1
|
Soto J, Linsley C, Song Y, Chen B, Fang J, Neyyan J, Davila R, Lee B, Wu B, Li S. Engineering Materials and Devices for the Prevention, Diagnosis, and Treatment of COVID-19 and Infectious Diseases. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:2455. [PMID: 37686965 PMCID: PMC10490511 DOI: 10.3390/nano13172455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
Following the global spread of COVID-19, scientists and engineers have adapted technologies and developed new tools to aid in the fight against COVID-19. This review discusses various approaches to engineering biomaterials, devices, and therapeutics, especially at micro and nano levels, for the prevention, diagnosis, and treatment of infectious diseases, such as COVID-19, serving as a resource for scientists to identify specific tools that can be applicable for infectious-disease-related research, technology development, and treatment. From the design and production of equipment critical to first responders and patients using three-dimensional (3D) printing technology to point-of-care devices for rapid diagnosis, these technologies and tools have been essential to address current global needs for the prevention and detection of diseases. Moreover, advancements in organ-on-a-chip platforms provide a valuable platform to not only study infections and disease development in humans but also allow for the screening of more effective therapeutics. In addition, vaccines, the repurposing of approved drugs, biomaterials, drug delivery, and cell therapy are promising approaches for the prevention and treatment of infectious diseases. Following a comprehensive review of all these topics, we discuss unsolved problems and future directions.
Collapse
Affiliation(s)
- Jennifer Soto
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Chase Linsley
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Yang Song
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Binru Chen
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jun Fang
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Josephine Neyyan
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Raul Davila
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Brandon Lee
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Benjamin Wu
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Song Li
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
2
|
Gambichler T, Goesmann S, Korte V, Skrygan M, Harnischfeger F, Scheel CH, Hamdani N, Budde H, Sieme M, Becker JC, Schmidt W. Failure to detect SARS-CoV-2 at RNA and protein level in the sweat of patients with COVID-19. Br J Dermatol 2023; 188:568-570. [PMID: 36708033 DOI: 10.1093/bjd/ljac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Silke Goesmann
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Vera Korte
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Marina Skrygan
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | | | | | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Heidi Budde
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Marcel Sieme
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Jüergen C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Schmidt
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
3
|
Muacevic A, Adler JR. Pemphigus Vulgaris Possibly Associated with COVID-19 Infection. Cureus 2023; 15:e33897. [PMID: 36819405 PMCID: PMC9935475 DOI: 10.7759/cureus.33897] [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: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Pemphigus vulgaris (PV) represents damage to epidermal keratinocytes, resulting in acantholysis due to the production of autoantibodies against desmoglein-1 and desmoglein-3. Autoimmune blistering disorders such as pemphigus vulgaris or bullous pemphigoid that develop following coronavirus disease 2019 (COVID-19) have been reported in several studies. Herein, we report a case of PV onset following COVID-19 infection in a 17-year-old female, demonstrating --the potential pathogenic capacity of SARS-CoV-2 to develop PV.
Collapse
|
4
|
Corrà A, Verdelli A, Mariotti EB, Ruffo di Calabria V, Quintarelli L, Aimo C, Sunderkötter CH, Caproni M. Cutaneous vasculitis: Lessons from COVID-19 and COVID-19 vaccination. Front Med (Lausanne) 2022; 9:1013846. [PMID: 36569148 PMCID: PMC9780506 DOI: 10.3389/fmed.2022.1013846] [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] [Received: 08/07/2022] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
Cutaneous vasculitis (CV) is an inflammatory skin-limited vascular disease affecting the dermal and/or hypodermal vessel wall. From the pathogenetic point of view, idiopathic forms are described as well as the induction from various triggers, such as drugs, infections, and vaccines. Following SARS-CoV-2 pandemic outbreak, cases of CV induced by both COVID-19 and COVID-19 vaccinations have been reported in literature. The aim of our work was to collect multiple cases available in the literature and analyze the frequency of the different forms of induced vasculitis, as well as their histological and immunopathological features. Although rare, CV induced by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and vaccines may provide interesting insights into the pathogenesis of these inflammatory processes that may in the future be useful to understand the mechanisms underlying cutaneous and systemic vasculitis.
Collapse
Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | | | | | - Lavinia Quintarelli
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cord H. Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| |
Collapse
|
5
|
Meller S, Al Khatri MSA, Alhammadi HK, Álvarez G, Alvergnat G, Alves LC, Callewaert C, Caraguel CGB, Carancci P, Chaber AL, Charalambous M, Desquilbet L, Ebbers H, Ebbers J, Grandjean D, Guest C, Guyot H, Hielm-Björkman A, Hopkins A, Kreienbrock L, Logan JG, Lorenzo H, Maia RDCC, Mancilla-Tapia JM, Mardones FO, Mutesa L, Nsanzimana S, Otto CM, Salgado-Caxito M, de los Santos F, da Silva JES, Schalke E, Schoneberg C, Soares AF, Twele F, Vidal-Martínez VM, Zapata A, Zimin-Veselkoff N, Volk HA. Expert considerations and consensus for using dogs to detect human SARS-CoV-2-infections. Front Med (Lausanne) 2022; 9:1015620. [PMID: 36569156 PMCID: PMC9773891 DOI: 10.3389/fmed.2022.1015620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sebastian Meller
- Department of Small Animal Medicine & Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | | | - Hamad Khatir Alhammadi
- International Operations Department, Ministry of Interior of the United Arab Emirates, Abu Dhabi, United Arab Emirates
| | - Guadalupe Álvarez
- Faculty of Veterinary Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Guillaume Alvergnat
- International Operations Department, Ministry of Interior of the United Arab Emirates, Abu Dhabi, United Arab Emirates
| | - Lêucio Câmara Alves
- Department of Veterinary Medicine, Federal Rural University of Pernambuco, Recife, Brazil
| | - Chris Callewaert
- Center for Microbial Ecology and Technology, Department of Biotechnology, Ghent University, Ghent, Belgium
| | - Charles G. B. Caraguel
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Paula Carancci
- Faculty of Veterinary Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Anne-Lise Chaber
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Marios Charalambous
- Department of Small Animal Medicine & Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Loïc Desquilbet
- École Nationale Vétérinaire d’Alfort, IMRB, Université Paris Est, Maisons-Alfort, France
| | | | | | - Dominique Grandjean
- École Nationale Vétérinaire d’Alfort, Université Paris-Est, Maisons-Alfort, France
| | - Claire Guest
- Medical Detection Dogs, Milton Keynes, United Kingdom
| | - Hugues Guyot
- Clinical Department of Production Animals, Fundamental and Applied Research for Animals & Health Research Unit, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Anna Hielm-Björkman
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - Amy Hopkins
- Medical Detection Dogs, Milton Keynes, United Kingdom
| | - Lothar Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Hanover, Germany
| | - James G. Logan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Arctech Innovation, The Cube, Dagenham, United Kingdom
| | - Hector Lorenzo
- Faculty of Veterinary Science, University of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Fernando O. Mardones
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal and Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leon Mutesa
- Center for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Rwanda National Joint Task Force COVID-19, Kigali, Rwanda
| | | | - Cynthia M. Otto
- Penn Vet Working Dog Center, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marília Salgado-Caxito
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal and Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Esther Schalke
- Bundeswehr Medical Service Headquarters, Koblenz, Germany
| | - Clara Schoneberg
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Anísio Francisco Soares
- Department of Animal Morphology and Physiology, Federal Rural University of Pernambuco, Recife, Brazil
| | - Friederike Twele
- Department of Small Animal Medicine & Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Victor Manuel Vidal-Martínez
- Laboratorio de Parasitología y Patología Acuática, Departamento de Recursos del Mar, Centro de Investigación y de Estudios Avanzados del IPN Unidad Mérida, Mérida, Yucatán, Mexico
| | - Ariel Zapata
- Faculty of Veterinary Science, University of Buenos Aires, Buenos Aires, Argentina
| | - Natalia Zimin-Veselkoff
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal and Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Holger A. Volk
- Department of Small Animal Medicine & Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
- Center for Systems Neuroscience Hannover, Hanover, Germany
| |
Collapse
|
6
|
Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
Collapse
Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| |
Collapse
|
7
|
Quintero-Bustos G, Aguilar-Leon D, Saeb-Lima M. Histopathological and Immunohistochemical Characterization of Skin Biopsies From 41 SARS-CoV-2 (+) Patients: Experience in a Mexican Concentration Institute: A Case Series and Literature Review. Am J Dermatopathol 2022; 44:327-337. [PMID: 35170469 DOI: 10.1097/dad.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT The SARS-CoV-2 pandemic brought countless clinical and pathophysiological questions. Although mucocutaneous infections are the most visible, they are among the least studied. This article provides relevant information to characterize morphologically and immunohistochemically the dermatoses from patients with COVID-19, during the first year of the pandemic. Immunohistochemistry reactions against the spike protein were performed in 48 skin biopsies, and the positive cases were classified according to their histomorphology; at the end, 41 biopsies led us to identify 12 morphological patterns that mimic other skin pathologies, among which pityriasiform patterns predominate. For the literature review, we selected cases of SARS-CoV-2 dermatoses that included complete histopathological information and that were published during the same interval of time; after careful evaluation, 205 biopsies were selected and then classified into 8 groups according to previously published proposals. Dermatoses associated with SARS-CoV-2 are as diverse in their clinical expression as in their histopathology, mimicking entities totally unrelated to COVID-19. Furthermore, some of these groups are characteristically associated with an aggressive course of the disease. Undoubtedly, it is necessary to delve into the possibility that these findings are translatable into prognostic and therapeutic factors.
