appeared not to be directly associated with COVID-19 in this case series. Lifestyle changes associated with community containment and lockdown measures are a possible explanation for these lesions.
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Affiliation(s)
- Anne Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pneumology, ENT, and Dermatology Pole, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Caroline Peeters
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Alexia Verroken
- Department of Laboratory Medicine, Division of Microbiology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Isabelle Tromme
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Dominique Tennstedt
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Liliane Marot
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Department of Anatomopathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Claire Dachelet
- Department of Anatomopathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Division of Clinical Biochemistry, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Cedric Hermans
- Department of Internal Medicine, Division of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pneumology, ENT, and Dermatology Pole, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
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Sameni F, Hajikhani B, Yaslianifard S, Goudarzi M, Owlia P, Nasiri MJ, Shokouhi S, Bakhtiyari M, Dadashi M. COVID-19 and Skin Manifestations: An Overview of Case Reports/Case Series and Meta-Analysis of Prevalence Studies. Front Med (Lausanne) 2020; 7:573188. [PMID: 33224961 PMCID: PMC7668416 DOI: 10.3389/fmed.2020.573188] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
Background and Aim: Since the onset of the 2019-nCoV disease (COVID-19), many skin manifestations have been reported in COVID-19 patients. This study aims to provide a systematic review and meta-analysis of various skin manifestations among patients with COVID-19 through case reports/case series and prevalence studies. Methods: A systematic literature search strategy was conducted by reviewing original research articles published in Medline, Web of Science, and Embase databases in 2020. Statistical analysis was performed using STATA software, version 14.0 (Stata Corporation, College Station, Texas, USA) to report the global prevalence of skin manifestations among patients with COVID-19. Results: Forty-three studies (35 articles were case reports/case series, and 8 articles were prevalence studies) were included in our study. A meta-analysis of prevalence studies showed that skin manifestations among patients with COVID-19 were reported in four countries (China, Thailand, France, and Italy), with an overall prevalence of 1.0% [(95% CI) 0.1-1.9] among 2,621 patients. Evaluation of the results of the case reports/case series revealed that, out of 54 patients with COVID-19, 48 patients (88.8%) showed skin manifestations. Erythematous rash (59.1%) and urticaria (14.8%) were the most common skin manifestation reported in studied patients. Conclusion: Infection with 2019-nCoV may lead to skin manifestations with various clinical symptoms. These clinical features combined with clinical symptoms of COVID-19 may aid in the timely diagnosis of patients with COVID-19.
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Affiliation(s)
- Fatemeh Sameni
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Yaslianifard
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parviz Owlia
- Molecular Microbiology Research Center, Shahed University, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shokouhi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Bakhtiyari
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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32
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Docampo-Simón A, Sánchez-Pujol MJ, Gimeno-Gascon A, Palazón-Cabanes JC, Juan-Carpena G, Vergara-De Caso E, González-Villanueva I, Blanes-Martínez M, Betlloch-Mas I. No SARS-CoV-2 antibody response in 25 patients with pseudo-chilblains. Dermatol Ther 2020; 33:e14332. [PMID: 32975345 PMCID: PMC7536931 DOI: 10.1111/dth.14332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 01/23/2023]
Abstract
Chilblain‐like acral lesions have been identified in some coronavirus disease 2019 (COVID‐19) patients. It has been suggested that these pseudo‐chilblains could be a specific marker of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Most patients with these lesions have had negative polymerase chain reactions (PCRs), but some authors believe serology tests are likely to give positive results. We designed a prospective study including all patients with pseudo‐chilblains treated in outpatient department in April and May 2020 and then performed SARS‐CoV‐2 PCR and serology tests on all available patients. We evaluated 59 patients, of whom 17 had undergone PCR before the study period, all with negative results. For the present study, we performed 20 additional PCRs, serology tests in 25 patients, and a parvovirus B19 antibody test in 15 patients. All results were negative. Our findings counter the hypothesis that serology is likely to reveal SARS‐CoV‐2 infection in patients with pseudo‐chilblains. One hypothesis for our negative results is that the time period between symptom onset and antibody production is longer in these patients; another is that the lesions are caused by behavioral changes during lockdown rather than SARS‐CoV‐2 infection. We nevertheless maintain that COVID‐19 should be ruled out in people presenting with chilblain‐like lesions.
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Affiliation(s)
- Alexandre Docampo-Simón
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María José Sánchez-Pujol
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Juan Carlos Palazón-Cabanes
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Gloria Juan-Carpena
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Eduardo Vergara-De Caso
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Iris González-Villanueva
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mar Blanes-Martínez
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Isabel Betlloch-Mas
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain.,Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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33
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Marraha F, Al Faker I, Gallouj S. A Review of the Dermatological Manifestations of Coronavirus Disease 2019 (COVID-19). Dermatol Res Pract 2020; 2020:9360476. [PMID: 32849867 PMCID: PMC7422480 DOI: 10.1155/2020/9360476] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected 210 countries and territories around the world. The virus has spread rapidly, and the disease is still extending up to now. The pathophysiology for SARS-CoV-2 has not been well elucidated, and diverse hypotheses to date have been proposed. Initially, no skin manifestations were observed among patients with COVID-19, but recently a few cases have been described. In this review, we discuss these various cutaneous manifestations and skin problems related to personal protective equipment, as well as different cutaneous anti-COVID-19 drug-associated reactions. We also focus on the currently proposed managements of these rare manifestations.
