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Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications

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A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "COVID-19 Vaccines and Vaccination".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 28810

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Dr. Andrea Denegri

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Cardiology Division, Parma University Hospital, via Antonio Gramsci 14, 43126 Parma, Italy
Interests: acute coronary syndrome; interventional cardiology; biomarkers

Special Issue Information

Dear Colleagues,

The coronavirus disease (COVID-19) due to a novel coronavirus (CoV2) has rapidly spread worldwide and changed various systems, especially healthcare systems. This virus not only affects the pulmonary parenchyma but also profoundly impacts the cardiovascular system. Systemic complications associated with SARS-CoV2 infection are frequently found in COVID-19 disease, with several manifestations and indiscriminate havoc on multiple organ systems including the heart, brain, kidney, and the vasculature. Moreover, long COVID-19 syndrome has emerged as a new pandemic, causing substantial disability to millions of people globally.

Therefore, we would like to encourage the presentation to this Special Issue additional insights on the link between COVID-19 disease and systemic complications, in order to provide clinicians a range of the potential manifestations of SARS-CoV-2 beyond the destructive lung infection.

Adding new information on these subjects may lead to a better understanding of the pathogenesis not only of COVID-19 infection but also of different diseases and aid in the design of new therapeutic and prophylactic strategies.

Dr. Andrea Denegri
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

COVID-19
SARS-CoV2
cardiovascular and systemic complications
post-acute sequelae of SARS-CoV-2 infection
long COVID-19 syndrome

Published Papers (9 papers)

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Research

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16 pages, 3281 KiB

Open AccessArticle

Insights from Real-World Practice: The Dynamics of SARS-CoV-2 Infections and Vaccinations in a Large German Multiple Sclerosis Cohort

by Hernan Inojosa, Dirk Schriefer, Yassin Atta, Anja Dillenseger, Undine Proschmann, Katharina Schleußner, Christina Woopen, Tjalf Ziemssen and Katja Akgün

Vaccines 2024, 12(3), 265; https://doi.org/10.3390/vaccines12030265 - 03 Mar 2024

Viewed by 856

Abstract

The SARS-CoV-2 pandemic profoundly impacted people with multiple sclerosis (pwMS). Disease-related aspects and demographic factors may influence vaccination rates, infection susceptibility, and severity. Despite prior research, comprehensive real-world data obtained throughout the pandemic remain limited. We investigated SARS-CoV-2 vaccination and infection patterns in a large monocentric real-world cohort. We collected prospective data from medical visits at the MS Center Dresden, Germany, from the pandemic’s beginning until 31 May 2022. Logistic regression and rank correlation analyses were used to explore associations between SARS-CoV-2 outcomes and patient characteristics. Of 2115 pwMS assessed (mean age 46.5, SD ± 12.9; median expanded disability status scale 2.5), 77.9% were under disease-modifying treatment (DMT), primarily B-cell depletion (25.4%). A total of 35.5% reported SARS-CoV-2 infections, and 77.4% were fully vaccinated. PwMS with increased disability, older age, and comorbidities were associated with higher vaccination rates, possibly due to the awareness of these populations regarding complications of SARS-CoV-2 infections. Infections were more common in younger females, people with a lower degree of disability, those with relapsing MS, and those who were not vaccinated. PwMS on B-cell depletion reported more infections than untreated pwMS and those receiving other types of disease-modifying therapy, despite higher vaccination rates. Most infections were mild, with no severity differences according to demographic or disease-related factors, except for gender. Notably, all fatal cases occurred in unvaccinated pwMS. Our studies suggest that demographic and disease-related factors, especially age and the use of B-cell depletion, significantly influenced SARS-CoV-2 vaccination and infection rates in our cohort. These factors may be considered in future preventive campaigns in further pandemics. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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11 pages, 811 KiB

Open AccessArticle

Outcomes of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients: A Multi-Institutional Analysis

by Maged Makhoul, Eitan Keizman, Uri Carmi, Ori Galante, Eduard Ilgiyaev, Moshe Matan, Artur Słomka, Sigal Sviri, Arieh Eden, Arie Soroksky, Danny Fink, Leonid Sternik, Gil Bolotin, Roberto Lorusso and Yigal Kassif

