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1.
Curr Pain Headache Rep ; 25(11): 73, 2021 Nov 11.
Article in English | MEDLINE | ID: covidwho-1527506

ABSTRACT

PURPOSE OF REVIEW: Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. RECENT FINDINGS: The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.


Subject(s)
COVID-19/epidemiology , Headache/epidemiology , Anosmia/physiopathology , COVID-19/complications , COVID-19/mortality , COVID-19/physiopathology , Endothelium, Vascular , Headache/etiology , Headache/physiopathology , Headache/therapy , Humans , Inflammation , Migraine Disorders/physiopathology , SARS-CoV-2 , Tension-Type Headache/physiopathology , Trigeminal Ganglion/physiopathology , Trigeminal Ganglion/virology , Trigeminal Nerve/physiopathology , Trigeminal Nerve/virology , Viral Tropism
2.
Med Sci Monit ; 27: e932962, 2021 Jun 19.
Article in English | MEDLINE | ID: covidwho-1278722

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of the recent pandemic of coronavirus disease 19 (COVID-19). As the infection spreads, there is increasing evidence of neurological and psychiatric involvement in COVID-19. Headache, impaired consciousness, and olfactory and gustatory dysfunctions are common neurological manifestations described in the literature. Studies demonstrating more specific and more severe neurological involvement such as cerebrovascular insults, encephalitis and Guillain-Barre syndrome are also emerging. Respiratory failure, a significant condition that leads to mortality in COVID-19, is hypothesized to be partly due to brainstem impairment. Notably, some of these neurological complications seem to persist long after infection. This review aims to provide an update on what is currently known about neurological involvement in patients with COVID-19 due to SARS-CoV-2 infection. In this review, we demonstrate invasion routes of SARS-CoV-2, provide evidence to support the neurotropism hypothesis of the virus, and investigate the pathological mechanisms that underlie neurological complications associated with SARS-CoV-2.


Subject(s)
COVID-19/physiopathology , Nervous System Diseases/virology , Ageusia/virology , Anosmia/virology , COVID-19/complications , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/virology , Encephalitis/virology , Headache/physiopathology , Headache/virology , Humans , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Neuroimmunomodulation/physiology , Pandemics , SARS-CoV-2/isolation & purification , Stroke/physiopathology , Stroke/virology
3.
Mol Neurobiol ; 58(9): 4487-4494, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1242821

ABSTRACT

Headache is the most common neurological symptom in COVID-19, reported in 6.5 to 34% of patients. Few studies have analyzed its characteristics, and some of them included cases without laboratory confirmation or reported only critical patients. We aimed to analyze the clinical characteristics of COVID-19 associated headache in laboratory-confirmed cases. We conducted a retrospective evaluation of patients with COVID-19 and neurological symptoms. Patients who reported headache answered an interview about its clinical characteristics. Twenty-four patients with COVID-19 associated headache completed the interview. Mean age of patients was 53.8 (standard deviation-17.44), and 14 out of 24 (58.3%) were male. The majority (75%) had no previous history of headache. Fever was documented in 19 out of the 24 patients (79.1%). Headache was predominantly bifrontal or holocranial, in pressure, during hours, worsening with cough or physical activity. COVID-19 headache tends to appear in the first days of symptoms, be either frontal or holocranial and last for days. The quality of pain in pressure and the worsening with cough or physical activity were reported in most cases. We have not found any characteristic that could differentiate COVID-19 associated headache from other causes of headache, possibly because of its multifactorial mechanism.


Subject(s)
COVID-19/complications , Headache/etiology , SARS-CoV-2 , Adolescent , Adult , Antihypertensive Agents/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Comorbidity , Cytokines/physiology , Endothelium, Vascular/physiopathology , Endothelium, Vascular/virology , Female , Fever/etiology , Headache/physiopathology , Humans , Inflammation , Male , Models, Biological , Neoplasms/epidemiology , Retrospective Studies , Symptom Assessment , Trigeminal Nerve/virology , Young Adult
4.
Epidemiol Infect ; 149: e92, 2021 04 05.
Article in English | MEDLINE | ID: covidwho-1169347

ABSTRACT

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.


