Aspectos clínicos de la COVID-19
DOI :
https://doi.org/10.18002/ambioc.i19.7326Mots-clés :
COVID-19, Transmisión, Síntomas, MortalidadRésumé
La transmisión del SARS-CoV-2 generalmente ocurre por gotitas respiratorias de diferente tamaño. Los síntomas de presentación suelen incluir fiebre, tos, astenia, mialgia o disnea. La mayoría de las personas infectadas son asintomáticas o tienen una
enfermedad leve, pero una minoría desarrolla insuficiencia respiratoria progresiva que requiere hospitalización y soporte respiratorio. El tratamiento es fundamentalmente de soporte, sin embargo, en pacientes hospitalizados, algunos agentes antivirales directos (administrados durante los primeros días de la infección) y el tratamiento inmunomodulador con esteroides y bloqueadores de citocinas (en el periodo de hiperinflamación), pueden mejorar el pronóstico. No obstante, se necesitan nuevas
moléculas antivirales frente a SARS-CoV-2, con buena tolerancia y que se puedan administrar por vía oral, para evitar la progresión de la enfermedad, prevenir el contagio en pacientes de riesgo y cortar la cadena de transmisión. La duración exacta de la inmunidad después de la infección natural o la vacunación aún espera un estudio de seguimiento a largo plazo. Después de una COVID aguda, un número significativo de pacientes desarrollan diversos síntomas persistentes que, en la mayoría de personas, mejoran espontáneamente a lo largo de las semanas o meses siguientes. La pandemia de COVID-19 ha provocado millones de infecciones en todo el mundo, con morbi-mortalidad significativa, y generado una tensión extrema en los
sistemas sanitarios y económicos. La buena noticia es la aparición de vacunas muy eficaces que están ayudando a controlar la enfermedad en países desarrollados; de su implementación masiva durante los próximos meses, incluyendo a los países con menos recursos, va a depender el control adecuado de esta pandemia
Téléchargements
Références
Ackermann M, Verleden SE, Kuehnel M, et al. 2020. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med, 383:120–128.
Aguilar RB, Hardigan P, Mayi B, et al. 2020. Current understanding of COVID-19 clinical course and investigational treatments. Front Med, 7:555301.
Andersen KG, Rambaut A, Lipkin WI, et al. 2020. The proximal origin of SARS-CoV-2. Nat Med, 26:450–452.
Bastard P, Gervais A, Le Voyer T, et al. 2021. Autoantibodies neutralizing type I IFNs are present in~4 % of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths. Sci Inmunol, 6:eabl4340.
Bastard P, Rosen LB, Zhang Q, et al. 2020. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science, 370:eabd4585.
Beigel JH, Tomashek KM, Dodd LE, et al. 2020. Remdesivir for the treatment of Covid-19 — final report. N Engl J Med, 383:1813-1826.
Bergwerk M, Gonen, T, Lustig Y, et al. Covid-19. 2021. Breakthrough infections in vaccinated health care workers. N Engl J Med, 385: 1474- 1484.
Berlin A, RM Gulick RM y Martinez FJ. 2020. Severe Covid-19. N Eng J Med, 383:2451-2460.
Brooks SK, Webster RK, Smith LE, et al. 2020. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 395:912-920.
Buchan BW, Hoff JS, Gmehlin CG, et al. 2020. Distribution of SARS-CoV-2 PCR cycle threshold values provide practical insight into overall and target-specific sensitivity among symptomatic patients. Am J Clin Pathol, 154:479-85.
CDC COVID-19 Response Team. 2020. Geographic Differences in COVID-19 cases, deaths, and incidence- United States, February 12-April 7, 2020. MMWR Morb Mortal Wkly Rep, 69:465–471.
CDC. Centers for Disease Control and Prevention. Duration of isolation and precautions for adults with COVID-19. [Online].; 2020. Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
CDC. Centers for Disease Control and Prevention. Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). [Online].;¡ 2020. Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
CDC. Centers for Disease Control and Prevention. Interim guidance for rapid antigen testing for SARS-CoV-2. [Online].; 2020. Disponible en: https://www.cdc .gov/coronavirus/2019-ncov/ lab/resources/antigen-tests-guidelines.html
Chan JCX, Kwok KY, Ma JKF, et al. 2020a. Radiology and COVID-19. Hong Kong Med J, 26:286–288.
Chan JCX, Kwok KY, Ma JKF, et al. 2020b. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 95:514–523.
