New Delhi: COVID-19 can affect almost any organ and the first symptoms may not be at all related to complaints about breasts, experts at AIIMS said Wednesday.
They emphasize that classification of cases into mild, moderate and severe categories based solely on respiratory symptoms should be re-examined to include other organ involvement.
Experts from the institute, including its director Dr Randeep Guleria, Dr MV Padma Srivastava, head of the Department of Neurology, Dr Ambuj Roy, professor of cardiology and Dr Neeraj Nischal, university professor in the department of medicine during their weekly ‘National Clinical Grand’ Rounds ‘organized in collaboration with NITI Aayog discussed several possible extra-pulmonary complications of COVID-19.
Dr Guleria said eight months into COVID-19, much has been learned and as a result strategies are changed from time to time.
From what we consider a viral pneumonia has many other manifestations that are outside the lungs, he said.
“As we learned more and more about COVID-19, we realized that it causes a lot of extra pulmonary manifestations. This is basically due to the fact that this virus enters the cell via ACE2 receptors which although many are present in upper respiratory tract and lungs, they are also present in many organs and thus other organs are affected as well.
“We have seen many patients present with features that are not overwhelmingly longer, but extra pulmonary manifestations,” said Dr. Guleria.
He said that although pulmonary manifestations continue to dominate as far as the majority of COVID-19 cases are concerned, there is a significant number of patients who will present manifestations that may be accompanied by pulmonary manifestations or without pulmonary manifestations.
“We as clients need to have a high index of suspicion during this pandemic – when we suspect, treat and isolate these patients so that we can provide them with good quality care,” he stressed.
The experts in the program presented a number of cases in which the patients were labeled as asymptomatic as mild COVID, but had serious life-threatening extra-pulmonary manifestations such as stroke and heart block.
“What started as a viral pneumonia is now a multisystem disease. However, the jury is out whether SARS-COV2 is to blame for these extra pulmonary manifestations or just an innocent bystander who happened to be in the wrong place at the wrong time, “said Dr. Nischal.
“So the classification of COVID-19 in mild, moderate and severe cases based solely on respiratory symptoms should be reconsidered to include other organ involvement,” he said.
Dr Nischal further emphasized that management of such patients with other organ involvement should be in accordance with existing guidelines of that particular complication.
The doctor from the Department of Medicine also highlighted the case of a 35-year-old man who had a headache and was vomiting, but was found to have life-threatening cortical venous thrombosis.
When tested, it was found to be positive for COVID-19. He was asymptomatic for COVID-19 according to existing guidelines for severity, Dr. Nischal said.
“There is a wide range of neurological manifestations linked to COVID-19. In some patients the brain is involved and it can lead to clotting, result in stroke or can cause infection and lead to encephalitis or other complications that ‘. have nothing to do with lungs, “said Dr. Padma.
Dr Ambuj’s team presented the case of a patient who came with a very low pulse rate, positively detected COVID-19 and required initial support with some medications to improve heart rate.
“Normally, pacemakers are inserted into such patients to improve their heart rate, but based on experiences documented in literature, we realized that some of these may be due to COVID-19, so a pacemaker was not inserted and their heart rate gradually improved with supportive care.
“Sometimes the heart’s electrical pulse system that causes heartbeat can be affected in COVID-19 and it is self-limiting and improves over time.” These patients who would otherwise require normal pacemaker may not ever need it.
“However, more evidence is needed to be definitive about this because it is a new disease and limited information and experience regarding it is available from now on,” Dr Roy said.
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