Subject(s)
Ambulatory Care , COVID-19 Testing/methods , COVID-19/diagnosis , Abdominal Pain/physiopathology , Adolescent , Adult , COVID-19/physiopathology , Case-Control Studies , Clinical Decision Rules , Cough/physiopathology , Diarrhea/physiopathology , Disease Progression , Dyspnea/physiopathology , Female , Fever/physiopathology , Headache/physiopathology , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Myalgia/physiopathology , Odds Ratio , Patient Selection , Pharyngitis/physiopathology , Rhinorrhea/physiopathology , SARS-CoV-2 , Sensitivity and Specificity , Severity of Illness Index , Young Adult
5.
Medicina (Kaunas) ; 57(3)2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1167648

ABSTRACT

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.


Subject(s)
COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adult , COVID-19/physiopathology , Cesarean Section , Cough/physiopathology , Female , Fetal Growth Retardation/epidemiology , Fetal Membranes, Premature Rupture/epidemiology , Headache/physiopathology , Hospitalization , Hospitals, Maternity , Humans , Labor, Induced , Obstetric Labor, Premature/epidemiology , Portugal/epidemiology , Postpartum Hemorrhage/epidemiology , Pregnancy , Pregnancy Outcome , Premature Birth/epidemiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Stillbirth/epidemiology , Vacuum Extraction, Obstetrical
6.
Curr Neuropharmacol ; 19(1): 92-96, 2021.
Article in English | MEDLINE | ID: covidwho-1154160

ABSTRACT

The pandemic novel coronavirus disease (COVID-19) has become a global concern in which the respiratory system is not the only one involved. Previous researches have presented the common clinical manifestations including respiratory symptoms (i.e., fever and cough), fatigue and myalgia. However, there is limited evidence for neurological and psychological influences of SARS-CoV-2. In this review, we discuss the common neurological manifestations of COVID-19 including acute cerebrovascular disease (i.e., cerebral hemorrhage) and muscle ache. Possible viral transmission to the nervous system may occur via circulation, an upper nasal transcribrial route and/or conjunctival route. Moreover, we cannot ignore the psychological influence on the public, medical staff and confirmed patients. Dealing with public psychological barriers and performing psychological crisis intervention are an important part of public health interventions.


Subject(s)
COVID-19/physiopathology , Central Nervous System Viral Diseases/physiopathology , Cerebrovascular Disorders/physiopathology , Myalgia/physiopathology , Nervous System Diseases/physiopathology , Blood-Brain Barrier , COVID-19/psychology , COVID-19/transmission , Central Nervous System Viral Diseases/psychology , Central Nervous System Viral Diseases/transmission , Cerebral Hemorrhage/physiopathology , Conjunctiva , Dizziness/physiopathology , Ethmoid Bone , Headache/physiopathology , Health Personnel/psychology , Humans , Nervous System Diseases/psychology , SARS-CoV-2
7.
J Med Case Rep ; 15(1): 171, 2021 Mar 26.
Article in English | MEDLINE | ID: covidwho-1154035

ABSTRACT

BACKGROUND: The pandemic of this century has overwhelmed the healthcare systems of affected countries, and all resources have been diverted to coronavirus disease 2019. At the onset, coronavirus disease 2019 can present as any other acute febrile undifferentiated illness. In tropical regions, clinicians are increasingly challenged to differentiate these febrile illnesses without the use of diagnostics. With this pandemic, many of these tropical diseases are neglected and go underreported. Dengue is holoendemic in the Maldives, and dengue viruses circulate throughout the year. Reports about coinfections with dengue virus and severe acute respiratory syndrome coronavirus 2 are scarce, and the outcome and the dynamics of the disease may be altered in the presence of coinfection. We have described the clinical manifestation and serial laboratory profile, and highlighted the atypical findings uncommon in dengue infection. CASE PRESENTATION: Case 1 was a 39-year old Asian male, presented on day 6 of dengue infection with warning signs. Reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 that was done as per hospital protocol was found to be positive. Case 2 was a 38-year old Asian male, was admitted on day 5 of illness with symptoms of acute respiratory infection with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2. Evaluation of progressive leukopenia and thrombocytopenia showed positive dengue serology. CONCLUSION: Clinicians must be conscientious when working on the differential diagnosis of possible tropical diseases in cases of coronavirus disease 2019, specifically, when patients develop hemoconcentration, thrombocytopenia, and transaminitis with elevated expression of aspartate higher than alanine transaminase, which is frequently observed in dengue infection. Caution must be taken during the administration of intravenous fluids when treating patients with coronavirus disease 2019 and dengue coinfection, as coronavirus disease 2019 patients are more prone to develop pulmonary edema. Timely diagnosis and appropriate management are essential to avoid the devastating complications of severe forms of dengue infection. It is important to repeat and reconfirm the dengue serology in coronavirus disease 2019 patients to avoid false positivity. Diligence and care must be taken not to neglect other endemic tropical diseases in the region during the present pandemic.


