Covid-19: pathophysiology, natural history, and diagnosis
DOI:
https://doi.org/10.37135/ee.04.11.13Abstract
SARS CoV-2 is transmitted primarily through the airway. The mean time from exposure to presentation of symptoms is 5 days. Infected patients can remain asymptomatic or have a wide spectrum of manifestations such as: fever, dry cough, and general malaise. Approximately 20% of patients with COVID-19 require hospitalization (10% in the general area, 5% require intermediate care, and the remaining 5% enter intensive care due to their serious condition). Laboratory and radiological examinations show common but nonspecific abnormalities. Diagnosis is through the reverse transcription polymerase chain reaction test when it detects SARS CoV-2. This systematic review aimed to synthesize important elements related to the physiopathology, clinical manifestations, and diagnosis of COVID-19.
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Mehta P, McAuley D, Brown M, Sanchez E, Tattersall R, Manson J. COVID-19: consider cytokine storm syndromes and immunosuppression The Lancet Infect Dis [Internet]. 2020 [citado 12 Jun 2020]; 395(10229): 1033–1034. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext. https://doi.org/10.1016/S0140-6736(20)30628-0.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet Infect Dis [Internet]. 2020 [citado 13 Jun 2020]; 395(10223): 497–506. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext. https://doi.org/10.1016/S0140-6736(20)30183-5.
Gauna M, Bernava J. Recomendaciones diagnósticas y terapéuticas ante la Respuesta Inmune Trombótica Asociada a Covid-19 (RITAC). Cor Salu [Internet]. 2020 [citado 13 Jun 2020]; 2020; 12(1): 60-63. Disponible en: http://www.revcorsalud.sld.cu/index.php/cors/article/view/615/1096.
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med [Internet]. 2020 [citado 14 Jun 2020]; 46(5): 846-848. Disponible en: https://link.springer.com/article/10.1007/s00134-020-05991-x. https://doi.org/10.1007/s00134-020-05991-x.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet Infect Dis [Internet]. 2020 [citado 15 Jun 2020]; 395(10229):1054–1062. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext. https://doi.org/10.1016/S0140-6736(20)30566-3.
Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol [Internet]. 2020 [citado 15 Jun 2020]; 146(1): 110-118. Disponible en: https://www.jacionline.org/article/S0091-6749(20)30495-4/fulltext. https://doi.org/10.1016/j.jaci.2020.04.006.
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med [Internet]. 2020 [citado 14 Jun 2020]; 180(7): 934-943. Disponible en: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184. https://doi.org/10.1001/jamainternmed.2020.0994.
Shereen M, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of Advanced Research [Internet]. 2020 [citado 15 Jun 2020]; 24: 91-98. Disponible en: https://www.sciencedirect.com/science/article/pii/S2090123220300540?via%3Dihub. https://doi.org/10.1016/j.jare.2020.03.005.
Qiu Y, Zhao Y, Wang Q, Li J, Zhou Z, Liao C, et al. Predicting the angiotensin converting enzyme 2 (ACE2) utilizing capability as the receptor of SARS-CoV-2. Microbes Infect [Internet]. 2020 [citado 16 Jun 2020]; 22(4-5): 221-225. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1286457920300496?via%3Dihub. https://doi.org/10.1016/j.micinf.2020.03.003.
Helmy Y, Fawzy M, Elaswad A, Sobieh A, Kenney S, Shehata A. The COVID-19 Pandemic: A Comprehensive Review of Taxonomy, Genetics, Epidemiology, Diagnosis, Treatment, and Control. J Clin Med [Internet]. 2020 [citado 16 Jun 2020]; 9(4): 1225. Disponible en: https://www.mdpi.com/2077-0383/9/4/1225. https://doi.org/10.3390/jcm9041225.
Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature [Internet]. 2020 [citado 17 Jun 2020]; 579(7798): 270-273. Disponible en: https://www.nature.com/articles/s41586-020-2012-7. https://doi.org/10.1038/s41586-020-2012-7.
Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Virus [Internet]. 2020 [citado 17 Jun 2020]; 12(4): 372. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32230900/. https://doi.org/10.3390/v12040372.