Chu DK, Akl EA, Duda S, et al. 2020. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet, 395:1973-1987.
Cohen MS, Nirula A, Mulligan M, et al. 2021. Bamlanivimab prevents Covid-19 morbidity and mortality in nursing-home setting. [Online].; Disponible en: https://www.croiconference.org/abstract/bamlanivimab-prevents-covid-19-morbidity-and-mortality-in-nursing-home-setting/
Corey L, Beyrer C, Cohen MS, et al. 2021. SARS-CoV-2 variants in patients with immunosuppression. N Engl J Med, 385:562-566.
Crook H, Raza S, Nowell J et al. 2021. Long covid—mechanisms, risk factors, and management. BMJ, 374:n1648.
De Biasi S, Meschiari M, Gibellini L, et al. 2020. Marked T cell activation, senescence, exhaustion and skewing towards TH17 in patients with COVID-19 pneumonia. Nat Commun, 11:3434.
Ellinghaus D, Degenhardt F, Bujanda L et al. 2020. Genomewide association study of severe covid-19 with respiratory failure. N Engl J Med, 383:1522–1534.
Feldstein LR, Rose EB, Horwitz SM, et al. 2020. Multisystem Inflammatory Syndrome in U.S. children and adolescents. N Engl J Med, 83:334–346.
Fenizia C, Biasin M, Cetin I, et al. 2020. Analysis of SARSCoV- 2 vertical transmission during pregnancy. Nat Commun, 11:5128.
Fox SE, Akmatbekov A, Harbert JL, et al. 2020. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med, 8:681–686.
Gandhi R. 2020. The multidimensional challenge of treating COVID-19: remdesivir is a foot in the door. Clin Infect Dis, ciaa1132.
Gandhi R, Lynch J y del Rio C. 2020. Mild or moderate Covid-19. N Engl J Med, 383:1757-1766.
Gasecka A, Borovac JA, Guerreiro RA, et al. 2021. Thrombotic complications in patients with COVID-19: pathophysiological mechanisms, diagnosis, and treatment. Cardiovasc Drugs Ther,35: 215–229.
Gold JAW, Rossen LM, Ahmad FB, et al. 2020. Race, ethnicity, and age trends in persons who died from COVID-19 — United States, May–August 2020. Morb Mortal Wkly Rep, 69:1517-1521.
Gordon AC, Mouncey PR, Al-Beidh F, et al. 2021. Interleukin-6 receptor antagonists in critically ill patients with Covid-19. N Engl J Med, 384:1491-1502.
Gottlieb RL, Nirula A, Chen P, et al. 2021. Effect of bamlanivimab as monotherapy or in combination with etesevimab on viral load in patients with mild to moderate COVID-19: a randomized clinical trial. JAMA, 325(7):632-644.
Greenhalgh T, Jimenez JL, Prather KA, et al. 2021. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. Lancet, 397:1603-1605.
Guimarães PO, Quirk D, Furtado RH, et al. 2021. Tofacitinib in patients hospitalized with Covid-19 pneumonia. N Engl J Med, 385:406-415.
Guo T, Fan Y, Chen M, et al. 2020. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol, 5:811-818.
Hanley B, Naresh KN, Roufosse C, et al. 2020. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe, 1:e245–e253.
He X, Lau EHY, Wu P, et al. 2020. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med, 6:672-675.
Helms J, Tacquard C, Severac F, et al. 2020. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med, 46:1089-1098.
Hoffmann M, Kleine-Weber H, Schroeder S, et al. 2020. SARS-CoV-2 cell entry depends on ACE-2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell, 181:271-280.e8.
Horby P, Lim WS, Emberson JR, et al. 2021. Dexamethasone in hospitalized patients with covid- 19 - Preliminary report. N Engl J Med, 384:693-704.
Huang C, Wang Y, Li X, et al. 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395:497-506.
Huang L, Ya Q, Gu X et al. 2021. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet, 398:747–758.
Hussman J. 2020. Cellular and molecular pathways of COVID-19 and potential points of therapeutic intervention. Front Pharmacol, 11:1169.
IDSA. Infectious Diseases Society of America guidelines on the diagnosis of COVID-19:serologic testing. [Online].; 2020. Disponible en: https://www.idsociety.org/practice-guideline/covid-19-guideline-serology/
Ji T, Liu Z, Wang G, et al. 2020. Detection of COVID-19: A review of the current literature and future perspectives. Biosens Bioelectron, 166:112455.