Subject(s)
COVID-19/complications , Dengue/complications , Leukopenia/blood , Thrombocytopenia/blood , Abdominal Pain/physiopathology , Adult , Anosmia/physiopathology , COVID-19/blood , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Coinfection , Cough/physiopathology , Dengue/blood , Dengue/physiopathology , Dengue/therapy , Diarrhea/physiopathology , Dysgeusia/physiopathology , Fever/physiopathology , Fluid Therapy , Headache/physiopathology , Humans , Male , Myalgia/physiopathology , Pharyngitis/physiopathology , SARS-CoV-2 , Vomiting/physiopathology
8.
Curr Pain Headache Rep ; 25(3): 19, 2021 Feb 25.
Article in English | MEDLINE | ID: covidwho-1100995

ABSTRACT

PURPOSE OF REVIEW: This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion. RECENT FINDINGS: COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1-4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.


Subject(s)
Endothelium/physiopathology , Headache/physiopathology , Posterior Leukoencephalopathy Syndrome/physiopathology , Seizures/physiopathology , Vision Disorders/physiopathology , Acute Chest Syndrome/epidemiology , Aminolevulinic Acid/analogs & derivatives , Anemia, Sickle Cell/epidemiology , Autoimmune Diseases/epidemiology , Blood-Brain Barrier/metabolism , Brain Edema/diagnostic imaging , Brain Edema/physiopathology , COVID-19/epidemiology , Cerebrovascular Circulation/physiology , Cytokines/metabolism , Eclampsia/epidemiology , Female , Homeostasis/physiology , Humans , Hypertension/physiopathology , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/epidemiology , Posterior Leukoencephalopathy Syndrome/therapy , Pre-Eclampsia/epidemiology , Pregnancy , Prognosis , Renal Insufficiency/epidemiology , SARS-CoV-2 , Vasospasm, Intracranial/physiopathology
9.
JAMA Netw Open ; 4(2): e210202, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1100834

