ABSTRACT
Introduction Respiratory manifestations are common among patients with Systemic Lupus Erythematosus (SLE) and can present as chest pain, dyspnea, and cough and are often accompanied by fever. These symptoms can resemble those of COVID-19, which may cause increased anxiety in SLE patients. Therefore, the aim of this study is to investigate the impact of SLE-related respiratory manifestations on anxiety, depression, and quality of life among SLE patients during the COVID-19 pandemic. Patients and methods The study involved SLE patients and was conducted in the year 2020, after the start of the pandemic in Morocco, using a cross-sectional design. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), while the quality of life was assessed using the Short Form-12 Health Survey (SF12). Statistical analysis was performed using R software (R Foundation, Vienna, Austria). Results A total of 102 SLE patients, with an average age of 41.6 ± 13.7 years, participated in the study, of whom 92.2% were female. Respiratory manifestations were reported by 20.6% of the patients, and there were no significant differences observed in the general characteristics of the study population between the two groups with and without SLE-related respiratory manifestations. The study found that the prevalence of anxiety and depression was significantly higher in patients with SLE-related respiratory manifestations (50% Vs. 76,2% and 50% Vs. 85,7% successively). These patients also reported significantly more impairment in their physical quality of life (31.8 ± 8.9 Vs. 38.5 ± 10.9). This was observed across three domains of the SF12 survey, including physical functioning (34.4 ± 11.4 Vs. 39.9 ± 11.7), bodily pain (26.9 ± 11.2 Vs. 36.1 ± 14.3), and general health (28.6 ± 10.7 Vs. 35.2 ± 12.3). Although the association between mental quality of life and respiratory manifestations did not reach statistical significance (33.5 ± 12.5 Vs. 39.1 ± 11.5), there was a trend toward poorer mental quality of life in patients with SLE-related respiratory manifestations. Moreover, two domains of mental quality of life were significantly more affected in these patients, namely "social functioning" (30.6 ± 11.3 Vs. 38.7 ± 12.4) and "role-emotional" (26.8 ± 11.6 Vs. 33.8 ± 10.8). Conclusion During the COVID-19 pandemic, the presence of SLE-related respiratory manifestations appeared to be associated with a more negative impact on the psychological health and quality of life of SLE patients.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent responsible for coronavirus disease (COVID-19), is an issue of global concern since March 2020. The respiratory manifestations of COVID-19 have widely been explained in the last couple of months of the pandemic. Initially, the virus was thought to be restricted to the pulmonary system; however, as time progressed and cases increased during the second wave of COVID-19, the virus affected other organs, including the nervous system. The neurological implication of SARS-CoV-2 infection is mounting, as substantiated by various reports, and in the majority of COVID-19 patients with neurological symptoms, the penetration of SARS-CoV-2 in the central nervous system (CNS) is likely. SARS-CoV-2 can enter the nervous system by exploiting the routes of olfactory mucosa, olfactory, and sensory nerve endings, or endothelial and nerve tissues, thus crossing the neural-mucosal interface in the olfactory mucosa in the nose. Owing to multifactorial and complex pathogenic mechanisms, COVID-19 adds large-scale risk to the entire nervous system. A thorough understanding of SARS-CoV-2 neurological damage is still vague; however, our comprehension of the virus is rapidly developing. The present comprehensive review will gain insights and provide neurological dimensions of COVID-19 and their associated anomalies. The review presents the entry routes of SARS-CoV-2 into the CNS, to ascertain potential targets in the tissues owing to infection. We also discuss the molecular mechanisms involved, the array of clinical symptoms, and various nervous system diseases following the attack of SARS-CoV-2.