Vaccines 2023, 11(1), 108; https://doi.org/10.3390/vaccines11010108 - 01 Jan 2023

Cited by 5 | Viewed by 2423

Abstract

Background: In March 2020, COVID-19 was announced as a global pandemic. The first COVID-19 patient was connected to an ECMO device in Israel during that time. Since then, over 200 patients have required ECMO support due to COVID-19 infection. The present study is a multi-institutional analysis of all COVID-19 patients requiring veno-venous (VV) ECMO in Israel. The aim was to characterize and compare the survivors and deceased patients as well as establish risk factors for mortality. Methods: This retrospective multi-institutional study was conducted from March 2020 to March 2021 in eleven of twelve ECMO centers operating in Israel. All COVID-19 patients on VV ECMO support were included in the cohort. The patients were analyzed based on their comorbidities, procedural data, adverse event on ECMO, and outcomes. Univariate and multivariate analyses were used to compare the deceased and the surviving patients. Results: The study included 197 patients, of which 150 (76%) were males, and the mean age was 50.7 ± 12 years. Overall mortality was 106 (54%). Compared with the deceased subjects, survivors were significantly younger (48 ± 11 vs. 53 ± 12 years), suffered less from ischemic heart disease (IHD) (3% vs. 12%), and were ventilated for a significantly shorter period (≤4 days) prior to cannulation (77% vs. 63%). Patients in the deceased group experienced more kidney failure and sepsis. Rates of other complications were comparable between groups. Conclusions: Based on this study, we conclude that early cannulation (≤4 days) of younger patients (≤55 years) may improve overall survival and that a history of IHD might indicate a reduced prognosis. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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8 pages, 256 KiB

Open AccessArticle

Is There Any Correlation between Baseline Serum Cortisol Levels and Disease Severity in PCR-Positive COVID-19 Patients with and without Diabetes Mellitus?

by Müge Keskin, Sefika Burcak Polat, İhsan Ates, Seval İzdes, Hatice Rahmet Güner, Oya Topaloglu, Reyhan Ersoy and Bekir Cakır

Vaccines 2022, 10(8), 1361; https://doi.org/10.3390/vaccines10081361 - 20 Aug 2022

Viewed by 1772

Abstract

Background: COVID-19 has caused a pandemic and is associated with significant mortality. The pathophysiology of COVID-19, affecting many organs and systems, is still being investigated. The hypothalamus, pituitary gland, and possibly adrenal glands are the targets of SARS-CoV-2 because of its angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors expression. Hypocortisolemia can be seen in the postinfection period. COVID-19 infection tends to be severe in diabetic patients due to immune dysfunction. In this study, our aim was to investigate the relationship between basal cortisol levels and the course of COVID-19 infection in diabetic and non-diabetic patients. Methods: Our retrospective study included 311 PCR-positive COVID-19 patients over the age of 18 who were hospitalized in Ankara City Hospital Infectious Diseases Department or Intensive Care Unit (ICU) between 15 March 2020 and 15 May 2020. Serum basal cortisol, fasting plasma glucose (FPG), HbA1c values, and diabetes history were recorded within the first 24 h of hospitalization. The presence of pulmonary involvement was noted from the patients’ imaging records. Pregnant and breastfeeding women, patients with chronic liver disease or chronic kidney disease, and patients who were already using steroids or had started COVID-19 infection treatment within the 72 h before blood collection were excluded from the study. Results: Of the 311 patients, 100 had Type 2 Diabetes Mellitus (T2D), while 211 did not. The age, serum basal cortisol, and glucose levels of the patients with T2D (64.51 ± 12.29, 19.5 ± 13.12, and 143.5 (77–345)) were higher than those of the patients without T2D (46.67 ± 16.38, 15.26 ± 8.75, and 96 (65–202)), and the differences were statistically significant (p = 0.004, p = 0.004, and p < 0.001, respectively). The basal cortisol values of the ICU patients (27.89 (13.91–75)) were significantly higher than those of the ward patients (13.68 (1.48–51.93)) and patients who were transferred to the ICU from the ward due to worsening conditions (19.28 (7.74–55.21)) (p < 0.001 and p = 0.007, respectively). The factors affecting ICU admission were determined to be age, T2D history, basal cortisol, and elevation in FPG using univariate logistic regression analysis. In the multiple logistic regression analysis, age, basal cortisol level, and infiltrative involvement in thorax CT were determined to be the risk factors affecting intensive care admission. Conclusion: High basal cortisol levels in patients with T2D may predict the severity of COVID-19 infection or mortality. Although high basal cortisol levels are among the risk factors affecting ICU admission, patients with COVID-19 should also be evaluated in terms of clinical and laboratory findings and relative adrenal insufficiency. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

