Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.
Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Int J Antimicrob Agents. 2020 Aug;56(2):106024. doi: 10.1016/j.ijantimicag.2020.106024. Epub 2020 May 22.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health threat. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, SARS-CoV-2 infection may also involve other organs/systems and present with extra-respiratory manifestations, including cardiac, gastrointestinal, hepatic, renal, neurological, olfactory, gustatory, ocular, cutaneous and haematological symptoms. Occasionally, these extra-respiratory symptoms/signs represent the initial presentation of SARS-CoV-2 infection, prior to fever or respiratory manifestations. Therefore, this comprehensive review of the extra-respiratory manifestations of COVID-19 is intended to help clinicians better understand the range of clinical presentations associated with SARS-CoV-2 infection, allowing the consideration of COVID-19 in differential diagnoses. A screening test for SARS-CoV-2 should be performed when patients have these extra-respiratory manifestations. In addition, clinicians should be alerted to the adverse effects of anti-SARS-CoV-2 agents that can mimic the extra-respiratory manifestations of COVID-19. Moreover, some extra-respiratory manifestations, such as ocular and gastrointestinal involvement, may be caused by direct invasion of SARS-CoV-2. Therefore, protective measures should be taken while managing the associated clinical specimens. Finally, several extra-respiratory manifestations, such as cardiac involvement, acute kidney injury, coagulation disorders and thrombotic complications, could be associated with a poor prognosis.
新型冠状病毒病（COVID-19），由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起，已成为全球健康威胁。尽管大多数 COVID-19 患者表现出发热和呼吸道症状，但 SARS-CoV-2 感染也可能涉及其他器官/系统，并出现呼吸道外表现，包括心脏、胃肠道、肝脏、肾脏、神经、嗅觉、味觉、眼部、皮肤和血液学症状。偶尔，这些呼吸道外症状/体征是 SARS-CoV-2 感染的初始表现，先于发热或呼吸道表现。因此，对 COVID-19 的呼吸道外表现进行综合回顾，旨在帮助临床医生更好地了解与 SARS-CoV-2 感染相关的各种临床表现，以便在鉴别诊断中考虑 COVID-19。当患者出现这些呼吸道外表现时，应进行 SARS-CoV-2 的筛查试验。此外，临床医生应警惕抗 SARS-CoV-2 药物的不良反应，这些不良反应可能模仿 COVID-19 的呼吸道外表现。此外，一些呼吸道外表现，如眼部和胃肠道受累，可能是由 SARS-CoV-2 的直接侵袭引起的。因此，在处理相关临床标本时应采取防护措施。最后，一些呼吸道外表现，如心脏受累、急性肾损伤、凝血障碍和血栓并发症，可能与预后不良有关。
