RESUMO
Many skin manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection reflect activation of cutaneous and systemic immune responses involving effector pathways of both the innate and adaptive arms of the immune system. This article reviews evidence from the recent clinical and scientific literature that informs the current understanding of the consequences of coronavirus disease 2019 (COVID-19)-induced immune cell activation, as relevant to dermatology. Topics include the clinical consequences of autoantibody production in patients with COVID-19, immunologic evidence for chilblains as a manifestation of SARS-CoV-2 infection, and the relationship between type I interferons and COVID-19 disease severity.
Assuntos
COVID-19/fisiopatologia , Dermatopatias/fisiopatologia , Pérnio/fisiopatologia , Eritema Multiforme/fisiopatologia , Exantema/fisiopatologia , Humanos , Pitiríase Rósea/fisiopatologia , Pele/fisiopatologia , Dermatopatias Vesiculobolhosas/fisiopatologiaRESUMO
As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.
Assuntos
Infecções por Coronavirus/prevenção & controle , Dermatoses Faciais/etiologia , Traumatismos Faciais/etiologia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , COVID-19 , Infecções por Coronavirus/epidemiologia , Eritema/etiologia , Eritema/fisiopatologia , Exantema/etiologia , Exantema/fisiopatologia , Dermatoses Faciais/fisiopatologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/fisiopatologia , Feminino , Saúde Global , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de RiscoRESUMO
IMPORTANCE: Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols. OBJECTIVE: To distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics, and laboratory values. DESIGN: Patients diagnosed and hospitalized with active COVID-19 pneumonia or MIS-C at Children's of Alabama Hospital in Birmingham, AL from April 1 through September 1, 2020 were identified retrospectively. Active COVID-19 and MIS-C cases were defined using diagnostic codes and verified for accuracy using current US Centers for Disease Control case definitions. All clinical notes were reviewed for documentation of COVID-19 pneumonia or MIS-C, and clinical notes and electronic medical records were reviewed for patient demographics, presenting signs and symptoms, prior exposure to or testing for the SARS-CoV-2 virus, laboratory data, imaging, treatment modalities and response to treatment. FINDINGS: 111 patients were identified, with 74 classified as mild COVID-19, 8 patients as moderate COVID-19, 8 patients as severe COVID-19, 10 as mild MIS-C and 11 as severe MIS-C. All groups had a male predominance, with Black and Hispanic patients overrepresented as compared to the demographics of Alabama. Most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis, and gastrointestinal symptoms were predominant in the MIS-C population whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients. CONCLUSIONS AND RELEVANCE: This study is one of the first to directly compare COVID-19 and MIS-C in the pediatric population. The significant differences found between symptoms at presentation, demographics, and laboratory findings will aide health-care providers in distinguishing the two disease entities.
Assuntos
COVID-19/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Dor Abdominal/fisiopatologia , Adolescente , Negro ou Afro-Americano , Asma/epidemiologia , Proteína C-Reativa/metabolismo , COVID-19/epidemiologia , COVID-19/metabolismo , Estudos de Casos e Controles , Criança , Pré-Escolar , Comorbidade , Conjuntivite/fisiopatologia , Doença da Artéria Coronariana , Diabetes Mellitus/epidemiologia , Diarreia/fisiopatologia , Dilatação Patológica , Ecocardiografia , Exantema/fisiopatologia , Feminino , Febre/fisiopatologia , Cardiopatias Congênitas/epidemiologia , Hispânico ou Latino , Humanos , Hiponatremia/metabolismo , Masculino , Náusea/fisiopatologia , Neoplasias/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Obesidade/epidemiologia , SARS-CoV-2 , Índice de Gravidade de Doença , Distribuição por Sexo , Volume Sistólico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Fatores de Tempo , Vômito/fisiopatologiaRESUMO
The severe acute respiratory syndrome coronavirus two (SARS-CoV-2), which causes the 2019 coronavirus disease (COVID-19), has infected patients worldwide. Physicians have increasingly identified cutaneous findings as a significant clinical manifestation of COVID-19. In this review, we describe the clinical presentation, onset, duration, associated symptoms, treatment, and outcome of cutaneous manifestations thus far reported to be related to COVID-19. We have included data from 63 studies and subdivided reported cutaneous manifestations into the categories of viral exanthem, urticarial, vesicular, chilblains/chilblains-like, non-chilblains vasculopathy-related, pityriasis rosea-like, erythema multiforme-like, Kawasaki/Kawasaki-like disease, and others. Physicians should be aware of the known common cutaneous manifestations of COVID-19 and future research is required to better understand the pathophysiology and prognosis of each COVID-19-related skin manifestation.
Assuntos
COVID-19/fisiopatologia , Dermatopatias/fisiopatologia , Pérnio/fisiopatologia , Eritema Multiforme/fisiopatologia , Exantema/fisiopatologia , Humanos , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Pitiríase Rósea/fisiopatologia , SARS-CoV-2 , Dermatopatias Vasculares/fisiopatologia , Dermatopatias Vesiculobolhosas/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Urticária/fisiopatologiaRESUMO
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.