ABSTRACT

Importance: Owing to concerns of coronavirus disease 2019 (COVID-19) outbreaks, many congregant settings are forced to close when cases are detected because there are few data on the risk of different markers of transmission within groups. Objective: To determine whether symptoms and laboratory results on the first day of COVID-19 diagnosis are associated with development of a case cluster in a congregant setting. Design, Setting, and Participants: This cohort study of trainees with COVID-19 from May 11 through August 24, 2020, was conducted at Joint Base San Antonio-Lackland, the primary site of entry for enlistment in the US Air Force. Symptoms and duration, known contacts, and cycle threshold for trainees diagnosed by reverse transcription-polymerase chain reaction were collected. A cycle threshold value represents the number of nucleic acid amplification cycles that occur before a specimen containing the target material generates a signal greater than the predetermined threshold that defines positivity. Cohorts with 5 or more individuals with COVID-19 infection were defined as clusters. Participants included 10 613 trainees divided into 263 parallel cohorts of 30 to 50 people arriving weekly for 7 weeks of training. Exposures: All trainees were quarantined for 14 days on arrival. Testing was performed on arrival, on day 14, and anytime during training when indicated. Protective measures included universal masking, physical distancing, and rapid isolation of trainees with COVID-19. Main Outcomes and Measures: Association between days of symptoms, specific symptoms, number of symptoms, or cycle threshold values of individuals diagnosed with COVID-19 via reverse transcription-polymerase chain reaction and subsequent transmission within cohorts. Results: In this cohort study of 10 613 US Air Force basic trainees in 263 cohorts, 403 trainees (3%) received a diagnosis of COVID-19 in 129 cohorts (49%). Among trainees with COVID-19 infection, 318 (79%) were men, and the median (interquartile range [IQR]) age was 20 (19-23) years; 204 (51%) were symptomatic, and 199 (49%) were asymptomatic. Median (IQR) cycle threshold values were lower in symptomatic trainees compared with asymptomatic trainees (21.2 [18.4-27.60] vs 34.8 [29.3-37.4]; P < .001). Cohorts with clusters of individuals with COVID-19 infection were predominantly men (204 cohorts [89%] vs 114 cohorts [64%]; P < .001), had more symptomatic trainees (146 cohorts [64%] vs 53 cohorts [30%]; P < .001), and had more median (IQR) symptoms per patient (3 [2-5] vs 1 [1-2]; P < .001) compared with cohorts without clusters. Within cohorts, subsequent development of clusters of 5 or more individuals with COVID-19 infection compared with those that did not develop clusters was associated with cohorts that had more symptomatic trainees (31 of 58 trainees [53%] vs 43 of 151 trainees [28%]; P = .001) and lower median (IQR) cycle threshold values (22.3 [18.4-27.3] vs 35.3 [26.5-37.8]; P < .001). Conclusions and Relevance: In this cohort study of US Air Force trainees living in a congregant setting during the COVID-19 pandemic, higher numbers of symptoms and lower cycle threshold values were associated with subsequent development of clusters of individuals with COVID-19 infection. These values may be useful if validated in future studies.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/transmission , Military Personnel/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , Carrier State/diagnosis , Carrier State/epidemiology , Carrier State/transmission , Cohort Studies , Cough/physiopathology , Female , Headache/physiopathology , Humans , Male , Myalgia/physiopathology , Pharyngitis/physiopathology , Residence Characteristics , Risk Factors , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology , Young Adult
10.
PLoS One ; 16(2): e0246793, 2021.
Article in English | MEDLINE | ID: covidwho-1079373

ABSTRACT

BACKGROUND: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina. RESEARCH QUESTION: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality? STUDY DESIGN AND METHODS: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. RESULTS: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects. INTERPRETATION: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/physiopathology , Adult , Argentina/epidemiology , Asthma/epidemiology , Asthma/physiopathology , COVID-19/diagnosis , Comorbidity , Cough/epidemiology , Cough/physiopathology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/physiopathology , Female , Fever/epidemiology , Fever/physiopathology , Headache/epidemiology , Headache/physiopathology , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Intensive Care Units , Male , Middle Aged , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Young Adult
11.
Rev Neurosci ; 32(3): 351-361, 2021 04 27.
Article in English | MEDLINE | ID: covidwho-1067453

ABSTRACT

The ongoing pandemic of Coronavirus disease 2019 (COVID-19) has infected more than 27 million confirmed cases and 8,90,000 deaths all around the world. Verity of viral infections can infect the nervous system; these viral infections can present a wide range of manifestation. The aim of the current study was to systematically review the COVID-19 associated central nervous system manifestations, mental and neurological symptoms. For that we conducted a comprehensive systematic literature review of four online databases, including Web of Science, PubMed, Scopus and Embase. All relevant articles that reported psychiatric/psychological symptoms or disorders in COVID-19 without considering time and language restrictions were assessed. All the study procedures were performed based on the PRISMA criteria. Due to the screening, 14 studies were included. The current study result indicated that, the pooled prevalence of CNS or mental associated disorders with 95% CI was 50.68% (6.68-93.88). The most prevalence symptoms were hyposmia/anosmia/olfactory dysfunction (number of study: 10) with 36.20% (14.99-60.51). Only one study reported numbness/paresthesia and dysphonia. Pooled prevalence of numbness/paresthesia and dysphonia was 5.83% (2.17-12.25) and 2.39% (10.75-14.22). The pooled prevalence of depression and anxiety was 3.52% (2.62-4.54) and 13.92% (9.44-19.08). Our findings demonstrate that COVID-19 has a certain relation with neurological symptoms. The hypsomia, anosmia or olfactory dysfunction was most frequent symptom. Other symptoms were headache or dizziness, dysgeusia or ageusia, dysphonia and fatigue. Depression, anxiety, and confusion were less frequent symptoms.


