The Pathophysiology, Diagnosis and Treatment of Corona Virus Disease 2019 (COVID-19)
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REVIEW ARTICLE
The Pathophysiology, Diagnosis and Treatment of Corona Virus Disease 2019 (COVID-19) Subir Kumar Das1
Received: 2 June 2020 / Accepted: 4 August 2020 Ó Association of Clinical Biochemists of India 2020
Abstract Since the beginning of this century, beta coronaviruses (CoV) have caused three zoonotic outbreaks. However, little is currently known about the biology of the newly emerged SARS-CoV-2 in late 2019. There is a spectrum of clinical features from mild to severe life threatening disease with major complications like severe pneumonia, acute respiratory distress syndrome, acute cardiac injury and septic shock. The genome of SARSCoV-2 encodes polyproteins, four structural proteins and six accessory proteins. SARS-CoV-2 tends to utilize Angiotensin-converting enzyme 2 (ACE2) of various mammals. The imbalance between ACE/Ang II/AT1R pathway and ACE2/Ang(1–7)/Mas receptor pathway in the renin-angiotensin system leads to multi-system inflammation. The early symptoms of COVID-19 pneumonia are low to midgrade fever, dry cough and fatigue. Vigilant screening is important. The diagnosis of COVID-19 should be based on imaging findings along with epidemiological history and nucleic acid detection. Isolation and quarantine of suspected cases is recommended. Management is primarily supportive, with newer antiviral drugs/vaccines under investigation. Keywords Angiotensin Angiotensin converting enzyme Chloroquine Corona virus COVID-19 Cytokine storm RNA-dependent RNA polymerase Spike protein SARS-CoV2
& Subir Kumar Das [email protected] 1
Introduction Coronaviruses (CoVs) is accountable for mixture of ailments in human and animals that include respiratory, enteric, renal, and neurological diseases [1]. These are categorized into four genera, for instance alpha-CoV, betaCoV, gamma-CoV, and delta-CoV2. Seven coronaviruses (CoVs) of beta-CoVs have been isolated from human beings till date [2]. There have already been three zoonotic outbreaks in this century. Severe acute respiratory syndrome coronavirus (SARS-CoV) with about 10% case fatality rate (CFR) was initially witnessed from China in 2002, while Middle East respiratory syndrome coronavirus (MERS-CoV) infection with about 34.4% CFR was originally detailed from Saudi Arabia in June 2012 [2]. This third outbreak coronavirus disease 19 (COVID-19) is indisputably the most frightening compared to the previous epidemics, which has spread from a marketplace in Wuhan, China in December 2019 to more than 213 countries and territories, infecting more than 1.5 crore people with death toll more than 6 lakhs of the world within nine months. With nearly 4% CFR, we have never thought anything like this highly contagious and pathogenic COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since the Spanish flu [3]. However, pathogenesis of SARS-CoV-2 is yet to decode and as result there is no appropriate management for COVID-19 patients. This article focuses on understanding the structure of the virus, pathogenesis for d
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