What we know so far: unusual symptoms of Corona

While most people with the characteristic symptoms of COVID-19 cough are now familiar, fever, muscle aches, headaches, and difficulty in breathing a new crop of medical conditions stem from more than 4 million confirmed cases of the disease across the world. These include rashes, diarrhea, kidney abnormalities and potentially life-threatening blood clots. It is not uncommon for the infecting virus directly and affecting various tissues and organs of the body, but is a bit ‘unusual for a primary respiratory virus such as SARS-CoV-2, which is responsible for COVID-19, as they have very coverage area of the body. “There are a number of other viruses seen influenced so many different organs of the body,” says Dr. Kristin Englund, an expert on infectious diseases Cleveland Clinic. “But we see flu or other respiratory viruses spread so many different organs? Not usually.” Building Relationships of these non-respiratory effects kick started as doctors to always treat more patients, and most of the current scientific knowledge of them is still in the early stages, and not confirmed by rigorous studies. But it acknowledges it could no previous health professionals their help and possibly the effects on patients minimize health on site. here is an overview of what the science says, so far, of these lesser-known effects of the disease. rashes and toes “COVID” is not uncommon to see rashes to someone with a viral infection, says Dr. Kanade Shinkai, professor of dermatology at the University of California, San Francisco, and editor in chief of JAMA Dermatology thinking chicken pox or herpes there could be two reasons. in both the invading virus is aimed directly into the skin, as is the case with the chickenpox virus seizures in pustules insidious on the skin, or the injuries are a byproduct of an aggressive immune systems to fight with all our strength against invading microbes as the rash that during the Epstein-Barr virus or the shape of the Western Nile infections can. “What is clear COVID-19, if these are associated with the infection associated rashes specific for the virus, it really means that the virus in the skin, or when reacting an immune system event to the virus, which is elsewhere the body, “said Shinkai. Until now, doctors have reported a number of skin related diseases COVID-19 could be connected, including head to toe red rash, hive-like rash, hit like blisters or rashes suggestions purply over large patches spread Skin. Recently, the injuries that have captured the most attention, are red, tender bumps that around the toes and heels name “COVID fingers.”, Says Show Shinkai it there are insufficient data to determine whether these skin symptoms at all COVID 19 are related. Recently, more and more reports of rashes to the attention of doctors, but the limited amount of testing in the United States arrive (often through telemedicine consultations), previously given, not all of these reports were followed with COVID-19 test. In an attempt to address that, to create dermatologists worldwide registry information COVID-19 start patients and their skin conditions on confirmed. need to begin to see if there is a link between the two, says Shinkai, doctors head to toe evidence of any positive COVID 19-patient “literally looking between your toes” Run -for all relevant records on skin to confirm. The next priority is looking at the case histories of patients with skin rashes, including medications might that could contribute to their skin reactions take. Finally, as far as possible if the patient’s match, clinicians should biopsy of skin lesions to test for SARS-CoV-2 instead. All that could be in the treatment of patients in the coming months and even years to be useful, as could the skin lesions be an early sign of infection that Health care decisions advise to lead people could use to isolate and possibly reduce their risk of spread the infection to others. The rash can also help people to identify the purple rash at higher risk of complications COVID-19, which could be tips, for example, are also common in people who are prone to developing blood clots that block the important blood flow to the brain and other organs CAN. “These studies are needed to understand really help us if anything about the skin results will help us predict who gets sick and who could suffer a serious illness,” said Shinkai. “These are important questions that we might better to give the triage people, if they are or where to infection even consider other ways to support them through their infection.” Good and intestines when experts learned bowel, such as SARS-CoV docks 2 virus to the body’s cells to start the infection, they realized COVID-19 symptoms would not be limited to the lungs. To bind to a cell, the virus uses a receptor, called ACE2, which can be found on lung cells, but also abundant in intestinal cells. “We were all thinking the same thing,” says Dr. Brennan are mirrors, director of health research at Cedars-Sinai Medical Center and professor of medicine and public health at the University of California, Los Angeles. “We knew that ACE2 is so strongly expressed in the gastrointestinal tract (GI) and we know that the virus is in the saliva. So what in the gastrointestinal system could get, because it is in the saliva, and we swallow the saliva.” As more and more people have developed COVID-19, it is clear that not all infected show the classic respiratory symptoms that doctors in the early years of the pandemic focused on themselves; many people only diarrhea, nausea and vomiting. An influential New England Journal of Medicine paper describes COVID-19 symptoms that will be published in February, he said that only 3.8% of patients have diarrhea. “Who took on to say that if someone has diarrhea, then you probably do not COVID-19 Many doctors,” says Spiegel, who also co-editor of the American Journal of Gastroenterology is. “This has been proven false or contradictory. But it laid the foundation for our understanding that good, maybe [COVID-19] is not really a GI problem at all.” In an article in Nature Medicine on May 13, the researchers Hong Kong SARS-CoV Posted 2 reported both bat and human intestinal cells can infect the lab. Scientists have created organoid or groups of intestinal cells for about facial expressions and then exposed to the virus in a laboratory dish. SARS-CoV-2 could churn out copies of itself, both the bat and environments organoid man. Not