Subject(s)
Anosmia/epidemiology , Anxiety/epidemiology , COVID-19/physiopathology , Depression/epidemiology , Anosmia/physiopathology , Anxiety/psychology , COVID-19/psychology , Depression/psychology , Dysgeusia/epidemiology , Dysgeusia/physiopathology , Dysphonia/epidemiology , Dysphonia/physiopathology , Fatigue/epidemiology , Fatigue/physiopathology , Headache/epidemiology , Headache/physiopathology , Humans , Hypesthesia/epidemiology , Hypesthesia/physiopathology , Nervous System Diseases/epidemiology , Nervous System Diseases/physiopathology , Paresthesia/epidemiology , Paresthesia/physiopathology , Prevalence , SARS-CoV-2
12.
Iran J Allergy Asthma Immunol ; 19(6): 570-588, 2020 Dec 19.
Article in English | MEDLINE | ID: covidwho-1068115

ABSTRACT

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.


Subject(s)
COVID-19/physiopathology , Conjunctivitis/physiopathology , Exanthema/physiopathology , Fever/physiopathology , Gastrointestinal Diseases/physiopathology , Shock/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Abdominal Pain/physiopathology , Acute Kidney Injury/physiopathology , COVID-19/epidemiology , COVID-19/therapy , Cheilitis/physiopathology , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Headache/physiopathology , Humans , Meningism/physiopathology , Myalgia/epidemiology , Prognosis , Respiration, Artificial , Sex Distribution , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Vomiting/physiopathology
13.
Neuro Endocrinol Lett ; 41(5): 223-230, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1055494

ABSTRACT

BACKGROUND: In December 2019, a new coronavirus, SARS-CoV-2, appeared in Wuhan, China. This virus is the cause of the COVID-19 disease. This infection later spread to the whole world. The goal of this article is to present the clinical and laboratory characteristics of patients with COVID-19 treated in the Faculty Hospital Pilsen. METHODS: In this monocentric, retrospective study, clinical and biochemical data of 89 adult patients with COVID-19 was analyzed. These patients were in the care of the Faculty Hospital Pilsen between March 14 and April 7. RESULTS: In this cohort, made up of 89 patients, 63 were treated as outpatients and 26 were hospitalized. 10 patients required intensive care. The most common symptoms among patients were cough and fever. Dyspnea was present in 29 patients. A CT scan showed bilateral pneumonia in 23 of the admitted patients. Fever and bilateral pneumonia were significantly more common in patients ≥ 60 years old (p=0.047, and p=0.001, respectively). Of lab results, the patients in intensive care had significantly higher values of C-reactive protein, procalcitonin, lactate dehydrogenase, interleukin 6, myoglobin and ferritin. CONCLUSION: The most common symptoms of COVID-19 are fever and cough. These two symptoms are simultaneously present in more than half the cases. Approximately 1/10th of patients requires intensive care. Higher values of lactate dehydrogenase, myoglobin and ferritin on patient admission appear to be a strong predictive factor of the patient's status progressing into requiring ICU attention.


Subject(s)
COVID-19/physiopathology , Cough/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Adult , Age Factors , Aged , Ambulatory Care/statistics & numerical data , Arthralgia/physiopathology , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/epidemiology , Comorbidity , Czech Republic/epidemiology , Diabetes Mellitus/epidemiology , Female , Ferritins/blood , Headache/physiopathology , Hospitalization/statistics & numerical data , Humans , Hypertension/epidemiology , Intensive Care Units , Interleukin-6/blood , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Myalgia/physiopathology , Myoglobin/blood , Obesity/epidemiology , Procalcitonin/blood , SARS-CoV-2 , Tomography, X-Ray Computed
14.
Chest ; 159(2): e107-e113, 2021 02.
Article in English | MEDLINE | ID: covidwho-1053266

ABSTRACT

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Bacteremia/complications , COVID-19/complications , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Cerebellar Diseases/complications , Cerebellar Diseases/diagnostic imaging , Cough/physiopathology , Diarrhea/physiopathology , Disease Progression , Dyspnea/physiopathology , Emergency Service, Hospital , Fever/physiopathology , Headache/physiopathology , Humans , Ischemic Stroke/complications , Ischemic Stroke/diagnostic imaging , Lymphopenia/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Myalgia/physiopathology , Oximetry , Pneumonia, Staphylococcal/complications , Radiography, Thoracic , SARS-CoV-2 , Staphylococcal Infections/complications , Tomography, X-Ray Computed
15.
Neurology ; 96(11): e1527-e1538, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1028513

ABSTRACT

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. METHODS: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. RESULTS: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. CONCLUSIONS: The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.


