COVID-19: Are we dealing with a multisystem vasculopathy in disguise of a viral infection?
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COVID‑19: Are we dealing with a multisystem vasculopathy in disguise of a viral infection? Ritwick Mondal1 · Durjoy Lahiri1 · Shramana Deb2 · Deebya Bandyopadhyay1 · Gourav Shome3 · Sukanya Sarkar4 · Sudeb R. Paria1 · Tirthankar Guha Thakurta5 · Pratibha Singla6 · Subhash C. Biswas4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract After the emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the last two decades, the world is facing its new challenge in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic with unprecedented global response. With the expanding domain of presentations in COVID-19 patients, the full range of manifestations is yet to unfold. The classical clinical symptoms for SARS-CoV-2 affected patients are dry cough, high fever, dyspnoea, lethal pneumonia whereas many patients have also been found to be associated with a few additional signs and clinical manifestations of isolated vasculopathy. Albeit a deep and profound knowledge has been gained on the clinical features and management of COVID-19, less clear association has been provided on SARS-CoV-2 mediated direct or indirect vasculopathy and its possible correlation with disease prognosis. The accumulative evidences suggest that novel coronavirus, apart from its primary respiratory confinement, may also invade vascular endothelial cells of several systems including cerebral, cardio-pulmonary as well as renal microvasculature, modulating multiple visceral perfusion indices. Here we analyse the phylogenetic perspective of SARS-CoV-2 along with other strains of β-coronaviridae from a standpoint of vasculopathic derangements. Based on the existing case reports, literature and open data bases, we also analyse the differential pattern of vasculopathy related changes in COVID-19 positive patients. Besides, we debate the need of modulation in clinical approach from a hemodynamical point of view, as a measure towards reducing disease transmission, morbidity and mortality in SARS-CoV-2 affected patients. Keywords Vasculopathy · SARS-CoV-2 · ACE2 · Endothelium · Hemodynamics · Thrombosis · Hypercytokinemia
Highlights • As the pandemic of COVID-19 keeps unfolding, several * Durjoy Lahiri [email protected] 1
Institute of Post Graduate Medical Education and Research, SSKM Hospital, 52/1A, S.N. Pandit Street, Kolkata 700025, India
2
S.N. Pradhan Centre for Neuroscience, University of Calcutta, Kolkata, India
3
Department of Microbiology, University of Calcutta, Kolkata, India
4
CSIR-Indian Institute of Chemical Biology, Kolkata, India
5
KPC Medical College and Hospital, Kolkata, India
6
Gian Sagar Medical College and Hospital, Patiala, Punjab, India
atypical manifestations of this viral infection have surfaced up. • Recent evidence shows that SARS-CoV-2 infection may be associated with widespread vasculopathy across different organ systems. • Comparative study between various coronavirus reveals similari
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