A STUDY ON EXTRAPULMONARY MANIFESTATIONS OF COVID-19:

A STUDY ON EXTRAPULMONARY MANIFESTATIONS OF COVID-19:

INTRODUCTION:

“Corona” the pandemic viral disease which is spread over the world from Wuhan city of China.It initially began as series of atypical respiratory disease and soom it was discovered that novel corona viruses are responsible.The corona viruses are positive single stranded RNA viruses with a crown like appearance due to the presence of spike like glycoprotiens. It belongs to the family Coronaviridae and subfamily orthocoronaviridae.It is classified into 4 genera alphaCoV,betaCoV,deltaCoV and gammaCoV.Out of which SARS-CoV-2 belongs to betaCoV.

NAMING OF COVID-19:

It is named as SARS-CoV-2 by the Coronavirus study group of the INTERNATIONAL COMMITTEE ON TAXONOMY OF VIRUSES based upon it’s genetic relationship with the SARS-Co-V that caused an outbreak of disease in 2002-2003.Based on phylogeny,taxonomy and established practice ,the CSG recognizes it as the sister to Severe acute respiratory syndrome(SARS-CoVs)and designated as SARS-CoV-2.

MANIFESTATIONS OF CORONA:

It is well known that the coronavirus principally affects the respiratory system and produces symptoms like sore throat,dry cough,fever,dyspnoea and it produces PNEUMONIA in patients with comorbidities like Diabetes mellitus,Hypertension.It also produces constitutional symptoms like fatigue,headache,myalgia,arthralgia.In addition to all these manifestations the patients also have effects on other systems of our body.They include

1. Gastrointestinal manifestations
2. Neurological manifestations
3. Cutaneous manifestations
4. Haematological abnormalities
5. Vascular abnormalities
6. Ocular manifestations
7. Cardiac dysfunction
8. Renal dysfunction
9. Liver dysfunction
10. Placental abnormalities in Pregnant women

GASTROINTESTINAL MANIFESTATIONS:

Recent studies have shown that most of the Covid-19 positive patients produces gastrointestinal manifestations.Few cases of Covid-19 present ONLY WITH GASTROINTESTINAL SYMPTOMS without any Respiratory symptoms.Even the viral nucleic acid is present in the anal swab of the hospitalized patients suggesting that FAECO-ORAL TRANSMISSION is the alternative root for Covid-19 spread.The manifestations include..

1. Diarrhoea
2. Vomiting
3. Nausea
4. Belching
5. Abdominal pain

NEUROLOGICAL  MANIFESTATIONS:

Recent studies have shown that it gets access to the CNS through the SYSTEMIC CIRCULATION or from nose it enters through the CRIBRIFORM PLATE of the ethmoidal bone and damage neuronal tissue by interacting with ACE2receptors.It may cause GULLAIN-BARRE SYNDROME-Acute demyelinating inflammatory poly neuropathy..so the manifestations will be

• Loss of smell
• Loss of taste

                      Sensory loss with tingling sensation

It may also leads to Meningitis,encephalitis so the patient will have

• Altered behavior
• Altered speech
•  Flaccid paralysis
• Seizures

A recent study also shown that there is ACUTE NECROTIZING ENCEPHALOPATHY in patients whose nasopharyngeal swab was COVID-19// positive.A team of researcher at CSIR-INDIAN INSTITUTE OF CHEMICAL BIOLOGY have found that corona may affect the RESPIRATORY CENTRE OF BRAIN-PREBOTZINGER COMPLEX,the primary centre that controls respiratory rhythm and it may lead to collapse of COVID-19 patients.Examinations of CSF with SARS-CoV-2 had confirmed VIRAL RNA..

CUTANEOUS MANIFESTATIONS:

Cutaneous manifestations are the well known effects of viral infections.So the recent studies have shown that COVID-19 positive patients had these kind of cutaneous manifestations..

1. Morbilliform rash
2. Urticaria
3. Vesicular eruptions
4. Acral lesions
5. Liveloid eruptions

MORBILLIFORM RASHES:In Italy,there is a study that out of 18 patients 14 of them have this kind of rashes.

