Extrapulmonary manifestations of COVID-19
Top Cited Papers
- 10 July 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Nature Medicine
- Vol. 26 (7), 1017-1032
- https://doi.org/10.1038/s41591-020-0968-3
Abstract
Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.Funding Information
- U.S. Department of Health & Human Services | National Institutes of Health (T32 - HL007854, K23- DK111847)
- U.S. Department of Health & Human Services | National Institutes of Health
- U.S. Department of Defense (PR-181960)
- U.S. Department of Health & Human Services | NIH | National Institute of Neurological Disorders and Stroke (5T32 - NS007153)
- U.S. Department of Health & Human Services | NIH | National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 - AR050026, U01- AR068043)
- U.S. Department of Health & Human Services | NIH | National Institute of Arthritis and Musculoskeletal and Skin Diseases
- U.S. Department of Health & Human Services | NIH | National Institute of Diabetes and Digestive and Kidney Diseases (R01 - MD014161, U01- DK116066)
- U.S. Department of Health & Human Services | NIH | National Institute of Diabetes and Digestive and Kidney Diseases
- U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute (K08-HL122526, R01 - HL152236, R03 - HL146881)
This publication has 248 references indexed in Scilit:
- Thrombosis as an intravascular effector of innate immunityNature Reviews Immunology, 2012
- Platelets in defense against bacterial pathogensCellular and Molecular Life Sciences, 2009
- When Children With Kawasaki Disease Grow Up: Myocardial and Vascular Complications in AdulthoodJournal of the American College of Cardiology, 2009
- Binding of SARS coronavirus to its receptor damages islets and causes acute diabetesActa Diabetologica, 2009
- Regulation of ACE2 in cardiac myocytes and fibroblastsAmerican Journal of Physiology-Heart and Circulatory Physiology, 2008
- Detection of Soluble Angiotensin-Converting Enzyme 2 in Heart Failure: Insights Into the Endogenous Counter-Regulatory Pathway of the Renin-Angiotensin-Aldosterone SystemJournal of the American College of Cardiology, 2008
- Adaptive immune cells temper initial innate responsesNature Medicine, 2007
- Glomerular Localization and Expression of Angiotensin-Converting Enzyme 2 and Angiotensin-Converting EnzymeJournal of the American Society of Nephrology, 2006
- Multiple organ infection and the pathogenesis of SARSThe Journal of Experimental Medicine, 2005
- Interleukin‐6 is the major regulator of acute phase protein synthesis in adult human hepatocytesFEBS Letters, 1989