|
1
|
Wettasinghe I, Puthra S, Sugathapala HA, Mendis S. Rapidly Progressive, Symmetrical, Acute Cutaneous Necrosis of Bilateral Lower Limbs: A Rare Presentation of Polyarteritis Nodosa. Cureus 2024; 16:e58649. [PMID: 38770516 PMCID: PMC11103124 DOI: 10.7759/cureus.58649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Acute cutaneous necrosis is a rare presentation of polyarteritis nodosa (PAN). In this study, we report a presentation with symmetrical cutaneous necrosis of the lower limbs, which ascended upward at a rapid rate. A 47-year-old man presented with a fever of one day and pain in the feet for six days. He had no history of claudication. Upon examination, he was febrile, and subtle bluish discoloration was observed on the sole of his foot. There was a bilateral stocking-type paresthesia up to the ankle joint. His blood pressure on admission was 210/120 mmHg. Eight hours later, the pain subsided, but a left-sided foot drop was noted along with the paresthesia extending up both feet to approximately 10 cm above the medial malleolus. The feet turned black, and dark discoloration spread rapidly upward over the next 16 hours, and the skin became necrosed. A clinical diagnosis of vasculitis was established, and the patient received IV methylprednisolone at a daily dosage of 1 g for three days, effectively stopping the advancement of necrosis. This was followed by treatment with IV cyclophosphamide. A conclusive diagnosis of PAN was made, and the patient underwent wound debridement. After three months of physiotherapy, a successful skin graft was performed. Prompt identification of the underlying etiology is crucial to prevent the advancement of necrosis and save the limbs. When vasculitis is suspected, ruling out infectious causes is essential before starting early immunosuppressive treatment.
Collapse
Affiliation(s)
| | - Shiran Puthra
- Internal Medicine, Colombo South Teaching Hospital, Colombo, LKA
| | | | - Suresh Mendis
- Internal Medicine, Colombo South Teaching Hospital, Colombo, LKA
| |
Collapse
|
|
2
|
Ye Y, Xiong C, Dai Y, Wang Y, Yang X, Cheng L, Hou C, Nie N, Tang H, Ma X, Zhang A, Cao G, He Y, Jiang J, Li L. Assessment of post-COVID-19 fatigue among female survivors 2 years after hospital discharge: a nested case-control study. BMC Public Health 2023; 23:2455. [PMID: 38062429 PMCID: PMC10704782 DOI: 10.1186/s12889-023-17382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Fatigue is a common symptom of long COVID syndrome. Compared to male survivors, females have a higher incidence of post-COVID fatigue. Therefore, long-term follow-up is necessary to understand which groups of females are more vulnerable to post-COVID fatigue. METHODS This is a nested case-control study of female COVID-19 survivors who were discharged from two designated hospitals in Wuhan, China in 2020, and received 2-year follow-up from March 1 to April 6, 2022. All patients completed the Checklist Individual Strength-subscale subjective fatigue (CIS-fatigue), a chronic obstructive pulmonary disease (COPD) assessment test (CAT), and the Hospital Anxiety and Depression Scale (HADS; including the HADS-Anxiety [HADS-A] and the HADS-Depression [HADS-D]). Individuals with CIS-fatigue scores of 27 or higher were classified as cases. The risk factors for fatigue was analysed with multivariable logistic regression analysis. RESULTS A total of 899 female COVID-19 survivors were enrolled for analysis, including 47 cases and 852 controls. Compared with controls, cases had higher CAT, HADS-A and HADS-D scores, and showed a higher prevalence of symptoms, including anxiety (cases vs. controls, 44.7% vs. 4.0%, p < 0.001), chest tightness (21.2% vs. 2.3%, p < 0.001), dyspnoea (19.1% vs. 0.8%, p < 0.001) and so on. In multivariable logistic regression analysis, age (OR, 1.03; 95% CI, 1.01-1.06; p = 0.02) and cerebrovascular disease (OR, 11.32; 95% CI, 2.87-43.00; p < 0.001) were risk factors for fatigue. Fatigue had a statistically significant moderate correlation with depression (r = 0.44, p < 0.001), but not with CAT ≥ 10. CONCLUSION Female COVID-19 patients who had cerebrovascular disease and older age have higher risk of fatigue. Patients with fatigue have higher CAT scores, and are more likely to have concurrent depression.
Collapse
Affiliation(s)
- Yidan Ye
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Chuyue Xiong
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Yang Dai
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Yan Wang
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Xinyue Yang
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Lixia Cheng
- Department of Medical and Research Management, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Wuhan Taikang Tongji Hospital, Wuhan, China
| | - Chao Hou
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Naifu Nie
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Huan Tang
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Xiangyu Ma
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Anqiang Zhang
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, China
| | - Guoqiang Cao
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
- Wuhan Huoshenshan Hospital, Wuhan, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China
| | - Ji Jiang
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China.
| | - Li Li
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Army Medical University, Chongqing, 400042, China.
- Wuhan Huoshenshan Hospital, Wuhan, China.
| |
Collapse
|
|
3
|
Bostanghadiri N, Ziaeefar P, Mofrad MG, Yousefzadeh P, Hashemi A, Darban-Sarokhalil D. COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1879554. [PMID: 37674935 PMCID: PMC10480030 DOI: 10.1155/2023/1879554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/07/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
The world is presently in crisis facing an outbreak of a health-threatening microorganism known as COVID-19, responsible for causing uncommon viral pneumonia in humans. The virus was first reported in Wuhan, China, in early December 2019, and it quickly became a global concern due to the pandemic. Challenges in this regard have been compounded by the emergence of several variants such as B.1.1.7, B.1.351, P1, and B.1.617, which show an increase in transmission power and resistance to therapies and vaccines. Ongoing researches are focused on developing and manufacturing standard treatment strategies and effective vaccines to control the pandemic. Despite developing several vaccines such as Pfizer/BioNTech and Moderna approved by the U.S. Food and Drug Administration (FDA) and other vaccines in phase 4 clinical trials, preventive measures are mandatory to control the COVID-19 pandemic. In this review, based on the latest findings, we will discuss different types of drugs as therapeutic options and confirmed or developing vaccine candidates against SARS-CoV-2. We also discuss in detail the challenges posed by the variants and their effect on therapeutic and preventive interventions.
Collapse
Affiliation(s)
- Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Ziaeefar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morvarid Golrokh Mofrad
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Parsa Yousefzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
4
|
Wanjari M, Late S, Sharma R, Munjewar P. Long-term pulmonary and extra-pulmonary consequences of COVID-19: A comprehensive review of current evidence and future perspectives. NARRA J 2023; 3:e156. [PMID: 38454970 PMCID: PMC10919748 DOI: 10.52225/narra.v3i2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/26/2023] [Indexed: 03/09/2024]
Abstract
The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been significant, affecting countless individuals worldwide. The existence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable levels of illness and mortality. While considerable attention has been devoted to the immediate handling of COVID-19, there is a growing concern about the long-term effects of this disease. The recent studies have brought to light various complexities associated with COVID-19, encompassing both respiratory and non-respiratory problems such as lung scarring, heart diseases, neurological effects, and psychological consequences. The purpose of this review is to provide a comprehensive understanding of the persistent repercussions of COVID-19. It presents a summary of recent studies that have examined the frequency and severity of these complications, as well as an exploration of the potential mechanisms that contribute to their development. Specifically, it delves into the role of immune dysregulation, prolonged inflammation, and dysfunction of blood vessel linings in the origin of these complications. Moreover, the clinical significance of these long-term consequences is discussed, including their potential impact on healthcare systems and society as a whole. Our review highlights the necessity for continuous monitoring and management of patients diagnosed with COVID-19, along with the importance of conducting follow-up studies over an extended period to determine the most effective strategies for prevention and treatment of these complications.
Collapse
Affiliation(s)
- Mayur Wanjari
- Departement of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Sampada Late
- Department of Nursing, Government Hospital Samudrapur, Wardha, India
| | - Ranjana Sharma
- Department of Medical Surgical Nursing, Srimati Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, India
| | - Pratiksha Munjewar
- Department of Medical Surgical Nursing, Srimati Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, India
| |
Collapse
|
|
5
|
Djordjevic I, Kostic A, Budic I, Vacic N, Elek Z, Konstantinovic S. Consequences of Transplacental Transmission of the SARS-CoV-2 Virus: A Single-Center Experience. CHILDREN 2022; 9:children9071020. [PMID: 35884003 PMCID: PMC9323985 DOI: 10.3390/children9071020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
The issues of vertical viral transmission from mother to fetus and the potential complications caused by SARS-CoV-2 coagulopathy are still unclear. There are few literature data about the vertical transmission of SARS-CoV-2 and health outcomes in neonates born to mothers with symptomatic or asymptomatic coronavirus disease, with the existing data based on small sample sizes. This case series study consists of two newborn children (one pre-term and one term) who were born to SARS-CoV-2-positive mothers and admitted to the neonatal intensive care unit a few hours after birth. One child had cyanotic changes that affected the entire left leg and the left forearm, with multiple livid changes on the front of the chest and abdomen, the right upper arm, right thigh, neck, and face, and one child had an altered umbilical cord. The first child was treated conservatively, and the second child was treated surgically.
Collapse
Affiliation(s)
- Ivona Djordjevic
- Pediatric Surgery Clinic, University Clinical Center Nis, Dr Zorana Djindjica Blvd. 48, 18000 Nis, Serbia; (A.K.); (N.V.); (S.K.)
