1Southern Research, Frederick, Maryland.
2College of Optometry, Western University of Health Sciences, Pomona, California.
Am J Trop Med Hyg. 2020 Jul;103(1):18-21. doi: 10.4269/ajtmh.20-0279. Epub 2020 May 13.
The ongoing pandemic COVID-19, caused by SARS-CoV-2, has already resulted in more than 3 million cases and more than 200,000 deaths globally. Significant clinical presentations of COVID-19 include respiratory symptoms and pneumonia. In a minority of patients, extrapulmonary organs (central nervous system, eyes, heart, and gut) are affected, with detection of viral RNA in bodily secretions (stool, tears, and saliva). Infection of such extrapulmonary organs may serve as a reservoir for SARS-CoV-2, representing a potential source of viral shedding after the cessation of respiratory symptoms in recovered patients or in asymptomatic individuals. It is extremely important to understand this phenomenon, as individuals with intermittent virus shedding could be falsely identified as reinfected and may benefit from ongoing antiviral treatment. The potential of SARS-CoV-2 infection to rapidly disseminate and infect extrapulmonary organs is likely mediated through the nonstructural and accessory proteins of SARS-CoV-2, which act as ligands for host cells, and through evasion of host immune responses. The focus of this perspective is the extrapulmonary tissues affected by SARS-CoV-2 and the potential implications of their involvement for disease pathogenesis and the development of medical countermeasures.
由 SARS-CoV-2 引起的持续大流行 COVID-19 已在全球范围内导致超过 300 万例病例和超过 20 万例死亡。COVID-19 的显著临床特征包括呼吸道症状和肺炎。在少数患者中，肺外器官（中枢神经系统、眼睛、心脏和肠道）受到影响，身体分泌物（粪便、眼泪和唾液）中检测到病毒 RNA。这些肺外器官的感染可能成为 SARS-CoV-2 的储库，代表了在呼吸道症状停止后康复患者或无症状个体中病毒脱落的潜在来源。了解这种现象极其重要，因为间歇性病毒脱落的个体可能被错误地认定为再次感染，并可能受益于持续的抗病毒治疗。SARS-CoV-2 通过其非结构和辅助蛋白，作为宿主细胞的配体，以及通过逃避宿主免疫反应，迅速传播和感染肺外器官的潜力。本观点的重点是受 SARS-CoV-2 影响的肺外组织，以及它们参与疾病发病机制和医疗对策发展的潜在意义。