Assuntos
COVID-19/fisiopatologia , Conjuntivite/fisiopatologia , Exantema/fisiopatologia , Febre/fisiopatologia , Gastroenteropatias/fisiopatologia , Choque/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Dor Abdominal/fisiopatologia , Injúria Renal Aguda/fisiopatologia , COVID-19/epidemiologia , COVID-19/terapia , Queilite/fisiopatologia , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Meningismo/fisiopatologia , Mialgia/epidemiologia , Prognóstico , Respiração Artificial , Distribuição por Sexo , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Vômito/fisiopatologiaAssuntos
Infecções por Coronavirus/complicações , Exantema/etiologia , Transtornos de Início Tardio/etiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/complicações , Fatores Etários , Idoso , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Exantema/epidemiologia , Exantema/fisiopatologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Transtornos de Início Tardio/epidemiologia , Transtornos de Início Tardio/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prognóstico , Estudos de Amostragem , Fatores SexuaisAssuntos
COVID-19/fisiopatologia , Miocardite/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Dor Abdominal/fisiopatologia , Injúria Renal Aguda/fisiopatologia , Adolescente , Adulto , Astenia/fisiopatologia , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/terapia , Dor no Peito/fisiopatologia , Conjuntivite/fisiopatologia , Angiografia Coronária , Unidades de Cuidados Coronarianos , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Eletrocardiografia , Exantema/fisiopatologia , Oxigenação por Membrana Extracorpórea , Feminino , Febre/fisiopatologia , França , Cefaleia/fisiopatologia , Humanos , Hipotensão/fisiopatologia , Hipotensão/terapia , Unidades de Terapia Intensiva , Imageamento por Ressonância Magnética , Masculino , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Miocardite/sangue , Miocardite/diagnóstico por imagem , Miocardite/terapia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Respiração Artificial , SARS-CoV-2 , Volume Sistólico , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Taquicardia/fisiopatologia , Troponina/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/terapia , Adulto JovemAssuntos
Anticorpos Antibacterianos/sangue , COVID-19/complicações , Síndrome de Linfonodos Mucocutâneos/complicações , Mycoplasma pneumoniae/patogenicidade , Pneumonia por Mycoplasma/complicações , SARS-CoV-2/patogenicidade , Síndrome Respiratória Aguda Grave/complicações , Adolescente , Western Blotting , COVID-19/diagnóstico , COVID-19/patologia , COVID-19/virologia , Teste para COVID-19 , Criança , Pré-Escolar , Coinfecção , Conjuntivite/diagnóstico , Conjuntivite/fisiopatologia , Edema/diagnóstico , Edema/fisiopatologia , Exantema/diagnóstico , Exantema/fisiopatologia , Feminino , Febre/diagnóstico , Febre/fisiopatologia , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/patologia , Síndrome de Linfonodos Mucocutâneos/virologia , Mycoplasma pneumoniae/crescimento & desenvolvimento , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/microbiologia , Pneumonia por Mycoplasma/patologia , SARS-CoV-2/crescimento & desenvolvimento , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/patologia , Síndrome Respiratória Aguda Grave/virologia , Estomatite/diagnóstico , Estomatite/fisiopatologiaRESUMO
BACKGROUND: Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum, emerging related to encephalitis, seizures, antiepileptic drug withdrawal, or metabolic disturbances. Among RESLES, mild encephalitis/encephalopathy with reversible splenial lesion (MERS) has been defined as a distinct clinicoradiologic syndrome associated with viral infections. CASE PRESENTATION: We report two children with multisystem inflammatory syndrome-children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed RESLES during the disease course. Encephalopathy was the main central nervous system symptom. Both of the children showed a rapid recovery, and brain magnetic resonance imaging revealed complete resolution of the splenial lesion within 1 week. CONCLUSION: The complete resolution of the splenial lesion and rapid recovery from encephalopathy in RESLES associated with SARS CoV-2 were similar to observed in MERS.
Assuntos
Encefalopatias/diagnóstico por imagem , COVID-19/diagnóstico , Corpo Caloso/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Encefalopatias/fisiopatologia , COVID-19/diagnóstico por imagem , COVID-19/fisiopatologia , Criança , Dispneia/fisiopatologia , Eletroencefalografia , Exantema/fisiopatologia , Feminino , Febre/fisiopatologia , Glucocorticoides/uso terapêutico , Alucinações/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Transtornos Neurocognitivos/diagnóstico por imagem , Transtornos Neurocognitivos/fisiopatologia , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Taquipneia/fisiopatologia , Tratamento Farmacológico da COVID-19RESUMO
A heart transplant 62-year-old patient referred for coronavirus-19 disease (COVID-19) pneumonia. At admission, he was febrile, tachypnoeic, and mild hypoxic with dry cough; during hospitalization, a diffuse morbilliform skin rash appeared. He was treated with tocilizumab with symptoms improvement, without a complete pulmonary function recovery. Skin rash, highly suggestive for COVID-19 cutaneous involvement, persisted for ten days despite tocilizumab administration.