- Faculty of Medicine, University of Nis, Blvd Zoran Djindjic 81, 18108 Nis, Serbia;
- Correspondence: ; Tel.: + 381-(63)-8122532
| | - Ana Kostic
- Pediatric Surgery Clinic, University Clinical Center Nis, Dr Zorana Djindjica Blvd. 48, 18000 Nis, Serbia; (A.K.); (N.V.); (S.K.)
| | - Ivana Budic
- Faculty of Medicine, University of Nis, Blvd Zoran Djindjic 81, 18108 Nis, Serbia;
- Clinic for Anesthesiology and Intensive Care, University Clinical Center Nis, Dr Zorana Djindjica Blvd. 48, 18000 Nis, Serbia
| | - Nikola Vacic
- Pediatric Surgery Clinic, University Clinical Center Nis, Dr Zorana Djindjica Blvd. 48, 18000 Nis, Serbia; (A.K.); (N.V.); (S.K.)
| | - Zlatan Elek
- Clinical Hospital Center Kosovska Mitrovica, Anri Dinan Street 10, 38220 Kosovska Mitrovica, Serbia;
- Faculty of Medicine, University of Pristina, Filip Visnjic Street bb, 38220 Kosovska Mitrovica, Serbia
| | - Strahinja Konstantinovic
- Pediatric Surgery Clinic, University Clinical Center Nis, Dr Zorana Djindjica Blvd. 48, 18000 Nis, Serbia; (A.K.); (N.V.); (S.K.)
| |
Collapse
|
|
6
|
Durmus Kocak N, Oruc O, Boga S, Acar C, Kavas M, Aydogan Eroglu S, Gundogus B, Sogukpinar O, Bekir S, Oztin Guven AA, Akbay MO, Arinc S, Duman D, Takir HB, Yaman F, Ozbaki F, Sonkaya E, Bulbul EU, Anil Tokyay D, Dagyildizi L, Akturk UA, Oztas S, Ernam D, Gungor G, Adiguzel N, Yildiz T, Mocin OY, Gunen H, Yildiz R, Sevim T, Torun T. Use of Radiology, D-Dimer, and Mean Platelet Volume Combination as a Prognostic Marker in Hospitalized Coronavirus Disease-19 Patients. Front Med (Lausanne) 2022; 8:788551. [PMID: 35186972 PMCID: PMC8850409 DOI: 10.3389/fmed.2021.788551] [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] [Received: 10/02/2021] [Accepted: 12/31/2021] [Indexed: 01/08/2023] Open
Abstract
IntroductionThe search for biomarkers that could help in predicting disease prognosis in the Coronavirus Disease-2019 (COVID-19) outbreak is still high on the agenda.ObjectiveTo find out the efficacy of D-dimer and mean platelet volume (MPV) combination as a prognostic marker in hospitalized COVID-19 patients with bilateral infiltration.Materials and MethodsStudy design: Retrospective observational cohort. Patients who were presented to our hospital between March 16, 2020 and June 07, 2020 were reviewed retrospectively. The primary outcome of the study was specified as the need for intensive care, while the secondary outcomes were duration of treatment and hospitalization. Receiver operator curve (ROC) analyzes were carried out to assess the efficacy of D-dimer and MPV parameters as prognostic markers.ResultsBetween the mentioned dates, 575 of 1,564 patients were found to be compatible with COVID-19, and the number of patients who were included in the study was 306. The number of patients who developed the need for intensive care was 40 (13.1%). For serum D-dimer levels in assessing the need for intensive care, the area under the curve (AUC) was found to be 0.707 (95% CI: 0.620–0.794). The AUC for MPV was 0.694 (95% CI: 0.585–0.803), when D-dimer was ≥1.0 mg/L. When patients with a D-dimer level of ≥1.0 mg/L were divided into two groups considering the MPV cut-off value as 8.1, the rate of intensive care transport was found to be significantly higher in patients with an MPV of ≥8.1 fL compared to those with an MPV of <8.1 fL (32.6 vs. 16.0%, p = 0.043). For the prognostic efficacy of the combination of D-dimer ≥ 1.0 mg/L and MPV ≥ 8.1 fL in determining the need for intensive care, following values were determined: sensitivity: 57.7%, specificity: 70.8%, positive predictive value (PPV): 32.0%, negative predictive value (NPV): 84.0%, and accuracy: 63.0%. When D-dimer was ≥1.0, the median duration of treatment in MPV <8.1 and ≥8.1 groups was 5.0 [interquartile range (IQR): 5.0–10.0] days for both groups (p = 0.64). The median length of hospital stay (LOS) was 7.0 (IQR: 5.0–10.5) days in the MPV <8.1 group, while it was 8.5 (IQR: 5.0–16.3) days in the MPV ≥ 8.1 group (p = 0.17).ConclusionIn COVID-19 patients with a serum D-dimer level of at least 1.0 mg/L and radiological bilateral infiltration at hospitalization, if the MPV value is ≥8.1, we could predict the need for intensive care with moderate efficacy and a relatively high negative predictive value. However, no correlation could be found between this combined marker and the duration of treatment and the LOS.
Collapse
Affiliation(s)
- Nagihan Durmus Kocak
- University of Health Sciences Sancaktepe Martyr Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
- *Correspondence: Nagihan Durmus Kocak
| | - Ozlem Oruc
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sibel Boga
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cem Acar
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Kavas
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selma Aydogan Eroglu
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Baran Gundogus
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Sogukpinar
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sumeyye Bekir
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aysem Askim Oztin Guven
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Makbule Ozlem Akbay
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sibel Arinc
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Dildar Duman
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Huriye Berk Takir
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | | | - Fatma Ozbaki
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Esin Sonkaya
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Esra Usta Bulbul
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Dilem Anil Tokyay
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Lale Dagyildizi
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ulku Aka Akturk
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selahattin Oztas
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Dilek Ernam
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gokay Gungor
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nalan Adiguzel
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tekin Yildiz
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Yazicioglu Mocin
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hakan Gunen
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Reyhan Yildiz
- Department of Chest Diseases Immunology and Allergy Diseases Science, Faculty of Medicine, Ankara, Turkey
| | - Tulin Sevim
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tulay Torun
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
|
7
|
Kaushal K, Kaur H, Sarma P, Bhattacharyya A, Sharma DJ, Prajapat M, Pathak M, Kothari A, Kumar S, Rana S, Kaur M, Prakash A, Mirza AA, Panda PK, Vivekanandan S, Omar BJ, Medhi B, Naithani M. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. J Crit Care 2022; 67:172-181. [PMID: 34808527 PMCID: PMC8604557 DOI: 10.1016/j.jcrc.2021.09.023] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022]
Abstract
Ferritin is a known inflammatory biomarker in COVID-19. However, many factors and co-morbidities can confound the level of serum ferritin. This current metaanalysis evaluates serum ferritin level in different severity levels in COVID-19. Studies evaluating serum ferritin level in different clinical contexts (COVID-19 vs. control, mild to moderate vs. severe to critical, non-survivor vs. survivor, organ involvement, ICU and mechanical ventilation requirement) were included (total 9 literature databases searched). Metaanalysis and metaregression was carried out using metaphor "R" package. Compared to control (COVID-19 negative), higher ferritin levels were found among the COVID-19 patients [SMD -0.889 (95% C.I. -1.201, -0.577), I2 = 85%]. Severe to critical COVID-19 patients showed higher ferritin levels compared to mild to moderate COVID-19 patients [SMD 0.882 (0.738, 1.026), I2 = 85%]. In meta-regression, high heterogeneity was observed could be attributed to difference in "mean age", and "percentage of population with concomitant co-morbidities". Non-survivors had higher serum ferritin level compared to survivors [SMD 0.992 (0.672, 1.172), I2 = 92.33%]. In meta-regression, high heterogeneity observed could be attributed to difference in "mean age" and "percentage of male sex". Patients requiring ICU [SMD 0.674 (0.515 to 0.833), I2 = 80%] and mechanical ventilation [SMD 0.430 (0.258, 0.602), I2 = 32%] had higher serum ferritin levels compared to those who didn't. To conclude, serum ferritin level may serve as an important biomarker which can aid in COVID-19 management. However, presence of other co-morbid conditions/confounders warrants cautious interpretation.
Collapse
Affiliation(s)
| | - Hardeep Kaur
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Phulen Sarma
- Department of Pharmacology, PGIMER, Chandigarh, India
| | | | - Dibya Jyoti Sharma
- Department of Internal medicine, Silchar Medical College and Hospital, India
| | | | - Mona Pathak
- Department of Research & Development, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | | | - Subodh Kumar
- Department of Pharmacology, PGIMER, Chandigarh, India
| | | | | | - Ajay Prakash
- Department of Pharmacology, PGIMER, Chandigarh, India
| | | | | | | | | | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India.
| | | |
Collapse
|
|
8
|
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
|
|
9
|
Abstract
PURPOSE OF REVIEW This review examines the global literature regarding rashes encountered in children and adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and aims to provide practicing pediatricians with an understanding of the relationship between instances of rashes and coronavirus disease 2019 (COVID-19) in children in order to effectively evaluate and treat patients. RECENT FINDINGS The true incidence of cutaneous reactions in children infected with SARS-CoV-2 is not known. Children's immune systems differ from those of adults and rashes as a manifestation of immune responses, in turn, differ in morphology and distribution. Rarely, children develop a severe multisystem inflammatory syndrome that has overlapping clinical features with Kawasaki disease. In addition, vaccinations produce rashes similar to natural infections. The rashes associated with COVID-19 vaccination are mild and transient, and should not preclude vaccination. Lastly, children who chronically wear masks are more likely to experience flaring of acne around the nose and mouth ('maskne') and facial conditions such as seborrheic dermatitis. SUMMARY There are ongoing worldwide registries, clinical and basic science studies to better understand the burden of skin disease and pathophysiology of rashes seen in patients infected with COVID-19. Robust vaccination programs should be encouraged as a way to contain viral spread among children and the greater population.
Collapse
Affiliation(s)
| | - James Gary Dinulos
- Seacoast Dermatology, PLLC, Portsmouth
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover New Hampshire
- Department of Dermatology, University of Connecticut School of Medicine, Framingham, Connecticut, USA
| |
Collapse
|
|
10
|
Acharya Y, Alameer A, Calpin G, Alkhattab M, Sultan S. A comprehensive review of vascular complications in COVID-19. J Thromb Thrombolysis 2021; 53:586-593. [PMID: 34724155 PMCID: PMC8558544 DOI: 10.1007/s11239-021-02593-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 02/08/2023]
Abstract
This study aims to review the available literature pertinent to vascular complications in COVID-19. A systematic search was performed using PubMed and Google Scholar to identify all relevant studies based on our study objective. Multiple studies have reported widespread systemic inflammation and procoagulant/hypercoagulable state in COVID-19, including thrombotic microangiopathy, endothelial dysfunction, bleeding disorder, and thrombosis. However, large specialised studies on vascular complications are lacking despite current evidence indicating dysfunctional coagulation pathways. Furthermore, there are no clear and definitive recommendations regarding thromboprophylaxis or full therapeutic anticoagulation in COVID-19. Several studies have reported hypercoagulability and vascular complications as important predictors of patient outcome in COVID-19. Therefore, it is important to understand the pathogenesis, epidemiology, management, and outcomes of patients who develop venous or arterial thrombosis and those with a pre-existing thrombotic disease who contract COVID-19 for risk stratification, thromboprophylaxis, optimal antithrombotic therapy during active infection and long-term anticoagulation following discharge or recovery.
