Post-COVID syndrome: pulmonary complications

Post-COVID syndrome: pulmonary complications

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worlwide and caused a pandemic that is still ongoing. The virus can cause a disease named as COVID-19, which is composed of multi systemic manifestations with a pulmonary system predominance. As the time passes, we are dealing more and more with a wide variety of effects and complications of the disease in survivors as far as with concerns about the clinical outcome and the timeline of symptoms in different patients. Since the lungs are the most involved organs and the post-COVID prolonged and persistent effects are mainly related to the pulmonary system, it is crucial to define and predict the outcome and to determine the individuals that can progress to fibrosis and loss of function of lungs. This review summarizes the current literature regarding the pulmonary complications in post-COVID syndrome and the management of these conditions.Key words: Post-COVID, pulmonary complications, multisystem inflammatory syndrome in adults (MIS-A)

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  • 1. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. The Journal of Heart and Lung Transplantation 2020; 39(5): 405-407. doi: 10.1016/j.healun.2020.03.012
  • 2. Huang C, Wang Y, Li X, Ren L, Zhao J et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506. doi: 10.1016/S0140- 6736(20)30183-5
  • 3. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
  • 4. Halpin DMG, Singh D, Hadfield RM. Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective. The European Respiratory Journal 2020; 55(5): 2001009. doi: 10.1183/13993003.01009-2020
  • 5. Sokolowska M, Lukasik ZM, Agache I, Akdis CA, Akdis D et al. Immunology of COVID-19: Mechanisms, clinical outcome, diagnostics, and perspectives-A report of the European Academy of Allergy and Clinical Immunology (EAACI). Allergy 2020; 75(10): 2445-2476. doi: 10.1111/all.14462
  • 6. Zeng QL, Li GM, Ji F, Ma SH, Zhang GF et al. Clinical course and treatment efficacy of COVID-19 near Hubei Province, China: A multicentre, retrospective study. Transboundary and Emerging Diseases 2020; 67(6): 2971-2982. doi: 10.1111/ tbed.13674
  • 7. Shah W, Hillman T, Playford E D, Hishmeh L. Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ 2021; 372 :n136 doi:10.1136/bmj. n136
  • 8. Oronsky B, Larson C, Hammond TC, Oronsky A, Kesari S et al. A Review of Persistent Post-COVID Syndrome (PPCS). Clinical Reviews in Allergy and Immunology 2021; 20: 1–9. doi: 10.1007/s12016-021-08848-3
  • 9. Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. Morbidity and Mortality Weekly Report 2020; 69(30): 993-998. doi: 10.15585/mmwr.mm6930e1
  • 10. Cirulli E, Barrett KM, Riffle S, Bolze A, Neveux I et al. Longterm COVID-19 symptoms in a large unselected population. Medrxiv. 2020 Jan 1.
  • 11. Carfì A, Bernabei R, Landi F. Gemelli Against COVID-19 PostAcute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; 324(6): 603-605. doi: 10.1001/ jama.2020.12603
  • 12. Bowles KH, McDonald M, Barrón Y, Kennedy E, O’Connor M et al. Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients. Annals of Internal Medicine 2021; 174(3): 316-325. doi: 10.7326/M20-5206
  • 13. Chopra V, Flanders SA, O’Malley M, Malani AN, Prescott HC. Sixty-Day Outcomes Among Patients Hospitalized With COVID-19. Annals of Internal Medicine 2021; 174(4): 576- 578. doi: 10.7326/M20-5661
  • 14. Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021; 372: n693. doi: 10.1136/bmj.n693
  • 15. George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax 2020; 75(11): 1009-1016. doi: 10.1136/ thoraxjnl-2020-215314
  • 16. Korompoki E, Gavriatopoulou M, Hicklen RS, NtanasisStathopoulos I, Kastritis E et al. Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review. Journal of Infection 2021; 83(1): 1-16. doi: 10.1016/j. jinf.2021.05.004
  • 17. Osuchowski MF, Winkler MS, Skirecki T, Cajander S, Shankar-Hari M et al. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respiratory Medicine 2021; 9(6): 622-642. doi: 10.1016/ S2213-2600(21)00218-6
