COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment

Anant Parasher

doi:10.1136/postgradmedj-2020-138577

journal article Open Access Sep 25, 2020

COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment

Anant Parasher

Postgraduate Medical Journal Vol. 97 No. 1147 pp. 312-320 · Oxford University Press (OUP)

View at Publisher Save 10.1136/postgradmedj-2020-138577

Abstract

ABSTRACTBackgroundThe severe acute respiratory syndrome (SARS) coronavirus-2 is a novel coronavirus belonging to the family Coronaviridae and is now known to be responsible for the outbreak of a series of recent acute atypical respiratory infections originating in Wuhan, China. The disease caused by this virus, termed coronavirus disease 19 or simply COVID-19, has rapidly spread throughout the world at an alarming pace and has been declared a pandemic by the WHO on March 11, 2020. In this review, an update on the pathophysiology, clinical presentation and the most recent management strategies for COVID-19 has been described.Materials and MethodsA search was conducted for literature and various articles/case reports from 1997 to 2020 in PUBMED/MEDLINE for the keywords coronavirus, SARS, Middle East respiratory syndrome and mRNA virus.Results and ConclusionsCOVID-19 has now spread globally with increasing morbidity and mortality among all populations. In the absence of a proper and effective antibody test, the diagnosis is presently based on a reverse-transcription PCR of nasopharyngeal and oropharyngeal swab samples. The clinical spectrum of the disease presents in the form of a mild, moderate or severe illness. Most patients are either asymptomatic carriers who despite being without symptoms have the potential to be infectious to others coming in close contact, or have a mild influenza-like illness which cannot be differentiated from a simple upper respiratory tract infection. Moderate and severe cases require hospitalisation as well as intensive therapy which includes non-invasive as well as invasive ventilation, along with antipyretics, antivirals, antibiotics and steroids. Complicated cases may require treatment by immunomodulatory drugs and plasma exchange therapy. The search for an effective vaccine for COVID-19 is presently in full swing, with pharmaceutical corporations having started human trials in many countries.

Topics

No keywords indexed for this article. Browse by subject →

References

91

[1]

Yuki "COVID-19 pathophysiology: a review [published online ahead of print, 2020 Apr 20]" Clin Immunol (2020) 10.1016/j.clim.2020.108427

[2]

A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome

Thomas G. Ksiazek, Dean Erdman, Cynthia S. Goldsmith et al.

New England Journal of Medicine 2003 10.1056/nejmoa030781

[3]

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

Qun Li, Xuhua Guan, Peng Wu et al.

New England Journal of Medicine 2020 10.1056/nejmoa2001316

[4]

Zheng "Functional exhaustion of antiviral lymphocytes in COVID-19 patients" (2020) 10.1038/s41423-020-0402-2

[5]

Zhang "Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study" Lancet Infect Dis (2020) 10.1016/s1473-3099(20)30230-9

[6]

Cascella (2020)

[7]

He "Main clinical features of COVID-19 and potential prognostic and therapeutic value of the microbiota in SARS-CoV-2 Infections" Front Microbiol (2020) 10.3389/fmicb.2020.01302

[8]

[9]

The Coronavirus Spike Protein Is a Class I Virus Fusion Protein: Structural and Functional Characterization of the Fusion Core Complex

Berend-Jan Bosch, Ruurd van der Zee, Cornelis A. M. de Haan et al.

Journal of Virology 2003 10.1128/jvi.77.16.8801-8811.2003

[10]

Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus

Wenhui Li, Michael J. Moore, Natalya Vasilieva et al.

Nature 2003 10.1038/nature02145

[11]

Chen "Structure analysis of the receptor binding of 2019-nCoV [published online ahead of print, 2020 Feb 17]" Biochem Biophys Res Commun (2020) 10.1016/j.bbrc.2020.02.071

[12]

Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein

Alexandra C. Walls, Young-Jun Park, M. Alejandra Tortorici et al.

Cell 2020 10.1016/j.cell.2020.02.058

[13]

Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses

Michael Letko, Andrea Marzi, Vincent Munster

Nature Microbiology 2020 10.1038/s41564-020-0688-y

[14]

Characterization of spike glycoprotein of SARS-CoV-2 on virus entry and its immune cross-reactivity with SARS-CoV

Xiuyuan Ou, Yan Liu, Xiaobo Lei et al.

Nature Communications 2020 10.1038/s41467-020-15562-9

[15]

Li "siRNA targeting the leader sequence of SARS-CoV inhibits virus replication" Gene Ther (2005) 10.1038/sj.gt.3302479

[16]

Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus

Wenhui Li, Michael J. Moore, Natalya Vasilieva et al.