Collapse
Affiliation(s)
- Yogesh Acharya
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Newcastle Road, H91 YR71, Galway, Ireland
| | - Aqeel Alameer
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Gavin Calpin
- Department of General Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Maha Alkhattab
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Newcastle Road, H91 YR71, Galway, Ireland
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Newcastle Road, H91 YR71, Galway, Ireland. .,Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and National University of Ireland Galway affiliated Hospital, Doughiska, Ireland.
| |
Collapse
|
|
11
|
Muhammad A, Iftikhar N, Mashhood A, Virdi G, Ud Din H, Akbar A, Ahmad B, Khalid A. Dermatological Manifestations of COVID-19 in Patients Reporting to a Tertiary Care Hospital in Rawalpindi, Pakistan. Cureus 2021; 13:e18973. [PMID: 34820228 PMCID: PMC8606119 DOI: 10.7759/cureus.18973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction The clinicopathological description of dermatological manifestations of COVID-19 leaves much to be desired. There is a need to determine their association with disease severity, outcome, and other clinical variables. Objectives The objectives of this study are to record and histopathologically examine the cutaneous manifestations of COVID-19 and correlate these to age, disease severity, and mortality. Methods All confirmed COVID-19 patients admitted to a single tertiary healthcare hospital in Rawalpindi, Pakistan, were included. Their diseases were classified as mild, moderate, severe, and critical. The recent onset skin eruptions in these patients were recorded via photographs along with relevant clinical data. The photographs were independently reviewed by a group of three dermatologists without knowledge of the clinical information. The skin manifestations were divided into disease-specific and nonspecific categories using an already defined algorithm. Histopathological examination of skin manifestations was conducted. Results A total of 23% (n=47) had "new" skin manifestations. Specific skin findings were seen in 21.6% (n=44), which consisted of ecchymosis/purpura in 50% (n=22), maculopapular exanthem in 18% (n=8), livedo reticularis in 16.2% (n=7), ischemia/gangrene in 16.2% (n=7), perniosis in 15.9 % (n=7), vesiculo-bullous rash in 9% (n=4) and urticaria in 4% (n=1). Non-specific findings were seen in 6% (n=13) and included bedsores, dermatitis passivata, dryness, herpes labialis, oral ulcerations, and nasogastric tube-induced ulcerations. There was a significant association (p=0.03) between disease severity and specific skin lesions. Ischemia/gangrene was significantly associated with COVID-19 disease severity and mortality. Vesiculobullous lesions were associated with higher mortality, though not with disease severity. Livedo reticularis had a higher-than-expected count in critical disease, albeit statistically insignificant. The association of maculopapular exanthem and ecchymosis/purpura with severe/critical disease was statistically insignificant. Urticaria was significantly associated with low disease severity. Mean age with specific manifestations was 56.86 ± 15.81 and with nonspecific/without any manifestations was 42.58 ± 16.96, a highly significant difference, with p-value < 0.001. Old age (>60 years) was significantly associated with ecchymosis (p=0.038), maculopapular exanthem (p=0.021), and vesiculo-bullous rash (p=0.029). Histopathology varied according to the type of skin lesion. Conclusions Dermatological manifestations coexist in many patients and tend to appear more in severe cases of COVID-19 among the older age group and only minimally in mild/moderate cases. Their presence could help set prognostic criteria of COVID-19 disease in the future.
Collapse
Affiliation(s)
- Anjum Muhammad
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Nadia Iftikhar
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Asher Mashhood
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Gurnam Virdi
- Dermatology, Academy of Aesthetic Medicine, Sheffield, GBR
| | - Hafeez Ud Din
- Histopathology, Armed Forces Institute of Pathology, Rawalpindi, PAK
| | - Afnan Akbar
- Basic Sciences, Army Medical College, Rawalpindi, PAK
| | - Bilal Ahmad
- Endocrinology and Diabetes, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Abrar Khalid
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| |
Collapse
|
|
12
|
Sadeghzadeh‐Bazargan A, Rezai M, Najar Nobari N, Mozafarpoor S, Goodarzi A. Skin manifestations as potential symptoms of diffuse vascular injury in critical COVID-19 patients. J Cutan Pathol 2021; 48:1266-1276. [PMID: 33978234 PMCID: PMC8239514 DOI: 10.1111/cup.14059] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
As a respiratory viral infection caused by a novel coronavirus, COVID-19 became rapidly pandemic within a few months. Despite the wide range of manifestations and organ involvement in COVID-19 patients, the exact pathogenesis of severe and fatal types of COVID-19 and causes involved with the individual base of the disease is not yet understood. Several studies have reported clinical, laboratory, and histopathological data in favor of vascular injury in multiple organs of critically ill patients with COVID-19 as a result of hyperactive immune response, inflammation, and cytokine storm. Also, both clinical and histopathological evidence points to such vascular involvements in the skin. Given the ease of clinical examinations and skin biopsy and the lower risks of transmission of COVID-19 to healthcare workers, the present review article was conducted to investigate the vascular skin manifestations of COVID-19 patients clinically and/or histopathologically as helpful clues for better understanding the pathogenesis and predicting the prognosis of the disease, especially in severe cases.
Collapse
Affiliation(s)
| | - Mahdi Rezai
- Department of Emergency Medicine Management Research Center, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Samaneh Mozafarpoor
- Dermatologist, Skin Disease and Leishmaniasis Research Center, Department of DermatologyIsfahan University of Medical SciencesIsfahanIran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| |
Collapse
|
|
13
|
Morelli C, Francavilla M, Stabile Ianora AA, Cozzolino M, Gualano A, Stellacci G, Sacco A, Lorusso F, Pedote P, De Ceglie M, Scardapane A. The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review. Microorganisms 2021; 9:microorganisms9102037. [PMID: 34683358 PMCID: PMC8541408 DOI: 10.3390/microorganisms9102037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Our daily experience in a COVID hospital has allowed us to learn about this disease in many of its changing and unusual aspects. Some of these uncommon manifestations, however, appeared more frequently than others, giving shape to a multifaceted COVID-19 disease. This pictorial review has the aim to describe the radiological aspects of atypical presentations and of some complications of COVID-19 disease in adults and children and provide a simple guide for radiologists to become familiar with the multiform aspects of this disease.
Collapse
Affiliation(s)
- Chiara Morelli
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
- Correspondence:
| | | | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Monica Cozzolino
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Alessandra Gualano
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | | | - Antonello Sacco
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Filomenamila Lorusso
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Pasquale Pedote
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Michele De Ceglie
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| |
Collapse
|
|
14
|
Song H, Men H, Song C, Feng H, Tan H, Zuo S. Low-molecular-weight heparin reduces the formation of lower limb deep venous thrombosis in patients with hypertensive intracerebral hemorrhage. Am J Transl Res 2021; 13:10509-10516. [PMID: 34650721 PMCID: PMC8507008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To demonstrate that low-molecular-weight heparin (LMWH) can reduce the formation of lower limb deep venous thrombosis (DVT) and improve the quality of life (QOL) of patients with hypertensive intracerebral hemorrhage (HICH). METHODS Totally, 98 patients with HICH were selected according to different treatment and intervention schemes. Patients receiving routine intracranial pressure reduction and blood pressure regulation intervention were included in group A (n=46) and those receiving LMWH calcium on the basis of treatment in group A were included in group B (n=52). The total effective rate of patients was compared between the two groups, and the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP), D-dimer, and inflammatory factor levels as well as complications and QOL scores before and after treatment were recorded and compared. RESULTS The FDP and D-dimer showed an increasing trend in both groups after treatment, with the increase being significantly lower in group B than in group A (P<0.001). Serum tumor necrosis factor-α and interleukin-1β levels increased significantly in the two groups after treatment, with the increase being significantly lower in group B than in group A (P<0.05). Complications of pulmonary embolism, DVT, intracranial hemorrhage, and gastrointestinal hemorrhage were better in group B than in group A (P<0.05). In terms of QOL, physical and mental health, material life, and social functioning were significantly higher in patients of group B than for those in group A (P<0.001). CONCLUSIONS The application of LMWH in patients with HICH can reduce the formation of lower limb DVT.
Collapse
Affiliation(s)
- He Song
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Huanli Men
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Chunwang Song
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Hongwei Feng
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Haopeng Tan
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| | - Shuhao Zuo
- Department of Neurosurgery, Shijiazhuang People's Hospital Shijiazhuang 050011, Hebei, China
| |
Collapse
|
|
15
|
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
|
|
16
|
Biswal JK, Mohanty SK, Behera SN, Swain SK, Sahoo AK. Acute Limb Ischemia: A Catastrophic COVID-19 Sequel Leading to Amputation. Cureus 2021; 13:e16456. [PMID: 34466301 PMCID: PMC8396422 DOI: 10.7759/cureus.16456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 12/13/2022] Open
Abstract
A positive-sense single-stranded ribonucleic acid (RNA) virus causes the novel coronavirus illness 2019 (COVID-19). COVID-19 symptoms range from mild to moderate to severe and very severe. Fever, cough, headache, anosmia, ageusia, body ache, and diarrhoea are mild to moderate grade symptoms, whereas systemic involvements (pneumonia, myocarditis, stroke, and other coagulation abnormalities) are more serious. Except for a few patients who have mild complaints of cough and shortness of breath, the majority of patients are recuperating entirely from the viral infection. Patients with severe to very severe illnesses experience significant lung damage and fibrosis. These are the patients who are more likely to experience extrapulmonary complications after COVID-19. The disease's aberrant presentation may be related to systemic involvement and a hypercoagulable condition with micro and macro-angiopathy. Acute limb ischemia is one of the symptoms of the hypercoagulable condition. Its presentation can be in the form of chilblains, bullae, acral cyanosis, bruising, blood blisters, dry gangrene, or life-threatening acute limb ischemia. Unfortunately, most patients have to undergo amputation due to a delay in presentation or rapidly progressing disease. Here we present a case series of two COVID-19 infected patients who were initially discharged from the hospital after proper treatment but developed acute limb ischemia within the home isolation period and their treatment strategy.