only as COVID-19 appears to affect the gastrointestinal system, it suggests that if it works, it is a particularly damaging effect it can have on the patient. is a study in the Journal of Gastroenterology published, the mirrors worked with colleagues in Wuhan, in China, where the virus first emerged in humans and found to be that people with intestinal problems tend diagnosed later, and they also tend bear to other infections. Probably because the gastrointestinal system is a “massive immune organ,” he says. “Once you are infected, it takes a long time to eliminate the virus. We have found that people on average diarrhea for five days, have a range of one to 14 days.” Appreciating that COVID-19 can gut and respiratory tract is affecting important, especially when it comes to spreading the infection take a look. Studies have shown that this virus are shed in the stool, which means that the shared bathroom can be a source of infection. Spiegel advises people who are diagnosed with COVID-19 and even home use a separate bathroom from the rest of their house or apartment colleagues, if possible, and if not, then separate rolls of toilet paper. He also suggests that someone close in these situations, the toilet lid before fogging to clean a virus in wastewater to prevent hot flashes and complete the seat and your hands after every cleaning visit. “And if I and I’m living with someone who is positive, I bathroom wearing a mask safe,” he says. In most cases, the harsh stomach acid usually kills the microbes that enter the intestine through saliva would. Spiegel and his team hypothesized that the heartburn drugs to neutralize the highly acidic environment of the stomach to protect her food, it can be to create a fertile ground for travel to SARS-CoV-2 free in the intestinal system. They are currently conducting a study to determine if those who use these drugs may have a higher risk of developing well-COVID-related symptoms 19. Kidney The intestine is not the open goal only for the virus; kidney cells also carry the ACE2 receptor. In some studies, doctors have results SARS-CoV-2 reported in the urine of infected people, even though extensive studies of renal tissue are inconclusive so far. “Some studies have found the virus in urine, and some studies do. Some viruses autopsies found in the kidney, and some are not,” says Dr. Kenar Jhaveri, associate chief of nephrology at North Well Health, a large health care provider without profit in the New York area. It is also not yet clear what the virus to find ways actually, when it comes to an infection. “Just because it’s the virus is there in a particular organ, does not mean it is pathological. We do not know if it’s cause and effect,” he says, he began to come as more patients hospitalized with COVID-19 beginning in 2020 Jhaveri and colleagues have started under-19 COVID a spike in cases of acute renal failure to see the patient and called study to better understand life, what, if any, the relationship has had the virus kidney. “While we in the trenches suddenly we were getting nearly three times the amount of consultations were what you would normally get at this time of year,” he says. “It ‘was unusual, and we wanted to quantify.” He studied electronic medical records of more than 5,000 people for COVID-19 in hospital in North Well Health (hospitals throughout New York system), and reported the results of the journal Kidney International. He found that 36.6% of the approved COVID-19 patients developed acute renal failure and need to compensate for these 1830 patients, 14% of dialysis for their inability to renal function. (These were all patients who have had a kidney transplant or you do not have an existing end-stage renal disease.) Kidney damage associated with worsening respiratory symptoms; developed that almost 90% of the fans to kidney problems to about 22%, which has requested the non-mechanical ventilation. With so much data, says Jhaveri, it is possible that the SARS-CoV-2 virus may be the kidney in one or both of the two ways influenced even before renal cell to infect directly with the ACE2 receptor and / or triggering inflammation aggressive in the body. “The cytokine storm [the immune system], the blood-vessels from acts leaking fluid flow and reduced blood to various organs,” he says. “There tubules in the kidney that are part of the excretion products are components of the kidneys and they do not like when there is less blood flow. When that happens, you develop ischemic injury. You do not get the oxygen supply in the situation and It will hurt the kidneys. ” Other early studies of patients hospitalized COVID-19 See also similar percentage of people with kidney complications in around 30% to 40%. What’s more of, says Dr. C. John Sperati, associate professor of medicine in the Division of Nephrology at the Johns Hopkins University School of Medicine, is the possibility that in some people with COVID-19, on the damage the virus it can cause structural damage to the kidneys well before that experience no symptoms. “It starts Give it time, seven or 10 days after symptoms develop, can develop 30% of their decreased renal function,” says Sperati. But among hospitalized patients, for example, to find physicians microscopic amounts of blood, as well as hints of urine protein, two of which are signs of cell damage to the kidneys, even if patients do not complain of any symptoms. This means that humans infected with the virus that are not in the hospital, can be a significant percentage of the risk of kidney damage, but they can not be treated until the damage severe enough to need is dialysis. The problem is that if they are not diagnosed with COVID-19 to arrive at this extreme point, you are much more likely to have a severe or fatal; COVID develop under-19 patients, acute kidney injury, he says Sperati is significantly higher mortality between the need for dialysis. Tests for blood and protein in the urine may suggest what people might be at higher risk of developing kidney problems related to their COVID-19 infection, and doctors could away from some control drugs that could further strain kidneys. In the longer term Sperati is concerned about the possible medical Heritage COVID-19 could have on the kidneys. Protein and blood cell damage in the urine signal that can be combined with COVID-19, put people at higher risk of renal impairment later in life, even if not immediately experience kidney problems related to their COVID- 19 infection. The