Subject(s)
COVID-19/mortality , Confusion/physiopathology , Consciousness Disorders/physiopathology , Hospital Mortality , Stroke/physiopathology , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/physiopathology , Anosmia/epidemiology , Anosmia/physiopathology , Ataxia/epidemiology , Ataxia/physiopathology , COVID-19/physiopathology , Confusion/epidemiology , Consciousness Disorders/epidemiology , Cranial Nerve Diseases/epidemiology , Cranial Nerve Diseases/physiopathology , Delirium/epidemiology , Delirium/physiopathology , Female , Headache/epidemiology , Headache/physiopathology , Humans , Male , Middle Aged , Paresthesia/epidemiology , Paresthesia/physiopathology , Primary Dysautonomias/epidemiology , Primary Dysautonomias/physiopathology , Recurrence , SARS-CoV-2 , Seizures/epidemiology , Seizures/physiopathology , Stroke/epidemiology , Vertigo/epidemiology , Vertigo/physiopathology
16.
BMJ Open ; 11(1): e042745, 2021 01 12.
Article in English | MEDLINE | ID: covidwho-1027129

ABSTRACT

BACKGROUND: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. METHODS: The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort. FINDINGS: Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group. CONCLUSION: COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies.


Subject(s)
COVID-19/diagnosis , COVID-19/physiopathology , Primary Health Care/methods , Adolescent , Adult , Age Factors , Brazil , COVID-19/complications , Child , Cohort Studies , Cough/etiology , Cough/physiopathology , Fatigue/etiology , Fatigue/physiopathology , Female , Fever/etiology , Fever/physiopathology , Headache/etiology , Headache/physiopathology , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Prospective Studies , Reverse Transcriptase Polymerase Chain Reaction/methods , SARS-CoV-2 , Sex Factors , Young Adult
17.
Eur Rev Med Pharmacol Sci ; 24(24): 13044-13048, 2020 12.
Article in English | MEDLINE | ID: covidwho-1000849

ABSTRACT

As a severe and highly contagious infection, coronavirus disease (COVID-19) affects all aspects of society and has become a global public health problem. Because of the complexity of the pathology of COVID-19, it is difficult to treat. An increasing number of reports have indicated that COVID-19 may have neurological complications, including stroke. The nervous system complications of COVID-19 have gradually attracted research attention. In this review, we summarize the latest findings related to COVID 19, elaborate on the possible mechanism of COVID 19 related onset of stroke, and summarize current treatment options because an improved understanding and appropriate treatments may improve the prognosis of patients with COVID-19-related stroke.


Subject(s)
Anosmia/physiopathology , COVID-19/physiopathology , Headache/physiopathology , Stroke/physiopathology , Taste Disorders/physiopathology , Angiotensin-Converting Enzyme 2/metabolism , Anticoagulants/therapeutic use , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/physiopathology , COVID-19/complications , COVID-19/immunology , COVID-19/therapy , Consciousness Disorders/physiopathology , Cytokines/immunology , Endothelium, Vascular/metabolism , Endothelium, Vascular/physiopathology , Humans , Receptors, Coronavirus/metabolism , Renin-Angiotensin System , SARS-CoV-2 , Stockings, Compression , Stroke/etiology , Stroke/immunology , Stroke/therapy , Thrombolytic Therapy
18.
Neuro Endocrinol Lett ; 41(5): 223-230, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-972898