Collapse
Affiliation(s)
| | | | | | | | - Ashok Kumar Sahoo
- Surgery, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND.,Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| |
Collapse
|
|
17
|
Ramani SL, Samet J, Franz CK, Hsieh C, Nguyen CV, Horbinski C, Deshmukh S. Musculoskeletal involvement of COVID-19: review of imaging. Skeletal Radiol 2021; 50:1763-1773. [PMID: 33598718 PMCID: PMC7889306 DOI: 10.1007/s00256-021-03734-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has revealed a surprising number of extra-pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While myalgia is a common clinical feature of COVID-19, other musculoskeletal manifestations of COVID-19 were infrequently described early during the pandemic. There have been emerging reports, however, of an array of neuromuscular and rheumatologic complications related to COVID-19 infection and disease course including myositis, neuropathy, arthropathy, and soft tissue abnormalities. Multimodality imaging supports diagnosis and evaluation of musculoskeletal disorders in COVID-19 patients. This article aims to provide a first comprehensive summary of musculoskeletal manifestations of COVID-19 with review of imaging.
Collapse
Affiliation(s)
| | - Jonathan Samet
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Colin K Franz
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), 355 E Erie St, Chicago, IL, 60611, USA
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Christine Hsieh
- Department of Rheumatology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Craig Horbinski
- Division of Pathology, Department of Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Swati Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.
| |
Collapse
|
|
18
|
Rastogi A, Dogra H, Jude EB. COVID-19 and peripheral arterial complications in people with diabetes and hypertension: A systematic review. Diabetes Metab Syndr 2021; 15:102204. [PMID: 34303918 PMCID: PMC8266514 DOI: 10.1016/j.dsx.2021.102204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
AIMS Identify the prevalence, risk factors and outcomes of lower extremity ischemic complications. METHODS A systematic review was conducted by searching PubMed and SCOPUS databases for SARS-CoV-2, COVID-19 and peripheral arterial complications. RESULTS Overall 476 articles were retrieved and 31 articles describing 133 patients were included. The mean age was 65.4 years. Pain and gangrene were the most common presentation. Hypertension (51.3%), diabetes (31.9%) and hypercholesterolemia (17.6%) were associated co-morbidities. Overall, 30.1% of patients died and amputation was required in 11.8% patients. CONCLUSIONS COVID-19 patients with diabetes or hypertension are susceptible for lower limb complications and require therapeutic anti-coagulation.
Collapse
Affiliation(s)
- Ashu Rastogi
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India.
| | - Himika Dogra
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Tameside on Lyne, UK
| |
Collapse
|
|
19
|
Caramaschi S, Kapp ME, Miller SE, Eisenberg R, Johnson J, Epperly G, Maiorana A, Silvestri G, Giannico GA. Histopathological findings and clinicopathologic correlation in COVID-19: a systematic review. Mod Pathol 2021; 34:1614-1633. [PMID: 34031537 PMCID: PMC8141548 DOI: 10.1038/s41379-021-00814-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
The severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) pandemic has had devastating effects on global health and worldwide economy. Despite an initial reluctance to perform autopsies due to concerns for aerosolization of viral particles, a large number of autopsy studies published since May 2020 have shed light on the pathophysiology of Coronavirus disease 2019 (COVID-19). This review summarizes the histopathologic findings and clinicopathologic correlations from autopsies and biopsies performed in patients with COVID-19. PubMed and Medline (EBSCO and Ovid) were queried from June 4, 2020 to September 30, 2020 and histopathologic data from autopsy and biopsy studies were collected based on 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 58 studies reporting 662 patients were included. Demographic data, comorbidities at presentation, histopathologic findings, and virus detection strategies by organ system were collected. Diffuse alveolar damage, thromboembolism, and nonspecific shock injury in multiple organs were the main findings in this review. The pathologic findings emerging from autopsy and biopsy studies reviewed herein suggest that in addition to a direct viral effect in some organs, a unifying pathogenic mechanism for COVID-19 is ARDS with its known and characteristic inflammatory response, cytokine release, fever, inflammation, and generalized endothelial disturbance. This study supports the notion that autopsy studies are of utmost importance to our understanding of disease features and treatment effect to increase our knowledge of COVID-19 pathophysiology and contribute to more effective treatment strategies.
Collapse
Affiliation(s)
- Stefania Caramaschi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia—AOU Policlinico of Modena, Modena, Italy
| | - Meghan E. Kapp
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara E. Miller
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Rosana Eisenberg
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joyce Johnson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Antonino Maiorana
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia—AOU Policlinico of Modena, Modena, Italy
| | - Guido Silvestri
- Emory Vaccine Center and Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Giovanna A. Giannico
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
|
20
|
Dezoteux F, Mille B, Fievet C, Moreau AS, Duhamel A, Drumez E, Mathieu D, Poissy J, Staumont-Salle D, Buche S. Vascular skin manifestations in patients with severe COVID-19 in intensive care units: a monocentric prospective study. Eur J Dermatol 2021; 31:ejd.2021.4107. [PMID: 34463284 PMCID: PMC8572689 DOI: 10.1684/ejd.2021.4107] [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] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
Various skin manifestations have been reported during the coronavirus disease 2019 (COVID-19) pandemic. Among these are acral vascular skin lesions in non-severe patients, but few studies have focused specifically on patients with severe COVID-19 admitted to the intensive care unit (ICU) We aimed to assess the frequency of acral vascular skin manifestations (AVSM) in patients admitted to the ICU based on systematic dermatological examination We conducted a clinical, observational and prospective study in the ICU of Lille University Hospital (France). All adult patients with RT-PCR-confirmed severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection were included on May 5th and 6th, 2020 A total of 39 patients with severe COVID-19 were examined (34 males and five females; median age: 61 [55-59]). We observed AVSM in 11/39 patients (28%) including five with acral necrotic lesions, three with haemorrhagic blisters, one with acral livedoid rash, and one with erosive distal lesions. Chilblain or chilblain-like lesions were not seen, unlike ambulatory or non-severe patients described in the literature. There was no difference regarding the median length of stay in the ICU, initial symptoms of COVID-19 or baseline characteristics, except for a lower BMI in patients with AVSM. All patients had biological coagulation abnormalities (e.g. higher levels of fibrinogen or D-dimers), but there was no difference between patients with and without AVSM AVSM are infrequent and heterogenous and seem to be non-specific to patients with severe SARS-CoV-2, and possibly unrelated to COVID-19. The pathophysiology of AVSM described during the COVID-19 pandemic is not fully elucidated.
Collapse
Affiliation(s)
- Frédéric Dezoteux
- Service de Dermatologie, CHU Lille, F-59000 Lille, France
- INSERM U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, CHU Lille, F-59000 Lille, France
| | - Baptiste Mille
- Service de Dermatologie, CHU Lille, F-59000 Lille, France
| | | | | | - Alain Duhamel
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, University Lille, CHU Lille, F-59000 Lille, France
- Department of Biostatistics, CHU Lille, F-59000 Lille, France
| | - Elodie Drumez
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, University Lille, CHU Lille, F-59000 Lille, France
- Department of Biostatistics, CHU Lille, F-59000 Lille, France
| | - Daniel Mathieu
- Department of Intensive Care, CHU, F-59000 Lille, France
| | - Julien Poissy
- Department of Intensive Care, CHU, F-59000 Lille, France
| | - Delphine Staumont-Salle
- Service de Dermatologie, CHU Lille, F-59000 Lille, France
- INSERM U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, CHU Lille, F-59000 Lille, France
| | | |
Collapse
|
|
21
|
Vaidya T, Nanivadekar A, Patel R. Imaging spectrum of abdominal manifestations of COVID-19. World J Radiol 2021; 13:157-170. [PMID: 34249237 PMCID: PMC8245751 DOI: 10.4329/wjr.v13.i6.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.
Collapse
Affiliation(s)
- Tanvi Vaidya
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | | | - Rajan Patel
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| |
Collapse
|
|
22
|
Magomedov A, Zickler D, Karaivanov S, Kurreck A, Münch FH, Kamhieh-Milz J, Ferse C, Kahl A, Piper SK, Eckardt KU, Dörner T, Kruse JM. Viscoelastic testing reveals normalization of the coagulation profile 12 weeks after severe COVID-19. Sci Rep 2021; 11:13325. [PMID: 34172793 PMCID: PMC8233385 DOI: 10.1038/s41598-021-92683-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/14/2021] [Indexed: 02/06/2023] Open
Abstract
COVID 19 is associated with a hypercoagulable state and frequent thromboembolic complications. For how long this acquired abnormality lasts potentially requiring preventive measures, such as anticoagulation remains to be delineated. We used viscoelastic rotational thrombelastometry (ROTEM) in a single center cohort of 13 critical ill patients and performed follow up examinations three months after discharge from ICU. We found clear signs of a hypercoagulable state due to severe hypofibrinolysis and a high rate of thromboembolic complications during the phase of acute illness. Three month follow up revealed normalization of the initial coagulation abnormality and no evidence of venous thrombosis in all thirteen patients. In our cohort the coagulation profile was completely normalized three months after COVID-19. Based on these findings, discontinuation of anticoagulation can be discussed in patients with complete venous reperfusion.
Collapse
Affiliation(s)
- Abakar Magomedov
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Stoyan Karaivanov
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annika Kurreck
- Department of Hematology and Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frédéric H Münch
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Julian Kamhieh-Milz
- Department of Transfusion Medince, Universitätsmedizin Berlin, Berlin, Germany
- Wimedko GmbH, Manfred-von-Richthofen Str. 15, 12101, Berlin, Germany
| | - Caroline Ferse
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Kahl
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Dörner
- Department of Rheumatology und Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Rheumaforschungszentrum (DRFZ) Berlin, Berlin, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
|
23
|
Goddard SA, Tran DQ, Chan MF, Honda MN, Weidenhaft MC, Triche BL. Pulmonary Vein Thrombosis in COVID-19. Chest 2021; 159:e361-e364. [PMID: 34099150 PMCID: PMC8175944 DOI: 10.1016/j.chest.2020.11.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/05/2020] [Accepted: 11/25/2020] [Indexed: 12/18/2022] Open
Abstract
Research on COVID-19, the cause of a rapidly worsening pandemic, has led to the observation of laboratory derangements such as a propensity towards a hypercoagulable state. However, there are currently no reports on the incidence of pulmonary venous thrombosis in the setting of COVID-19. We report a case in which follow-up chest CT scans revealed an expansile filling defect in a branch of the right inferior pulmonary vein, which is consistent with pulmonary venous thrombosis. Our objective was to provide insight into an uncommon sequela of COVID-19 and consequently garner increased clinical suspicion for pulmonary VTE during hospitalization.
