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Extrapulmonary manifestations of COVID-19.
Metadata
Journalnature medicine36.13Date
2020 Jul 10
a month ago
Publication Type
Review
Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural
Journal Article
Volume
2020-07 / 26 : 1017-1032
Author
Gupta A 1, 2, 3, Madhavan MV 1, 2, Sehgal K 4, 5, 6, Nair N 7, Mahajan S 3, 8, Sehrawat TS 9, Bikdeli B 1, 2, 3, Ahluwalia N 10, Ausiello JC 7, Wan EY 1, Freedberg DE 11, Kirtane AJ 2, Parikh SA 1, 2, Maurer MS 1, Nordvig AS 12, Accili D 7, Bathon JM 13, Mohan S 14, 15, Bauer KA 4, 6, Leon MB 1, 2, Krumholz HM 3, 8, 16, Uriel N 1, Mehra MR 17, Elkind MSV 12, 15, Stone GW 2, 18, Schwartz A 1, Ho DD 19, Bilezikian JP 7, Landry DW 20
Affiliation
  • 2. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
  • 3. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA.
  • 4. Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
  • 5. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
  • 6. Harvard Medical School, Boston, MA, USA.
  • 7. Division of Endocrinology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, NY, USA.
  • 8. Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
  • 9. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
  • 10. Division of Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 11. Division of Digestive and Liver Diseases, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
  • 12. Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University and the NewYork-Presbyterian Hospital, New York, NY, USA.
  • 13. Division of Rheumatology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
  • 14. Division of Nephrology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
  • 15. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
  • 16. Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
  • 17. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA.
  • 18. Division of Cardiology, Department of Medicine, the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 19. Aaron Diamond AIDS Research Center, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
  • 20. Division of Nephrology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA. [email protected]
Doi
PMIDMESH
Adaptive Immunity
Betacoronavirus
Coronavirus Infections
Disease Progression
Endothelium, Vascular
Humans
Inflammation
Organ Specificity
Pandemics
Pneumonia, Viral
Renin-Angiotensin System
Thrombosis
Virus Internalization
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.
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36.1
Nat Mednature medicine
Metadata
LocationUnited States
FromNATURE PUBLISHING GROUP

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