ABSTRACT

BACKGROUND: In December 2019, a new coronavirus, SARS-CoV-2, appeared in Wuhan, China. This virus is the cause of the COVID-19 disease. This infection later spread to the whole world. The goal of this article is to present the clinical and laboratory characteristics of patients with COVID-19 treated in the Faculty Hospital Pilsen. METHODS: In this monocentric, retrospective study, clinical and biochemical data of 89 adult patients with COVID-19 was analyzed. These patients were in the care of the Faculty Hospital Pilsen between March 14 and April 7. RESULTS: In this cohort, made up of 89 patients, 63 were treated as outpatients and 26 were hospitalized. 10 patients required intensive care. The most common symptoms among patients were cough and fever. Dyspnea was present in 29 patients. A CT scan showed bilateral pneumonia in 23 of the admitted patients. Fever and bilateral pneumonia were significantly more common in patients ≥ 60 years old (p=0.047, and p=0.001, respectively). Of lab results, the patients in intensive care had significantly higher values of C-reactive protein, procalcitonin, lactate dehydrogenase, interleukin 6, myoglobin and ferritin. CONCLUSION: The most common symptoms of COVID-19 are fever and cough. These two symptoms are simultaneously present in more than half the cases. Approximately 1/10th of patients requires intensive care. Higher values of lactate dehydrogenase, myoglobin and ferritin on patient admission appear to be a strong predictive factor of the patient's status progressing into requiring ICU attention.


Subject(s)
COVID-19/physiopathology , Cough/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Adult , Age Factors , Aged , Ambulatory Care/statistics & numerical data , Arthralgia/physiopathology , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/epidemiology , Comorbidity , Czech Republic/epidemiology , Diabetes Mellitus/epidemiology , Female , Ferritins/blood , Headache/physiopathology , Hospitalization/statistics & numerical data , Humans , Hypertension/epidemiology , Intensive Care Units , Interleukin-6/blood , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Myalgia/physiopathology , Myoglobin/blood , Obesity/epidemiology , Procalcitonin/blood , SARS-CoV-2 , Tomography, X-Ray Computed
20.
Brain Behav Immun ; 88: 11-16, 2020 08.
Article in English | MEDLINE | ID: covidwho-935435

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) represents a novel pneumonia leading to severe acute respiratory syndrome (SARS). Recent studies documented that SARS-Coronavirus2 (SARS-CoV2), responsible for COVID-19, can affect the nervous system. The aim of the present observational study was to prospectively assess subjective neurological symptoms (sNS) in patients with SARS-CoV2 infection. METHODS: We included patients hospitalized at the University Hospital of Rome "Tor Vergata", medical center dedicated to the treatment of patients with COVID-19 diagnosis, who underwent an anamnestic interview about sNS consisting of 13 items, each related to a specific symptom, requiring a dichotomized answer. RESULTS: We included 103 patients with SARS-CoV2 infection. Ninety-four patients (91.3%) reported at least one sNS. Sleep impairment was the most frequent symptom, followed by dysgeusia, headache, hyposmia, and depression. Women more frequently complained hyposmia, dysgeusia, dizziness, numbeness/paresthesias, daytime sleepiness, and muscle ache. Moreover, muscle ache and daytime sleepiness were more frequent in the first 2 days after admission. Conversely, sleep impairment was more frequent in patients with more than 7 days of hospitalization. In these patients we also documented higher white blood cells and lower C-reactive protein levels. These laboratory findings correlated with the occurrence of hyposmia, dysgeusia, headache, daytime sleepiness, and depression. CONCLUSIONS: Patients with SARS-CoV2 infection frequently present with sNS. These symptoms are present from the early phases of the disease. The possibly intrinsic neurotropic properties of SARS-CoV2 may justify the very high frequency of sNS. Further studies targeted at investigating the consequences of SARS-CoV2 infection on the CNS should be planned.


Subject(s)
Coronavirus Infections/physiopathology , Depression/physiopathology , Dysgeusia/physiopathology , Headache/physiopathology , Olfaction Disorders/physiopathology , Pneumonia, Viral/physiopathology , Sleepiness , Adult , Aged , Betacoronavirus , C-Reactive Protein/immunology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Depression/epidemiology , Dizziness/epidemiology , Dizziness/physiopathology , Dysgeusia/epidemiology , Female , Headache/epidemiology , Hospitalization , Humans , Hypesthesia/epidemiology , Hypesthesia/physiopathology , Italy/epidemiology , Leukocyte Count , Male , Middle Aged , Myalgia/epidemiology , Myalgia/physiopathology , Olfaction Disorders/epidemiology , Pandemics , Paresthesia/epidemiology , Paresthesia/physiopathology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , SARS-CoV-2 , Sex Distribution , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/physiopathology
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