URTICARIA:Out of 18 patients 3 of them had presented with urticaria

VESICULAR ERUPTIONS:The corona positive patients also had varicella like vesicular eruptions throughout their body.

ACRAL LESIONS:It is otherwise known as “COVID TOES”.In a report from Kuwait were described as having Perniosis like acral lesions.

LIVELOID ERUPTIONS:It is secondary to SYSTEMIC THROMBOTIC VASCULOPATHY in COVID-19 positive patients.

HAEMATOLOGICAL MANIFESTATIONS:

In blood there will be HYPERACTIVE IMMUNE RESPONSE which in turn

leads to CYTOKINE STORM in the circulatory system with diminished oxygen carrying capacity which results in Multi-organ failure.Initially there will be lymphopenia,then Leucocytosis and THROMBOCYTOPENIA which will rarely lead to DISSEMINATED INTRAVASCULAR COAGULATION.

VASCULAR MANIFESTATIONS:  In blood vessels there will be MICROVASULAR DILATATION SIGN,E ngorgement or Mural thickening.

OCULAR MANIFESTATIONS:  It may infect eyes either through respiratory droplets or migrate from nasopharynx via Nasolacrimal duct or direct haematogenous spread to eyes.

RENAL DYSFUNCTION:  Acc to recent research it is estimated that there is coexpression of ACE2 and TMPRSS(Tramsmembrane protease serine 2 precusror)in podocytes makes proximal convoluted tubule as potent receptor for SARS-CoV-2.It can cause acute renal failure with increased creatinine levels and rhabdomyosis.About 0.5-19% patient with COVID-19 demonstrate degree of acute renal failure.

LIVER DYSFUNCTION:Some histopathological studies confirm presence of SARS-CoV-2 in liver tissue.In blood samples increase in the level of liver enzymes.

CARDIAC MANIFESTATIONS:It significantly correlates with age,male gender,hypertension,preexisting cardiac diseases.There will be Myocarditis and Acute myocardial infection.The myocardial injury can be manifested by elevated cardiac troponin I

Creatine kinase and lactate dehydrogenase.Arrhythmias may be present in patients with coronary artery disease..A recent study have shown that a 34 yr old died due to acute heart failure because of SARS-CoV-2

MALE REPRODUCTIVE SYSTEM:  ORCHITIS-Rare and important complication of COVID-19.It is due to high expression of ACE2 in human testes and uterus.Recently a study has reported that a COVID-19 patient presented with Testicular pain..

COVID-19 AND PREGNANCY: Recent studies have shown that there possibility of in utero transmission.The virus is also detected in the placenta,vaginal tract,maternal blood and umbilical cord of infants,but only rare positive births.IgG and IgM antibodies are present in maternal blood but IgG antibodies only present in cord of infant as the IgM antibodies are not transfused through placenta..

PLACENTAL INJURY: There will be Decidual arteriopathy,MATERNAL MALPERFUSION and INTRAVILLOUS THROMBI  are common in SARS-CoV-2.So there will be fetal vascular malperfusion.Though there are placental injury ,deficient oxygen and nutrient supply only rare positive births…

REFERENCE ARTICLES :

1. Features evoluation and treatment of Corona Virus  https://www.ncbi.nlm.nih.gov/books/NBK554776/
2. SARS – CoV-2:what’s in a name : www.medscape.com
3. Extra pulmonary manifestations of Covid-19 https://www.researchgate.net/publication/341477548_Extrapulmonary_manifestations_of_COVID-19_Radiologic_and_clinical_overview
4. Gullain-Barre syndrome during SARS – CoV-2 https://pubmed.ncbi.nlm.nih.gov/32388880/
5. Skin Manifestation of Covid – 19 https://www.ccjm.org/content/early/2020/05/12/ccjm.87a.ccc031
6. Covid – 19 may affect the Respiratory Centre by Researchers at CSIR https://www.hindustantimes.com/india-news/covid-19-may-infect-respiratory-centre-of-brain-suggests-research/story-HnqKDAmEEmLh3pquLdTDaM.html
7. Possible in Utero SARS – CoV – 2    transmission – www.medscape.com
8. Placental pathology in Covid – 19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279066/

Ms. P. Harini

Third year BHMS