Collapse
Affiliation(s)
- Stephanie A Goddard
- Department of Radiology, Tulane University Health Sciences Center, New Orleans, LA.
| | - Daniel Q Tran
- Department of Radiology, Tulane University Health Sciences Center, New Orleans, LA
| | - Michael F Chan
- Department of Radiology, Tulane University Health Sciences Center, New Orleans, LA
| | - Michelle N Honda
- Department of Radiology, Tulane University Health Sciences Center, New Orleans, LA
| | - Mandy C Weidenhaft
- Department of Radiology, Tulane University Health Sciences Center, New Orleans, LA
| | - Benjamin L Triche
- Department of Radiology, Tulane University Health Sciences Center, New Orleans, LA
| |
Collapse
|
|
24
|
Fang XZ, Wang YX, Xu JQ, He YJ, Peng ZK, Shang Y. Immunothrombosis in Acute Respiratory Dysfunction of COVID-19. Front Immunol 2021; 12:651545. [PMID: 34149692 PMCID: PMC8207198 DOI: 10.3389/fimmu.2021.651545] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/12/2021] [Indexed: 01/10/2023] Open
Abstract
COVID-19 is an acute, complex disorder that was caused by a new β-coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on current reports, it was surprising that the characteristics of many patients with COVID-19, who fulfil the Berlin criteria for acute respiratory distress syndrome (ARDS), are not always like those of patients with typical ARDS and can change over time. While the mechanisms of COVID-19–related respiratory dysfunction in COVID-19 have not yet been fully elucidated, pulmonary microvascular thrombosis is speculated to be involved. Considering that thrombosis is highly related to other inflammatory lung diseases, immunothrombosis, a two-way process that links coagulation and inflammation, seems to be involved in the pathophysiology of COVID-19, including respiratory dysfunction. Thus, the current manuscript will describe the proinflammatory milieu in COVID-19, summarize current evidence of thrombosis in COVID-19, and discuss possible interactions between these two.
Collapse
Affiliation(s)
- Xiang-Zhi Fang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Xin Wang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji-Qain Xu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Jun He
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe-Kang Peng
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
|
25
|
Birlutiu V, Feiereisz AI, Oprinca G, Dobritoiu S, Rotaru M, Birlutiu RM, Iancu GM. Cutaneous manifestations associated with anosmia, ageusia and enteritis in SARS-CoV-2 infection - A possible pattern? Observational study and review of the literature. Int J Infect Dis 2021; 107:72-77. [PMID: 33887455 PMCID: PMC8054550 DOI: 10.1016/j.ijid.2021.04.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The cutaneous manifestations of coronavirus disease 2019 (COVID-19) have been covered insufficiently in the literature. METHODS Thirty-nine patients admitted to the study hospital with confirmed COVID-19 who experienced various skin manifestations during hospitalization or in the convalescence period, were analysed retrospectively. RESULTS Thirty-nine patients with COVID-19, admitted to the study hospital between 23 March and 12 September 2020, had intra-infectious rash or lesions of cutaneous vasculitis during convalescence. The most common cutaneous manifestations of COVID-19 were erythematous and erythematous papular rash. Twenty-seven of the 39 patients had anosmia (69.2%), 26 patients had ageusia (66.7%), 34 patients had pneumonia (87.2%) and 24 patients had intra-infectious enterocolitis (61.5%). Skin biopsies were rarely performed in these patients. This article reports the results of biopsies performed in two patients, showing histopathological and immunohistochemical changes in erythematous rash and erythema multiforme-like lesions. Both skin biopsies revealed early fibrous remodelling of the dermis, suggesting similarity with changes that occur in the lungs and other tissues in patients with COVID-19. CONCLUSIONS Correlations between skin lesions and anosmia, ageusia and enteritis in patients with COVID-19 do not seem to be accidental, but are associated with a similar response to ACE2 receptor expression in these tissues.
Collapse
Affiliation(s)
- Victoria Birlutiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Infectious Diseases Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | | | - George Oprinca
- Department of Pathology, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | - Simona Dobritoiu
- Infectious Diseases Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | - Maria Rotaru
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Dermatology Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | - Rares Mircea Birlutiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; FOISOR Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, Bucharest, Romania.
| | - Gabriela Mariana Iancu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Dermatology Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| |
Collapse
|
|
26
|
Rebutini PZ, Zanchettin AC, Stonoga ETS, Prá DMM, de Oliveira ALP, Dezidério FDS, Fonseca AS, Dagostini JCH, Hlatchuk EC, Furuie IN, Longo JDS, Cavalli BM, Dino CLT, Dias VMDCH, Percicote AP, Nogueira MB, Raboni SM, de Carvalho NS, Machado-Souza C, de Noronha L. Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features. Front Immunol 2021; 12:685919. [PMID: 34122449 PMCID: PMC8187864 DOI: 10.3389/fimmu.2021.685919] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
Since the beginning of the pandemic, few papers describe the placenta’s morphological and morphometrical features in SARS-CoV-2–positive pregnant women. Alterations, such as low placental weight, accelerated villous maturation, decidual vasculopathy, infarcts, thrombosis of fetal placental vessels, and chronic histiocytic intervillositis (CHI), have been described.
Collapse
Affiliation(s)
- Patricia Zadorosnei Rebutini
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| | - Aline Cristina Zanchettin
- Postgraduate Program in Biotechnology Applied in Health of Children and Adolescent, Pelé Pequeno Príncipe, Research Institute, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | | | - Daniele Margarita Marani Prá
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| | | | - Felipe da Silva Dezidério
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| | - Aline Simoneti Fonseca
- Postgraduate Program in Biotechnology Applied in Health of Children and Adolescent, Pelé Pequeno Príncipe, Research Institute, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | | | - Elisa Carolina Hlatchuk
- Department of Medical Pathology, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Isabella Naomi Furuie
- Department of Tocogynecology, Clinical Hospital, Universidade Federal do Paraná, UFPR, Curitiba, Brazil
| | - Jessica da Silva Longo
- Department of Tocogynecology, Clinical Hospital, Universidade Federal do Paraná, UFPR, Curitiba, Brazil
| | - Bárbara Maria Cavalli
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Carolina Lumi Tanaka Dino
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | | | - Ana Paula Percicote
- Department of Medical Pathology, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Meri Bordignon Nogueira
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil.,Virology Laboratory, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Sonia Mara Raboni
- Department of Infectious Disease, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Newton Sergio de Carvalho
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Cleber Machado-Souza
- Postgraduate Program in Biotechnology Applied in Health of Children and Adolescent, Pelé Pequeno Príncipe, Research Institute, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Lucia de Noronha
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| |
Collapse
|
|
27
|
Cuomo R, Giardino FR, Pozzi M, Nisi G, Sisti A, Han J, Nuzzo A, Muratori A, Cigna E, Losco L, Grimaldi L. Management of skin damage of health workers' face: the role of plastic surgery in the time of Pandemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021185. [PMID: 33988151 PMCID: PMC8182579 DOI: 10.23750/abm.v92i2.11006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022]
Abstract
Background and aim: The Sars-Cov-2 virus is characterized by a being highly contagiousness, and this is the reason why massive use of personal protective equipment is required by medical and paramedical staff of the COVID-19 dedicated departments. The aim of this manuscript is to describe and share our experience in the prevention and treatment of the personal protective equipment related pressure sores and other skin alterations in the medical and paramedical staff. Methods: All healthcare workers with PPE-related skin damages were registered at time 0. Age, sex, profession, type of skin damage, diseases and possible drugs were registered. Results: Two strategies were employed: the first strategy was to immediately treat the skin and the second one was to prevent pressure wounds formation both in already affected healthcare workers and the recurrence in healed staff. Three weeks after the two strategies were used, the incidence rate PPE-related skin damage was reduced in a statistically significant way. Conclusions: Proper management helps in reducing the incidence of pressure ulcers related to personal protective devices in Covid-19 Units. Skin prevention and hydration, have been obtained achieved by using products applied at home, autonomously.
Collapse
Affiliation(s)
| | - Francesco Ruben Giardino
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Mirco Pozzi
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Giuseppe Nisi
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Andrea Sisti
- Visiting Researcher - Department of Plastic Surgery, Cleveland Clinic Ohio, USA.
| | - Jingjian Han
- Jining First People's Hospital - Jining Medical University - Jining city - People's Republic of China.
| | - Angelo Nuzzo
- COVID Department - Intensive Care Unit - University of Siena - Italy.
| | - Alessia Muratori
- COVID Department - Intensive Care Unit - University of Siena - Italy.
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; Pisa, Italy.
| | - Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; Pisa, Italy.
| | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| |
Collapse
|
|
28
|
Baldassarre LA, Yang EH, Cheng RK, DeCara JM, Dent S, Liu JE, Rudski LG, Strom JB, Thavendiranathan P, Barac A, Zaha VG, Bucciarelli-Ducci C, Ellahham S, Deswal A, Lenneman C, Villarraga HR, Blaes AH, Ismail-Khan R, Ky B, Leja MJ, Scherrer-Crosbie M. Cardiovascular Care of the Oncology Patient During COVID-19: An Expert Consensus Document From the ACC Cardio-Oncology and Imaging Councils. J Natl Cancer Inst 2021; 113:513-522. [PMID: 33179744 PMCID: PMC7717327 DOI: 10.1093/jnci/djaa177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022] Open
Abstract
In response to the coronavirus disease 2019 (COVID-19) pandemic, the Cardio-Oncology and Imaging Councils of the American College of Cardiology offers recommendations to clinicians regarding the cardiovascular care of cardio-oncology patients in this expert consensus statement. Cardio-oncology patients-individuals with an active or prior cancer history and with or at risk of cardiovascular disease-are a rapidly growing population who are at increased risk of infection, and experiencing severe and/or lethal complications by COVID-19. Recommendations for optimizing screening and monitoring visits to detect cardiac dysfunction are discussed. In addition, judicious use of multimodality imaging and biomarkers are proposed to identify myocardial, valvular, vascular, and pericardial involvement in cancer patients. The difficulties of diagnosing the etiology of cardiovascular complications in patients with cancer and COVID-19 are outlined, along with weighing the advantages against risks of exposure, with the modification of existing cardiovascular treatments and cardiotoxicity surveillance in patients with cancer during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Lauren A Baldassarre
- Affiliations of authors: Section of Cardiovascular Medicine, Department of Medicine, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Richard K Cheng
- Cardio-Oncology Program, Department of Medicine, Division of Cardiology and Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jeanne M DeCara
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC, USA
| | - Jennifer E Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence G Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Vlad G Zaha
- Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, Division of Cardiology, Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, UK
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic-Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Anita Deswal
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carrie Lenneman
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Anne H Blaes
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, Division of Oncologic Sciences, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monika J Leja
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
|
29
|
Tomsitz D, Biedermann T, Brockow K. Im Zusammenhang mit COVID‐19‐Infektionen beschriebene Hautmanifestationen. J Dtsch Dermatol Ges 2021; 19:530-535. [PMID: 33861006 PMCID: PMC8250391 DOI: 10.1111/ddg.14353_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
Die Prävalenz aller kutanen Manifestationen, die direkt mit einer COVID‐19‐Infektion assoziiert sind, ist unbekannt. Allerdings steigt die Anzahl der entsprechenden Berichte schnell an und unser vorläufiges Wissen entwickelt sich rasch weiter. Die gemeldeten Hautmanifestationen lassen sich in zwei Gruppen einteilen: (1) Hautveränderungen, die unspezifisch auf eine mögliche infektiöse Erkrankung hinweisen, speziell makulopapulöses Exanthem, Urtikaria und Erythema multiforme, und (2) Hautveränderungen, die spezifischer auf eine COVID‐19‐Infektion hindeuten, insbesondere windpockenartige Läsionen, Livedo reticularis oder Frostbeulen‐artige Läsionen. Letztere scheinen mit thromboembolischen Ereignissen und vaskulären Veränderungen in Zusammenhang zu stehen.
