351
|
Roncati L, Lusenti B, Nasillo V, Manenti A. Fatal SARS-CoV-2 coinfection in course of EBV-associated lymphoproliferative disease. Ann Hematol 2020; 99:1945-1946. [PMID: 32447425 PMCID: PMC7245576 DOI: 10.1007/s00277-020-04098-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Luca Roncati
- Hemolymphopathology Team, University Hospital of Modena, Modena, Italy.
| | - Beatrice Lusenti
- Hemolymphopathology Team, University Hospital of Modena, Modena, Italy
| | - Vincenzo Nasillo
- Hemolymphopathology Team, University Hospital of Modena, Modena, Italy
| | - Antonio Manenti
- Surgery Department, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
352
|
Lai CC, Ko WC, Lee PI, Jean SS, Hsueh PR. Extra-respiratory manifestations of COVID-19. Int J Antimicrob Agents 2020; 56:106024. [PMID: 32450197 PMCID: PMC7243791 DOI: 10.1016/j.ijantimicag.2020.106024] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
Most COVID-19 patients show fever and respiratory symptoms, however they may present extra-respiratory manifestations. Cardiac, gastrointestinal, hepatic, renal, neurologic, olfactory, gustatory, ocular, cutaneous and haematologic symptoms. Extra-respiratory symptoms/signs may represent the initial presentation of SARS-CoV-2 infection. This review is aimed to help clinicians better understand the range of clinical presentations associated with SARS-CoV-2.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health threat. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, SARS-CoV-2 infection may also involve other organs/systems and present with extra-respiratory manifestations, including cardiac, gastrointestinal, hepatic, renal, neurological, olfactory, gustatory, ocular, cutaneous and haematological symptoms. Occasionally, these extra-respiratory symptoms/signs represent the initial presentation of SARS-CoV-2 infection, prior to fever or respiratory manifestations. Therefore, this comprehensive review of the extra-respiratory manifestations of COVID-19 is intended to help clinicians better understand the range of clinical presentations associated with SARS-CoV-2 infection, allowing the consideration of COVID-19 in differential diagnoses. A screening test for SARS-CoV-2 should be performed when patients have these extra-respiratory manifestations. In addition, clinicians should be alerted to the adverse effects of anti-SARS-CoV-2 agents that can mimic the extra-respiratory manifestations of COVID-19. Moreover, some extra-respiratory manifestations, such as ocular and gastrointestinal involvement, may be caused by direct invasion of SARS-CoV-2. Therefore, protective measures should be taken while managing the associated clinical specimens. Finally, several extra-respiratory manifestations, such as cardiac involvement, acute kidney injury, coagulation disorders and thrombotic complications, could be associated with a poor prognosis.
Collapse
Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shio-Shin Jean
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
353
|
Ward JW, del Rio C. The COVID-19 Pandemic: An Epidemiologic, Public Health, and Clinical Brief. Clin Liver Dis (Hoboken) 2020; 15:170-174. [PMID: 32489652 PMCID: PMC7242012 DOI: 10.1002/cld.973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- John W. Ward
- Coalition for Global Hepatitis EliminationTask Force for Global HealthDecaturGA
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGA
| | - Carlos del Rio
- Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGA
- Department of MedicineEmory University School of MedicineAtlantaGA
| |
Collapse
|
354
|
Morais-Almeida M, Aguiar R, Martin B, Ansotegui IJ, Ebisawa M, Arruda LK, Caminati M, Canonica GW, Carr T, Chupp G, Corren J, Dávila I, Park HS, Hanania NA, Rosenwasser L, Sánchez-Borges M, Virchow JC, Yáñez A, Bernstein JA, Caraballo L, Chang YS, Chikhladze M, Fiocchi A, González-Diaz SN, Tanno LK, Levin M, Ortega-Martell JA, Passalacqua G, Peden DB, Rouadi PW, Sublett JL, Wong GWK, Bleecker ER. COVID-19, asthma, and biological therapies: What we need to know. World Allergy Organ J 2020; 13:100126. [PMID: 32426090 PMCID: PMC7229954 DOI: 10.1016/j.waojou.2020.100126] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022] Open
Abstract
Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.