Collapse
Affiliation(s)
- Gabriel Quintero-Bustos
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | | |
Collapse
|
8
|
Pandemic chilblains: Are they SARS-CoV-2-related or not? Clin Immunol 2022; 237:108984. [PMID: 35338000 PMCID: PMC8942450 DOI: 10.1016/j.clim.2022.108984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 03/18/2022] [Indexed: 01/04/2023]
Abstract
The exact etiopathology of chilblains observed during the Coronavirus Disease 2019 (COVID-19) pandemic is still unclear. Initially, SARS-CoV-2 appeared as the obvious causing agent, but two years of various investigations have failed to convincingly support its direct implication. Most affected individuals have no detectable virus, no anti-SARS-CoV-2 antibodies and no symptoms of COVID-19. Analyses of skin biopsies similarly failed to unambiguously demonstrate presence of the virus or its genome. In a recent hypothesis, SARS-CoV-2 would cause the lesions before being promptly eliminated by unusually strong type I interferon responses. With others, we feel that environmental factors have not been sufficiently considered, in particular cold exposure related to unprecedented containment measures. The cause of pandemic chilblains remains a stimulating puzzle which warrants further investigation.
Collapse
|
9
|
Soares CD, Souza LL, de Carvalho MG, Pontes HA, Mosqueda-Taylor A, Hernandez-Guerrero JC, do Nascimento Medeiros SD, de Oliveira Sales A, Alves FA, Lopes Pinto CA, de Almeida OP. Oral Manifestations of Coronavirus Disease 2019 (COVID-19): A Comprehensive Clinicopathologic and Immunohistochemical Study. Am J Surg Pathol 2022; 46:528-536. [PMID: 34720100 PMCID: PMC8923271 DOI: 10.1097/pas.0000000000001825] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents rapid transmission and significant mortality worldwide. It is responsible for coronavirus disease 2019 (COVID-19). The disease presents diverse clinical symptoms, including fever, cough, dyspnea, and pneumonia. However, other manifestations associated with COVID-19 need to be clarified, leading specialists to an early diagnosis and better prognosis. We describe the spectrum of clinicopathologic COVID-19-related oral lesions that can be the first and/or the unique manifestation of the disease. Fourteen patients with a mean age of 58 years (range: 23 to 88 y) with oral lesions were included. All patients were confirmed to be infected with SARS-CoV-2 by reverse transcription polymerase chain reaction testing. Patients demonstrated mild symptoms, including dysgeusia, anosmia, fever, and headache. The lesions were recognized and classified into 2 groups: (1) lesions caused by ischemia and/or hemorrhage and (2) lesions secondary to inflammatory events associated with viral load. The palate was most affected (n=8), followed by the tongue (n=4), and both the lip and palate (n=2). Histologic analysis demonstrated thrombosis of small arteries and capillaries, associated with areas of hemorrhage and chronic inflammatory infiltrate. Immunohistochemistry showed positive staining for spike protein (SARS-CoV and SARS-CoV-2) and angiotensin-converting enzyme 2 in the surface epithelium, salivary glands, inflammatory cells, and endothelial cells. Although the incidence of oral lesions among patients infected with SARS-CoV-2 appears to be uncommon, these findings suggest that the oral mucosa can also be a target organ for SARS-CoV-2.
Collapse
Affiliation(s)
- Ciro D. Soares
- Department of Oral Diagnosis, University of Campinas, Piracicaba
- Laboratório de Citopatologia, Private Pathology Service
- Health Care Department, Universidad Autónoma Metropolitana, Ciudad de México
| | - Lucas L. Souza
- Department of Oral Diagnosis, University of Campinas, Piracicaba
- Department of Oral Pathology, University Hospital João de Barros Barreto, Belém, Pará, Brazil
| | - Maria G.F. de Carvalho
- Department of Oral Diagnosis, University of Campinas, Piracicaba
- Laboratório de Citopatologia, Private Pathology Service
| | - Hélder A.R. Pontes
- Department of Oral Diagnosis, University of Campinas, Piracicaba
- Department of Oral Pathology, University Hospital João de Barros Barreto, Belém, Pará, Brazil
| | | | | | | | | | - Fábio A. Alves
- Department of Stomatology, University of São Paulo
- Stomatology Department, A.C. Camargo Hospital
| | | | | |
Collapse
|
10
|
Azzazi Y, Abdelkader HA, Khedr H, El-Komy MHM. Extensive cutaneous leukocytoclastic vasculitis after Sinopharm vaccine: case report and review of the literature. J Cutan Pathol 2022; 49:736-742. [PMID: 35355299 DOI: 10.1111/cup.14235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/17/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
Cutaneous leukocytoclastic vasculitis (LCV) has been reported as a rare form of cutaneous reaction to different SARS-Cov-2 vaccines. Herein, we present the first case of cutaneous LCV following BBIBP-CorV (Sinopharm) vaccine, that occurred in a female patient with no prior comorbidities. A literature review about similar cases following different COVID-19 vaccines is discussed. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Yousra Azzazi
- Department of Dermatology, Faculty of Medicine, Cairo University
| | | | - Hadeer Khedr
- Department of Dermatology, Faculty of Medicine, Cairo University
| | | |
Collapse
|
11
|
Colonna C, Restano L, Monzani N, Zussino M, Ponziani A, Cambiaghi S, Cavalli R. Rare and common manifestations of COVID-19 in children. JEADV CLINICAL PRACTICE 2022; 1:21-30. [PMID: 37829273 PMCID: PMC9088562 DOI: 10.1002/jvc2.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 01/08/2023]
Abstract
Introduction It has been almost 2 years since the first reports on cutaneous manifestations of COVID-19. Those reported in children are different and include macular, papular, lichenoid, vesicular, urticarial, and vascular morphologies, among others. The prognosis of isolated cutaneous involvement in COVID-19 in children is usually self-limiting but the extreme variety of clinical presentations complicates the clinical approach. Methods Numerous reviews have been systematically drafted and edited giving the clinicians a future direction for skin presentations during pandemics. Results and Discussion Hereby we report the rare and common manifestations of COVID-19 in children and question the recurrence phenomena and age-related distribution of the eruptions.
Collapse
Affiliation(s)
- Cristiana Colonna
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Lucia Restano
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Nicola A. Monzani
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
- Neonatal Intensive Care UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Martina Zussino
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Alessandra Ponziani
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Stefano Cambiaghi
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Riccardo Cavalli
- Pediatric Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| |
Collapse
|
12
|
Nuovo GJ, Suster D, Tili E, Awad H, Magro C. A Standardization Protocol for the In Situ Detection of SARS-CoV2 RNA and Proteins. Appl Immunohistochem Mol Morphol 2022; 30:83-90. [PMID: 35175238 PMCID: PMC8862676 DOI: 10.1097/pai.0000000000000992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
This manuscript details a stringent protocol for the in situ detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) RNA and 4 different viral proteins: envelope, spike, membrane, and nucleocapsid. Key aspects of the protocol are: (1) analysis of adjacent (serial) sections for viral RNA and at least 2 viral proteins; (2) cytologic alterations in the cells scored as virus positive based on an hematoxylin and eosin stain; (3) in situ demonstration of a host response in the cells scored as virus positive; (4) co-labeling experiments that show that the viral RNA and/or proteins co-localize with each other and the angiotensin converting enzyme 2 (ACE2) receptor; and (5) lack of signal in equivalent tissues obtained before the pandemic. Optimization conditions for the four viral proteins as well as the ACE2 receptor were each antigen retrieval in an EDTA solution which facilitates co-expression analyses. It is recommended not to use either electron microscopy or qRTPCR as methods to corroborate in situ SARS-CoV2 detection. This stringent protocol, that relies on sequentially labeled serial sections and can be completed in one working day, demonstrated the following: (1) infectious SARS-CoV2 is abundant in the lung in fatal coronavirus disease-2019 and is seen primarily in macrophages and endothelial cells; (2) circulating viral capsid proteins (spike, envelope, membrane without RNA) are evident in multiple organs including the skin and brain where it is endocytosed by ACE2+ cells and induce an endothelialitis; (3) both the infectious virus and circulating spike protein induce complement activation and cytologic changes in the viral positive cells.
Collapse
Affiliation(s)
- Gerard J. Nuovo
- Ohio State University Comprehensive Cancer Center
- Discovery Life Sciences, Powell, OH
| | - David Suster
- Department of Pathology, Rutgers University Hospital, Newark, NJ
| | | | - Hamdy Awad
- Ohio State University Medical Center, Columbus
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| |
Collapse
|
13
|
SARS-CoV-2 might transmit through the skin while the skin barrier function could be the mediator. Med Hypotheses 2022; 159:110752. [PMID: 35002019 PMCID: PMC8721925 DOI: 10.1016/j.mehy.2021.110752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 01/07/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, it were reported that COVID-19 patients could have cutaneous symptoms, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was observed on the skin of COVID-19 patients, which indicated that the skin is one target of SARS-CoV-2. Meanwhile, reports about SARS-CoV-2 transmission through food cold-chain overpacks emerged. With the fact that SARS-CoV-2 could survive on the skin for more than 9 h, the skin could be implicated in SARS CoV-2 transmission. Angiotensin-converting enzyme 2 (ACE2), a critical membrane protein for SARS-CoV-2 that enters a host cell, was recognized to be associated with the risk of SARS-CoV-2 infection. Therefore, tissues that express ACE2 might have the potential to be infected by and transmit SARS-CoV-2. The skin is one such tissue that expresses ACE2. However, unlike the lung that expresses ACE2 on the upper-most epithelial layer, the skin is composed of different layers of cells that function as a barrier, and cells under the top epidermal layer express ACE2. Since the skin barrier is the first line of protection, the typical position of ACE2-expressing cells in the skin implies that the skin barrier function could be the mediator of SARS-CoV-2. In our study, we found that ACE2 could be expressed in the skin, and its expression level is increased in psoriasis, an inflammatory disease of the skin with barrier dysfunction. Additionally, by applying the SARS-CoV-2 pseudovirus on mouse models with or without deteriorated skin barrier, we found that the SARS-CoV-2 pseudovirus could infect the skin and lungs of mouse models, and when the skin barrier was impaired, more SARS-CoV-2-infected cells could be found. Thus, we hypothesized that a deteriorated condition of the skin barrier might increase the risk of SARS-CoV-2 infection through the skin.
