Extrapulmonary manifestations of coronavirus disease (COVID-19): current status (a literature review)

Abstract

The aim of the study is to analyze the literature data on modern views concerning extrapulmonary manifestations of coronavirus disease (COVID-19). Based on the analysis of current publications, the article analyzes the clinical manifestations of coronavirus disease (COVID-19) as a multisystem disorder with two main types of clinical manifestations, namely pulmonary and extrapulmonary. Determining pathogenetic mechanisms of extrapulmonary symptoms are, on the one hand, the tropism of SARS-CoV-2 to ACE2 receptors, expressed not only by alveolar epithelial type II cells, but also by cells of the heart, nervous system, vascular endothelium, small and large intestine, basal layer cells of the epidermis, cells of endocrine organs, etc., and on the other hand, immune-dependent mechanisms, in particular the development of “cytokine storm”. It is shown that the spectrum of extrapulmonary manifestations of COVID-19 is very wide, and clinical manifestations are characterized by significant polymorphism. Extrapulmonary symptoms of COVID-19 were analyzed considering the organs of the gastrointestinal tract, nervous, cardiovascular and endocrine systems, skin and others. Attention is drawn to a certain association between definite extrapulmonary manifestations and the severity of COVID-19 course. Thus, particular extrapulmonary manifestations are associated with a milder course of COVID-19 (anosmia, dysgeusia, etc.), others, vice versa, occur in severe disease (damage to liver, kidney, heart, pancreas). In addition, some extrapulmonary manifestations, especially of the nervous system, may remain in patients even after an acute period of the disease. Some extrapulmonary manifestations, which are currently described in a small number of patients, are also reviewed. Conclusions. COVID-19 is characterized by a wide range and high frequency of extrapulmonary manifestations, which is explained by both the direct action of SARS-CoV-2 and immune-dependent mechanisms. Some extrapulmonary manifestations are associated with a milder course of COVID-19, others, on the contrary, occur in severe disease.

A case of severe COVID-19 and influenza co-infection

“…However, other researchers have demonstrated co-infection outcomes similar to those of COVID-19 mono-infection [6,7]. Having regard to the similarity of clinical symptoms in respiratory infections, the presence of a pathogen other than SARS-CoV-2 can not provide assurance of the co-infection absence [8,9].…”