Covid-19: desde la epidemiologia e inmunología a la clínica.
DOI:
https://doi.org/10.54139/salus.v25i3.128Palabras clave:
COVID-19, epidemiologia, respuesta inmunológica innata, respuesta inmunológica adaptativa, manifestaciones clínicasResumen
Introducción: El coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2) quien causa la enfermedad por coronavirus 2019, aparece en el mundo con una alta tasa de propagación, convirtiéndose en un problema de salud pública, al ser declarado pandemia por la OMS el 11 de marzo de 2020. El SARS-CoV-2, entra a la célula por su unión con la enzima convertidora de angiotensina II (ACE2) produciendo daño citopático directo en neumocitos, cardiocitos y podocitos, así como en células endoteliales. Sin embargo, es la respuesta inmunológica (RI) tanto innata como adaptativa, activada por el mismo virus, quien se convierte en un mecanismo de daño tisular, al ser evadida o persistir de forma exagerada. El órgano blanco por excelencia del SARS-CoV-2 es el pulmón, otros órganos son comprometidos en especial cardiaco, renal y gastrointestinal, el objetivo de la revisión es documentar la relación entre la epidemiologia e inmunología con la expresión clínica de la enfermedad. Metodología: Se realizó una búsqueda de la literatura de artículos sobre epidemiologia, respuesta inmunológica y clínica de la COVID-19, hasta julio de 2021, seleccionando aquellos con mayor interés, de los 188 artículos revisados, se incluyeron 41 artículos considerados por el autor como relevantes. Conclusiones: la RI exagerada y no regulada produce muchas de las manifestaciones clínicas de la covid-19, la tormenta de citocinas, la hiperinflamación y el estado de hipercoagubilidad, se relacionan con enfermedad severa, complicaciones y secuelas.
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Cortés ME. La pandemia de COVID-19: Importancia de estar alerta ante las Zoonosis. Rev Fac Med Hum 2021; 21(1): 137-141. https://doi.org/10.25176/RFMH.v21i1.3451
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020 May;109:102433. https://doi.org/10.1016/j.jaut.2020.102433.
Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).Disponible en: https://coronavirus.jhu.edu/
Orsucci D, Ienco EC, Nocita G, Napolitano A, Vista M. Neurological features of COVID-19 and their treatment: a review. Drugs Context. 2020 Jun 11;9:2020-5-1. https://doi.org/10.7573/dic.2020-5-1.
García-Azorín D, Sierra Á, Trigo J, Alberdi A, Blanco M, Calcerrada I, et al. Frequency and phenotype of headache in covid-19: a study of 2194 patients. Sci Rep. 2021 Jul 19;11(1):14674. https://doi.org/10.1038/s41598-021-94220-6.
Belvis R. Headaches during COVID-19: my clinical case and review of the literature. Headache. 2020 Jul;60(7):1422-1426. https://doi.org/10.1111/head.13841.
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690 https://doi.org/10.1001/jamaneurol.2020.1127.
Gottlieb M, Long B. Dermatologic manifestations and complications of COVID-19. Am J Emerg Med. 2020; 38(9):1715-1721. https://doi.org/10.1016/j.ajem.2020.06.011.
Goha A, Mezue K, Edwards P, Nunura F, Baugh D, Madu E. COVID-19 and the heart: An update for clinicians. Clin Cardiol. 2020 Nov;43(11):1216-1222. https://doi.org/10.1002/clc.23406.
Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Müller MA, Drosten C, Pöhlmann S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Apr 16;181(2):271-280.e8. https://doi.org/10.1016/j.cell.2020.02.052.
Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020 Aug;45(8):100618. https://doi.org/10.1016/j.cpcardiol.2020.100618.
Kopel J, Perisetti A, Gajendran M, Boregowda U, Goyal H. Clinical insights into the gastrointestinal manifestations of COVID-19. Digestive Dis Sci. (2020) 65:1932-1939. https://doi.org/10.1007/s10620-020-06362-8.
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. (2020) 75:1730-1741. https://doi.org/10.1111/all.14238.
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020 May; 158(6): 1831-1833.e3 https://doi.org/10.1053/j.gastro.2020.02.055.
Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, Pan P, Wang W, Hu D, Liu X, Zhang Q, Wu J. Coronavirus infections and immune responses. J Med Virol. 2020 Apr;92(4):424-432. https://doi.org/10.1002/jmv.25685.
Sheahan T, Morrison TE, Funkhouser W, Uematsu S, Akira S, Baric RS, Heise MT. MyD88 is required for protection from lethal infection with a mouse-adapted SARS-CoV. PLoS Pathog. 2008 Dec;4(12):e1000240. https://doi.org/10.1371/journal.ppat.1000240.
Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, Wang T, Zhang X, Chen H, Yu H, Zhang X, Zhang M, Wu S, Song J, Chen T, Han M, Li S, Luo X, Zhao J, Ning Q. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020 May 1;130(5):2620-2629. https://doi.org/10.1172/JCI137244. PMID: 32217835; PMCID: PMC7190990.
Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020 Jun;8(6):e46-e47. https://doi.org/10.1016/S2213-2600(20)30216-2.