Kai-Wang To K, Sridhar S, Hei-Yeung Chiud K, et al. 2021. Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic. Emeg Microbes Infect, 10:507-535.
Kamal M, Abo Omirah M, Hussein A y Saeed H. 2021. Assessment and characterisation of post-COVID-19 manifestations. Int J Clin Pract, 75:e13746.
Kampf G, Todt D, Pfaender S y Steinmann E. 2020. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect, 104:246-251.
Kang M, Wei J, Yuan J, et al. 2020. Probable evidence of fecal aerosol transmission of SARS-CoV-2 in a high-rise building. Ann Intern Med, 173:974-980.
Kimball A, Hatfield KM, Arons M, et al. 2020. Asymptomatic and presymptomatic SARSCoV-2 infections in residents of a long-term care skilled nursing facility — King County, Washington. MMWR Morb Mortal Wkly Rep, 69:377-381.
Klompas M, Baker MA y Rhee C. 2020. Airborne transmission of SARS-CoV-2: theoretical considerations and available evidence. JAMA, 324:441-442.
Larsen DA y Wigginton KR. 2020. Tracking COVID-19 with wastewater. Nat Biotechnol, 38:1151–1153.
Lauer SA, Grantz KH, Bi Q, et al. 2020. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med, 172:577-582.
Li Q, Guan X, Wu P, et al. 2020. Early transmission dynamics in Wuhan, China, of novel coronavirus infected pneumonia. N Engl J Med, 823:1199–1207.
Lu R, Zhao X, Li J, et al. 2020. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet,10224:565-574.
Ma J, Qi X, Chen H, et al. 2021. COVID-19 patients in earlier stages exhaled millions of SARS-CoV-2 per hour. Clin Infect Dis, 72:e652-e654.
Mao L, Jin H, Wang M, et al. 2020. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol, 77:683-690.
Mehta P, McAuley DF, Brown M, et al. 2020. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet, 395:1033–1034.
Meng X, Deng Y, Dai Z y Meng Z. 2020. COVID- 19 and anosmia: a review based on upto-date knowledge. Am J Otolaryngol, 41:102581.
Moore JB y June CH. 2020. Cytokine release syndrome in severe COVID-19. Science, 368:473-474.
National Geografic. ‘Wet markets’ likely launched the coronavirus. Here’s what you need to know. [Online].; 2020. Disponible en: https://www.nationalgeographic.com/animals/2020/04/coronavirus-linked-to-chinese-wet-markets/
Office for National Statistics. The prevalence of long COVID symptoms and COVID-19complications. [Online].; 2020 . Disponible en: https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications
Pairo-Castineira E, Clohisey S, Klaric L, et al. 2021. Genetic mechanisms of critical illness in covid-19. Nature, 591: 92–98.
Paules CI, Marston HD y Fauci AS. 2020. Coronavirus infections, more than just the common cold. JAMA, 323:707-708.
Petrilli CM, Jones SA, Yang J, et al. 2020. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. Br Med J, 369:m1966.
Poland GA, Ovsyannikova IG y Kennedy RB. 2020. SARSCoV-2 immunity: review and applications to phase 3 vaccine candidates. Lancet, 396:1595–1606.
RECOVERY Collaborative Group. 2021. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet, 397:1637-1645.
Richardson S, Hirsch JS, Narasimhan M, et al. 2020. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA, 323:2052-2059.
Rydyznski Moderbacher C, Ramirez SI, Dan JM, et al. 2020. Antigen-specific adaptive immunity to SARSCoV- 2 in acute COVID-19 and associations with age and disease severity. Cell, 183:996– 1012.e19.
Salmanton-García J, Sprute R, Stemler J, et al. 2021. COVID-19-associated pulmonary aspergillosis. Emerg Infect Dis, 27:1077-1086.
Sharma A, Farouk IA y Lal SK. 2021. COVID-19: A review on the novel coronavirus disease evolution, transmission, detection, control and prevention. Viruses, 202:2-25.
Solomon T. 2021. Neurological infection with SARS-CoV- 2 - the story so far. Nat Rev Neurol, 17:65–66.
Stebbing, J. y Lauschke, VM. 2021. JAK inhibitors — more than just glucocorticoids. N Engl J Med, 385:463-465.