Review

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12 pages, 248 KiB

Open AccessReview

Anti-SARS-CoV-2 Vaccination and PIMS-TS—Friends or Foe? Case Reports and Literature Review

by Violetta Opoka-Winiarska, Izabela Morawska-Michalska, Paulina Mertowska, Krzysztof Gosik, Olga Kądziołka and Ewelina Grywalska

Vaccines 2024, 12(3), 278; https://doi.org/10.3390/vaccines12030278 - 07 Mar 2024

Viewed by 855

Abstract

Pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), also known as a multisystem inflammatory syndrome in children (MIS-C), is diagnosed in children who develop an inadequate inflammatory response after exposure to the SARS-CoV-2 virus. The pathogenesis of the abnormal response of the immune system to a previous SARS-COV-2 infection has not been explained. Similarly, the safety and effectiveness of COVID-19 vaccinations in this group of patients have become the subject of clinical discussion. Presenting experiences from many centers aims to answer this question. We present 4 cases of patients who suffered from PIMS-TS. Three of them were safely vaccinated against COVID-19 after illness. One patient developed PIMS-TS temporarily associated with COVID-19 vaccination. We also collected and discussed data from other centers. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

13 pages, 3054 KiB

Open AccessReview

Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review

by Emmanouil Karampinis, Agoritsa Gravani, Polyxeni Gidarokosta, Dimitrios Petros Bogdanos, Angeliki-Viktoria Roussaki-Schulze and Efterpi Zafiriou

Vaccines 2023, 11(8), 1298; https://doi.org/10.3390/vaccines11081298 - 29 Jul 2023

Cited by 9 | Viewed by 2448

Abstract

From the beginning of public vaccinations until the relaxation of COVID-19 measures, many case reports, case series and case–control studies have been published indicating cutaneous side effects of COVID-19 vaccination. Post-vaccination pustular eruption was reported as well, with a challenging differential diagnosis between pustular psoriasis, AGEP (acute generalized exanthematous pustulosis) and neutrophil pustular eruptions. We report a case of 56-year-old woman presented with acute generalized pustular flare up culminated 5 days after the second dose of BNT162b2(Pfizer) vaccination. She was diagnosed with pustular psoriasis flare and due to the regulating role of IL-1 in pustular psoriasis and in the cytokine storm observed in cases of COVID-19 postvaccination inflammation; we decided to treat the patient with an IL-1 antagonist, subcutaneous anakinra (100 mg daily) along with acitretin. One week later, after anakinra withdrawal, she presented a pustular psoriasis flare and a 7-day anakinra re-administration led to a satisfactory improvement in the skin lesions. We also reviewed the medical literature and found 28 case reports with pustular eruption after the COVID-19 vaccination. We compared the patients reported, regarding sex, age, number of doses, post-vaccination period and vaccine brand, and compared those results with our patient. Finally, as indicated by our case and other cases with similarly treated pustular eruptions. targeted therapy to this cytokine imbalance such as anakinra (IL-1) antagonist can improve the clinical course of the patient. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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14 pages, 963 KiB

Open AccessReview

COVID-19 Infection and Vaccination and Its Relation to Amyloidosis: What Do We Know Currently?

by Wing-Yin Leung, Henry H. L. Wu, Lauren Floyd, Arvind Ponnusamy and Rajkumar Chinnadurai

Vaccines 2023, 11(7), 1139; https://doi.org/10.3390/vaccines11071139 - 24 Jun 2023