Collapse
Key Words
- AAAAI, American Academy of Allergy, Asthma and Immunology
- ACAAI, American College of Allergy, Asthma and Immunology
- ACE2, Angiotensin-converting enzyme 2
- ADCC, Antibody-Dependent Cell-mediated Cytotoxicity
- AEs, Adverse events
- Asthma
- BTS, British Thoracic Society
- Biologics
- COVID-19
- COVID-19, Coronavirus Disease 2019
- DNA, Deoxyribonucleic acid
- EBM, Evidence Based Medicine
- ELF, European Lung Foundation
- ERS, European Respiratory Society
- FDA, Food and Drug Administration
- GINA, Global Initiative for Asthma
- GSK, Glaxo Smith Kline
- ICS, inhaled corticosteroids
- ICU, Intensive Care Unit
- IL13, Interleukin 13
- IL4, Interleukin 4
- IL5, Interleukin 5
- IL5Ra, Interleukin 5 alfa receptor
- IL5r, Interleukin 5 receptor
- IL6, Interleukin 6
- IgE, Immunoglobulin E
- NHLBI, National Heart, Lung, and Blood Institute
- OCS, Oral corticosteroids
- PDGFRA, Platelet-Derived Growth Factor Receptor A
- PROSE study, Preventative Omalizumab or Step-up therapy for fall Exacerbations study
- Pandemic
- RCTs, Randomized Controlled Trials
- SAEs, Serious Adverse Events
- SARP, Severe Asthma Research Programme
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SC, Subcutaneous
- SIAAIC, Italian Society of Allergy, Asthma and Clinical Immunology
- Severe
- T2, Type 2 inflammation
- TMPRSS2, Transmembrane Protease Serine 2 Enzyme
- Treatment
- USA, United States of America
- mAb, Monoclonal antibody
Collapse
Affiliation(s)
| | - Rita Aguiar
- Allergy Centre, CUF Descobertas Hospital, Lisbon, Portugal
| | | | | | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagwa, Japan
| | - L Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marco Caminati
- Department of Internal Medicine, University of Verona, Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital IRCCS, Milano, Italy
| | - Tara Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Geoffrey Chupp
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Corren
- David Geffen School of Medicine, University of California at Los Angelas (UCLA), Los Angeles, CA, USA
| | - Ignacio Dávila
- University Hospital, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, Universitätsmedizin, Rostock, Germany
| | - Anahí Yáñez
- INAER-Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Jonathan A Bernstein
- University of Cincinnati, College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, KuTaisi, Tskaltubo, Georgia
| | | | | | - Luciana Kase Tanno
- Division of Allergy, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - David B Peden
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | - James L Sublett
- Pediatric Allergy & Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Gary W K Wong
- Department of Paediatrics, Chinese University of Hong Kong, Hong Kong
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| |
Collapse
|
355
|
Kariyanna PT, Aurora L, Jayarangaiah A, Yadav V, Hossain NA, Akter N, Salifu MO, McFarlane IM. Utility of D-dimer as a Prognostic Factor in SARS CoV2 Infection: A Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:337-340. [PMID: 32851129 PMCID: PMC7447555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Coronavirus Disease-2019 (COVID-19) is currently a public health emergency and has been listed by the World Health Organization (WHO) as a pandemic. It has commonly been associated with pulmonary manifestations and there is a growing body of evidence of multisystem involvement of the virus. As evidenced by various case reports and cohort studies, COVID-19-associated coagulopathy has been a common manifestation amongst the critically ill and has been associated with increased mortality. The presence of venous thromboembolic events in patients who are critically ill due to COVID-19 has prompted the adoption of anticoagulation regimens aimed at preventing thromboembolic phenomena. Coagulation abnormalities have also been implicated in the progression and the severity of COVID-19 related acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). There is strong evidence that D-dimer levels help predict which patients are at risk of thromboembolic events, progression to ARDS, DIC, immune dysregulation and mortality. We will review the utility of D-dimer as screening tool and in the risk stratification of COVID-19 patients prone to developing thromboembolic events, DIC, immune dysregulation and death. To date, the studies that have been published show the presence of elevated D-dimer levels in both the adult and pediatric populations and the measured level correlates with disease severity. Studies have also shown the relative increase of D-dimer levels in non-survivors compared to survivors. The elevation of D-dimer levels has shown to guide clinical decision making, namely the initiation of therapeutic anticoagulation and mortality benefit in patients with severe COVID-19 pneumonia compared to severe non COVID-19 pneumonia. Although the current body of literature suggested the use of D-dimer as a risk stratification tool and as a test to augment clinical judgement regarding the initiation of anticoagulation, randomized control trials are needed to fully understand the relationship between COVID-19 infection and the efficacy of D-dimer assays in clinical decision making.