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Affiliation(s)
- Farah Marraha
- Department of Dermatology, University Hospital Center of Tangier, Tetouan, Al Hoceima, Morocco
- Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Ibtissam Al Faker
- Department of Dermatology, University Hospital Center of Tangier, Tetouan, Al Hoceima, Morocco
- Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Salim Gallouj
- Department of Dermatology, University Hospital Center of Tangier, Tetouan, Al Hoceima, Morocco
- Faculty of Medicine and Pharmacy Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Vidali S, Morosetti D, Cossu E, Luisi MLE, Pancani S, Semeraro V, Consales G. D-dimer as an indicator of prognosis in SARS-CoV-2 infection: a systematic review. ERJ Open Res 2020; 6:00260-2020. [PMID: 32685436 PMCID: PMC7357271 DOI: 10.1183/23120541.00260-2020] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulates pro-thrombotic changes. This, combined with its tropism for endothelium and lung structures, may explain its association with thrombotic events, reduction of pulmonary gas exchange, acute respiratory distress syndrome (ARDS) and a composite end-point (intensive care unit, invasive ventilation, death). This study aims to highlight the correlation between elevated D-dimer (an indirect thrombosis marker) and the increased rate of poor prognosis-associated conditions, and to introduce D-dimer-labelled anticoagulant administration as a potentially useful tool to prevent complications and positively influence coronavirus disease 2019 (COVID-19) course. Methods An online database search (PubMed, Google Scholar, Scopus, Web of Science and Cochrane) was performed between 13 March and 10 April 2020. The most relevant keywords were "D-dimer", "SARS-CoV-2", "COVID-19", "thrombosis" and "ARDS". Selection was independently conducted by three reviewers. References and previews of accepted articles were evaluated. Data inclusion/extraction inaccuracy was limited by the work of three reviewers. Selection bias reduction was addressed by thoughtfully designing the search protocol. Quality assessment was performed with the Newcastle-Ottawa Scale. The systematic review protocol was not registered because we anticipated the very limited available evidence on the topic and due to the urgency of the study. Results 16 studies were evaluated. Good-quality criteria were reached in 13 out of 16 studies. D-dimer was increased and significantly higher in COVID-19 patients compared with healthy controls, in COVID-19 patients with severe disease or a composite end-point compared with non-severe disease, in ARDS compared with non-ARDS patients and in deceased ARDS patients compared with ARDS patients who survived (all p<0.001). COVID-19 patients treated with anticoagulants demonstrated lower mortality compared with those not treated (p=0.017). Conclusions Correlations exist between COVID-19 infection, severe elevation of D-dimer levels, and increase in the rate of complications and composite end-point. The appropriateness of early and continuous D-dimer monitoring and labelled anticoagulation as management tools for COVID-19 disease deserves accurate investigation, to prevent complications and reduce interventions.
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Affiliation(s)
- Sofia Vidali
- Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Daniele Morosetti
- Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Elsa Cossu
- Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Rome, Italy
| | | | | | - Vittorio Semeraro
- Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Guglielmo Consales
- Anesthesiology and Resuscitation, Santo Stefano Hospital, Prato, Italy.,Anesthesiology and Resuscitation, Azienda USL Toscana Centro, Florence, Italy
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35
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Cheah IK, Halliwell B. Could Ergothioneine Aid in the Treatment of Coronavirus Patients? Antioxidants (Basel) 2020; 9:E595. [PMID: 32646061 PMCID: PMC7402156 DOI: 10.3390/antiox9070595] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 01/08/2023] Open
Abstract
Infection with SARS-CoV-2 causes the coronavirus infectious disease 2019 (COVID-19), a pandemic that has, at present, infected more than 11 million people globally. Some COVID-19 patients develop a severe and critical illness, spurred on by excessive inflammation that can lead to respiratory or multiorgan failure. Numerous studies have established the unique array of cytoprotective properties of the dietary amino acid ergothioneine. Based on studies in a range of in vitro and in vivo models, ergothioneine has exhibited the ability to modulate inflammation, scavenge free radicals, protect against acute respiratory distress syndrome, prevent endothelial dysfunction, protect against ischemia and reperfusion injury, protect against neuronal damage, counteract iron dysregulation, hinder lung and liver fibrosis, and mitigate damage to the lungs, kidneys, liver, gastrointestinal tract, and testis, amongst many others. When compiled, this evidence suggests that ergothioneine has a potential application in the treatment of the underlying pathology of COVID-19. We propose that ergothioneine could be used as a therapeutic to reduce the severity and mortality of COVID-19, especially in the elderly and those with underlying health conditions. This review presents evidence to support that proposal.
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Affiliation(s)
- Irwin K. Cheah
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore;
- Life Science Institute, Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore 117456, Singapore
| | - Barry Halliwell
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore;
- Life Science Institute, Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore 117456, Singapore
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36
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Piccolo V, Bassi A. Acral findings during the COVID-19 outbreak: Chilblain-like lesions should be preferred to acroischemic lesions. J Am Acad Dermatol 2020; 83:e231. [PMID: 32446827 PMCID: PMC7242179 DOI: 10.1016/j.jaad.2020.05.077] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Andrea Bassi
- Unità Operativa di Dermatologia Lucca-Azienda USL Toscana Nordovest, Italy; Department of Health Science, University of Florence, Florence, Italy
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