Volume 23, Issue 5 (December & January - Special Issue on COVID-19 2020)                   J Arak Uni Med Sci 2020, 23(5): 604-613 | Back to browse issues page

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Omidi A, Shatizadeh Malekshahi S, Veisi P. Extrapulmonary Manifestations of Coronavirus Disease 2019: A Narrative Review. J Arak Uni Med Sci 2020; 23 (5) :604-613
URL: http://jams.arakmu.ac.ir/article-1-6318-en.html
1- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
2- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. , s.shatizadeh@modares.ac.ir
3- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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1. Introduction
oronaviruses are a large family of viruses that are known to cause respiratory infections in humans [1]. SARS-CoV-2 is a new type of this family that was initiated in late 2019 and its related disease is known as COVID-19 [4]. Symptoms such as fever, cough, fatigue, muscle aches, joint pain, and shortness of breath have been reported as common symptoms of this virus [4, 7]. In addition to these symptoms, SARS-CoV-2 also affects various organs of the body such as the gastrointestinal tract, nervous system, skin, olfactory system, cardiovascular system, liver, kidneys and eyes. This study aims to provide comprehensive information on extrapulmonary complications of COVID-19 in order to develop control and intervention strategies.
2. Materials and Methods
This is a narrative review study. The literature search was conducted in databases such as PubMed, Scopus, ScienceDirect, and Google Scholar on studies published in English from December 2019 to May 10, 2020 using following keywords:COVID-19, SARS-CoV-2, olfactory dysfunction, loss of taste, gastrointestinal disease, skin manifestations, cardiovascular disease, kidney disease, liver disease, neurological disorder, eye disease, thyroid disease, and diabetes complications. In the initial search, 1105 articles were yielded. After removing duplicates and evaluating their titles and abstracts, 32 articles were selected for the review.
3. Results
SARS-CoV-2 can cause neurological manifestations from relatively specific symptoms such as anosmia, ageusia, myopathy and stroke to nonspecific symptoms such as headache, dizziness, loss of consciousness or seizures [30]. Studies on COVID-19 patients have also reported common gastrointestinal symptoms, such as diarrhea, nausea, and vomiting [14]. Another reported rare symptom is a skin rash in the form of erythematosus, chronic urticaria, and chickenpox-like blisters that occur without itching or slight itching in the trunk [16]. Acute heart failure has been reported as the most common heart disease in COVID-19 cases. Other diseases are myocarditis and cardiac arrest [20]. Recent reports indicate acute renal failure in patients with COVID-19, and hypothetical mechanisms have been proposed, including sepsis leading to cytokine storm or direct cell damage by SARS-CoV-2 [23]. Liver damage in these patients may be directly related to viral infection of the liver cells, immune-mediated inflammation such as cytokine storm, and hypoxia caused by pneumonia [2829]. There is a two-way relationship between COVID-19 and diabetes; diabetes is associated with an increased risk of severe COVID-19. On the other hand, sudden diabetes and severe metabolic complications of diabetes, such as diabetic ketoacidosis, for which very high doses of insulin are needed, have also been observed in patients with COVID-19 [37].
4. Discussion and Conclusion
The results of this review study showed that the complications of COVID-19 are not limited to the lungs, but can go beyond and affect other organs. There have been numerous reports of systemic consequences of COVID-19. Awareness of the effects of SARS-CoV-2 infection outside the airways can be important in the management of patients with underlying diseases. Due to the novelty of COVID-19, information in this field is constantly updated and increased, and the mechanisms associated with the complications are not yet fully clear. Further studies should be performed on the various damages caused by COVID-19 to determine the exact relationship between the pathogenesis, prognosis and severity of the disease.

Ethical Considerations
Compliance with ethical guidelines

This article is a meta-analysis with no human or animal sample. 

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization, writing – original draft: Somayeh Shatizadeh Malekshahi; Research: Somayeh Shatizadeh Malekshahi, Ameneh Omidi and Parsa Veisi; Edited and writing – original draft: Somayeh Shatizadeh Malekshahi and Ameneh Omidi.

Conflicts of interest
The authors declare no conflict of interest.

The authors would like to thank all colleagues in the Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University.

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Type of Study: Review Article | Subject: COVID-19
Received: 2020/05/11 | Accepted: 2020/10/5

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