This Wednesday, experts from AIIMS, New Delhi, reported that covid-19 can not just affect your lungs but almost all organs; and that the initial symptoms of the infection might be totally unrelated to chest or respiratory complaints.
They stressed that the classification of cases into mild, moderate, and severe categories based just on respiratory symptoms should be revisited to include other organ involvement.
During their weekly ‘National Clinical Grand Rounds’ organised in collaboration with NITI Aayog, experts from the institute—including its director Dr Randeep Guleria, Dr MV Padma Srivastava, head of department of Neurology, Dr Ambuj Roy, Professor of Cardiology and Dr Neeraj Nischal, Associate Professor in the department of Medicine—discussed various possible extra-pulmonary complications of covid-19.
“From what we thought of as a viral pneumonia has a lot of other manifestations which are beyond the lungs,” Dr. Guleria said. He emphasized on how much they have been able to learn about covid-19, ever since the outbreak.
“As we have known more and more about covid-19, we have realised it causes many extra pulmonary manifestations. This is basically of the fact that this virus enters into cell through ACE2 receptors which although are present abundantly in upper airways and lungs, they are also present in many organs and thus other organs are also affected,” Dr Guleria said.
“We have seen many patients who presented with features which are not been predominantly pulmonary but extra pulmonary manifestations,” he added.
According to him, even though pulmonary manifestations continue to dominate as far as majority of covid-19 cases are concerned, a significant number of patients may show signs of other manifestations, with or without pulmonary manifestations.
Dr. Guleria stressed on the need for clinicians to have a high index of suspicion during this pandemic about when to suspect, treat and isolate these patients in order to provide them with good quality care.
In the programme, the experts have presented a number of cases in which asymptomatic or mild covid patients had serious life-threatening extra-pulmonary manifestations like stroke and heart blocks.
“What started off as a viral pneumonia is now a multi-systemic disease. However, the jury is out whether SARS-CoV-2 is the culprit in these extra pulmonary manifestations or just an innocent bystander which happens to be at the wrong place at a wrong time,” Dr Nischal said.
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So the classification of COVID-19 into mild, moderate and severe cases based only on respiratory symptoms should be relooked into to incorporate other organ involvement
The doctor from the Medicine Department also highlighted the case of a 35-year old man, asymptomatic for covid-19, who had headache and was vomiting. He was later found to have life-threatening cortical vein thrombosis.
“There is a big spectrum of neurological manifestations which have been linked to covid-19. In some patients, brain is involved and it may lead to clotting, resulting in stroke or can cause infection and lead to encephalitis or other complications which have nothing to do with lungs,” Dr Padma said.
Dr Ambuj’s team presented the case of a patient who came with a very low pulse rate, detected covid-19 positive and required initial support with some medicines to improve heart rate.
“Normally pacemaker is put in such patients to improve their heart rate but based on experiences documented in literature, we realised some of these could be due to covid-19, so a pacemaker was not put and her heart rate gradually improved with supportive treatment,” they informed.
“Sometimes, the electrical pulse system of the heart which gives rise to heart beat can be affected in covid-19 and it is self-limiting and improves with time. So these patients who would otherwise normally require pacemaker may not even need it,” said Dr Roy.
“However, more evidence is needed to be definitive about this as it is a new disease and limited information and experience regarding it is available as of now,” he concluded.
(With inputs from PTI)