COVID-19: patogénesis del daño multisistémico

Authors

  • Álvaro Yévenes Interno de Medicina, Universidad de Chile
  • Lucas González Interno de Medicina, Universidad de Chile

Abstract

Sepsis se define como una infección asociada a daño orgánico a distancia distinto del sitio de infección. Sin embargo, los mecanismos fisiopatológicos del SARS-CoV-2 son más amplios que las comunes infecciones bacterianas para las cuales los mecanismos son bastante comprendidos. La infección por SARS-CoV-2 puede activar respuestas inmunitarias innatas y adaptativas. Sin embargo, las respuestas inflamatorias innatas incontroladas y las respuestas inmunitarias adaptativas deterioradas pueden provocar daños tisulares, tanto a nivel local como sistémico. Por otro lado, se ha estudiado en autopsia la presencia viral en distintos órganos lo que implica no solo daño a distancia como en sepsis sino también por replicación viral.

Keywords:

COVID-19, betacoronavirus, infección por coronavirus, fisiopatología, pandemia

References

(1) Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020 Mar 5; 382(10): 929–36.

(2) Yang X, Yu Y, Xu J, Shu H, Xia J ’an, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020 May; 8(5): 475–81.

(3) Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020 Jul 23; 383(4): 334–46.

(4) Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent J-L. Sepsis and septic shock. Nat Rev Dis Primers. 2016 Jun 30; 2: 16045.

(5) Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar; 395(10229): 1054–62.

(6) Departamento de epidemiología, MINSAL. Informe epidemiológico N°44: enfermedad por SARS-CoV-2 (COVID-19) Chile 21-8-2020. Disponible en: https://www.minsal.cl/wpcontent/uploads/2020/08/Informe-Epidemiologico-44-MINSAL.pdf

(7) Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Jul 1; 5(7): 811–8.

(8) Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020 Jun; 215: 108427.

(9) Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb; 395(10223): 507–13.

(10) Wu C, Liu Y, Yang Y, Zhang P, Zhong W, Wang Y, et al. Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. Acta Pharm Sin B. 2020 May; 10(5): 766–88.

(11) Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020 Mar; 63(3): 457–60.

(12) Zhang Y, Geng X, Tan Y, Li Q, Xu C, Xu J, et al. New understanding of the damage of SARS-CoV-2 infection outside the respiratory system. Biomed Pharmacother. 2020 Jul; 127: 110195.

(13) Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Apr 16; 181(2): 271–80.e8.

(14) Mao R, Liang J, Shen J, Ghosh S, Zhu L-R, Yang H, et al. Implications of COVID-19 for patients with pre-existing digestive diseases. The Lancet Gastroenterology & Hepatology. 2020 May; 5(5): 425–7.

(15) Wong SH, Lui RN, Sung JJ. Covid-19 and the digestive system. J Gastroenterol Hepatol. 2020 May; 35(5): 744–8.

(16) Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z, et al. Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. Gut. 2020 Jun; 69(6): 1141–3.

(17) Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection. Genomics. bioRxiv; 2020. p. 30029.

(18) Anti-2019-nCoV Volunteers, Li Z, Wu M, Yao J, Guo J, Liao X, et al. Caution on Kidney Dysfunctions of COVID-19 Patients. Infectious Diseases (except HIV/AIDS). medRxiv; 2020.

(19) Fan C, Li K, Ding Y, Lu WL, Wang J. ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection [Internet]. Available from: http://dx.doi.org/10.1101/2020.02.12.20022418

(20) Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020 Jul; 87: 18–22.

(21) Zhou L, Zhang M, Wang J, Gao J. Sars-Cov-2: Underestimated damage to nervous system. Travel Med Infect Dis. 2020 Mar 24; 101642.

(22) Sun T, Guan J. Novel coronavirus and the central nervous system. Eur J Neurol [Internet]. 2020 Mar 26; Available from: http://dx.doi.org/10.1111/ene.14227

(23) Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Jun; 92(6): 552–5.

(24) Vallamkondu J, John A, Wani WY, Ramadevi SP, Jella KK, Reddy PH, et al. SARS-CoV-2 pathophysiology and assessment of coronaviruses in CNS diseases with a focus on therapeutic targets. Biochim Biophys Acta Mol Basis Dis. 2020 Oct 1; 1866(10): 165889.

(25) Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb; 395(10223): 497–506.

(26) Adão R, Guzik TJ. Inside the heart of COVID-19. Cardiovasc Res. 2020 May 1; 116(6): e59–61.

(27) Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020 Jul 28; 71(15): 762–8.

(28) Zhang B, Zhou X, Zhu C, Feng F, Qiu Y, Feng J, et al. Immune phenotyping based on neutrophil-tolymphocyte ratio and IgG predicts disease severity and outcome for patients with COVID-19. Infectious Diseases (except HIV/AIDS). medRxiv; 2020.

(29) Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020 May; 20(5): 269–70.

(30) Tan M, Liu Y, Zhou R, Deng X, Li F, Liang K, et al. Immunopathological characteristics of coronavirus disease 2019 cases in Guangzhou, China. Immunology. 2020 Jul; 160(3): 261–8.

(31) Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respiratory Medicine. 2020 Apr; 8(4): 420–2.