Collapse
|
14
|
Clinicopathologic features among different viral epidemic outbreaks involving the skin. Clin Dermatol 2022; 40:573-585. [PMID: 36509508 PMCID: PMC8219845 DOI: 10.1016/j.clindermatol.2021.06.003] [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] [Indexed: 01/08/2023]
Abstract
The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision, but increasing information suggests some analogies with the major viral outbreaks in the last century, and a general warning has been issued on the possibility that coinfections can make the differential diagnosis and treatment difficult, especially in tropical countries. Some reports have noted that the presence of high dengue antibodies can give a false-negative result when testing for severe acute respiratory syndrome coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap among different pathogens. However, strong clinicopathologic correlation might provide some clues to address differentials. Waiting for laboratory and instrumental results, the timing and distribution of skin lesions is often pathognomonic. Histopathologic findings characterize certain reaction patterns and provide insights on pathogenetic mechanisms. Unfortunately, skin assessment, especially invasive examinations such as biopsy, takes a back seat in severely ill patients. A literature retrieval was performed to collect information from other epidemics to counteract what has become the most frightening disease of our time.
Collapse
Key Words
- (covid-19), coronavirus 2019 disease
- (who), world health organization
- (sars), severe acute respiratory syndrome coronavirus
- (sars-cov-2), novel coronavirus
- (mers), middle east respiratory syndrome
- (r0), basic reproductive number
- (mis), multisystem inflammatory syndrome
- (iga), immunoglobulin a
- (ace-2), angiotensin‐converting enzyme 2
- (dengv), dengue virus
- (ttp), thrombotic thrombocytopenic purpura
- (vwf), von willebrand factor
- (cd1a), cluster of diffentiation 1-a
- (rt-pcr), reverse transcription polymerase chain reaction
- (chikv), chikungunya virus
- (e1, e2), envelope glycoprotein
- (ifn-i), interferon-type-i
- (zikv), zika virus
- (ebov), ebola virus
Collapse
|
15
|
Robustelli Test E, Sena P, Locatelli AG, Carugno A, di Mercurio M, Moggio E, Gambini DM, Arosio MEG, Callegaro A, Morotti D, Gianatti A, Vezzoli P. RNAscope in situ hybridization and RT-PCR for detection of SARS-CoV-2 in chilblain-like lesions: A clinical, laboratory and histopathological study. Pediatr Dermatol 2022; 39:77-83. [PMID: 34989043 DOI: 10.1111/pde.14903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of chilblain-like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS-CoV-2 infection has not been unequivocally established. METHODS In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1 June 2020. RESULTS The mean age was 14.2 years, and 21 patients (78%) experienced mild systemic symptoms a median of 28 days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients - 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT-PCR for SARS-CoV-2 showing only 1 positive. Histopathological examinations of 7 skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS-CoV-2 RNA in skin biopsies, both with real-time polymerase chain reaction (RT-PCR) and RNAscope in situ hybridization (ISH). LIMITATIONS Limited number of cases, unavailability of laboratory confirmation of COVID-19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. CONCLUSIONS These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN-I or complement-mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.
Collapse
Affiliation(s)
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Erica Moggio
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marco Enrico Giovanni Arosio
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Denise Morotti
- Pathology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Pamela Vezzoli
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| |
Collapse
|
16
|
Rahman HS, Abdulateef DS, Hussen NH, Salih AF, Othman HH, Mahmood Abdulla T, Omer SHS, Mohammed TH, Mohammed MO, Aziz MS, Abdullah R. Recent Advancements on COVID-19: A Comprehensive Review. Int J Gen Med 2021; 14:10351-10372. [PMID: 34992449 PMCID: PMC8713878 DOI: 10.2147/ijgm.s339475] [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] [Received: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
Over the last few decades, there have been several global outbreaks of severe respiratory infections. The causes of these outbreaks were coronaviruses that had infected birds, mammals and humans. The outbreaks predominantly caused respiratory tract and gastrointestinal tract symptoms and other mild to very severe clinical signs. The current coronavirus disease-2019 (COVID-19) outbreak, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading illness affecting millions of people worldwide. Among the countries most affected by the disease are the United States of America (USA), India, Brazil, and Russia, with France recording the highest infection, morbidity, and mortality rates. Since early January 2021, thousands of articles have been published on COVID-19. Most of these articles were consistent with the reports on the mode of transmission, spread, duration, and severity of the sickness. Thus, this review comprehensively discusses the most critical aspects of COVID-19, including etiology, epidemiology, pathogenesis, clinical signs, transmission, pathological changes, diagnosis, treatment, prevention and control, and vaccination.
Collapse
Affiliation(s)
- Heshu Sulaiman Rahman
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
- Department of Medical Laboratory Sciences, Komar University of Science and Technology, Sulaimaniyah, Republic of Iraq
| | - Darya Saeed Abdulateef
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Narmin Hamaamin Hussen
- Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Aso Faiq Salih
- Department of Pediatrics, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Hemn Hassan Othman
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Trifa Mahmood Abdulla
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Shirwan Hama Salih Omer
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Talar Hamaali Mohammed
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Mohammed Omar Mohammed
- Department of Medicine, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
| | - Masrur Sleman Aziz
- Department of Biology, College of Education, Salahaddin University, Erbil, Republic of Iraq
| | - Rasedee Abdullah
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, Serdang, Selangor, 43400, Malaysia
| |
Collapse
|
17
|
Shahrigharahkoshan S, Gagnon LP, Mathieu S. Cutaneous Leukocytoclastic Vasculitis Induction Following ChAdOx1 nCoV-19 Vaccine. Cureus 2021; 13:e19005. [PMID: 34853744 PMCID: PMC8609955 DOI: 10.7759/cureus.19005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented event, and in order to control its spread and minimize its damages, all efforts are immediately mobilized. Mass vaccination is considered a promising solution to combat this universal issue. However, given the urgent need for vaccine production, some of the side effects may not have been presented during trials and will only appear during the mass vaccination. Limited vasculitis cases have been reported so far following vaccination against COVID-19. We present a case of cutaneous leukocytoclastic vasculitis (LCV) induced following the first dose of the ChAdOx1 nCoV-19 vaccine in an otherwise healthy individual.
Collapse
|
18
|
Arkin LM, Moon JJ, Tran JM, Asgari S, O'Farrelly C, Casanova JL, Cowen EW, Mays JW, Singh AM, Drolet BA. From Your Nose to Your Toes: A Review of Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic‒Associated Pernio. J Invest Dermatol 2021; 141:2791-2796. [PMID: 34561087 PMCID: PMC8279931 DOI: 10.1016/j.jid.2021.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023]
Abstract
Despite thousands of reported patients with pandemic-associated pernio, low rates of seroconversion and PCR positivity have defied causative linkage to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pernio in uninfected children is associated with monogenic disorders of excessive IFN-1 immunity, whereas severe COVID-19 pneumonia can result from insufficient IFN-1. Moreover, SARS-CoV-2 spike protein and robust IFN-1 response are seen in the skin of patients with pandemic-associated pernio, suggesting an excessive innate immune skin response to SARS-CoV-2. Understanding the pathophysiology of this phenomenon may elucidate the host mechanisms that drive a resilient immune response to SARS-CoV-2 and could produce relevant therapeutic targets.
Collapse
Affiliation(s)
- Lisa M Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John J Moon
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer M Tran
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samira Asgari
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity College Dublin, Dublin, Ireland
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA; Howard Hughes Medical Institute, The Rockefeller University, New York, New York, USA
| | - Edward W Cowen
- Dermatology branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, Maryland, USA
| | - Jacqueline W Mays
- Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Anne Marie Singh
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Beth A Drolet
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
| |
Collapse
|
19
|
Ma Z, Yang KY, Huang Y, Lui KO. Endothelial contribution to COVID-19: an update on mechanisms and therapeutic implications. J Mol Cell Cardiol 2021; 164:69-82. [PMID: 34838588 PMCID: PMC8610843 DOI: 10.1016/j.yjmcc.2021.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022]
Abstract
The global propagation of SARS-CoV-2 leads to an unprecedented public health emergency. Despite that the lungs are the primary organ targeted by COVID-19, systemic endothelial inflammation and dysfunction is observed particularly in patients with severe COVID-19, manifested by elevated endothelial injury markers, endotheliitis, and coagulopathy. Here, we review the clinical characteristics of COVID-19 associated endothelial dysfunction; and the likely pathological mechanisms underlying the disease including direct cell entry or indirect immune overreactions after SARS-CoV-2 infection. In addition, we discuss potential biomarkers that might indicate the disease severity, particularly related to the abnormal development of thrombosis that is a fatal vascular complication of severe COVID-19. Furthermore, we summarize clinical trials targeting the direct and indirect pathological pathways after SARS-CoV-2 infection to prevent or inhibit the virus induced endothelial disorders.