  • 18. Silva Andrade B, Siqueira S, de Assis Soares WR, de Souza Rangel F, Santos NO et al. Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms. Viruses 2021; 13(4): 700. doi: 10.3390/v13040700
  • 19. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
  • 20. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C et al. Post-acute COVID-19 syndrome. Nature Medicine 2021; 27(4): 601-615. doi: 10.1038/s41591-021-01283-z
  • 21. Wu X, Liu X, Zhou Y, Yu H, Li R et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respiratory Medicine 2021; 9(7): 747-754. doi: 10.1016/S2213-2600(21)00174-0
  • 22. Torres-Castro R, Vasconcello-Castillo L, Alsina-Restoy X, Solis-Navarro L, Burgos F et al. Respiratory function in patients post-infection by COVID-19: a systematic review and metaanalysis. Pulmonology 2021; 27(4): 328-337. doi: 10.1016/j. pulmoe.2020.10.013
  • 23. Truffaut L, Demey L, Bruyneel AV, Roman A, Alard S et al. Postdischarge critical COVID-19 lung function related to severity of radiologic lung involvement at admission. Respiratory Research 2021; 22(1): 29. doi: 10.1186/s12931-021-01625-y
  • 24. Goshua G, Pine AB, Meizlish ML, Chang CH, Zhang H et al. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. Lancet Haematology 2020; 7(8): e575-e582. doi: 10.1016/S2352- 3026(20)30216-7
  • 25. O’Sullivan J, Mc Gonagle D, Ward S, Preston R, O’Donnell J. Endothelial cells orchestrate COVID-19 coagulopathy. Lancet Haematology 2020; 7(8): e553-e555. doi: 10.1016/S2352- 3026(20)30215-5
  • 26. Canas CA, Canas F, Bautista-Vargas M, Bonilla-Abadia F. Role of Tissue Factor in the Pathogenesis of COVID-19 and the Possible Ways to Inhibit It. Clinical and Applied Thrombosis Hemostasis 2021; 27: 10760296211003983. doi: 10.1177/10760296211003983
  • 27. Java A, Apicelli AJ, Liszewski MK, Coler-Reilly A, Atkinson JP et al. The complement system in COVID-19: friend and foe? JCI Insight. 2020; 5(15): e140711. doi: 10.1172/jci.insight.140711
  • 28. Fan BE, Umapathi T, Chua K, Chia YW, Wong SW et al. Delayed catastrophic thrombotic events in young and asymptomatic post COVID-19 patients. Journal of Thrombosis and Thrombolysis 2021; 51(4): 971-977. doi: 10.1007/s11239-020- 02332-z
  • 29. Vadukul P, Sharma D, Vincent P. Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis. BMJ Case Reports 2020; 13(9): e238168. doi: 10.1136/bcr-2020- 238168
  • 30. Taha M, Nguyen P, Sharma A, Taha M, Samavati L. Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine 2021; 15: 1179548420986659. doi: 10.1177/1179548420986659
  • 31. Vechi HT, Maia LR, Alves MDM. Late acute pulmonary embolism after mild Coronavirus Disease 2019 (COVID-19): a case series. Revista do Instituto de Medicina Tropical de São Paulo 2020; 62: e63. doi: 10.1590/S1678-9946202062063
  • 32. Mehta JL, Calcaterra G, Bassareo PP. COVID-19, thromboembolic risk, and Virchow’s triad: Lesson from the past. Clinical Cardiology 2020; 43(12): 1362-1367. doi: 10.1002/clc.23460
  • 33. Maltezou HC, Pavli A, Tsakris A. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines (Basel). 2021; 9(5): 497. doi: 10.3390/vaccines9050497
  • 34. Salamanna F, Veronesi F, Martini L, Landini MP, Fini M. PostCOVID-19 Syndrome: The Persistent Symptoms at the Postviral Stage of the Disease. A Systematic Review of the Current Data. Frontiers in Medicine 2021; 8: 653516. doi: 10.3389/ fmed.2021.653516
  • 35. Jizzini M, Shah M, Zhou K. SARS-CoV-2 and Anti-Cardiolipin Antibodies. Clinical Medicine Insights: Case Reports 2020; 13: 1179547620980381. doi: 10.1177/1179547620980381
  • 36. Uthman IW, Gharavi AE. Viral infections and antiphospholipid antibodies. In Seminars in Arthritis and Rheumatism 2002; 31(4): 256-63. doi: 10.1053/sarh.2002.28303
  • 37. Schwensen HF, Borreschmidt LK, Storgaard M, Redsted S, Christensen S et al. Fatal pulmonary fibrosis: a post- COVID-19 autopsy case. Journal of Clinical Pathology 2021; 74(6): 400-2. doi: 10.1136/jclinpath-2020-206879
  • 38. Udwadia ZF, Koul PA, Richeldi L. Post-COVID lung fibrosis: The tsunami that will follow the earthquake. Lung India. 2021; 38(Supplement): S41-S47. doi: 10.4103/lungindia. lungindia_818_20.