Agra L, Madruga D, De Almeida E, Galvao De Franca J, Marreiro J, et al. Neutrophils and COVID-19: The road so far. International Immunopharmacology 90 (2021) 107233. https://doi.org/10.1016/j.intimp.2020.107233
Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in Covid-19. Respir. Res. 2020, jul 3; 21 (1), 169. https://doi.org/10.1186/s12931-020-01428-7
Y Liu Y, Du X, Chen J, Jin Y, Peng L, Wang H.H.X, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19, J. Infect. 81 (2020) e6-e12. https://doi.org/10.1016/j.jinf.2020.04.002
Yang A.P, Liu J, Tao W.Q, Li H.M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients, Int. Immunopharmacol. 84 (2020). https://doi.org/10.1016/j.intimp.2020.106504
Ricci D, Etna M, Rizzo F, Sandini S, Severa M, Coccia E. Innate Immune Response to SARS-CoV-2 Infection: From Cells to Soluble Mediators. Int. J. Mol. Sci. 2021, 22, 7017. https://doi.org/10.3390/ijms22137017
Jung CY, Park H, Kim DW, Choi YJ, Kim SW, Chang TI. Clinical Characteristics of Asymptomatic Patients with COVID-19: A Nationwide Cohort Study in South Korea. Int J Infect Dis. 2020 Oct;99:266-268. https://doi.org/10.1016/j.ijid.2020.08.001.
Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. https://doi.org/10.1001/jama.2020.1585.
Carvelli J, Demaria O, Vély F, Batista L, Benmansour NC, Fares J, et al. Association of COVID-19 inflammation with activation of the C5a-C5aR1 axis. Nature. 2020 Dec;588(7836):146-150. https://doi.org/10.1136/jitc-2020-SITC2020.0483.
Woodruff TM, Shukla AK. The Complement C5a-C5aR1GPCR Axis in COVID-19 Therapeutics. Trends Immunol. 2020 Nov;41(11):965-967. https://doi.org/10.1016/j.it.2020.09.008.
Brunetta E, Folci M, Bottazzi B, De Santis M, Gritti G, Protti A, Mapelli SN, Bonovas S, Piovani D, Leone R, et al. Macrophageexpression and prognostic significance of the long pentraxin PTX3 in COVID-19. Nat Immunol. 2021 Jan;22(1):19-24. https://doi.org/10.1038/s41590-020-00832-x.
Liu H, Hu T, Zhang C, Chen X, Zhang S, Li M, et al. Mechanisms ofCOVID-19. Thrombosis in an inflammatory environment and newanticoagulant targets, Am J Transl Res 2021; 13(5):3925-3941.
Middleton EA, He X, Denorme F, Campbell RA, Ng D, Salvatore SP,et al. Neutrophil extracellular traps contribute to immunothrombosisin COVID-19 acute respiratory distress syndrome. Blood 2020 Sep 3;136(10):1169-1179. https://doi.org/10.1182/blood.2020007008.
Lai CC, Liu Y, Wang CY, Wang YH, Hsueh SC, Yen M-Y, et al. Asymptomatic carrier state, acute respiratory disease, andpneumonia due to severe acute respiratory syndrome coronavirus2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect. 2020 Jun;53(3):404-412. https://doi.org/10.1016/j.jmii.2020.02.012.
Grifoni A, Weiskopf D, Ramírez S, Mateus J, Dan J, ModerbacherC, et al. Targets of T Cell Responses to SARS-CoV-2 Coronavirusin Humans with COVID-19 Disease and Unexposed Individuals. Cell. 2020 Jun 25;181(7):1489-1501.e15. https://doi.org/10.1016/j.cell.2020.05.015.
García-Salido A. Revisión narrativa sobre la respuesta inmunitariafrente a coronavirus: descripción general, aplicabilidad paraSARS-COV-2 e implicaciones terapéuticas. An Pediatr (Engl Ed). 2020 Jul;93(1):60.e1-60.e7. Spanish. https://doi.org/10.1016/j.anpedi.2020.04.016.
Sette A, Crotty S. Adaptive immunity to SARS-CoV-2 andCOVID-19. Cell. 2021 Feb 18;184(4):861-880. https://doi.org/10.1016/j.cell.2021.01.007.
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71(15):762-768. https://doi.org/10.1093/cid/ciaa248.
Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19- related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020, Sep; 17(9):1463-1471. https://doi.org/10.1016/j.hrthm.2020.05.001
Kantarcioglu B, Iqbal O, Walenga JM, Lewis B, Lewis J, Carter CA, Singh M, Lievano F, Tafur A, Ramacciotti E, Gerotziafas GT, Jeske W, Fareed J. An Update on the Pathogenesis of COVID-19 and the Reportedly Rare Thrombotic Events Following Vaccination. Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211021498. https://doi.org/10.1177/10760296211021498.
Rodríguez L, Núñez V. Fisiopatología y Manifestaciones Clínica SARS COVID (COVID-19). Artículos Origínales, 2020,30:8-15.
Wang F, Nie J, Wang H, Zhao Q, Xiong Y, Deng L, et al. Characteristics of Peripheral Lymphocyte Subset Alteration in COVID-19 Pneumonia. J Infect Dis 2020 May 11; 221(11):17621769. https://doi.org/10.1093/infdis/jiaa150.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese. JAMA. 2020; 323(13):1239-1242. https://doi.org/10.1001/jama.2020.2648.
Huang A, Garcia-Carreras B, Hitchings M, Yang B, Katzelnick L, Rattigan S, et al. A systematic review of antibody mediated immunity to coronaviruses: kinetics, correlates of protection, and association with severity. Nature Communications, 2020, 11:4704. https://doi.org/10.1038/s41467-020-18450-4.
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
