Aspectos clínicos de la COVID-19
DOI:
https://doi.org/10.18002/ambioc.i19.7326Palavras-chave:
COVID-19, Transmisión, Síntomas, MortalidadResumo
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
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Referências
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.
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