ABSTRACT
In case of coronavirus disease 2019 (COVID-19) in children suffering from primary immunodeficiency, the last one can be an aggravating or a mitigating factor of the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. WHIM (warts, hypogammaglobulinemia, infections, and myelokathexis) syndrome is usually classified as severe congenital neutropenia, but most patients have multiple leukocyte deficits, even panleukopenia, and therefore it can also be classified as severe combined immunodeficiency. B-lymphopenia is especially severe, and this probably partly explains the hypogammaglobulinemia. This rare disease, caused by autosomal dominant mutations, is a combined variant of immunodeficiency, which includes myelokathexis, susceptibility to infections, and hypogammaglobulinemia. Myelokathexis is a unique form of acyclic severe congenital neutropenia caused by the accumulation of mature and degenerative neutrophils in the bone marrow. Monocytopenia and lymphopenia, especially B-lymphopenia, also occur. In some patients, there are defects in the development of the cardiovascular, genitourinary and nervous systems, which in general can contribute to the extremely severe course of infectious inflammatory process, in particular due to the SARS-CoV-2. Objective: to analyze the clinical and laboratory peculiarities of coronavirus disease caused by SARS-CoV-2 in immunosuppressed patients on the example of a clinical case of COVID-19 in a child with previously diagnosed WHIM syndrome. Materials and methods. The article presents our own observation of coronavirus disease in a female adolescent suffering from previously verified primary immunodeficiency (WHIM syndrome) in the period after surgical routine correction of patent ductus arteriosus. On the 2nd day of sudden disease onset, the child was hospitalized in moderate condition with signs of airway inflammation as rhinopharyngitis and obstructive bronchitis. Results. Laboratory tests showed leukopenia, absolute neutropenia, increased levels of procalcitonin, C-reactive protein, D-dimer in serum and a reduction of activated partial thromboplastin time. The treatment included hydrobalance protection per os and by infusion, systemic and topical inhalation therapy with a short steroids course, antibacterial therapy as fourth generation cephalosporins, intravenous granulocyte colony stimulating factor, and symptomatic treatment. The girl's condition became progressively better, she was discharged from the hospital on the 7th day to continue treatment at the outpatient settings. Conclusions. The severity of respiratory pathology and the prognosis of COVID-19 depend on the immunodeficiency type and compromised part of immune system, as well as the heterogeneity of new SARS-CoV-2 strains. The aggravating/protective role of primary immunodeficiency, in particular WHIM syndrome, in determining COVID-19 severity is currently limited because of small number of observations and requires further data collection. The presented clinical case describes the classic moderate coronavirus disease as airway infection in an adolescent suffering from primary immunodeficiency. © 2022. The Authors.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19, the seventh coronavirus) is a new infectious disease that spread worldwide and rapidly became a pandemic. COVID-19 is rare in children and often asymptomatic. The respiratory system is mainly involved in COVID-19 infection. Objectives: This study aimed to review respiratory manifestations in children with COVID-19. Methods: We searched for studies published from January 2020 to January 2021 in PubMed, Google Scholar, and Scopus in English. The search words were "2019-nCoV," "novel coronavirus," "COVID-19," "SARS-CoV-2," "severe acute respiratory syndrome coronavirus 2," "children," "child," "infant," "teenager," "adolescent," "pediatric," and "neonate." Results: Cough was a common symptom in our study (18.8%-100%, mean=64%). Pneumonia prevalence in children with COVID-19 is 11%-67% (mean=46%). Mild respiratory symptoms (14% - 60%) and severe respiratory distress syndromes (14%) were reported in some studies. Upper respiratory tract infection (URTI) was reported in 4 studies ranging from 11.1% to 34.4% (mean=24.1%). Ground-glass opacities (GGO) was reported in 12.2% to 81% of cases (mean=49.01%). Isolated consolidations were reported in 17% and 58% of patients in two studies. Enhanced lung texture was reported in 1.3% to 50% (mean=20.07%) of patients. Bilateral patchy shadowing was seen in 12.3% to 68% (mean=46.58%) of patients. Conclusions: Cough is the most common manifestation of respiratory system involvement in children with COVID-19. GGO and bilateral patchy involvement are the most common finding on lung CT scans in children with COVID-19.
ABSTRACT
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health threat. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, SARS-CoV-2 infection may also involve other organs/systems and present with extra-respiratory manifestations, including cardiac, gastrointestinal, hepatic, renal, neurological, olfactory, gustatory, ocular, cutaneous and haematological symptoms. Occasionally, these extra-respiratory symptoms/signs represent the initial presentation of SARS-CoV-2 infection, prior to fever or respiratory manifestations. Therefore, this comprehensive review of the extra-respiratory manifestations of COVID-19 is intended to help clinicians better understand the range of clinical presentations associated with SARS-CoV-2 infection, allowing the consideration of COVID-19 in differential diagnoses. A screening test for SARS-CoV-2 should be performed when patients have these extra-respiratory manifestations. In addition, clinicians should be alerted to the adverse effects of anti-SARS-CoV-2 agents that can mimic the extra-respiratory manifestations of COVID-19. Moreover, some extra-respiratory manifestations, such as ocular and gastrointestinal involvement, may be caused by direct invasion of SARS-CoV-2. Therefore, protective measures should be taken while managing the associated clinical specimens. Finally, several extra-respiratory manifestations, such as cardiac involvement, acute kidney injury, coagulation disorders and thrombotic complications, could be associated with a poor prognosis.