Collapse
Affiliation(s)
- Dirk Tomsitz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| |
Collapse
|
|
30
|
Sultan S, Acharya Y. Antimalarial and cytotoxic drugs on COVID-19 and the cardiovascular burden: Literature review and lessons to be learned. Vascular 2021; 29:220-227. [PMID: 32691699 PMCID: PMC7375357 DOI: 10.1177/1708538120941635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19. METHODS A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the "TrialsTracker" project. RESULTS We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic microangiopathy, endothelial dysfunction, bleeding disorder, and thrombosis are increasingly being witnessed in COVID-19. Evidence of cardiac injury and stroke is mostly reported in hospitalized patients; however, large specialized studies that focus on cardiac or neuropathology are lacking. DISCUSSION There is no convincing clinical evidence of chloroquine, hydroxychloroquine with or without azithromycin, and remdesivir use in COVID-19. As evidence of systemic inflammation is rapidly unfolding, there is a dire need to maximize our resources to find the best possible solutions to the current crisis while conclusive evidence from clinical trials emerges.
Collapse
Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Ireland
| |
Collapse
|
|
31
|
Al-Harthi L, Campbell E, Schneider JA, Bennett DA. What HIV in the Brain Can Teach Us About SARS-CoV-2 Neurological Complications? AIDS Res Hum Retroviruses 2021; 37:255-265. [PMID: 32683890 PMCID: PMC8035916 DOI: 10.1089/aid.2020.0161] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of COVID-19, a disease that as of July 10, 2020, has infected >12 million people and killed >500,000. COVID-19 infection leads to acute respiratory distress syndrome in a subset of patients and is a primary driver of acute morbidity in infected persons. However, it is becoming increasingly clear that SARS-CoV-2 infection drives dysfunction and pathology outside the lungs, including reports of renal, cardiac, and neurological complications. In this study, we summarize the known incidence and evidence of neurological complications associated with SARS-CoV-2 infection and other pathogenic coronaviruses. These studies describe a poorly understood spectrum of COVID-19 central nervous system symptoms, ranging from common and subclinical issues such as anosmia and headache to more concerning reports of stroke and encephalopathy. We discuss potential mechanisms of pathogenesis, including a discussion of how the understanding of neurological complications known to occur in HIV-1 patients may provide insight into SARS-CoV-2-associated neurological manifestations. Specifically, three hypotheses are discussed that are informed by decades of knowledge about HIV pathogenesis in the brain, which include a potential direct viral effect, an indirect viral effect, and/or a neuroimmune axis effect. Individually or in combination these potential effects may contribute to COVID-19 neurological complications.
Collapse
Affiliation(s)
- Lena Al-Harthi
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward Campbell
- Department of Microbiology and Immunology, Loyola University, Chicago, Illinois, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - David A. Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
|
32
|
Papa A, Salzano AM, Di Dato MT, Lo Bianco G, Tedesco M, Salzano A, Myrcik D, Imani F, Varrassi G, Akhavan Akbari G, Paladini A. COVID-19 Related Acro-Ischemic Neuropathic-like Painful Lesions in Pediatric Patients: A Case Series. Anesth Pain Med 2021; 11:e113760. [PMID: 34336629 PMCID: PMC8314085 DOI: 10.5812/aapm.113760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A variety of skin manifestations have been associated with COVID-19 infection. Acral lesions on hands and feet, closely resembling chilblains, have been reported in association with COVID-19, which are nonspecific. These acro-ischemic painful lesions have been described mainly in asymptomatic and mildly symptomatic pediatric COVID-19 positive patients, without a precise pathogenetic mechanism. COVID-19-induced chilblains may portend an indolent course and a good outcome. In young patients, the IFN-1 response induces microangiopathic changes and produces a chilblain lupus erythematosus-like eruption with vasculitic neuropathic pain features. OBJECTIVES This paper presented a case series of pediatric patients with COVID-19-related skin lesions and neuropathic-like pain. METHODS Clinical outcomes were collected from 11 patients diagnosed with painful erythematous skin lesions with neuropathic-like pain and positive IgG for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RESULTS It is a mildly symptomatic condition not related to severe pain rates, and it is treated with paracetamol due to the transitory nature of the problem, which provides good results. CONCLUSIONS A particular point of interest is skin lesion manifestation as a further indirect sign of SARS-CoV-2 infection. Due to the initial manifestation of chilblains in pauci-symptomatic pediatric patients, they need to be immediately tested and isolated. Chilblains can be considered a clinical clue to suspect SARS-CoV-2 infection and help in early diagnosis, patient triage, and infection control.
Collapse
Affiliation(s)
- Alfonso Papa
- Pain Department, AO “Ospedali dei Colli”. Monaldi Hospital, Naples, Italy
| | - Anna Maria Salzano
- Pain Department, AO “Ospedali dei Colli”. Monaldi Hospital, Naples, Italy
| | | | - Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
- Basildon & Turrock University Hospitals, NHS Foundation Trust, Essex, London, UK
| | | | - Antonio Salzano
- Emergency Department, Frattamaggiore Hospital, Naples, Italy
| | - Dariusz Myrcik
- Emergency Med. Dept of Internal Medicine, University of Silesia in Katowice, Bytom, Poland
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
|
33
|
Xiao H, Luo Y, Shi J, Jin A, Mohty M, Nagler A, Gale RP, Huang H. How Do We Manage Hematopoietic Cell Transplant during the SARS-CoV-2 Pandemic? Acta Haematol 2021; 144:500-507. [PMID: 33690228 PMCID: PMC8018218 DOI: 10.1159/000513036] [Citation(s) in RCA: 4] [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: 08/31/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022]
Abstract
Patients receiving a hematopoietic cell transplant are thought to be at increased risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus infectious disease 2019. Transplant activities at our center continue, and notably, no patient has been infected with SARS-CoV-2. Indeed, social distancing, masking, and education for patients and donors are major pillars of prevention. We recommend potential transplant recipients and donors to be tested for SARS-CoV-2 with qRT-PCR, serum antibody detection, and a lung CT scan pretransplant. If possible, stem cells from HLA-matched unrelated donors by local processing laboratories should be cryopreserved and shipped before initiating pretransplant conditioning. An alternative HLA-haplotype-matched related donor should be identified and evaluated as a backup. The interval immediately after discharge is the time of greatest risk for SARS-CoV-2 infection because of travel and exposure to infected persons. We recommend self-isolation and minimal contact with family members. Nonessential clinic visits should be deferred or substituted with telemedicine consultations if possible. These recommendations are based on our experience at a major transplant center in China. Although some recommendations are evidence based, other recommendations are not and warrant validation in controlled trials.
Collapse
Affiliation(s)
- Haowen Xiao
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, China
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yi Luo
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jimin Shi
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Aiyun Jin
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, China
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Mohamad Mohty
- Sorbonne Université, Saint-Antoine Hospital, AP-HP, and INSERM UMRs 938, Paris, France
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Robert Peter Gale
- Research Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
| | - He Huang
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, China,
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China,
| |
Collapse
|
|
34
|
Abstract
OBJECTIVE Because of the increasing emergence of skin manifestations of COVID-19 worldwide, we investigated the published reports of these lesions. METHODS We conducted a literature search for original and review articles published from November 11, 2019 to September 30, 2020. RESULTS We identified 5 skin lesions common in patients with COVID-19: pseudo-chilblains, rashes containing macules and papules, and urticarial, vesicular, and vaso-occlusive lesions. These lesions manifested at various times in relation to the COVID-19 symptoms, which may indicate whether the lesions are virus-induced or are delayed immunological responses to the infection. Skin lesions were more prevalent among Europeans and United States residents than among Asians, as was pseudo-chilblain, and the morphology of the skin lesions varied among continents. Pseudo-chilblains were the most common COVID-19 skin manifestation in Europe and the United States, but there was only 1 reported case from Asian populations. Additionally, patients with vaso-occlusive lesions were more likely than those with pseudo-chilblains to be admitted to the intensive care unit and to die. CONCLUSION Different cutaneous manifestations in patients with COVID-19 could reflect a wide spectrum of viral interactions with the skin, though reporting bias may play a role as well.
Collapse
Affiliation(s)
- See Wei Tan
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | | | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
|
35
|
Ng SL, Ong YS, Khaw KY, Teh SP, Tan CS, Ming LC, Chan KG, Lee LH, Goh BH. Focused Review: Potential Rare and Atypical Symptoms as Indicator for Targeted COVID-19 Screening. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:189. [PMID: 33672384 PMCID: PMC7927030 DOI: 10.3390/medicina57020189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
The global pandemic of the coronavirus disease 2019 is a known consequence of infection of severe respiratory syndrome coronavirus-2 (SARS-CoV-2). It has affected nations worldwide with soaring number of cases daily. Symptoms such as fever, cough, and shortness of breath, diarrhea, nausea and vomiting are commonly presented in COVID-19 patients. This focused review aims to discuss these uncommon and atypical COVID-19 symptoms that may be presented which might affect neurological, cardiovascular, cutaneous and ocular systems and their possible mode of actions. Nonetheless, there are some cases of reported uncommon or atypical symptoms which may warrant healthcare professionals to be aware of, especially when in contact with patients. The knowledge and information concerning these symptoms might be able to provide additional cues for healthcare professional by subjecting patients to COVID-19 screening. Meanwhile, it might be able to further enhance the alertness and additional precautions being taken by healthcare personnel, which eventually lead to reduced risk of infections.