Nature 2003 10.1038/nature02145

[17]

Activation of the SARS coronavirus spike protein via sequential proteolytic cleavage at two distinct sites

Sandrine Belouzard, Victor C. Chu, Gary R. Whittaker

Proceedings of the National Academy of Sciences 2009 10.1073/pnas.0809524106

[18]

Belouzard "Mechanisms of coronavirus cell entry mediated by the viral spike protein" Viruses (2012) 10.3390/v4061011

[19]

[20]

Lai "The molecular biology of coronaviruses" Adv Virus Res (1997) 10.1016/s0065-3527(08)60286-9

[21]

Yang "Targeting the endocytic pathway and autophagy process as a novel therapeutic strategy in COVID-19" Int J Biol Sci (2020) 10.7150/ijbs.45498

[22]

Mason "Pathogenesis of COVID-19 from a cell biology perspective" Eur Respir J (2020) 10.1183/13993003.00607-2020

[23]

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China

Zunyou Wu, Jennifer M. McGoogan

JAMA 2020 10.1001/jama.2020.2648

[24]

Wan "Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS" J Virol (2020) 10.1128/jvi.00127-20

[25]

SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

Markus Hoffmann, Hannah Kleine-Weber, Simon Schroeder et al.

Cell 2020 10.1016/j.cell.2020.02.052

[26]

Sims "Severe acute respiratory syndrome coronavirus infection of human ciliated airway epithelia: role of ciliated cells in viral spread in the conducting airways of the lungs" J Virol (2005) 10.1128/jvi.79.24.15511-15524.2005

[27]

Tang "Early enhanced expression of interferon-inducible protein-10 (CXCL-10) and other chemokines predicts adverse outcome in severe acute respiratory syndrome" Clin Chem (2005) 10.1373/clinchem.2005.054460

[28]

Pathological findings of COVID-19 associated with acute respiratory distress syndrome

Zhe Xu, Lei Shi, Yijin Wang et al.

The Lancet Respiratory Medicine 2020 10.1016/s2213-2600(20)30076-x

[29]

[30]

Liu "Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China" (2020)

[31]

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

Jasper Fuk-Woo Chan, Shuofeng Yuan, Kin-Hang Kok et al.

The Lancet 2020 10.1016/s0140-6736(20)30154-9

[32]

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li et al.

The Lancet 2020 10.1016/s0140-6736(20)30183-5

[33]

Burke "Active monitoring of persons exposed to patients with confirmed COVID-19: United States, January–February 2020" (2020) 10.15585/mmwr.mm6909e1

[34]

Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient

Sean Wei Xiang Ong, Yian Kim Tan, Po Ying Chia et al.

JAMA 2020 10.1001/jama.2020.3227

[35]

[36]

Donnelly "Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in hong kong" Lancet (2003) 10.1016/s0140-6736(03)13410-1

[37]

Goyal "Clinical characteristics of COVID-19 in New York city" N Engl J Med (2020) 10.1056/nejmc2010419

[38]

Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu et al.

New England Journal of Medicine 2020 10.1056/nejmoa2002032

[39]

Young "Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore" JAMA (2020) 10.1001/jama.2020.3204

[40]

Cheung "Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the hong kong cohort and systematic review and meta-analysis" (2020)

[41]

[42]

[43]

Bhadra "Real-time sequence-validated loop-mediated isothermal amplification assays for detection of Middle East respiratory syndrome coronavirus (MERS-CoV)" PLoS One (2015) 10.1371/journal.pone.0123126

[44]

Chan "Development and evaluation of novel real-time reverse transcription-PCR assays with locked nucleic acid probes targeting leader sequences of human-pathogenic Coronaviruses" J Clin Microbiol (2015) 10.1128/jcm.01224-15

[45]

Zhang "Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes" Emerg Microbes Infect (2020) 10.1080/22221751.2020.1729071

[46]

Fang "Sensitivity of chest CT for COVID-19: comparison to RT-PCR" (2020)

[47]

Huang "Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion" (2020)

[48]

Yang "The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients" Int Immunopharmacol (2020) 10.1016/j.intimp.2020.106504

[49]

[50]

Showing 50 of 91 references

Cited By

551

EXPRESSION OF LRP1 AND OLR1 GENES IN THE BLOOD OF PATIENTSWITH OSTEOARTHRITIS AFTER SARS-CoV2 INFECTION

Yuriy Tugarov, Alevtyna Huet · 2023

Bulletin of Taras Shevchenko Nation...

Metrics

551

Citations

91

References

Details

Published: Sep 25, 2020
Vol/Issue: 97(1147)
Pages: 312-320
License: View

Authors

A

Anant Parasher

Medicine, Guru Teg Bahadur Hospital , New Delhi, India

Cite This Article

Anant Parasher (2020). COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment. Postgraduate Medical Journal, 97(1147), 312-320. https://doi.org/10.1136/postgradmedj-2020-138577

COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment

You May Also Like