Unlike initially thought, the lungs are not the only victims of the SARS-CoV-2 virus. By combing through the myriad reports out there, it is getting evident that this virus can attack other organ systems. This is leading to an ever-changing disease picture of how COVID-19 presents. This also means that even when the patients who get critically-ill from COVID-19 recover, they could have long-lasting sequelae of this infection.
Below are some of the pathology seen in the different organ systems courtesy of the virus.
They seem to be the primary target of the virus as it is the closest major organ to its entry-points. Disease presentations are pneumonia and Acute Respiratory Distress Syndrome (ARDS).
It looks like the virus invades the heart causing myocarditis. Congestive heart failure, infarctions and arrhythmias have been reported.
Elevated liver enzymes point to three possibilities – direct liver damage, damage from the drugs the patients are getting or from the immune response.
There is an increased propensity to form blood clots that is difficult to treat. These clots are appearing in blood vessels all over the body. This phenomenon may be a result of the cytokine storm and/or viral invasion of the endothelium.
The infection leads to over-reaction by the immune system called a “cytokine storm” that can be lethal. There is also a school of thought that the virus could invade lymphocytes.
The virus is causing acute kidney injury leading to the need for dialysis. Viral invasion has been seen in bipsies.
Central Nervous System
There have been about 4 cases of encephalitis/meningitis caused by the virus in the US. A team in Japan may have found viral traces in the cerebrospinal fluid of a patent who presented with meningitis. Strokes and seizures have been reported as presenting symptoms. It has also been postulated that the cases of patient presenting with extremely low oxygen saturations without respiratory distress might be due to viral effects in the brainstem causing central alveolar hypoventilation.
A group in Italy also reported on 5 cases of Guillain-Barré due to the infection.
Loss of smell (anosmia) due to virus attacking olfactory nerve or the receptors in the nose has been reported from several countries and centers. Loss of taste (dysgeusia) has been described too.
Conjunctivitis has been a presenting in some patients, a sign of the virus invading the eyes.
There is viral invasion of the lower GI tract that presents as diarrhea. Viral RNA has been isolated from feces.
A range of skin changes are being increasingly described by Italian doctors – patchy red rashes, chickenpox-like blisters, petechaie (look like broken blood vessels), mottling (livedo reticularis) and even urticaria like the rash one sees during an allergic reaction. Whether these are through direct viral invasion of skin or a result of the cytokine storm is not known yet.
This is by no means an exhaustive list. Feel free to send me additions or corrections if you find any more information. That is the only way we can all understand the disease process the SARS-CoV-2 cause better.
Stay safe y’all!
Nana Dadzie Ghansah is an anesthesiologist who lives and works in Lexington, Kentucky