Collapse
Affiliation(s)
- Swee Li Ng
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Yong Sze Ong
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Kooi Yeong Khaw
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- Tropical Medicine & Biology Platform, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Siew Phooi Teh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310027, China
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia
| | - Long Chiau Ming
- PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
- International Genome Centre, Jiangsu University, Zhenjiang 212013, China
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
| | - Bey-Hing Goh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310027, China
| |
Collapse
|
|
36
|
Jamshidi P, Hajikhani B, Mirsaeidi M, Vahidnezhad H, Dadashi M, Nasiri MJ. Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review. Front Med (Lausanne) 2021; 8:634208. [PMID: 33665200 PMCID: PMC7921489 DOI: 10.3389/fmed.2021.634208] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19. Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: "SARS-CoV-2" or "COVID-19" or "new coronavirus" or "Wuhan Coronavirus" or "coronavirus disease 2019" and "skin disease" or "skin manifestation" or "cutaneous manifestation." Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%). Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.
Collapse
Affiliation(s)
- Parnian Jamshidi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
37
|
Boss K, Kribben A, Tyczynski B. Pathological findings in rotation thromboelastometry associated with thromboembolic events in COVID-19 patients. Thromb J 2021; 19:10. [PMID: 33573670 PMCID: PMC7877314 DOI: 10.1186/s12959-021-00263-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe thromboembolic events are one of the major complications associated with COVID-19 infection, especially among critically ill patients. We analysed ROTEM measurements in COVID-19 patients with a severe disease course and in patients with severe sepsis. METHODS In this study, data obtained by extended analysis of haemostasis with standard laboratory tests and thromboelastometry of 20 patients with severe course of COVID-19 were retrospectively analysed and compared with similar data from 20 patients with severe sepsis but no COVID-19. RESULTS The thromboelastometry values obtained from 20 sepsis patients contained a maximum clot firmness above the normal range but among COVID-19 patients, hypercoagulability was much more pronounced, with significantly higher maximum clot firmness (FIBTEM: 38.4 ± 10.1 mm vs. 29.6 ± 10.8 mm; P = 0.012; EXTEM: 70.4 ± 10.4 mm vs. 60.6 ± 14.8 mm; P = 0.022). Additionally, fibrinogen levels were significantly higher among COVID-19 patients (757 ± 135 mg/dl vs. 498 ± 132 mg/dl, P < 0.0001). Furthermore, thromboelastometry showed fibrinolysis shutdown among COVID-19 patients with significantly lower maximum of lysis than among sepsis patients (EXTEM: 0.6 ± 1.2 % vs. 3.3 ± 3.7 %; P = 0.013). Seven of 20 COVID-19 patients experienced thromboembolic events, whereas no patient in the sepsis group experienced such events. CONCLUSIONS ROTEM analysis showed significantly different pathological findings characterized by hypercoagulability and fibrinolysis shutdown among COVID-19 patients with a severe disease course compared to patients with severe sepsis. These abnormalities seem to be associated with thromboembolic events.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Department of Medical Intensive Care I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
|
38
|
Iraji F, Galehdari H, Siadat AH, Bokaei Jazi S. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: A case report. Clin Case Rep 2021; 9:830-834. [PMID: 33598253 PMCID: PMC7869328 DOI: 10.1002/ccr3.3596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
COVID-19 is a novel disease that mostly affects the respiratory system but as the number of cases is rising significantly around the world, more extra-respiratory manifestations are being reported among which are various dermatologic manifestations.
Collapse
Affiliation(s)
- Fariba Iraji
- Dermatology DepartmentIsfahan University of Medical SciencesIsfahanIran
| | - Hamid Galehdari
- Dermatology DepartmentIsfahan University of Medical SciencesIsfahanIran
| | | | - Safoura Bokaei Jazi
- Faculty of Pharmaceutical SciencesIsfahan University of Medical SciencesIsfahanIran
| |
Collapse
|
|
39
|
Cutaneous Manifestations in Patients With COVID-19: Clinical Characteristics and Possible Pathophysiologic Mechanisms. ACTAS DERMO-SIFILIOGRAFICAS 2021. [PMID: 34012165 PMCID: PMC7843072 DOI: 10.1016/j.adengl.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections soon led to a pandemic with serious health, economic, political, and cultural repercussions across the globe. The disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), is a multisystemic disease that requires a multidisciplinary approach involving specialists from all fields and levels of care. In this article, we review the literature on the diverse cutaneous manifestations associated with COVID-19. We also describe the pathophysiologic mechanisms proposed to date and their possible association with these manifestations. Finally, we propose a system for classifying the cutaneous manifestations of COVID-19 according to their underlying pathophysiologic mechanisms and prognosis.
Collapse
|
|
40
|
Shah S, Akhade K, Ganguly S, Nanda R, Mohapatra E, Goel AK. Cutaneous manifestations associated with COVID-19 in children: A systematic review. J Family Med Prim Care 2021; 10:93-101. [PMID: 34017709 PMCID: PMC8132763 DOI: 10.4103/jfmpc.jfmpc_1389_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 01/19/2023] Open
Abstract
Cutaneous manifestation of COVID 19 in children has not yet been reviewed systematically. Hence, this review gives the clinicians a future direction to be vigilant for skin presentations during pandemics. The Pubmed database used for literature search with keywords COVID 19, children, and skin in different combinations. Articles published in English with cases of age one month to 18 years were eligible. The outcome included varied aspects of cutaneous and COVID 19 infection. The authors did not register review protocol. Of 51 publications identified, 13 studies containing 149 children met the eligibility criteria. Acrally located erythematous maculopapular lesion was the most common finding in 138 children. The researcher reported Erythema multiforme, varicella like exanthem, and Kawasaki disease like presentations in the rest of the cases. The duration of the skin lesion was 1 2 weeks in 43%. Skin biopsy done in 18 patients revealed superficial and deep perivascular and peri eccrine lymphocytic infiltrate and lymphocytic vasculitis. RT PCR was positive13.8% cases. Serological markers for HSV, parvovirus B19 analyzed across various studies, were negative, except positive mycoplasma pneumonia in 2 of 20 cases tested. Clinicopathologic analysis established chilblains like lesion in 43% cases with no confirmed etiology like cold exposure, autoimmune dysfunction, drug reaction, or viral infection. The usual cephalo caudal spread of a viral exanthem was also missing. However, a low number of discussed cases was a limitation of the study. The absence of any confirmed etiology for such cutaneous manifestations, the possibility of COVID 19, should be explored and thoroughly evaluated and isolated during such a pandemic.
Collapse
Affiliation(s)
- Seema Shah
- Assistant Professor, Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Kiran Akhade
- Project Coordinator, SCoE-SAM, State Centre of Excellence, Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyaki Ganguly
- Associate Professor, Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Rachita Nanda
- Additional Professor, Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Eli Mohapatra
- Professor, Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anil Kumar Goel
- Professor, Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| |
Collapse
|
|
41
|
Royer PY, Zayet S, Jacquin-Porretaz C, Kadiane-Oussou NJ, Toko L, Gendrin V, Klopfenstein T. Angioedema and COVID-19: A New Dermatological Manifestation? Infect Dis Rep 2021; 13:23-25. [PMID: 33401389 PMCID: PMC7838910 DOI: 10.3390/idr13010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 01/05/2023] Open
Abstract
The main localization of SARS-CoV-2 infection is the respiratory tract. Digestive and otorhinolaryngological localizations are also reported. More recently, dermatological manifestations have been reported during Coronavirus disease-19 (COVID-19). We report a case of a labial angioedema in a patient with confirmed COVID-19.
Collapse
Affiliation(s)
- Pierre-Yves Royer
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trevenans, France; (S.Z.); (N.J.K.-O.); (L.T.); (V.G.); (T.K.)
- Correspondence: ; Tel.: +33-384-982-227
| | - Souheil Zayet
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trevenans, France; (S.Z.); (N.J.K.-O.); (L.T.); (V.G.); (T.K.)
| | | | - N’dri Juliette Kadiane-Oussou
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trevenans, France; (S.Z.); (N.J.K.-O.); (L.T.); (V.G.); (T.K.)
| | - Lynda Toko
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trevenans, France; (S.Z.); (N.J.K.-O.); (L.T.); (V.G.); (T.K.)
| | - Vincent Gendrin
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trevenans, France; (S.Z.); (N.J.K.-O.); (L.T.); (V.G.); (T.K.)
| | - Timothée Klopfenstein
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trevenans, France; (S.Z.); (N.J.K.-O.); (L.T.); (V.G.); (T.K.)
| |
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: 5.0] [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
|
Cañas CA, Cañas F, Bautista-Vargas M, Bonilla-Abadía F. Role of Tissue Factor in the Pathogenesis of COVID-19 and the Possible Ways to Inhibit It. Clin Appl Thromb Hemost 2021; 27:10760296211003983. [PMID: 33784877 PMCID: PMC8020089 DOI: 10.1177/10760296211003983] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 (Coronavirus Disease 2019) is a highly contagious infection and associated with high mortality rates, primarily in elderly; patients with heart failure; high blood pressure; diabetes mellitus; and those who are smokers. These conditions are associated to increase in the level of the pulmonary epithelium expression of angiotensin-converting enzyme 2 (ACE-2), which is a recognized receptor of the S protein of the causative agent SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). Severe cases are manifested by parenchymal lung involvement with a significant inflammatory response and the development of microvascular thrombosis. Several factors have been involved in developing this prothrombotic state, including the inflammatory reaction itself with the participation of proinflammatory cytokines, endothelial dysfunction/endotheliitis, the presence of antiphospholipid antibodies, and possibly the tissue factor (TF) overexpression. ARS-Cov-19 ACE-2 down-regulation has been associated with an increase in angiotensin 2 (AT2). The action of proinflammatory cytokines, the increase in AT2 and the presence of antiphospholipid antibodies are known factors for TF activation and overexpression. It is very likely that the overexpression of TF in COVID-19 may be related to the pathogenesis of the disease, hence the importance of knowing the aspects related to this protein and the therapeutic strategies that can be derived. Different therapeutic strategies are being built to curb the expression of TF as a therapeutic target for various prothrombotic events; therefore, analyzing this treatment strategy for COVID-19-associated coagulopathy is rational. Medications such as celecoxib, cyclosporine or colchicine can impact on COVID-19, in addition to its anti-inflammatory effect, through inhibition of TF.
