Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review
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...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2023-06-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.11622/smedj.2021100 |
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| author | Jiacai Cho Joanne Lee Ching-Hui Sia Chieh Sian Koo Benjamin YQ Tan Weizhen Hong Ellie Choi Xueying Goh Louis Chai Nisha Suyien Chandran Horng Ruey Chua Bernard PL Chan Mark Muthiah Ting Ting Low Eng Soo Yap Manjari Lahiri |
| author_facet | Jiacai Cho Joanne Lee Ching-Hui Sia Chieh Sian Koo Benjamin YQ Tan Weizhen Hong Ellie Choi Xueying Goh Louis Chai Nisha Suyien Chandran Horng Ruey Chua Bernard PL Chan Mark Muthiah Ting Ting Low Eng Soo Yap Manjari Lahiri |
| author_sort | Jiacai Cho |
| collection | DOAJ |
| description | 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 2020 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. |
| format | Article |
| id | doaj-art-8f03afa9391642ef97ba48674762db8e |
| institution | Kabale University |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-8f03afa9391642ef97ba48674762db8e2025-02-09T13:49:10ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352023-06-0164634936510.11622/smedj.2021100Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic reviewJiacai ChoJoanne LeeChing-Hui SiaChieh Sian KooBenjamin YQ TanWeizhen HongEllie ChoiXueying GohLouis ChaiNisha Suyien ChandranHorng Ruey ChuaBernard PL ChanMark MuthiahTing Ting LowEng Soo YapManjari LahiriIntroduction: 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 2020 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.https://journals.lww.com/10.11622/smedj.2021100complicationscovid-19extrapulmonarysars-cov-2 |
| spellingShingle | Jiacai Cho Joanne Lee Ching-Hui Sia Chieh Sian Koo Benjamin YQ Tan Weizhen Hong Ellie Choi Xueying Goh Louis Chai Nisha Suyien Chandran Horng Ruey Chua Bernard PL Chan Mark Muthiah Ting Ting Low Eng Soo Yap Manjari Lahiri Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review Singapore Medical Journal complications covid-19 extrapulmonary sars-cov-2 |
| title | Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review |
| title_full | Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review |
| title_fullStr | Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review |
| title_full_unstemmed | Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review |
| title_short | Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review |
| title_sort | extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus 2 infection a systematic review |
| topic | complications covid-19 extrapulmonary sars-cov-2 |
| url | https://journals.lww.com/10.11622/smedj.2021100 |
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