Collapse
Affiliation(s)
- Zhangjing Ma
- Department of Chemical Pathology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin Y Yang
- Department of Chemical Pathology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Huang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Kathy O Lui
- Department of Chemical Pathology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Science, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
| |
Collapse
|
20
|
Seque CA, Enokihara MMSES, Porro AM, Tomimori J. Skin manifestations associated with COVID-19. An Bras Dermatol 2021; 97:75-88. [PMID: 34857407 PMCID: PMC8577992 DOI: 10.1016/j.abd.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 01/08/2023] Open
Abstract
This article will address the main aspects of skin manifestations associated with COVID-19, based on a review of the literature published to date. Since the beginning of the pandemic, more than 1,500 articles have been published on the subject. Regarding the pathophysiology, it is believed that the same mechanisms responsible for the disease in the main target organs also act in the skin, although they are not yet fully elucidated. The actual frequency of dermatological manifestations remains uncertain – it can range from 0.2% to 45%, being close to 6% in systematic reviews. Pioneering studies of large case series conducted in European countries and the USA provide the first information on the main skin manifestations associated with COVID-19 and propose classifications regarding their clinical presentation, pathophysiology, as well as their frequencies. Although there is yet no consensus, maculopapular eruptions are considered the most frequent presentations, followed by erythema pernio-like (EPL) lesions. Manifestations such as urticaria, vesicular conditions and livedo/purpura/necrosis are rare. The time of onset, severity, need for specific treatment and prognosis vary according to the clinical presentation pattern. The increasing histopathological description of skin conditions can contribute to the diagnosis, as well as to the understanding of the pathophysiology. Also, in the dermatological field, the relationship between COVID-19 and androgens has been increasingly studied. Despite all the generated knowledge, the actual biological meaning of skin manifestations remains uncertain. Therefore, the exclusion of the main differential diagnoses is essential for the correlation between skin manifestation and COVID-19.
Collapse
Affiliation(s)
- Camila Arai Seque
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | - Adriana Maria Porro
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Jane Tomimori
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
21
|
Nishimori N, Niwa Y, Kazama A, Yamamoto M, Fujita H. Extensive expression of SARS-CoV-2 spike protein from the eccrine secretory gland to acrosyringium in the maculopapular eruption of a COVID-19 patient. J Dermatol 2021; 49:e11-e12. [PMID: 34611906 DOI: 10.1111/1346-8138.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/18/2021] [Accepted: 09/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nobuyuki Nishimori
- Department of Dermatology, Sagamihara Kyodo Hospital, Sagamihara City, Japan.,Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Niwa
- Department of Dermatology, Sagamihara Kyodo Hospital, Sagamihara City, Japan.,Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Akio Kazama
- Department of Pathology, Sagamihara Kyodo Hospital, Sagamihara City, Japan
| | - Michiko Yamamoto
- Department of Respiratory Medicine, Sagamihara Kyodo Hospital, Sagamihara City, Japan
| | - Hideki Fujita
- Department of Dermatology, Sagamihara Kyodo Hospital, Sagamihara City, Japan.,Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
22
|
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.
Collapse
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.
| |
Collapse
|
23
|
Li H, Zhao Y, Zhou L. Cutaneous manifestations in children with SARS-CoV-2 infection and/or COVID-19: what do we know after 10 months under this pandemic? Int J Dermatol 2021; 61:39-45. [PMID: 34530491 PMCID: PMC8653232 DOI: 10.1111/ijd.15882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global crisis. However, cutaneous manifestations in children with SARS-CoV-2 infection have received little attention. OBJECTIVE Our study was aimed to present clinical and cutaneous manifestations of children with SARS-CoV-2 and to provide the basis for early diagnosis. METHODS We analyzed the clinical data of COVID-19 infected (CI) children worldwide from December 2019 to October 6, 2020, by using search terms "COVID-19," "SARS-CoV-2," "Coronavirus" in combination with "cutaneous," "lesion," "rash," "skin," "dermatology," "epidermis," "dermis," "multisystem inflammatory syndrome." We collected and analyzed the general information, clinical symptoms, cutaneous manifestations, laboratory examination results, history of close contact with CI patients or suspected CI patients, and outcome in CI children. RESULTS Among 90 CI children, there were 46 boys (59%) and 32 girls (41%). Erythema was the most frequent lesion, followed by conjunctivitis, and edematous lesions. Face was the most commonly affected location including lips, conjunctivae, tongue, eyes, and eyelids. Sixty-three (73.3%) patients had multisystem inflammatory syndrome (MIS-C). As for clinical symptoms, 70 (81.4%) CI children suffered fever, and 34 (39.5%) patients had lung involvement. Meanwhile, 65.1% of patients had cardiac involvement, 4.7% of patients were asymptomatic, and 71.6% of patients received intravenous immunoglobulin, as well as 31.1% of CI children received systemic corticosteroids. Three children were dead. The most frequent route of infection was familial clustering. As silent virus carriers of CI children, it is important to find out the clinical and cutaneous manifestations in CI children to prevent and control COVID-19 transmission.
Collapse
Affiliation(s)
- Hongxin Li
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yong Zhao
- Department of Reproductive Medicine,Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lin Zhou
- Department of Clinical Laboratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| |
Collapse
|
24
|
Atzori L, Ferreli C, Mateeva V, Vassileva S, Rongioletti F. Clinicopathologic features between different viral epidemic outbreaks involving the skin. Clin Dermatol 2021; 39:405-417. [PMID: 34517998 PMCID: PMC8071581 DOI: 10.1016/j.clindermatol.2021.04.002] [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] [Indexed: 12/15/2022]
Abstract
The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision, but increasing information suggests some analogies with the major viral outbreaks of the last century. A general warning has been issued on the possibility that coinfections can make differential diagnosis and treatment difficult, especially in tropical countries. Some reports have pointed out that the presence of high Dengue antibodies can give a false-negative result for severe acute respiratory syndrome coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap among different pathogens. A strong clinicopathologic correlation, however, may provide some clues to address the differential. Waiting for laboratory and instrumental results, the timing and distribution of skin lesions is often pathognomonic. Histopathologic findings characterize certain reaction patterns and provide insights on pathogenetic mechanisms. Unfortunately, skin assessments, especially invasive exams such as biopsy, are less important in severely ill patients. A literature review was performed to collect information from other epidemics to counteract what has become the most frightening disease of our time.
Collapse
Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Valeria Mateeva
- Department of Dermatology, Sofia University of Medicine, Sofia, Bulgaria
| | - Snejina Vassileva
- Department of Dermatology, Sofia University of Medicine, Sofia, Bulgaria
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Vita-SaluteS.Raffaele University, Milan, Italy
| |
Collapse
|
25
|
Gianotti R, Restano L, Cutrone M, Colonna C, Fellegara G, Debernardi I, Boggio F, Del Gobbo A, Monzani NA, Tripodo C, Gelmetti C, Berti E. Papulo-purpuric dermatitis of childhood: a distinct PLEVA-like eruption associated to SARS-CoV-2 infection. Clinical, histopathological and immunohistochemical study of 10 cases. Pediatr Dermatol 2021; 38:1185-1190. [PMID: 34463363 PMCID: PMC8646411 DOI: 10.1111/pde.14777] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We observed ten children with a papular eruption with purpuric features during the SARS-CoV-2 pandemic in Northern Italy (May-December 2020). Histological examination showed signs of SARS-CoV-2-related dermatosis. Evidence of nucleocapsid viral proteins using SARS-CoV-2 (2019-nCoV) nucleocapsid antibody revealed cuticular staining of the deep portion of the eccrine glands in all cases.
Collapse
Affiliation(s)
- Raffaele Gianotti
- Department of Pathophysiology and Transplantation, Dermatology Unit, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Restano
- Department of Clinical Sciences and Community Health, Pediatric Dermatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Cutrone
- Dipartimento Materno Infantile Unità Operativa di Pediatria e Patologia Neonatale, Vicenza, Italy
| | - Cristiana Colonna
- Department of Clinical Sciences and Community Health, Pediatric Dermatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Fellegara
- Pathology Unit C.D.I. Centro Diagnostico Italiano S.p.A. Milan, Milan, Italy
| | - Isacco Debernardi
- Pathology Unit C.D.I. Centro Diagnostico Italiano S.p.A. Milan, Milan, Italy
| | - Francesca Boggio
- Division of Pathology, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Adriano Monzani
- Department of Clinical Sciences and Community Health, Neonatal Intensive Care Unit, IRCCS Foundation Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Claudio Tripodo
- Tumor Immunology Unit. Department of Health Sciences, Istituto di Patologia Generale, University of Palermo School of Medicine, Palermo, Italy
| | - Carlo Gelmetti
- Department of Clinical Sciences and Community Health, Pediatric Dermatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio Berti
- Department of Pathophysiology and Transplantation, Dermatology Unit, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
26
|
Recalcati S, Tonolo S, Meroni E, Fantini F. SARS-CoV-2 in the sweat of COVID-19-positive patients: a possible route of transmission? J Eur Acad Dermatol Venereol 2021; 35:e865-e866. [PMID: 34416062 PMCID: PMC8656368 DOI: 10.1111/jdv.17607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/24/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S Recalcati
- Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - S Tonolo
- Microbiology and Virology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - E Meroni
- Microbiology and Virology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - F Fantini
- Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| |
Collapse
|
27
|
Kolivras A, Thompson C, Pastushenko I, Mathieu M, Bruderer P, de Vicq M, Feoli F, Harag S, Meiers I, Olemans C, Sass U, Dehavay F, Fakih A, Lam-Hoai XL, Marneffe A, Van De Borne L, Vandersleyen V, Richert B. A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review. J Cutan Pathol 2021; 49:17-28. [PMID: 34272741 PMCID: PMC8444728 DOI: 10.1111/cup.14099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Background The abundance of publications of COVID‐19‐induced chilblains has resulted in a confusing situation. Methods This is a prospective single‐institution study from 15 March to 13 May 2020. Thirty‐two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT‐scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy. Results COVID‐19‐induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work‐up in this study ruled‐out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases. Conclusion This study provides further clinicopathologic evidence of COVID‐19‐related chilblains. Negative PCR and antibody tests do not rule‐out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).