Collapse
Affiliation(s)
- Carlos A. Cañas
- Unit of Rheumatology, Fundación Valle del Lili, Universidad Icesi, Cali, Colombia
| | - Felipe Cañas
- Unit of Cardiology, Clínica Medellín, Medellín, Colombia
| | | | - Fabio Bonilla-Abadía
- Unit of Rheumatology, Fundación Valle del Lili, Universidad Icesi, Cali, Colombia
| |
Collapse
|
|
44
|
Gasparini G, Canepa P, Verdiani S, Carmisciano L, Cozzani E, De Grazia D, Andrea O, Icardi G, Parodi A. A retrospective study on the prevalence of anti-phospholipid antibodies, thrombotic events and cutaneous signs of vasculopathy in 173 hospitalized COVID-19 patients. Int J Immunopathol Pharmacol 2021; 35:20587384211042115. [PMID: 34541915 PMCID: PMC8460963 DOI: 10.1177/20587384211042115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypercoagulability is a risk factor of thromboembolic events in COVID-19. Anti-phospholipid (aPL) antibodies have been hypothesized to be involved. Typical COVID-19 dermatological manifestations of livedo reticularis and digital ischemia may resemble cutaneous manifestations of anti-phospholipid syndrome (APS). OBJECTIVES To investigate the association between aPL antibodies and thromboembolic events, COVID-19 severity, mortality, and cutaneous manifestations in patients with COVID-19. METHODS aPL antibodies [anti-beta2-glycoprotein-1 (B2GP1) and anti-cardiolipin (aCL) antibodies] were titered in frozen serum samples from hospitalized COVID-19 patients and the patients' clinical records were retrospectively analyzed. RESULTS 173 patients were enrolled. aPL antibodies were detected in 34.7% of patients, anti-B2GP1 antibodies in 30.1%, and aCL antibodies in 10.4%. Double positivity was observed in 5.2% of patients. Thromboembolic events occurred in 9.8% of patients, including 11 pulmonary embolisms, 1 case of celiac tripod thrombosis, and six arterial ischemic events affecting the cerebral, celiac, splenic, or femoral-popliteal arteries or the aorta. aPL antibodies were found in 52.9% of patients with vascular events, but thromboembolic events were not correlated to aPL antibodies (adjusted OR = 1.69, p = 0.502). Ten patients (5.8%) had cutaneous signs of vasculopathy: nine livedo reticularis and one acrocyanosis. No significant association was observed between the presence of cutaneous vasculopathy and aPL antibodies (p = 0.692). CONCLUSIONS Anti-phospholipid antibodies cannot be considered responsible for hypercoagulability and thrombotic events in COVID-19 patients. In COVID-19 patients, livedo reticularis and acrocyanosis do not appear to be cutaneous manifestations of APS.
Collapse
Affiliation(s)
- Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Paola Canepa
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Simonetta Verdiani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Section of Statistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| | - Denise De Grazia
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Orsi Andrea
- Hygiene and Preventive medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene and Preventive medicine Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| | - Giancarlo Icardi
- Hygiene and Preventive medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene and Preventive medicine Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, Ospedale Policlinico San MartinoIRCCS, Genoa, Italy
| |
Collapse
|
|
45
|
Dourmishev L, Guleva D, Pozharashka J, Drenovska K, Miteva L, Vassileva S. Autoimmune connective tissue diseases in the COVID-19 pandemic. Clin Dermatol 2021; 39:56-63. [PMID: 33972054 PMCID: PMC7833035 DOI: 10.1016/j.clindermatol.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Autoimmune connective tissue diseases are a heterogeneous group of clinical entities sharing a common feature-an impairment of structural components like collagen and elastin, arising by autoimmune mechanisms. Because most patients are on a long-term immunosuppressive therapy, which renders them vulnerable to infections, a new challenge appears in front of physicians in the coronavirus disease 2019 (COVID-19) era. Immune mechanisms are substantial for the control and ceasing of viral infections, and their impairment may cause serious complications; however, data from immunosuppressed transplant patients do not reveal a higher frequency or diseases' severity in those infected by COVID-19. Several immunotherapies used to treat autoimmune connective tissue diseases favorably modulate the immune response of severe acute respiratory syndrome coronavirus (SARS-CoV-2)-infected patients. The present review highlights the problems of susceptibility, severity, and therapeutic options in patients with autoimmune connective tissue diseases during the COVID-19 pandemic. The relationship between autoimmune connective tissue diseases and COVID-19 infection is explained with antiviral protection genes expression, hypercytokinemia, and lymphohistiocytosis/macrophage activation mechanisms. Recommendations concerning therapy for prevention during the pandemic period or in case of concomitant COVID-19 infection are also presented. Clinical trials are ongoing regarding COVID-19 therapy blocking the cytokine response. © 2021 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Lyubomir Dourmishev
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria.
| | - Dimitrina Guleva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Joana Pozharashka
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Lyubka Miteva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical University, Sofia, Bulgaria
| |
Collapse
|
|
46
|
White-Dzuro G, Gibson LE, Zazzeron L, White-Dzuro C, Sullivan Z, Diiorio DA, Low SA, Chang MG, Bittner EA. Multisystem effects of COVID-19: a concise review for practitioners. Postgrad Med 2021; 133:20-27. [PMID: 32921198 PMCID: PMC7651182 DOI: 10.1080/00325481.2020.1823094] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023]
Abstract
While COVID-19 has primarily been characterized by the respiratory impact of viral pneumonia, it affects every organ system and carries a high consequent risk of death in critically ill patients. Higher sequential organ failure assessment (SOFA) scores have been associated with increased mortality in patients critically ill patients with COVID-19. It is important that clinicians managing critically ill COVID-19 patients be aware of the multisystem impact of the disease so that care can be focused on the prevention of end-organ injuries to potentially improve clinical outcomes. We review the multisystem complications of COVID-19 and associated treatment strategies to improve the care of critically ill COVID-19 patients.
Collapse
Affiliation(s)
- Gabrielle White-Dzuro
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Gibson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Luca Zazzeron
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Colin White-Dzuro
- School of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zachary Sullivan
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daren A. Diiorio
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah A. Low
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
|
47
|
Lambert WC, Alhatem A, Lambert MW, Schwartz RA. What we have learned from the COVID-19 pandemic: Time to think outside the box, maybe far outside. Clin Dermatol 2021; 39:107-117. [PMID: 33972037 PMCID: PMC7834261 DOI: 10.1016/j.clindermatol.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 pandemic has had a profound effect on our lives and careers; this presentation explores some of the lessons we have learned from it and others that it may yet teach us. Socioeconomic effects have been profound, not all of them favorable. Travel and meeting activities, as well as many other activities, have been severely restricted. Social unrest has become intense, and it may have questionable political consequences, as the United States is undergoing a contested election result.
Collapse
Affiliation(s)
- W Clark Lambert
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - Albert Alhatem
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Muriel W Lambert
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
|
48
|
Abstract
Background/aim Sars-CoV-2 virus infection (COVID-19) was observed in China in the last months of 2019. In the period following, this infection spread all over the world. In March 2020 the World Health Organization announced the existence of a pandemic. The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents. Materials and methods In PubMed, Google Scholar databases, skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects are searched in detail. Results Pressure injury, contact dermatitis, itching, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. Skin problems related to personal hygiene measures could include itching, dryness, and contact dermatitis. Skin findings may also be observed in SARS-CoV-2 virus infections. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc. are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin findings. However, in asymptomatic or presymptomatic COVID-19 patients in particular, skin lesions can lead to the diagnosis of COVID-19. In addition, skin lesions may occur due to COVID-19 treatment agents. Conclusion Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in this pandemic period.
Collapse
Affiliation(s)
- Ülker GÜL
- Department of Dermatology, Gülhane Faculty of Medicine, Health Sciences University, İstanbulTurkey
| |
Collapse
|
|
49
|
Wruck W, Adjaye J. SARS-CoV-2 receptor ACE2 is co-expressed with genes related to transmembrane serine proteases, viral entry, immunity and cellular stress. Sci Rep 2020; 10:21415. [PMID: 33293627 PMCID: PMC7723043 DOI: 10.1038/s41598-020-78402-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic resulting from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which emerged in December 2019 in Wuhan in China has placed immense burden on national economies and global health. At present neither vaccination nor therapies are available. Here, we performed a meta-analysis of RNA-sequencing data from three studies employing human lung epithelial cells. Of these one focused on lung epithelial cells infected with SARS-CoV-2. We aimed at identifying genes co-expressed with angiotensin I converting enzyme 2 (ACE2) the human cell entry receptor of SARS-CoV-2, and unveiled several genes correlated or inversely correlated with high significance, among the most significant of these was the transmembrane serine protease 4 (TMPRSS4). Serine proteases are known to be involved in the infection process by priming the virus spike protein. Pathway analysis revealed virus infection amongst the most significantly correlated pathways. Gene Ontologies revealed regulation of viral life cycle, immune responses, pro-inflammatory responses- several interleukins such as IL6, IL1, IL20 and IL33, IFI16 regulating the interferon response to a virus, chemo-attraction of macrophages, and cellular stress resulting from activated Reactive Oxygen Species. We believe that this dataset will aid in a better understanding of the molecular mechanism(s) underlying COVID-19.
Collapse
Affiliation(s)
- Wasco Wruck
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstr.5, 40225, Düsseldorf, Germany
| | - James Adjaye
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstr.5, 40225, Düsseldorf, Germany.
| |
Collapse
|
|
50
|
Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, di Meo N, Morariu SH, Persichetti P, Segreto F, Zalaudek I, Neagu N. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. BIOLOGY 2020; 9:E449. [PMID: 33291502 PMCID: PMC7762103 DOI: 10.3390/biology9120449] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/07/2023]
Abstract
There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.
Collapse
Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Caterina Dianzani
- Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy;
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy;
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Silviu-Horia Morariu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Nicoleta Neagu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
| |
Collapse
|