Sterne JAC, Murthy S, Diaz JV, et al. 2020. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: A meta-analysis. JAMA, 324:1330-1341.
Tenforde MW, Kim SS, Lindsell CJ et al. 2020. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network—United States. MMWR Morb Mortal Wkly Rep, 69:993-998.
To KK, Tsang OT, Leung WS, et al. 2020. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis, 20:565–574.
Townsend L, Dyer AH, Jones K, et al. 2020. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One, 15:e0240784.
UK Government. COVID-19: long-term health effects. [Online].; 2021 Disponible en: https://www.gov.uk/government/publications/covid-19-long-term-healtheffects/covid-19-long-term-health-effects
Van Kampen JJA, van de Vijver D, Fraaij PLA, et al. 2021. Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19). Nat Commun, 12:267.
Varga Z, Flammer AJ, Steiger P, et al. 2020. Endothelial cell infection and endotheliitis in COVID-19. Lancet, 395:1417–1418.
Wajnberg A, Amanat F, Firpo A, et al. 2020. Robust neutralizing antibodies to SARSCoV-2 infection persist for months. Science, 370:1227–1230.
Wang W, Xu Y, Gao R, et al. 2020a. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 323:1061-1069.
Wang W, Xu Y, Gao R, et al. 2020b. Detection of SARSCoV- 2 in different types of clinical specimens. JAMA, 323:1843–1844.
WHO Solidarity Trial Consortium. 2021. Repurposed antiviral drugs for Covid-19—Interim
WHO Solidarity trial results. N Engl J Med, 384:497–511.
WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). [Online].; 2020. Disponble en: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
WHO. World Health Organization. COVID-19 Weekly epidemiological update (01/09/2021). [Online].; 2021. Disponible en: https://www.who.int/docs/default-source/corona- viruse/situation-reports/weekly_epidemiological_update_23.pdf?sfvrsn=6ac0778_5&download=true
Williamson EJ, Walker AJ, Bhaskaran K, et al. 2020. Factors associated with COVID-19-related death using OpenSAFELY. Nature, 845:430-436.
Wölfel R, Corman VM, Guggemos W, et al. 2020. Virological assessment of hospitalized patients with COVID-2019. Nature, 581:465-469.
Wong TL y Weitzer DJ. 2021. Long COVID and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS)-a systemic review and comparison of clinical presentation and symptomatology. Medicina (Kaunas), 57:418.
World Health Organization. What we know about Long-term effects of COVID-19. [Online].; 2020. Disponible en: https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-36-long-term-symptoms.pdf?sfvrsn=-5d3789a6_2
Wu Z y McGoogan JM. 2020. Characteristics of and important Lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323:1239–1242.
Wuhan Municipal Health Commission 2. Report of clustering pneumonia of unknown etiology in Wuhan City. [Online]. Disponible en: http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989
Zhao J, Yuan Q, Wang H, et al. 2020. Antibody responses to SARS-CoV-2 in patients with novel coronavirus disease 2019. Clin Infect Dis, 71:2027–2034.
Zhou F, Yu T, Du R, et al. 2020. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395:1054-1062.
Zhu N, Zhang D, Wang W, et al. 2020. A novel coronavirus from patients with pneumonia
in China, 2019. N Engl J Med, 382:727–733.
Téléchargements
Publiée
Comment citer
Numéro
Rubrique
Licence
Ce travail est disponible sous licence Creative Commons Attribution - Pas d’Utilisation Commerciale - Partage dans les Mêmes Conditions 4.0 International.
Los autores que publican en esta revista están de acuerdo con los siguientes términos:
- Los autores ceden de forma no exclusiva los derechos de explotación (reproducción, distribución, comunicación pública, transformación) a la Universidad de León, por lo que pueden establecer, por separado, acuerdos adicionales para la distribución no exclusiva de la versión de la obra publicada en la revista (por ejemplo, alojarlo en un repositorio institucional o publicarlo en un libro), con un reconocimiento de su publicación inicial en esta revista.
- Este trabajo se encuentra bajo la Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Puede consultarse desde aquí la versión informativa y el texto legal de la licencia.
- Se permite y se anima a los autores a difundir electrónicamente las versiones pre-print (versión antes de ser evaluada) y/o post-print (versión evaluada y aceptada para su publicación) de sus obras antes de su publicación, ya que favorece su circulación y difusión más temprana y con ello un posible aumento en su citación y alcance entre la comunidad académica.