Collapse
Affiliation(s)
- Athanassios Kolivras
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Curtis Thompson
- Departments of Dermatology and Pathology, Oregon Health and Science University, Portland, Oregon, USA.,CTA Pathology, Portland, Oregon, USA
| | - Ievgenia Pastushenko
- Laboratory of Stem Cells and Cancer, Université Libre de Bruxelles, Brussels, Belgium
| | - Marisa Mathieu
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascal Bruderer
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marine de Vicq
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Feoli
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Saadia Harag
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Meiers
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Olemans
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ursula Sass
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Dehavay
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Ali Fakih
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuan-Lan Lam-Hoai
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Alice Marneffe
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Van De Borne
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Valerie Vandersleyen
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Richert
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
28
|
Sachdeva M, Mufti A, Maliyar K, Lara-Corrales I, Salcido R, Sibbald C. A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses. Adv Skin Wound Care 2021; 34:348-354. [PMID: 34125725 DOI: 10.1097/01.asw.0000752692.72055.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.
Collapse
|
29
|
Panda M, Dash S, Behera B, Sil A. Dermatological Manifestations Associated with COVID-19 Infection. Indian J Dermatol 2021; 66:237-245. [PMID: 34446946 PMCID: PMC8375538 DOI: 10.4103/ijd.ijd_464_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) causing the 2019 coronavirus disease (COVID-19) has infected millions in recent years and is a major public health concern. Various cutaneous manifestations of the COVID-19 disease have been identified. Skin is a mirror to internal disease and can be the presenting sign of COVID-19 disease. Several cutaneous manifestations can indicate severe COVID-19 disease. In the present scenario, physicians should know the various cutaneous manifestations of COVID-19 disease for early diagnosis and proper management of the disease.
Collapse
Affiliation(s)
- Maitreyee Panda
- Department of Skin and VD, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Siddhartha Dash
- Department of Skin and VD, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
| | - Biswanath Behera
- Department of Skin and VD, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
| | - Abheek Sil
- Department of Dermatology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| |
Collapse
|
30
|
Cappel MA, Cappel JA, Wetter DA. Pernio (Chilblains), SARS-CoV-2, and COVID Toes Unified Through Cutaneous and Systemic Mechanisms. Mayo Clin Proc 2021; 96:989-1005. [PMID: 33714595 PMCID: PMC7826004 DOI: 10.1016/j.mayocp.2021.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
Pernio or chilblains is characterized by erythema and swelling at acral sites (eg, toes and fingers), typically triggered by cold exposure. Clinical and histopathologic features of pernio are well described, but the pathogenesis is not entirely understood; vasospasm and a type I interferon (IFN-I) immune response are likely involved. During the coronavirus disease 2019 (COVID-19) pandemic, dermatologists have observed an increase in pernio-like acral eruptions. Direct causality of pernio due to COVID-19 has not been established in many cases because of inconsistent testing methods (often negative results) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, a form of COVID-19‒associated pernio (also called COVID toes) is probable because of increased occurrence, frequently in young patients with no cold exposure or a history of pernio, and reports of skin biopsies with positive SARS-CoV-2 immunohistochemistry. PubMed was searched between January 1, 2020, and December 31, 2020 for publications using the following keywords: pernio, chilblain, and acral COVID-19. On the basis of our review of the published literature, we speculate that several unifying cutaneous and systemic mechanisms may explain COVID-19‒associated pernio: (1) SARS-CoV-2 cell infection occurs through the cellular receptor angiotensin-converting enzyme 2 mediated by transmembrane protease serine 2, subsequently affecting the renin-angiotensin-aldosterone system with an increase in the vasoconstricting, pro-inflammatory, and prothrombotic angiotensin II pathway. (2) Severe acute respiratory syndrome coronavirus 2 cell infection triggers an immune response with robust IFN-I release in patients predisposed to COVID-19‒associated pernio. (3) Age and sex discrepancies correlated with COVID-19 severity and manifestations, including pernio as a sign of mild disease, are likely explained by age-related immune and vascular differences influenced by sex hormones and genetics, which affect susceptibility to viral cellular infection, the renin-angiotensin-aldosterone system balance, and the IFN-I response.
Collapse
Key Words
- ace2, angiotensin-converting enzyme 2
- adam17, a disintegrin and metalloproteinase 17
- ang, angiotensin
- ang1-7, angiotensin-(1-7)
- angii, angiotensin ii
- at1r, angiotensin type 1 receptor
- at2r, angiotensin type 2 receptor
- covid-19, coronavirus disease 2019
- hif-1α, hypoxia-inducible factor 1α
- ifn, interferon
- ifn-i, type i interferon
- ifn-α, interferon α
- il, interleukin
- mxa, myxovirus resistance protein a
- no, nitric oxide
- nsp, nonstructural protein
- pcr, polymerase chain reaction
- pdc, plasmacytoid dendritic cell
- raas, renin-angiotensin-aldosterone system
- s1, spike protein 1
- s2, spike protein 2
- sars-cov, severe acute respiratory syndrome coronavirus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- th17, helper t cell 17
- tlr7, toll-like receptor 7
- tmprss2, transmembrane protease serine 2
Collapse
Affiliation(s)
- Mark A Cappel
- Gulf Coast Dermatopathology Laboratory, Dermatology Associates of Tampa Bay, Tampa, FL
| | | | | |
Collapse
|
31
|
Jindal R, Chauhan P, Goyal D, Shirazi N. Idiopathic perniosis presenting as acral purpuric lesions: Clustering of cases before COVID-19 pandemic and their comparison with chilblain like lesions reported in the literature. Dermatol Ther 2021; 34:e14951. [PMID: 33740317 PMCID: PMC8250052 DOI: 10.1111/dth.14951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Perniosis/chilblains are the acral inflammatory skin lesions developing in susceptible individuals as an abnormal reaction to cold. In the absence of a discernible cause, it is labeled as idiopathic perniosis (IP). With the ongoing COVID-19 pandemic, there was an upsurge of reports of chilblain like lesions (CLL) especially in young patients possibly implicated to the SARS-CoV-2 virus. Twelve clinically suspected and histopathologically confirmed cases of IP seen from November 2019 through February 2020 were retrospectively recruited. Clinical, dermoscopic, and histopathological characteristics of these were reviewed and compared with CLL reported in the literature. Mean age of patients was 26.58 ± 15.18 years with an equal male to female ratio. Characteristic histopathology findings were spongiosis (100%), dermal edema (100%), perivascular lymphocytic infiltrate (100%) with peri-eccrine accentuation (66.7%), keratinocyte necrosis (50%), focal basal vacuolar damage (58.3%), and lymphocytic vasculitis (58.3%). Significant dermoscopy findings were variable background color ranging from dull red and violaceous to copper red and brown orange, coiled vessels (44.4%) and orange-red structureless areas (63.9%). Lesions over palms and soles preferentially had white dots/clods and lines (38.9%). There appears no exclusive histopathological as well as dermoscopy features of CLL and IP, yet certain clues can be appreciated. Keratinocyte necrosis and severe dermal edema favors IP, whereas fibrin thrombi with involvement of both superficial and deep dermal vessels favor CLL. Dermoscopically presence of irregular, linear or branching vessels, red/purple dots and clods and gray brown reticule supports CLL while white dots/clods and lines supports IP.
Collapse
Affiliation(s)
- Rashmi Jindal
- Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Payal Chauhan
- Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Dikshita Goyal
- Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Nadia Shirazi
- Department of Pathology, HIHT University, Dehradun, India
| |
Collapse
|
32
|
Synowiec A, Szczepański A, Barreto-Duran E, Lie LK, Pyrc K. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): a Systemic Infection. Clin Microbiol Rev 2021; 34:e00133-20. [PMID: 33441314 PMCID: PMC7849242 DOI: 10.1128/cmr.00133-20] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To date, seven identified coronaviruses (CoVs) have been found to infect humans; of these, three highly pathogenic variants have emerged in the 21st century. The newest member of this group, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected at the end of 2019 in Hubei province, China. Since then, this novel coronavirus has spread worldwide, causing a pandemic; the respiratory disease caused by the virus is called coronavirus disease 2019 (COVID-19). The clinical presentation ranges from asymptomatic to mild respiratory tract infections and influenza-like illness to severe disease with accompanying lung injury, multiorgan failure, and death. Although the lungs are believed to be the site at which SARS-CoV-2 replicates, infected patients often report other symptoms, suggesting the involvement of the gastrointestinal tract, heart, cardiovascular system, kidneys, and other organs; therefore, the following question arises: is COVID-19 a respiratory or systemic disease? This review aims to summarize existing data on the replication of SARS-CoV-2 in different tissues in both patients and ex vivo models.
