Sandbox:Javaria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Complications
Anorexia associated with COVID-19
- According to a recent study by Pan et al, 48.5% presented with digestive symptoms as their chief complaint. Anorexia was the most common (83.8%) of digestive symptoms associated with SARS-Cov2 infection. With COVID-19 primarily being a respiratory disease, surprisingly around 3% cases had just the digestive symptoms but no respiratory symptoms.[1]
Natural history
History of anorexia associated with COVID-19
Diagnosis
Laboratory Findings
Treatment
Oral musical lesions associated with COVID-19
- Recently, according to Carreras-Presas et al. oral vesiculobullous lesions associated with COVID-19 infection have been reported in three patients.[2]
Pathophysiology
- An abundant Angiotensin-converting enzyme 2 (ACE2) receptor expression on epithelial cells of the oral cavity plays a pivotal role in allowing COVID-19 virus to enter the epithelial cells and cause infection. There is a strong association between ACE-2 and 2019-nCoV S protein. The presence of coronavirus in human saliva is attributed to the same reason.[3]
Natural history
History of oral musical lesions associated with COVID-19
Diagnosis
Laboratory Findings
Treatment
Dysgeusia associated with COVID-19
Hepatic injury associated with COVID-19
- Several studies have reported the incidence of liver injury in COVID-19 infected patients.
Pathophysiology
- The exact mechanism of liver injury is still unclear. There are a few proposed mechanisms by which the SARS-CoV2 virus can infect liver cells causing damage, leading to a rise in hepatic enzymes.
- Hepatic injury directly caused by the viral infection of the liver as the detection of SARS-CoV-2 RNA in stool gives rise to the notion of viral exposure in the liver. [4]
- A preliminary study suggested that Angiotensin-converting enzyme 2 (ACE2) receptor expression is enriched in cholangiocytes and not in hepatocytes, indicating that SARS-CoV-2 might directly bind to ACE2-positive cholangiocytes to dysregulate liver function. The studies have not yet answered about the specific mechanisms of cholangiocyte injury, and how hepatocyte injury occurs as it lacks ACE2 receptor.[5][6]
Natural history
- According to the data available to date, patients with severe disease had increased incidence of abnormal liver function. By Guan et al. of 1099 COVID-19 positive patients, 2.3% had a preexisting liver injury, but elevated levels of AST were observed in 18.2% of the patients with non-severe disease and 39·4% patients with severe disease. Other studies with a lesser sample size had similar findings reported.[4]
Diagnosis
Laboratory Findings
Treatment
References
- ↑ Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L (May 2020). "Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study". Am. J. Gastroenterol. 115 (5): 766–773. doi:10.14309/ajg.0000000000000620. PMC 7172492 Check
|pmc=value (help). PMID 32287140 Check|pmid=value (help). - ↑ Al-Khatib A (June 2020). "Oral manifestations in COVID-19 patients". Oral Dis. doi:10.1111/odi.13477. PMID 32521067 Check
|pmid=value (help). - ↑ Baghizadeh Fini M (May 2020). "Oral saliva and COVID-19". Oral Oncol. 108: 104821. doi:10.1016/j.oraloncology.2020.104821. PMC 7250788 Check
|pmc=value (help). PMID 32474389 Check|pmid=value (help). - ↑ 4.0 4.1 Zhang C, Shi L, Wang FS (May 2020). "Liver injury in COVID-19: management and challenges". Lancet Gastroenterol Hepatol. 5 (5): 428–430. doi:10.1016/S2468-1253(20)30057-1. PMC 7129165 Check
|pmc=value (help). PMID 32145190 Check|pmid=value (help). - ↑ Lee IC, Huo TI, Huang YH (June 2020). "Gastrointestinal and liver manifestations in patients with COVID-19". J Chin Med Assoc. 83 (6): 521–523. doi:10.1097/JCMA.0000000000000319. PMC 7176263 Check
|pmc=value (help). PMID 32243269 Check|pmid=value (help). - ↑ Kumar, Pramod; Sharma, Mithun; Kulkarni, Anand; Rao, Padaki N. (2020). "Pathogenesis of Liver Injury in Coronavirus Disease 2019". Journal of Clinical and Experimental Hepatology. doi:10.1016/j.jceh.2020.05.006. ISSN 0973-6883.