  • 39. Wang F, Kream RM, Stefano GB. Long-Term Respiratory and Neurological Sequelae of COVID-19. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 2020; 26: e928996. doi: 10.12659/MSM.928996
  • 40. Xu J, Xu X, Jiang L, Dua K, Hansbro PM et al. SARS-CoV-2 induces transcriptional signatures in human lung epithelial cells that promote lung fibrosis. Respiratory Research 2020; 21(1): 182. doi: 10.1186/s12931-020-01445-6
  • 41. Becker, R.C. COVID-19 and its sequelae: A platform for optimal patient care, discovery and training. Journal of Thrombosis and Thrombolysis 2021; 51(3): 587-594. doi: 10.1007/s11239-021-02375-w
  • 42. Amenta EM, Spallone A, Rodriguez-Barradas MC, El Sahly HM, Atmar RL et al. Postacute COVID-19: An Overview and Approach to Classification. Open Forum Infectious Diseseases 2020; 7(12): ofaa509. doi: 10.1093/ofid/ofaa509
  • 43. Fernández-de-Las-Peñas C, Palacios-Ceña D, GómezMayordomo V, Cuadrado ML, Florencio LL. Defining PostCOVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification. International Journal of Environmental Research and Public Health 2021; 18(5): 2621. doi: 10.3390/ijerph18052621
  • 44. Goërtz YMJ, Van Herck M, Delbressine JM, Vaes AW, Meys R et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Research 2020; 6(4): 00542-2020. doi: 10.1183/23120541.00542-2020
  • 45. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. Journal of Medical Virology 2021; 93(2): 1013-1022. doi: 10.1002/ jmv.26368
  • 46. Davis HE, Assaf GS, McCorkell L, Wei H, Low RJ et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. E Clinical Medicine. 2021: 101019. doi: 10.1016/j.eclinm.2021.101019
  • 47. Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax 2021; 76(4): 396-398. doi: 10.1136/thoraxjnl-2020-215818
  • 48. D’Cruz RF, Waller MD, Perrin F, Periselneris J, Norton S et al. Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia. ERJ Open Research 2021; 7(1): 00655-2020. doi: 10.1183/23120541.00655-2020
  • 49. Song WJ, Hui CKM, Hull JH, Birring SS, McGarvey L et al. Confronting COVID-19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses. Lancet Respiratory Medicine 2021; 9(5): 533-544. doi: 10.1016/S2213-2600(21)00125-9
  • 50. Chung M, Bernheim A, Mei X, Zhang N, Huang M et al. CT Imaging Features of 2019 Novel Coronavirus (2019- nCoV). Radiology 2020; 295(1): 202-207. doi: 10.1148/ radiol.2020200230
  • 51. Koo HJ, Lim S, Choe J, Choi SH, Sung H et al. Radiographic and CT Features of Viral Pneumonia. Radiographics 2018; 38(3): 719-739. doi: 10.1148/rg.2018170048
  • 52. Zoumot Z, Bonilla MF, Wahla AS, Shafiq I, Uzbeck M et al. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulmonary Medicine 2021; 21(1): 24. doi: 10.1186/s12890-020-01379-1
  • 53. Visca D, Ong CWM, Tiberi S, Centis R, D’Ambrosio L et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021; 27(2): 151-165. doi: 10.1016/j.pulmoe.2020.12.012
  • 54. Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-Mediated Inflammatory Responses: From Mechanisms to Potential Therapeutic Tools. Virologica Sinica 2020; 35(3): 266-271. doi: 10.1007/s12250-020-00207-4
  • 55. Clemons KV, Grunig G, Sobel RA, Mirels LF, Rennick DM et al. Role of IL-10 in invasive aspergillosis: increased resistance of IL-10 gene knockout mice to lethal systemic aspergillosis. Clinical and Experimental Immunology 2000; 122(2): 186-91. doi: 10.1046/j.1365-2249.2000.01382.x
  • 56. Cho JL, Villacreses R, Nagpal P, Guo J, Pezzulo AA et al. Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection. medRxiv. 2021 Jan 1.