Collapse
Affiliation(s)
- Aleksandra Synowiec
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Artur Szczepański
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
- Microbiology Department, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Emilia Barreto-Duran
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Laurensius Kevin Lie
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Krzysztof Pyrc
- Virogenetics Laboratory of Virology, Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| |
Collapse
|
33
|
Monte-Serrano J, García-Gil MF, García-García M, Casas-Flecha I, Matovelle-Ochoa C, Ara-Martín M. Granuloma annulare triggered by SARS-CoV-2 infection: Immunohistochemical staining. Dermatol Ther 2021; 34:e14897. [PMID: 33599069 PMCID: PMC7995008 DOI: 10.1111/dth.14897] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Juan Monte-Serrano
- Department of Dermatology, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | | | - Mar García-García
- Department of Pathology, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | - Inmaculada Casas-Flecha
- National Center of Microbiology, Institute of Health Carlos III (ISCIII), Flu and Respiratory Virus Unit, Madrid, Spain
| | | | - Mariano Ara-Martín
- Department of Dermatology, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| |
Collapse
|
34
|
Patrick MT, Zhang H, Wasikowski R, Prens EP, Weidinger S, Gudjonsson JE, Elder JT, He K, Tsoi LC. Associations between COVID-19 and skin conditions identified through epidemiology and genomic studies. J Allergy Clin Immunol 2021; 147:857-869.e7. [PMID: 33485957 PMCID: PMC7825803 DOI: 10.1016/j.jaci.2021.01.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is commonly associated with skin manifestations, and may also exacerbate existing skin diseases, yet the relationship between COVID-19 and skin diseases remains unclear. OBJECTIVE By investigating this relationship through a multiomics approach, we sought to ascertain whether patients with skin conditions are more susceptible to COVID-19. METHODS We conducted an epidemiological study and then compared gene expression across 9 different inflammatory skin conditions and severe acute respiratory syndrome coronavirus 2-infected bronchial epithelial cell lines, and then performed a genome-wide association study transdisease meta-analysis between COVID-19 susceptibility and 2 skin diseases (psoriasis and atopic dermatitis). RESULTS Skin conditions, including psoriasis and atopic dermatitis, increase the risk of COVID-19 (odds ratio, 1.55; P = 1.4 × 10-9) but decrease the risk of mechanical ventilation (odds ratio, 0.22; P = 8.5 × 10-5). We observed significant overlap in gene expression between the infected normal bronchial epithelial cells and inflammatory skin diseases, such as psoriasis and atopic dermatitis. For genes that are commonly induced in both the severe acute respiratory syndrome coronavirus 2 infection and skin diseases, there are 4 S100 family members located in the epidermal differentiation complex, and we also identified the "IL-17 signaling pathway" (P = 4.9 × 10-77) as one of the most significantly enriched pathways. Furthermore, a shared genome-wide significant locus in the epidermal differentiation complex was identified between psoriasis and severe acute respiratory syndrome coronavirus 2 infection, with the lead marker being a significant expression quantitative trait locus for S100A12 (P = 3.3 × 10-7). CONCLUSIONS Together our findings suggest association between inflammatory skin conditions and higher risk of COVID-19, but with less severe course, and highlight shared components involved in anti-COVID-19 immune response.
Collapse
Affiliation(s)
- Matthew T Patrick
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Mich.
| | - Haihan Zhang
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Mich
| | - Rachael Wasikowski
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Mich
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Mich
| | - James T Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Mich; Ann Arbor Veterans Affairs Hospital, Ann Arbor, Mich
| | - Kevin He
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Mich
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Mich; Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Mich; Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Mich.
| |
Collapse
|
35
|
Novak N, Peng W, Naegeli MC, Galvan C, Kolm‐Djamei I, Brüggen C, Cabanillas B, Schmid‐Grendelmeier P, Catala A. SARS-CoV-2, COVID-19, skin and immunology - What do we know so far? Allergy 2021; 76:698-713. [PMID: 32658359 PMCID: PMC7404682 DOI: 10.1111/all.14498] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023]
Abstract
The pandemic condition coronavirus disease (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can take asymptomatic, mild, moderate, and severe courses. COVID-19 affects primarily the respiratory airways leading to dry cough, fever, myalgia, headache, fatigue, and diarrhea and can end up in interstitial pneumonia and severe respiratory failure. Reports about the manifestation of various skin lesions and lesions of the vascular system in some subgroups of SARS-CoV-2-positive patients as such features outside the respiratory sphere, are rapidly emerging. Vesicular, urticarial, and maculopapular eruptions and livedo, necrosis, and other vasculitis forms have been reported most frequently in association with SARS-CoV-2 infection. In order to update information gained, we provide a systematic overview of the skin lesions described in COVID-19 patients, discuss potential causative factors, and describe differential diagnostic evaluations. Moreover, we summarize current knowledge about immunologic, clinical, and histologic features of virus- and drug-induced lesions of the skin and changes to the vascular system in order to transfer this knowledge to potential mechanisms induced by SARS-CoV-2.
Collapse
Affiliation(s)
- Natalijia Novak
- Department of Dermatology and Allergy University Hospital of Bonn Bonn Germany
| | - Wenming Peng
- Department of Dermatology and Allergy University Hospital of Bonn Bonn Germany
| | - Mirjam C. Naegeli
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Faculty of Medicine University Zurich Zurich Switzerland
| | - Christina Galvan
- Department of Dermatology and Venereology Móstoles Hospital Madrid Spain
| | - Isabel Kolm‐Djamei
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Faculty of Medicine University Zurich Zurich Switzerland
| | - Charlotte Brüggen
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Faculty of Medicine University Zurich Zurich Switzerland
- Hochgebirgsklinik Davos Davos Switzerland
| | - Beatriz Cabanillas
- Department of Dermatology and Allergy University Hospital of Bonn Bonn Germany
| | - Peter Schmid‐Grendelmeier
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Faculty of Medicine University Zurich Zurich Switzerland
| | - Alba Catala
- Department of Dermatology and Venereology Plató Hospital Barcelona Spain
| |
Collapse
|
36
|
Flores-Pliego A, Miranda J, Vega-Torreblanca S, Valdespino-Vázquez Y, Helguera-Repetto C, Espejel-Nuñez A, Borboa-Olivares H, Espino y Sosa S, Mateu-Rogell P, León-Juárez M, Ramírez-Santes V, Cardona-Pérez A, Villegas-Mota I, Torres-Torres J, Juárez-Reyes Á, Rizo-Pica T, González RO, González-Mariscal L, Estrada-Gutierrez G. Molecular Insights into the Thrombotic and Microvascular Injury in Placental Endothelium of Women with Mild or Severe COVID-19. Cells 2021; 10:cells10020364. [PMID: 33578631 PMCID: PMC7916402 DOI: 10.3390/cells10020364] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023] Open
Abstract
Clinical manifestations of coronavirus disease 2019 (COVID-19) in pregnant women are diverse, and little is known of the impact of the disease on placental physiology. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been detected in the human placenta, and its binding receptor ACE2 is present in a variety of placental cells, including endothelium. Here, we analyze the impact of COVID-19 in placental endothelium, studying by immunofluorescence the expression of von Willebrand factor (vWf), claudin-5, and vascular endothelial (VE) cadherin in the decidua and chorionic villi of placentas from women with mild and severe COVID-19 in comparison to healthy controls. Our results indicate that: (1) vWf expression increases in the endothelium of decidua and chorionic villi of placentas derived from women with COVID-19, being higher in severe cases; (2) Claudin-5 and VE-cadherin expression decrease in the decidua and chorionic villus of placentas from women with severe COVID-19 but not in those with mild disease. Placental histological analysis reveals thrombosis, infarcts, and vascular wall remodeling, confirming the deleterious effect of COVID-19 on placental vessels. Together, these results suggest that placentas from women with COVID-19 have a condition of leaky endothelium and thrombosis, which is sensitive to disease severity.
Collapse
Affiliation(s)
- Arturo Flores-Pliego
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico; (A.F.-P.); (C.H.-R.); (A.E.-N.); (M.L.-J.)
| | - Jael Miranda
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Ciudad de México 07360, Mexico; (J.M.); (S.V.-T.)
| | - Sara Vega-Torreblanca
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Ciudad de México 07360, Mexico; (J.M.); (S.V.-T.)
| | | | - Cecilia Helguera-Repetto
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico; (A.F.-P.); (C.H.-R.); (A.E.-N.); (M.L.-J.)
| | - Aurora Espejel-Nuñez
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico; (A.F.-P.); (C.H.-R.); (A.E.-N.); (M.L.-J.)
| | - Héctor Borboa-Olivares
- Community Interventions Research Branch, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico;
| | - Salvador Espino y Sosa
- Clinical Research Branch, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico; (S.E.yS.); (P.M.-R.)
| | - Paloma Mateu-Rogell
- Clinical Research Branch, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico; (S.E.yS.); (P.M.-R.)
| | - Moisés León-Juárez
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico; (A.F.-P.); (C.H.-R.); (A.E.-N.); (M.L.-J.)
| | - Victor Ramírez-Santes
- Department of Obstetrics, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico;
| | - Arturo Cardona-Pérez
- General Direction, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico;
| | - Isabel Villegas-Mota
- Department of Epidemiology, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico;
| | - Johnatan Torres-Torres
- Hospital General de México Dr Eduardo Liceaga, Ciudad de México 06720, Mexico; (J.T.-T.); (Á.J.-R.); (T.R.-P.)
| | - Ángeles Juárez-Reyes
- Hospital General de México Dr Eduardo Liceaga, Ciudad de México 06720, Mexico; (J.T.-T.); (Á.J.-R.); (T.R.-P.)
| | - Thelma Rizo-Pica
- Hospital General de México Dr Eduardo Liceaga, Ciudad de México 06720, Mexico; (J.T.-T.); (Á.J.-R.); (T.R.-P.)
| | - Rosa O. González
- Department of Mathematics, Autonomous Metropolitan University-Iztapalapa (UAM-I), Ciudad de México 14387, Mexico;
| | - Lorenza González-Mariscal
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Ciudad de México 07360, Mexico; (J.M.); (S.V.-T.)