Cited by 2 | Viewed by 14021

Abstract

Amyloidosis is a complex disorder characterized by deposited insoluble fibrillar proteins which misfold into β-pleated sheets. The pathogenesis of amyloidosis can vary but can be the result of immune dysregulation that occurs from sustained high inflammatory states, often known as AA amyloidosis. Multi-organ involvement including hepatic, gastrointestinal, renal, cardiac and immunological pathological manifestations has been observed amongst individuals presenting with amyloidosis. The recent global pandemic of severe acute respiratory syndrome coronavirus 2, also referred to as coronavirus 2019 (COVID-19), has been shown to be associated with multiple health complications, many of which are similar to those seen in amyloidosis. Though COVID-19 is recognized primarily as a respiratory disease, it has since been found to have a range of extra-pulmonary manifestations, many of which are observed in patients with amyloidosis. These include features of oxidative stress, chronic inflammation and thrombotic risks. It is well known that viral illnesses have been associated with the triggering of autoimmune conditions of which amyloidosis is no different. Over the recent months, reports of new-onset and relapsed disease following COVID-19 infection and vaccination have been published. Despite this, the exact pathophysiological associations of COVID-19 and amyloidosis remain unclear. We present a scoping review based on our systematic search of available evidence relating to amyloidosis, COVID-19 infection and COVID-19 vaccination, evaluating current perspectives and providing insight into knowledge gaps that still needs to be addressed going forward. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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Other

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14 pages, 871 KiB

Open AccessSystematic Review

Impact of Pre-Infection COVID-19 Vaccination on the Incidence and Severity of Post-COVID Syndrome: A Systematic Review and Meta-Analysis

by Milena Adina Man, Daniela Rosca, Felix Bratosin, Ovidiu Fira-Mladinescu, Adrian Cosmin Ilie, Sonia-Roxana Burtic, Ariadna Petronela Fildan, Camelia Melania Fizedean, Adelina Maria Jianu, Rodica Anamaria Negrean and Monica Steluta Marc

Vaccines 2024, 12(2), 189; https://doi.org/10.3390/vaccines12020189 - 12 Feb 2024

Cited by 1 | Viewed by 1326

Abstract

This systematic review critically evaluated the impact of a pre-infection COVID-19 vaccination on the incidence and severity of post-COVID-19 syndrome and aimed to assess the potential protective effect across different vaccines and patient demographics. This study hypothesized that vaccination before infection substantially reduces the risk and severity of post-COVID-19 syndrome. In October 2023, a comprehensive literature search was conducted across three databases, PubMed, Embase, and Scopus, focusing on studies published up to that date. Utilizing a wide array of keywords, the search strategy adhered to the PRISMA guidelines and was registered in the Open Science Framework. The inclusion criteria comprised studies focusing on patients with a breakthrough SARS-CoV-2 infection who developed post-COVID-19 syndrome. We included a total of 13 articles that met the inclusion criteria, analyzing more than 10 million patients with a mean age of 50.6 years, showing that the incidence of intensive care unit (ICU) admissions post-vaccination was as low as 2.4%, with a significant reduction in mortality risk (OR 0.66, 95% CI 0.58–0.74). The prevalence of post-COVID-19 syndrome symptoms was lower in vaccinated individuals (9.5%) compared to unvaccinated (14.6%), with a notable decrease in activity-limiting symptoms (adjusted OR 0.59, 95% CI 0.48–0.73). Vaccinated patients also showed a quicker recovery and return to work (HR 1.37, 95% CI 1.04–1.79). The pooled odds ratio of 0.77 indicates that vaccination is associated with a 23% reduction in the risk of developing post-COVID-19 syndrome (95% CI 0.75–0.79). Despite the protective effects observed, a substantial heterogeneity among the studies was noted. In conclusion, a pre-infection COVID-19 vaccination is associated with a significant reduction in the risk and severity of post-COVID-19 syndrome. However, the observed heterogeneity across studies suggests a need for further research with standardized methods to fully comprehend vaccine efficacy against long COVID. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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10 pages, 3470 KiB