  • 57. Ostridge K, Gove K, Paas KHW, Burke H, Freeman A et al. Using Novel Computed Tomography Analysis to Describe the Contribution and Distribution of Emphysema and Small Airways Disease in Chronic Obstructive Pulmonary Disease. Annals of the American Thoracic Society 2019; 16(8): 990-997. doi: 10.1513/AnnalsATS.201810-669OC
  • 58. Isasti G, Moreno T, Pérez I, Cabrera F, Palacios R et al. High prevalence of pulmonary arterial hypertension in a cohort of asymptomatic HIV-infected patients. AIDS Research and Human Retroviruses 2013; 29(2): 231-4. doi: 10.1089/ AID.2012.0166
  • 59. Suzuki YJ, Nikolaienko SI, Dibrova VA, Dibrova YV, Vasylyk VM et al. SARS-CoV-2 spike protein-mediated cell signaling in lung vascular cells. Vascular Pharmacology. 2021; 137: 106823.
  • 60. Suzuki YJ, Nikolaienko SI, Shults NV, Gychka SG. COVID-19 patients may become predisposed to pulmonary arterial hypertension. Medical Hypotheses 2021; 147: 110483. doi: 10.1016/j.mehy.2021.110483
  • 61. Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L et al. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morbidity and Mortality Weekly Report 2020; 69(32): 1074- 1080. doi: 10.15585/mmwr.mm6932e2
  • 62. Belot A, Antona D, Renolleau S, Javouhey E, Hentgen V et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Euro Surveillance 2020; 25(22): 2001010. doi: 10.2807/1560-7917.ES.2020.25.22.2001010
  • 63. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020; 324(3): 259-269. doi: 10.1001/ jama.2020.10369
  • 64. Chau VQ, Giustino G, Mahmood K, Oliveros E, Neibart E et al. Cardiogenic Shock and Hyperinflammatory Syndrome in Young Males With COVID-19. Circulation Heart Failure 2020; 13(10): e007485. doi: 10.1161/CIRCHEARTFAILURE.120.007485
  • 65. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H et al. LargeVessel Stroke as a Presenting Feature of Covid-19 in the Young. New England Journal of Medicine 2020; 382(20): e60. doi: 10.1056/NEJMc2009787
  • 66. Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Translational Research 2020; 220: 1-13. doi: 10.1016/j.trsl.2020.04.007
  • 67. Sokolovsky S, Soni P, Hoffman T, Kahn P, Scheers-Masters J. COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult. The American Journal of Emergency Medicine 2021; 39: 253.e1-253.e2. doi: 10.1016/j. ajem.2020.06.053
  • 68. Most ZM, Hendren N, Drazner MH, Perl TM. Striking Similarities of Multisystem Inflammatory Syndrome in Children and a Myocarditis-Like Syndrome in Adults: Overlapping Manifestations of COVID-19. Circulation. 2021; 143(1): 4-6. doi: 10.1161/CIRCULATIONAHA.120.050166
  • 69. Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020. MMWR Morbidity Mortality Weekly Report 2020; 69(40): 1450-1456. doi: 10.15585/mmwr.mm6940e1
  • 70. Vogel TP, Top KA, Karatzios C, Hilmers DC, Tapia LI et al. Multisystem inflammatory syndrome in children and adults (MIS-C/A): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2021; 39(22): 3037-3049. doi: 10.1016/j.vaccine.2021.01.054
  • 71. Parker A, Louw EH, Lalla U, Koegelenberg CFN, Allwood BW et al. Multisystem inflammatory syndrome in adult COVID-19 patients. SAMJ 2020; 110(10): 957-958. doi: 10.7196/ SAMJ.2020.v110i10.15244
  • 72. Zhang P, Li J, Liu H, Han N, Ju J et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Research 2020; 8: 8. doi: 10.1038/s41413- 020-0084-5
  • 73. George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax 2020; 75(11): 1009-1016. doi: 10.1136/ thoraxjnl-2020-21531
  • 74. Türktaş H, Oğuzülgen K. Covid-19 sonrası akciğer sekelleri: uzun dönem takip ve tedavi. Tuberkülöz ve Toraks 2020; 68(4): 419-429.
  • 75. Chaudhary S, Natt B, Bime C, Knox KS, Glassberg MK. Antifibrotics in COVID-19 Lung Disease: Let Us Stay Focused. Frontiers in Medicine (Lausanne) 2020; 7: 539. doi: 10.3389/ fmed.2020.00539