tetano
Editor, Senior Moderator
Singapore Med J
. 2021 Sep 21.
doi: 10.11622/smedj.2021100. Online ahead of print.
Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus 2 infection: a systematic review
Jiacai Cho[SUP] 1 2 [/SUP], Joanne Lee[SUP] 2 3 [/SUP], Ching-Hui Sia[SUP] 2 4 [/SUP], Chieh Sian Koo[SUP] 2 5 [/SUP], Benjamin Yq Tan[SUP] 2 6 [/SUP], Weizhen Hong[SUP] 2 7 [/SUP], Ellie Choi[SUP] 8 [/SUP], Xueying Goh[SUP] 2 9 [/SUP], Louis Chai[SUP] 2 10 [/SUP], Nisha Suyien Chandran[SUP] 2 8 [/SUP], Horng Ruey Chua[SUP] 2 7 [/SUP], Bernard Pl Chan[SUP] 2 6 [/SUP], Mark Muthiah[SUP] 2 5 [/SUP], Ting Ting Low[SUP] 2 4 [/SUP], Eng Soo Yap[SUP] 2 3 [/SUP], Manjari Lahiri[SUP] 1 2 [/SUP]
Affiliations
Abstract
Introduction: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity.
Methods: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded.
Results: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum.
Conclusion: Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
Keywords: COVID-19; SARS-CoV-2; complications; extrapulmonary.
. 2021 Sep 21.
doi: 10.11622/smedj.2021100. Online ahead of print.
Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus 2 infection: a systematic review
Jiacai Cho[SUP] 1 2 [/SUP], Joanne Lee[SUP] 2 3 [/SUP], Ching-Hui Sia[SUP] 2 4 [/SUP], Chieh Sian Koo[SUP] 2 5 [/SUP], Benjamin Yq Tan[SUP] 2 6 [/SUP], Weizhen Hong[SUP] 2 7 [/SUP], Ellie Choi[SUP] 8 [/SUP], Xueying Goh[SUP] 2 9 [/SUP], Louis Chai[SUP] 2 10 [/SUP], Nisha Suyien Chandran[SUP] 2 8 [/SUP], Horng Ruey Chua[SUP] 2 7 [/SUP], Bernard Pl Chan[SUP] 2 6 [/SUP], Mark Muthiah[SUP] 2 5 [/SUP], Ting Ting Low[SUP] 2 4 [/SUP], Eng Soo Yap[SUP] 2 3 [/SUP], Manjari Lahiri[SUP] 1 2 [/SUP]
Affiliations
- PMID: 34544216
- DOI: 10.11622/smedj.2021100
Abstract
Introduction: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity.
Methods: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded.
Results: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum.
Conclusion: Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
Keywords: COVID-19; SARS-CoV-2; complications; extrapulmonary.