Doctor of Pharmacy, Department of Pharmacy Practice, Samskruti College of Pharmacy, Hyderabad, Telangana, India

Correspondence: Sanjana Reddy M, Doctor of Pharmacy, Department of Pharmacy Practice, Samskruti College of Pharmacy, Hyderabad, Telangana, India, Email: sanjanareddy812@gmail.com

Citation: Sanjana RM, Shayoli S, Syed AN (2021) Etiopathogenesis, Diagnosis and Clinical Management of SARS-COV-2. Int J Med Clin Case Rep, 1(1);1-6

Copyright: © 2021, Sanjana Reddy M. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited

ABSTRACT

The pandemic caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) remained a significant issue for global health, economics, and society. This coronavirus seems to be associated with a substantial number of adult respiratory illnesses especially when rhinovirus infection is infrequent. Patients show flu-like symptoms with a dry cough, sore throat, high fever, and breathing problems. As this spreading virus has no treatment to date therefore prevention and management are the best options. This article focuses on the use of various therapeutic agents and their efficacy in SARS-CoV-2 patients in various levels of severity. The review also discusses the pathogenesis of SARS-CoV-2 along with the basics of oxygen therapy and mechanical ventilation for the patients having severe conditions. Use of Dexamethasone is promising as the new efficient drug for the treatment of SARS-CoV-2. It also depicts the consequences of the children suffering from SARS-CoV-2 which leads to multisystem inflammatory syndrome and Cytokine Release Syndrome (CRS).

KEYWORDS

Pathogenesis, Management, Cytokine Release Syndrome, Multisystem Inflammatory Syndrome in children, Dexamethasone

INTRODUCTION

The main objective of this article is to provide unbiased information to the healthcare workers on the aspects of pathogenesis, prevention, management, and treatment of SARS-COV-2.

The worldwide pandemic caused by the novel acute coronary syndrome coronavirus 2 (SARS-CoV 2) has resulted in a new and lethal disease known as coronavirus disease in 2019. It has the potential to cause a devastating social, economic, and political crisis that will leave deep scars. Countries are racing to slow the spread of the virus by testing and treating patients, carrying out contact tracing, limiting travel, quarantine citizens, and canceling large gatherings [1]. It is an enveloped virus with non- segmented with a positive Ribose nucleic acid (RNA) genome which causes a respiratory illness with a clinical severity arising from asymptomatic, mild to a severe acute respiratory disorder and even multi-organ failure. As it has a major and severe threat to the public with the contamination and transmission which is causing severe complications. It does not only cause viral pneumonia but has a major complication for the cardiovascular system as well as the patient having other comorbidities (like diabetes, hypertension) [2]. It is a large spherical pleomorphic particle with bulbous projections. The envelope consists of a lipid bilayer in which the membrane, the envelope, and the spike are anchored on the surface. It belongs to the orthocoronavirinae subfamily and order nidovirales. Members of beta coronavirus subgroup A have a spike-like protein known as Hemagglutinin Esterase (HE) [3].

CLINICAL PRESENTATION

As already discussed most of the SARS-CoV-2 cases are asymptomatic for several days on an average this was found to be 14 days described as the incubation period. But this count various and the median value is 4-5 days. From the studies, it is that there are the following symptoms as cough (86%), fever and chills (85%), shortness of breath (80%), diarrhea (27%), nausea (24%), redness of eyes (15%). There include other symptoms even are sputumproduction, headache, rhinorrhea, dysgeusia, sore throat, and vomiting. Still, experiments are going on and new symptoms are being evaluating [4].

PATHOGENESIS

The unique character of SARS-CoV-2 is the fusion cleavage site (RPPA sequence) [5]. After entering into epithelial cells these destroy the cells mainly involved in innate immunity in airways. The three main components of innate immunity include epithelial cells, alveolar macrophages, dendritic cells. SARS-CoV can also bind with dendritic cell-specific intracellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) and DC-SIGN related protein (DC-SIGNR) [6]. From the data analysis, they have concluded that many patients may die due to excessive response towards the virus by host immune system and release abnormally high quantity of leukocytes, cytokines into the circulating system and lead to a syndrome named as cytokine release syndrome (CRS). This condition leads to severe organ damage in patients with other comorbidities. This phenomenon in which there exist huge amounts of cytokines in the blood is termed as a cytokine storm. Cytokines that include are Interleukin (IL-1, IL-2, IL-6, IL-10, IL-12), Tumor Necrosis Factor (TNF-α), Interferon (INF-γ). The most important of all is IL-6 as they are also found in ARDS and it is also a pro-inflammatory agent that in turn activates many other inflammatory mediators that worsens the condition [7] in Figure 1.

CONCLUSION

It has been observed that oxygen therapy, corticosteroid therapy, and therapy with nonspecific antivirals like Remdesivir, Favipiravir have been approved to be effective in COVID-19 patients has therapeutic support. Following this protocol led to the improvement in recovery rate in patients suffering from severe SARS-CoV-2 condition. Also, several studies are being carried out on treatment with dexamethasone which are showing promising results as per early reports. However further evaluation has to be carried out in this context

ACKNOWLEDGEMENTS

We thank anonymous referees for thie ruseful suggestions

CONFLICT OF INTEREST

None

ETHICAL STATEMENT

Not required

ABBREVIATIONS

SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; RNA: Ribonucleic Acid; ACE: Angiotensin-converting Enzyme; DC-SIGN: Dendritic Cell-Specific Intercellular adhesion molecule-3-Grabbing Non-integrin; CRS: Cytokine Release Syndrome; IL: Interleukin; TNF: Tumor Necrosis Factor; IFN: Interferon; RT-PCR: Reverse Transcription Polymerase Chain Reaction; CXCL: C-X-C motif chemokine ligand 1; ARDS: Acute Respiratory Distress Syndrome; COPD: Chronic Obstructive Pulmonary Disease; ECG: Electrocardiogram; HFNO: High Flow Nasal Oxygen; PPE: Personal Protective Equipment; NIV: Non-Invasive Ventilation; QTc: QT Interval; MERS: Middle Eastern Respiratory Syndrome; ICU: Intensive Care Unit; CDC: the centers for Disease Control and Prevention; FDA: Food and Drug Administration; MIS-C: Medicatioal Interaction for Sensitizing Caregivers; VFD: Ventilation Free Days; CPAP: Continous Positive Airway Pressure.

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