Liu Y, Gayle A, Wilder A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med [Internet]. 2020 [citado 18 Jun 2020]; 27(2): 1-4. Disponible en: https://academic.oup.com/jtm/article/27/2/taaa021/5735319. https://doi.org/10.1093/jtm/taaa021.
Bulut C, Kato Y. Epidemiology of COVID-19. Turk J Med Sci. Med [Internet]. 2020 [citado 18 Jun 2020]; 50(SI-1): 563–570. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32299206/. https://doi.org/10.3906/sag-2004-172.
Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med [Internet]. 2020 [citado 19 Jun 2020]; 26(4): 450-452. Disponible en: https://www.nature.com/articles/s41591-020-0820-9 https://doi.org/10.1038/s41591-020-0820-9.
Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci [Internet]. 2020 [citado 19 Jun 2020]; 12(1): 8. Disponible en: https://www.nature.com/articles/s41368-020-0074-x.
Li MY, Li L, Zhang Y, Wang X-S. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty [Internet]. 2020 [citado 20 Jun 2020]; 9(1): 45. Disponible en: https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00662-x. https://doi.org/10.1186/s40249-020-00662-x.
Kakodkar P, Kaka N, Baig M. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19). Cureus [Internet]. 2020 [citado 20 Jun 2020]; 12(4): 1-18. Disponible en: https://www.cureus.com/articles/29670-a-comprehensive-literature-review-on-the-clinical-presentation-and-management-of-the-pandemic-coronavirus-disease-2019-covid-19. https://doi.org/10.7759/cureus.7560.
Li H, Liu S, Yu X, Tang S, Tang C. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents [Internet]. 2020 [citado 21 Jun 2020]; 55(5): 105951. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0924857920301011?via%3Dihub. https://doi.org/10.1016/j.ijantimicag.2020.105951.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet [Internet]. 2020 [citado 21 Jun 2020]; 395(10223): 507-513. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext. https://doi.org/10.1016/S0140-6736(20)30211-7.
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). In: StatPearls [Internet]; 2020 [citado 21 Jun 2020]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK554776/
Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol [Internet]. 2020 [citado 22 Jun 2020]; 215: 1-7. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S152166162030262X?via%3Dihub. https://doi.org/10.1016/j.clim.2020.108427.
Melgaço J, Azamor T, Ano A. Protective immunity after COVID-19 has been questioned: What can we do without SARS-CoV-2-IgG detection?. Cell Immunol [Internet]. 2020 [citado 22 Jun 2020]; 353: 104114. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0008874920302501?via%3Dihub. https://doi.org/10.1016/j.cellimm.2020.104114.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect [Internet]. 2020 [citado 22 Jun 2020]; 80(6): 607-613. Disponible en: https://www.journalofinfection.com/article/S0163-4453(20)30165-1/fulltext. https://doi.org/10.1016/j.jinf.2020.03.037.
Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Rev. Natl Sci [Internet]. 2020 [citado 23 Jun 2020]. Disponible en: https://academic.oup.com/nsr/article/7/6/998/5804736. https://doi.org/10.1093/nsr/nwaa041.
Joly BS, Siguret V, Veyradier A. Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19. Intensive Care Med [Internet].2020 [citado 23 Jun 2020]; 46(8): 1603-1606. Disponible en: https://link.springer.com/article/10.1007/s00134-020-06088-1?fbclid=IwAR0qmLQDCh3n_VFRMa5Q-zJP-9bK0aBHv_D31ylVmjQl_HxQust9pDUHNZ0. https://doi.org/10.1007/s00134-020-06088-1.
Levi M, Thachil J, Iba T, Levy J. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol [Internet].2020 [citado 24 Jun 2020] ;7(6): e438-e440. Disponible en: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(20)30145-9/fulltext. https://doi.org/10.1016/S2352-3026(20)30145-9.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost [Internet]. 2020 [citado 24 Jun 2020]; 18(4): 844-847. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14768. https://doi.org/10.1111/jth.14768.
Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis [Internet]. 2020 [citado 24 Jun 2020]; 50(1): 54-67. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14768. https://doi.org/10.1007/s11239-020-02134-3.
Helms J, Tacquard C, Severac F, Leonard I, Ohana M, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med [Internet]. 2020 [citado 25 Jun 2020]; 46(6): 1089-1098. Disponible en: https://link.springer.com/article/10.1007%2Fs00134-020-06062-x. https://doi.org/10.1007/s00134-020-06062-x.
Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S, et al. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect [Internet]. 2020 [citado 25 Jun 2020]; 10: 1-5. Disponible en: https://www.sciencedirect.com/science/article/pii/S1684118220301134?via%3Dihub. https://doi.org/10.1016/j.jmii.2020.05.001.
McIntosh K. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention. UpToDate; 2012 [citado 26 Jun 2020]. Disponible en: https://www.uptodate.com/contents/covid-19-epidemiology-virology-and-prevention?search=Coronavirus+infection+covid+19+epidemiology+virology+clinical+features+diagnosis+and+prevention&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1.
Deville J, Song E, Ouellete C. Coronavirus disease 2019 (COVID-19): Considerations in children. UpToDate; 2012 [citado 26 Jun 2020]. Disponible en: https://www.uptodate.com/contents/covid-19-management-in-children?search=coronavirus-disease-2019-covid-19-considerations-in-children%3E&source=search_result&selectedTitle=4%7E150&usage_type=default&display_rank=4.
Bialek S, Gierke R, Hughes M, McNamara L, et al. Coronavirus Disease 2019 in Children - United States, February 12–April 2, 2020. Morb Mortal Wkly Rep [Internet].2020 [citado 26 Jun 2020]; 69(14): 422-426. Disponible en: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm?s_cid=mm6914e4_w. https://doi.org/10.15585/mmwr.mm6914e4.
Xydakis M, Dehgani P, Holbrook E, Geisthoff U, Bauer C, Hautefort C, et al. Smell and taste dysfunction in patients with COVID-19. Lancet Infect Dis [Internet].2020 [citado 27 Jun 2020]; 20(9): 1015-1016. Disponible en: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30293-0/fulltext. https://doi.org/10.1016/S1473-3099(20)30293-0.
Li L, Qin L, Xu Z, Yin Y, Wang X, Kong B, et al. Artificial Intelligence Distinguishes COVID-19 from Community Acquired Pneumonia on Chest CT. Radiology [Internet].2020 [citado 27 Jun 2020]; 296(2): E65-E71. Disponible en: https://pubs.rsna.org/doi/10.1148/radiol.2020200905. https://doi.org/10.1148/radiol.2020200905.
Borghesi A, Maroldi R. COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression. Radiol Med [Internet].2020 [citado 28 Jun 2020]; 125(5): 509-513. Disponible en: https://link.springer.com/article/10.1007%2Fs11547-020-01200-3. https://doi.org/10.1007/s11547-020-01200-3.
Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology [Internet]. 2020 [citado 28 Jun 2020]; 296(2): E115-E117. Disponible en: https://pubs.rsna.org/doi/10.1148/radiol.2020200432. https://doi.org/10.1148/radiol.2020200432.
Simpson S, Kay F, Abbara S, Bhalla S, Chung J, Chung M, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging [Internet]. 2020 [citado 28 Jun 2020]; 2(2). Disponible en: https://pubs.rsna.org/doi/10.1148/ryct.2020200152. https://doi.org/10.1148/ryct.2020200152.
Wang H, Li X, Li T, Zhang S, Wang L, Wu X, et al. The genetic sequence, origin, and diagnosis of SARS-CoV-2. Eur J Clin Microbiol Infect Dis [Internet]. 2020 [citado 28 Jun 2020]; 39(9): 1629-1635. Disponible en: https://link.springer.com/article/10.1007%2Fs10096-020-03899-4. https://doi.org/10.1007/s10096-020-03899-4.