Open AccessCase Report

Multisystem Inflammatory Syndrome in Children (MIS-C), Possibly Due to COVID-19 mRNA Vaccination

by Alije Keka-Sylaj, Atifete Ramosaj, Arbana Baloku, Leonora Zogaj and Petrit Gjaka

Vaccines 2023, 11(5), 956; https://doi.org/10.3390/vaccines11050956 - 06 May 2023

Cited by 2 | Viewed by 2195

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening childhood disease caused by SARS-CoV-2 infection, manifested by the persistence of fever and multi-organ dysfunction, elevated inflammatory markers, and the lack of an alternative diagnosis. It is still unknown if vaccination can precipitate or abrogate MIS-C or if a natural infection preceding or occurring at the time of vaccination plays any role. We present one case of MIS-C in a 16-year-old girl who was fully immunized against COVID-19 (Pfizer), with the second dose received three weeks prior to onset of the disease. She had no history of COVID-19 disease or contact with COVID-19 patients. At admission, she was somnolent, pale, and dehydrated, with cyanotic lips and cold extremities; she was hypotensive with tachycardia and poorly palpable pulses. Initial laboratory results revealed elevated levels of inflammatory markers, and high level of SARS-CoV-2 IgG spike antibodies, while testing for SARS-CoV-2 acute infection and other inflammatory etiologies were negative. Vaccine-related MIS-C was suspected in our case due to the development of MIS-C three weeks following the second dose of the COVID-19 mRNA vaccine, the absence of previous infection or exposure to SARS-CoV-2, and a positive result for IgG anti-spike (S) antibodies. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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7 pages, 834 KiB

Open AccessCase Report

A Case Presenting with Neuromyelitis Optica Spectrum Disorder and Infectious Polyradiculitis Following BNT162b2 Vaccination and COVID-19

by Youngho Kim, Donghyun Heo, Moonjeong Choi and Jong-Mok Lee

Vaccines 2022, 10(7), 1028; https://doi.org/10.3390/vaccines10071028 - 27 Jun 2022

Cited by 4 | Viewed by 1968

Abstract

A 37-year-old woman presented with paraparesis and paresthesia in both legs 19 and 3 days after BNT162b2 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, respectively. Cerebrospinal fluid (CSF) analysis, nerve conduction study, electromyography, magnetic resonance imaging, and autoantibody tests were performed. Neurological examination showed hyperesthesia below the T7 level and markedly impaired bilateral leg weakness with absent deep tendon reflexes on the knees and ankles. CSF examination revealed polymorphonuclear dominant pleocytosis and elevated total protein levels. Enhancement of the pia mater in the lumbar spinal cord and positive sharp waves in the lumbar paraspinal muscles indicated infectious polyradiculitis. In contrast, a high signal intensity of intramedullary spinal cord on a T2-weighted image from C1 to conus medullaris and positive anti-aquaporin-4 antibody confirmed neuromyelitis optica spectrum disorder (NMOSD). The patient received intravenous methylprednisolone, antiviral agents, and antibiotics, followed by a tapering dose of oral prednisolone and azathioprine. Two months after treatment, she was ambulatory without assistance. The dual pathomechanism of NMOSD triggered by coronavirus disease 2019 (COVID-19) vaccination and polyradiculitis caused by SARS-CoV-2 infection may have caused atypical clinical findings in our patient. Therefore, physicians should remain alert and avoid overlooking the possibilities of diverse mechanisms associated with neurological manifestations after SARS-CoV-2 infection and COVID-19 vaccination. Full article

(This article belongs to the Special Issue Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications)

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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Pustular eruption following COVID-19 vaccination: a comprehensive case-based review
Author: Karampinis
Highlights: -Pustular eruption followed by vaccination can be a challenging diagnosis including pustular psoriasis, AGEP and neutrophilic dermatosis -Similarities in reported patient and vaccination-related characteristics cannot direct further the diagnosis, making the clinical and histopathology disease features the main indicators -Targeted therapy to this cytokine imbalance such as anakinra (IL-1) antagonist can improve the clinical course of the patient

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Acute and Post-acute Sequelae of SARS-CoV-2 Infection: Focus on Systemic Complications

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