COVID-19 as a systemic disease

Abstract

COVID-19 usually manifests by respiratory symptoms. However, it would be an erroneous simplification to consider it as a local respiratory disease. The nervous system and intestines are often involved even in patients with mild infection, although the risk of dissemination of the infectious process and the development of severe systemic disease is mainly associated with lung damage. The addition of infectious thrombotic microvasculitis (endothelitis) to bronchopneumonia-alveolitis not only forms a substrate for respiratory failure, but also increases a risk of viruses entry into the bloodstream. Viral sepsis develops, whereas inflammatory thrombosis damages new areas of the vascular bed. These mechanisms or direct viral invasion can result in involvement of many tissues and organs in the pathological process. This review examines the molecular, cellular and clinical manifestations and complications of the new coronavirus disease.

Factors affecting the severity of COVID-19 and the development of complications

“…ACE2 is also found in the central and peripheral nervous systems and skeletal muscles [1][2][3]. Chronic lung mir-journal.org Complicated course of and heart diseases, diabetes mellitus, and tumors are associated with ACE2 overexpression, which increases the risk of COVID-19 disease and mortality [4]. The risk of septic shock in patients with three or more comorbidities is much higher than in those without comorbidities [5].…”

“…Respiratory tract symptoms were infrequent: 35 children (4.5%) had cough and 32 had sore throat (4%) [11]. Although lethal outcomes of COVID-19 are rare in children, a severe course of the disease including cases of severe inflammation and nonrespiratory manifestations, is more frequent compared to influenza [4].…”

“…Men, including boys, exhibit a higher frequency and greater severity of COVID-19 infection compared to women. This may be due to the activating effect of androgens on coronavirus replication [4]. Testosterone participates in coregulation of the synthesis of ACE2 and transmembrane serine protease 2 (TMPRSS2) that facilitates the entry of SARS-CoV-2 into target cells.…”

The state of the circulatory, respiratory and hemostasis organs of the servisemen, suffered from coronavirus pneumonia, in a remote recovery period

“…Данный тип рецепторов широко представлен в организме человека: эпителий верхних дыхательных путей и желудочнокишечного тракта, альвеолоциты II типа, эндотелиальные клетки сосудов, кардиомиоциты. Такая экспрессия обусловливает вариативность клинических форм COVID-19 и вероятность поражения органов-мишеней [1,4,5].…”

“…Тяжелое течение новой коронавирусной инфекции может сопровождаться альвеолитом, который является начальным этапом острого респираторного дистресссиндрома, клинически проявляющегося прогрессирующей дыхательной недостаточностью [3,6,7]. Поражение системы кровообращения в первую очередь связано с возникновением диссеминированного эндотелиита и микротромбоваскулита, прямой альтерацией, а также вторичным миокардиальным повреждением на фоне гипоксии, «цитокинового шторма», аритмии, сепсиса и в результате лекарственной токсичности [1,4,8]. Нарушения в системе гемостаза можно охарактеризовать как коагулопатию, ассоциирующуюся с риском развития артериальных и венозных тромбозов вследствие микротромбоваскулита; достаточно часто диагностируется лимфо-, нейтро-и тромбоцитопения как предвестники ожидаемого «цитокинового шторма» [4,9].…”