liver liver is also filled with cells expressing the ACE2 receptor port, and laboratory studies cells in petri dishes with show that SARS-CoV-2, these cells with the receptor and can infect. also they appear increased more than half of its people, COVID-19 in hospital or below normal liver enzymes that the virus has entered the body could signal. Together, these two facts should question whether the virus can infect the liver damage and the cause. Fortunately, however, the current data suggest that COVID-19 infection does not lead to dramatic hepatic failure, said Dr. Raymond Chung, director of hepatology and liver center at Massachusetts General Hospital. This could mean that the virus effect on the liver is caused by direct infection and less likely because of the increased inflammatory response that a number of different organs, such as the progress influenced disease. “We see worse when liver tests to get the sickest patients and other organs such as the lungs and heart are concerned,” says Chung. “In many ways it can be a barometer of what is going on systemically in front of him. The liver can cause stress of [immune response] will respond.” Lumps and stroke one of the most pressing risks arising from the growing database of COVID-19 cases related to blood clots, including those that can lead to stroke. Even before doctors COVID-19, had studied, such as some viruses (such as influenza) and bacteria at higher risk of stroke contribute. However, some experts believe SARS-CoV-2 was clearly damage the circulatory system. “It remains possible that there is a certain aspect to this virus that leads to a certain increase in the risk of blood clotting,” says Dr. Michael Elkind, professor of neurology and epidemiology at Columbia University and president-elect of the American Heart Association. As with lung, kidney, liver and intestinal cells, blood vessel cells and the ACE2 receptor, which means that the virus could infect cells directly support the vessels and therefore the line, contributing to clot formation. “We autopsy studies looking at the effect of COVID-19 throughout the body, and we see signs of small blood clots in various organs throughout the body,” said Elkind. “This supports the idea that COVID-19 causes a tendency for blood clotting. Usually when we see the blood clots, we can see them in a place like the leg or lung. But in these cases we see in many parts of the body, which in fact indicates that this continues a systemic process. “with this concrete knowledge, doctors discuss at the moment, given that all patients hospitalized with COVID-19 in the blood have approved thinner where the risk to reduce blood clotting . “It is a controversial issue now. We are talking about higher doses of blood thinner arterial and venous blood clots to prevent,” said Elkind. Some early studies suggest that COVID-19 patients treated blood thinners, as they experienced fewer complications in the hospital and left hospital earlier than those who were not. That does not specify that the blood thinners are responsible for the improvement, but also shows it may be worth exploring in rigorous studies. Such studies are under way, both in animals and in the laboratory and the autopsy tissue available in infected patients. Researchers also are beginning to collect biopsies from patients COVID-19, while in the hospital, although this challenging given restrictions on all modes of implementation COVID-19 patients in whom the virus to health professionals and others could spread in the hospital. At Columbia University, scientists build a tissue biobank from the heart, including the COVID-19 was admitted patients, and could begin to show how the SARS-CoV-2 affects various organs, and the consequences of the health consequences for it. Odor and flavor of a further group of interesting reports of people affected by COVID-19 has to do with their loss of smell and taste. Most of us are familiar with the way the congestion of a cold or allergies can affect these senses; Doctors are now investigating if the smell to lose and / or taste may be a sign of infection SARS-CoV-2. On 26 March, the American Academy of Otolaryngology-Head and Neck Surgery has launched a survey on its website to collect more information on the prevalence of these symptoms by physicians and patients. The Academy is the professional organization for ear, nose and throat specialist, but the investigation has been to every doctor or patient open. As a publication of 900 people responded to 16 questions about smell and taste effects; about a quarter it reported that they lose this sense (for patients) or saw patients lose this sense (if the provider). Further studies are needed to see if these losses are permanent way, says Dr. James Denneny, executive vice president of ‘Academy and clinical professor at the University of Missouri. For until now researchers that SARS-CoV-2 particles are highly concentrated in the area where the nose, throat and mouth meet. Damage can be caused by the inflammatory response that causes tissue to swell and compress nerves and compromises, or due to direct viral infection for more detailed autopsy studies can provide information to clarify this question. “I expect the winds pandemic, there will be opportunities to look for pathological samples that can give us more clarity in the nerve endings in the research,” says Denneny. The success of these studies will also depend, to a certain extent on the data that have been and are currently being collected from patients, including blood and tissue samples that could provide valuable genetic information that affected, among other things on how the virus its various systems of the body. At the beginning of the pandemic, doctors do not seek wide-ranging symptoms, and even if they did not share a useful repository to capture and that the data were in a way that doctors took trends help, and model studies. “The position of the study that we have at this time should [X-ray and CT] a lot of data, such as X-ray data collected, and a lot of blood tests to do for patients,” says Englund. “We have to reach in the different hospital systems, we are able to a lot of data throughout the state would get wonderful to look more symptoms. Widespread testing us is to help patients understand the different symptoms they had that we have not recognized as relating to COVID -19 We understand this disease in its infancy. “All graphics Lon tweeting for TIME.
Image copyright Lon tweeting for TIME