- Correspondence: (L.G.-M.); (G.E.-G.); Tel.: +5255-5-747-3800 (ext. 3966) (L.G.-M.); +5255-5-520-9900 (ext. 160) (G.E.-G.)
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología, Ciudad de México 11000, Mexico
- Correspondence: (L.G.-M.); (G.E.-G.); Tel.: +5255-5-747-3800 (ext. 3966) (L.G.-M.); +5255-5-520-9900 (ext. 160) (G.E.-G.)
| |
Collapse
|
37
|
Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2021; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain-Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis.
Collapse
Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
| |
Collapse
|
38
|
Giordo R, Paliogiannis P, Mangoni AA, Pintus G. SARS-CoV-2 and endothelial cell interaction in COVID-19: molecular perspectives. VASCULAR BIOLOGY (BRISTOL, ENGLAND) 2021; 3:R15-R23. [PMID: 33659858 PMCID: PMC7923034 DOI: 10.1530/vb-20-0017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
SARS-CoV-2 is the agent responsible for the coronavirus disease (COVID-19), which has been declared a pandemic by the World Health Organization. The clinical evolution of COVID-19 ranges from asymptomatic infection to death. Older people and patients with underlying medical conditions, particularly diabetes, cardiovascular and chronic respiratory diseases are more susceptible to develop severe forms of COVID-19. Significant endothelial damage has been reported in COVID-19 and growing evidence supports the key pathophysiological role of this alteration in the onset and the progression of the disease. In particular, the impaired vascular homeostasis secondary to the structural and functional damage of the endothelium and its main component, the endothelial cells, contributes to the systemic proinflammatory state and the multiorgan involvement observed in COVID-19 patients. This review summarizes the current evidence supporting the proposition that the endothelium is a key target of SARS-CoV-2, with a focus on the molecular mechanisms involved in the interaction between SARS-CoV-2 and endothelial cells.
Collapse
Affiliation(s)
- Roberta Giordo
- Department of Medical Laboratory Sciences, College of Health Sciences, and Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Panagiotis Paliogiannis
- Department of Medical, Surgical and Experimental Surgery, University of Sassari, Sassari, Italy
| | - Arduino Aleksander Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Gianfranco Pintus
- Department of Medical Laboratory Sciences, College of Health Sciences, and Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro, Sassari, Italy
| |
Collapse
|
39
|
Hubiche T, Phan A, Leducq S, Rapp J, Fertitta L, Aubert H, Barbarot S, Chiaverini C, Giraudeau B, Lasek A, Mallet S, Labarelle A, Piram M, McCuaig C, Martin L, Monitor L, Nicol I, Bissuel M, Bellissen A, Jullien D, Lesort C, Vabres P, Maruani A. Acute acral eruptions in children during the COVID-19 pandemic: Characteristics of 103 children and their family clusters. Ann Dermatol Venereol 2021; 148:94-100. [PMID: 33551211 PMCID: PMC7831537 DOI: 10.1016/j.annder.2020.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/15/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
Background A marked increase in frequency of acute acral eruptions (AAE) was observed in children during the COVID-19 pandemic in the spring period. Objectives In this observational multicenter study, based on children with AAE, we aimed to assess the proportion of household members possibly infected by SARS-CoV-2. Methods We collected data from all children observed with AAE, prospectively from April 7, 2020 to June 22, 2020, and retrospectively since February 28, 2020. The primary outcome was the household infection rate, defined as the proportion of family clusters having at least one member with COVID-19 infection other than the child with AAE (“index child”). The definition of a case was based on characteristic clinical signs and a positive PCR or serology. Results The study included 103 children in 10 French departments and in Quebec. The median age was 13 years and the interquartile range [8–15], with a female-to-male ratio of 1/1.15. In children with AAE, all PCR tests were negative (n = 18), and serology was positive in 2/14 (14.3%) cases. We found no significant anomalies in the lab results. A total of 66 of the 103 families (64.1%) of included children had at least one other infected member apart from the index child. The total number of household members was 292, of whom 119 (40.8%) were considered possibly infected by SARS-CoV-2. No index children or households exhibited severe COVID-19. Discussion Among the 103 households included, 64.1% had at least one infected member. Neither children with AAE nor their households showed severe COVID-19.
Collapse
Affiliation(s)
- T Hubiche
- Nice University Hospital, Department of Dermatology, 06000 Nice, France
| | - A Phan
- Lyon University Hospital, Department of Pediatric Dermatology, Hospices Civils de Lyon, 69500 Bron, France
| | - S Leducq
- Universities of Tours and Nantes, inserm 1246-SPHERE, 37000 Tours, France; Tours University Hospital, Department of Dermatology, 37044 Tours Cedex 9, France
| | - J Rapp
- Nice University Hospital, Department of Dermatology, 06000 Nice, France
| | - L Fertitta
- AP-HP (Paris Hospitals), Paris-Necker Hospital, Department of Dermatology, 75015 Paris, France
| | - H Aubert
- Nantes University Hospital, Department of Dermatology, 44000 Nantes, France
| | - S Barbarot
- Nantes University Hospital, Department of Dermatology, 44000 Nantes, France
| | - C Chiaverini
- Nice University Hospital, Department of Dermatology, 06000 Nice, France
| | - B Giraudeau
- Universities of Tours and Nantes, inserm 1246-SPHERE, 37000 Tours, France; Tours University Hospital, Clinical Investigation Center-INSERM 1415, 37000 Tours, France
| | - A Lasek
- Saint Vincent de Paul Hospital, Université catholique de Lille, 59000 Lille, France
| | - S Mallet
- Marseille University Hospital, Department of Dermatology, 13000 Marseille, France
| | - A Labarelle
- Marseille University Hospital, Department of Dermatology, 13000 Marseille, France
| | - M Piram
- Sainte-Justine University Hospital, Division of Dermatology, Montreal, Quebec, Canada
| | - C McCuaig
- Sainte-Justine University Hospital, Division of Dermatology, Montreal, Quebec, Canada
| | - L Martin
- Angers Hospital University, Department of Dermatology, 49000 Angers, France
| | - L Monitor
- Nancy University Hospital, Department of Dermatology, 54511 Vandœuvre-lès-Nancy, France
| | - I Nicol
- Marseille University Hospital, Department of Dermatology, 13000 Marseille, France
| | - M Bissuel
- Casamance Private Hospital, Department of Pediatrics, 13400 Aubagnes, France
| | - A Bellissen
- Marseille University Hospital, Department of Dermatology, 13000 Marseille, France
| | - D Jullien
- Lyon University Hospital, Department of Dermatology, Hospital Edouard Herriot, 69003 Lyon, France
| | - C Lesort
- Lyon University Hospital, Department of Dermatology, Hospital Edouard Herriot, 69003 Lyon, France
| | - P Vabres
- Dijon University Hospital, Department of Dermatology, 21000 Dijon, France
| | - A Maruani
- Universities of Tours and Nantes, inserm 1246-SPHERE, 37000 Tours, France; Tours University Hospital, Department of Dermatology, 37044 Tours Cedex 9, France; Tours University Hospital, Clinical Investigation Center-INSERM 1415, 37000 Tours, France.
| | | |
Collapse
|
40
|
Chilblain-Like Lesions during COVID-19 Pandemic: The State of the Art. Life (Basel) 2021; 11:life11010023. [PMID: 33401712 PMCID: PMC7823415 DOI: 10.3390/life11010023] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 infection has spread all over the world in the last year, causing millions of COVID-19 cases among humans with a large variability of symptoms and signs, including those on the skin. Among these, a contemporary cluster of chilblain-like lesions with no certain relationship with the infection has been reported. The aim of this paper is to delineate a profile of chilblain-like lesions and to establish the state-of-the-art knowledge about this new phenomenon.
Collapse
|
41
|
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.
Collapse
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.
| |
Collapse
|
42
|
Rongioletti F, Ferreli C, Sena P, Caputo V, Atzori L. Clinicopathologic correlations of COVID-19-related cutaneous manifestations with special emphasis on histopathologic patterns. Clin Dermatol 2021; 39:149-162. [PMID: 33972045 PMCID: PMC7832768 DOI: 10.1016/j.clindermatol.2020.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skin is one of target organs affected by the novel coronavirus SARS-CoV-2, and in response to the current COVID-19 pandemic, a fast body of literature has emerged on related cutaneous manifestations. Current perspective is that the skin is not only a bystander of the general cytokines storm with thrombophilic multiorgan injury, but it is directly affected by the epithelial tropism of the virus, as confirmed by the detection of SARS-CoV-2 in endothelial cells and epithelial cells of epidermis and eccrine glands. In contrast with the abundance of epidemiologic and clinical reports, histopathologic characterization of skin manifestations is limited. Without an adequate clinicopathologic correlation, nosology of clinically similar conditions is confusing, and effective association with COVID-19 remains presumptive. Several patients with different types of skin lesions, including the most specific acral chilblains-like lesions, showed negative results at SARS-CoV-2 nasopharyngeal and serologic sampling. The aim of this review is to provide an overview of what has currently been reported worldwide, with a particular emphasis on microscopic patterns of the skin manifestations in patients exposed to or affected by COVID-19. Substantial breakthroughs may occur in the near future from more skin biopsies, improvement of immunohistochemistry studies, RNA detection of SARS-CoV-2 strain by real-time polymerase chain reaction-based assay, and electron microscopic studies.