Ortiz E, Simbaña K, Diaz A, Barreto A, Moyano C, Arcos V, et al. Epidemiological, socio-demographic and clinical features of the early phase of the COVID-19 epidemic in Ecuador. Public and Global Health [Internet]. 2020 [citado 29 Jun 2020]. Disponible en: http://medrxiv.org/lookup/doi/10.1101/2020.05.08.20095943. https://doi.org/10.1101/2020.05.08.20095943.
Kujawski, S, Wong, K, Collins, J, et al. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nat Med [Internet]. 2020 [citado 29 Jun 2020]; 26(6): 861-868. Disponible en: https://www.nature.com/articles/s41591-020-0877-5. https://doi.org/10.1038/s41591-020-0877-5.
To K, Tsang O, Leung W, Tam A, Wu T, Lung D, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. The Lancet Infect Dis [Internet]. 2020 [citado 30 Jun 2020]; 20(5): 565–574. Disponible en: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30196-1/fulltext. https://doi.org/10.1016/S1473-3099(20)30196-1.
Padhi A, Kumar S, Gupta E, Saxena S. Laboratory Diagnosis of Novel Coronavirus Disease 2019 (COVID-19) Infection. Medical Virology [Internet]. 2020 [citado 01 julio 2020]; 95–107. Disponible en: https://link.springer.com/chapter/10.1007%2F978-981-15-4814-7_9. https://doi.org/10.1007/978-981-15-4814-7_9.
Chan J, Kok K, Zhu Z, Chu H, To K, Yuan S, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. [Internet]. 2020 [citado 01 julio 2020]; 9(1): 221–236. Disponible en: https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1719902. https://doi.org/10.1080/22221751.2020.1719902.
Gao M, Yang L, Chen X, Deng Y, Yang S, Xu H, et al. A study on infectivity of asymptomatic SARS-CoV-2 carriers. Respir Med [Internet]. 2020 [citado 02 julio 2020];169: 106026. Disponible en: https://www.resmedjournal.com/article/S0954-6111(20)30166-9/fulltext. https://doi.org/10.1016/j.rmed.2020.106026.
Huang L, Zhang X, Zhang X, Wei Z, Zhang L, Xu J, et al. Rapid asymptomatic transmission of COVID-19 during the incubation period demonstrating strong infectivity in a cluster of youngsters aged 16-23 years outside Wuhan and characteristics of young patients with COVID-19: A prospective contact-tracing study. J Infect. [Internet]. 2020 [citado 02 julio 2020]; 80(6): e1-e13. Disponible en: https://www.journalofinfection.com/article/S0163-4453(20)30117-1/fulltext. https://doi.org/10.1016/j.jinf.2020.03.006.
Sakurai A, Sasaki T, Kato S, Hayashi M, Tsuzuki S, Ishihara T, et al. Natural History of Asymptomatic SARS-CoV-2 Infection. N Engl J Med [Internet]. 2020 [citado 03 julio 2020]; 383(9): 885-886. Disponible en: https://www.nejm.org/doi/10.1056/NEJMc2013020. https://doi.org/10.1056/NEJMc2013020.
Wang Y, Liu Y, Liu L, Wang X, Luo N, Li L. Clinical Outcomes in 55 Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Who Were Asymptomatic at Hospital Admission in Shenzhen, China. J Infect Dis [Internet]. 2020 [citado 03 julio 2020]; 221(11): 1770-1774. Disponible en: https://academic.oup.com/jid/article/221/11/1770/5807958. https://doi.org/10.1093/infdis/jiaa119.
Skarstein E. ACE2, COVID19 and serum ACE as a possible biomarker to predict severity of disease. J Clin Virol [Internet]. 2020 [citado 04 julio 2020]; 126:1. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1386653220300925?via%3Dihub. https://doi.org/10.1016/j.jcv.2020.104350.
Swärd P, Edsfeldt A, Reepalu A, Jehpsson L, Rosengren B, Karlsson M. Age and sex differences in soluble ACE2 may give insights for COVID-19. Crit Care [Internet]. 2020 [citado 04 julio 2020]; 24(1): 221. Disponible en: https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02942-2. https://doi.org/10.1186/s13054-020-02942-2.