Collapse
Affiliation(s)
- Pramod Theetha Kariyanna
- Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A
| | - Lyudmila Aurora
- Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A
| | - Apoorva Jayarangaiah
- Department of Internal Medicine, Albert Einstein College of Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, New York-10461, U.S.A
| | - Vivek Yadav
- Department of Internal Medicine, Brookdale University Hospitals and Medical Center, 1 Brookdale Plaza, Brooklyn, New York- 11212, USA
| | - Naseem. A. Hossain
- Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A
| | - Nasrin Akter
- Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A
| | - Moro O. Salifu
- Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A
| | - Isabel M. McFarlane
- Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, New York, U.S.A,Corresponding author:
| |
Collapse
|
356
|
Abdel-Aziz M, Abdel-Aziz NM, Abdel-Aziz DM, Azab N. Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1717077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.
Collapse
Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nada M. Abdel-Aziz
- Faculty of Dentistry, October University of Modern Science and Arts (MSA), October City, Egypt
| | - Dina M. Abdel-Aziz
- Faculty of Medicine, Misr University for Science and Technology (MUST), Misr, Egypt
| | - Noha Azab
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
357
|
Ampuero J, Sánchez-Torrijos Y, García Lozano MDR, Maya D, Romero-Gómez M. Impact of liver injury on the severity of COVID-19: Systematic Review with Meta-analysis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:125-135. [DOI: 10.17235/reed.2020.7397/2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
358
|
Butler M, Bano F, Calcia M, McMullen I, Sin Fai Lam CC, Smith LJ, Taylor D, Gee S. Clozapine prescribing in COVID-19 positive medical inpatients: a case series. Ther Adv Psychopharmacol 2020; 10:2045125320959560. [PMID: 32974002 PMCID: PMC7493264 DOI: 10.1177/2045125320959560] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/21/2020] [Indexed: 01/15/2023] Open
Abstract
There is both uncertainty regarding the safety of clozapine in COVID-19 patients owing to limited published data and a lack of consensus on continuing clozapine in patients with severe respiratory infections. COVID-19 is known to induce an acute immune response which can affect haematological parameters associated with clozapine monitoring, and systemic infection may reduce clozapine clearance. Clozapine, which has been associated with worse outcomes in some pneumonias, may in theory worsen outcomes in COVID-19. Despite these concerns, there are some data to indicate it is safe to continue clozapine in COVID-19 infection. In this retrospective case series, we describe our experiences of clozapine prescribing and disease progression of eight SARS-CoV-2 positive patients on medical wards in a major London teaching hospital. In four cases clozapine was stopped during the hospital admission. A COVID-19 pneumonia developed in four patients: three of these required intensive care unit admission for an average of 34 days. At the time of writing, three patients had died (two directly from COVID-19 pneumonia), two remained in general hospital wards, two were recovering in the community and one had been transferred to an inpatient psychiatric hospital. Follow-up length varied but in each case was not more than 104 days. Delirium was the most common adverse neuropsychiatric event, and in one case a relapse of psychosis occurred after cessation of clozapine. This retrospective case series illustrates the safe use of clozapine during COVID-19 infection. Our experiences suggest that consideration should be made to continuing clozapine even in those most unwell with COVID-19. We also identify areas which require larger scale hypothesis-testing research.
Collapse
Affiliation(s)
- Matthew Butler
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, SE5 8AF, UK and South London and Maudsley NHS Foundation Trust, London, UK
| | - Felicity Bano
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Marilia Calcia
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | | | | | | | - David Taylor
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Siobhan Gee
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|