Collapse
Affiliation(s)
- Franco Rongioletti
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; IRCCS San Raffaele Hospital and Dental School, Vita Salute University, 20132 Milan, Italy
| | - Caterina Ferreli
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Paolo Sena
- Unit of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Caputo
- Unit of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Atzori
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
43
|
Gambichler T, Reuther J, Stücker M, Stranzenbach R, Torres-Reyes C, Schlottmann R, Schmidt WE, Hayajneh R, Sriram A, Becker JC. SARS-CoV-2 spike protein is present in both endothelial and eccrine cells of a chilblain-like skin lesion. J Eur Acad Dermatol Venereol 2020; 35:e187-e189. [PMID: 33002210 PMCID: PMC7537109 DOI: 10.1111/jdv.16970] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Data on SARS‐CoV‐2 detection in lesional skin is controversial.1‐8 We report a PCR‐proven COVID‐19 patient with a chilblain‐like SARS‐CoV‐2 positive skin lesion. An 80‐year‐old woman presented to the emergency department at the End of March 2020. She reported an onset of fever (38.4 C°) several days before admission, along with cough and shortness of breath. RT‐PCR from a nasopharyngeal swab was positive for SARS‐CoV‐2. An X‐ray showed evidence for right‐sided pneumonic infiltrates.
Collapse
Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J Reuther
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Stücker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - R Stranzenbach
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - C Torres-Reyes
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - R Schlottmann
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - W E Schmidt
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - R Hayajneh
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Sriram
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
44
|
Type I Interferon Signature in Chilblain-Like Lesions Associated with the COVID-19 Pandemic. Dermatopathology (Basel) 2020; 7:57-63. [PMID: 33291622 PMCID: PMC7768511 DOI: 10.3390/dermatopathology7030010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022] Open
Abstract
Contemporarily to the new SARS-CoV-2 mediated COVID-19 pandemic, a rise in patients with acral chilblain lesions has been described. They manifest late after mild disease or asymptomatic exposure to SARS-CoV-2. Their pathogenic evolution is currently unknown. In biopsies from three patients with acral partially ulcerating chilblain lesions that occurred associated to the COVID-19 pandemic, we analysed the expression of type I interferon induced proteins and signal transduction kinases. Histology demonstrated perivascular and periadnexal lymphohistiocytic infiltrates and endothelial dominated MxA-staining, as well as pJAK1 activation. Our findings demonstrate induction of the type I IFN pathway in lesional sections of COVID-19-associated chilblain-like lesions. This may indicate a local antiviral immune activation status associated with preceding exposure to SARS-CoV-2.
Collapse
|
45
|
Fathizadeh H, Taghizadeh S, Safari R, Khiabani SS, Babak B, Hamzavi F, Ganbarov K, Esposito S, Zeinalzadeh E, Dao S, Köse Ş, Kafil HS. Study presence of COVID-19 (SARS-CoV-2) in the sweat of patients infected with Covid-19. Microb Pathog 2020; 149:104556. [PMID: 33031898 PMCID: PMC7534876 DOI: 10.1016/j.micpath.2020.104556] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease, which started in Wuhan, Chin, has now become a public health challenge in most countries around the world. Proper preventive measures are necessary to prevent the spread of the virus to help control the pandemic. Because, SARS-CoV-2 is new, its transmission route has not been fully understood. In this study, we aimed to investigate the presence of SARS-CoV-2 in the sweat secretion of COVID-19 patients. Sweat specimens of 25 COVID- 19 patients were collected and tested for SARS-CoV-2 RNA by Real-time Polymerase Chain Reaction (RT-PCR) method. After RNA extraction and cDNA amplification, all samples were examined for the presence of ORF-1ab and N genes related to COVID-19. Results annotated by Realtime PCR machines software based on Dynamic algorithm. The results of this study showed the absence of SARS-CoV-2 in the sweat samples taken from the foreheads of infected people. Therefore, it can be concluded that the sweat of patients with COVID- 19 cannot transmit SARS-CoV-2. However they can be easily contaminated with other body liquids.
Collapse
Affiliation(s)
- Hadis Fathizadeh
- Department of Microbiology and Immunology, Kashan University of Medical Sciences, Kashan, Iran
| | - Sepehr Taghizadeh
- Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rohollah Safari
- Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Shabestari Khiabani
- Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bayaz Babak
- Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Hamzavi
- Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Elham Zeinalzadeh
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sounkalo Dao
- Faculté de Médecine, de Pharmacie et d'Odonto-Stomatologie (FMPOS), University of Bamako, Bamako, Mali
| | - Şükran Köse
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
46
|
Ko CJ, Harigopal M, Gehlhausen JR, Bosenberg M, McNiff JM, Damsky W. Discordant anti-SARS-CoV-2 spike protein and RNA staining in cutaneous perniotic lesions suggests endothelial deposition of cleaved spike protein. J Cutan Pathol 2020; 48:47-52. [PMID: 32895985 DOI: 10.1111/cup.13866] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prior studies have shown the presence of immunohistochemical staining for the SARS-CoV-2 spike protein (SP) in endothelial cells and eccrine epithelium of acral perniosis classified as "COVID toes." Yet, other studies have been unable to detect SARS-CoV-2 RNA in skin biopsies of "COVID toes" by reverse-transcriptase polymerase chain reaction testing. OBJECTIVE In order to address these apparently conflicting findings, we compared detection of SARS-CoV-2 SP, through RNA in situ hybridization (ISH) vs immunohistochemistry (IHC), in skin biopsies of acral perniotic lesions presenting during the COVID-19 pandemic. RESULTS Three of six cases showed positive immunohistochemical labeling of endothelial cells, with one of three cases with sufficient depth also having labeling of eccrine glands, using an anti-SP SARS-CoV-2 antibody. These three cases positive with IHC were negative for SP by RNA ISH. CONCLUSION While the gold standard for detection of SARS-CoV-2 in tissue sections has yet to be determined, the detection of SARS-CoV-2 SP alone without spike RNA suggests that cleaved SP may be present in cutaneous endothelial cells and eccrine epithelium, providing a potential pathogenetic mechanism of COVID-19 endotheliitis.
Collapse
Affiliation(s)
- Christine J Ko
- Department of Dermatology, Yale Medical School, New Haven, Connecticut, USA.,Department of Pathology, Yale Medical School, New Haven, Connecticut, USA
| | - Malini Harigopal
- Department of Pathology, Yale Medical School, New Haven, Connecticut, USA
| | - Jeff R Gehlhausen
- Department of Dermatology, Yale Medical School, New Haven, Connecticut, USA
| | - Marcus Bosenberg
- Department of Dermatology, Yale Medical School, New Haven, Connecticut, USA.,Department of Pathology, Yale Medical School, New Haven, Connecticut, USA
| | - Jennifer M McNiff
- Department of Dermatology, Yale Medical School, New Haven, Connecticut, USA.,Department of Pathology, Yale Medical School, New Haven, Connecticut, USA
| | - William Damsky
- Department of Dermatology, Yale Medical School, New Haven, Connecticut, USA.,Department of Pathology, Yale Medical School, New Haven, Connecticut, USA
| |
Collapse
|
47
|
Tatu AL, Nadasdy T, Bujoreanu FC. Familial clustering of COVID-19 skin manifestations. Dermatol Ther 2020; 33:e14181. [PMID: 32794366 PMCID: PMC7435557 DOI: 10.1111/dth.14181] [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: 07/21/2020] [Revised: 08/01/2020] [Accepted: 08/08/2020] [Indexed: 12/29/2022]
Abstract
The medical community in the past months has seen a flourishing of information related to the SARS‐CoV‐2 virus responsible for the COVID‐19 pandemic. From the early days of the pandemic, the SARS‐CoV‐2 virus has been linked to multiple different types of skin involvement. To the best of our knowledge, we are the first to report on a case of familial clustering of a maculopapular COVID‐19 rash. Eight persons presented COVID‐19 symptoms, six were confirmed via SAR‐CoV‐2 chemoluminescent immunoassays, and the four related by blood presented skin manifestations. Although, it has not been fully established if the SARS‐CoV‐2 can in fact cause viral exanthems, our observations regarding the familial clustering and the temporal evolution seen in this family seem to present strong evidence of a viral exanthema related to SARS‐CoV‐2 infection.
Collapse
Affiliation(s)
- Alin Laurentiu Tatu
- Department of Dermatology, "St. Parascheva" Clinical Hospital of Infectious Diseases, Galati, Romania.,Faculty of Medicine and Pharmacy/Clinical Department, Dermatology, Medical, and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform, ReForm-UDJG "Dunărea de Jos" University, Galati, Romania
| | - Thomas Nadasdy
- Department of Dermatology, "St. Parascheva" Clinical Hospital of Infectious Diseases, Galati, Romania
| | - Florin Ciprian Bujoreanu
- Department of Dermatology, "St. Parascheva" Clinical Hospital of Infectious Diseases, Galati, Romania.,Department of Dermatology, "Dunărea de Jos" University of Galati, Doctoral School-Medicine, Galati, Romania
| |
Collapse
|
48
|
Kaya G, Kaya A, Saurat JH. Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature. Dermatopathology (Basel) 2020; 7:3-16. [PMID: 32608380 PMCID: PMC7583593 DOI: 10.3390/dermatopathology7010002] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions-and in severe cases, microvascular injury and thrombosis-associated with COVID-19, and provide important clues to their pathological mechanisms.
Collapse
Affiliation(s)
- Gürkan Kaya
- Departments of Dermatology and Clinical Pathology, University Hospital of Geneva, 1205 Geneva, Switzerland
| | - Aysin Kaya
- Department of Clinical Pharmacology and Toxicology, University of Geneva, 1205 Geneva, Switzerland; (A.K.); (J.-H.S.)
| | - Jean-Hilaire Saurat
- Department of Clinical Pharmacology and Toxicology, University of Geneva, 1205 Geneva, Switzerland; (A.K.); (J.-H.S.)
| |
Collapse
|