clinical presentation of covid-19 “the thousand faces disease” adit - materi papdi... · 2020....
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Clinical Presentation of Covid-19
“The Thousand Faces Disease”
PAPDI WEBINAR, 13 APRIL 2020
ADITYO SUSILO
DIVISI PENYAKIT TROPIK DAN INFEKSI, IPD
FKUI / RSCM / RSUI
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11 April 2020
CFR 8,5 %
New cases
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Indonesia
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Gugus Tugas Penanganan COVID 19
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Pathogenesis of the 1000 Faces Disease
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- ACE 2 Receptor
- Tissue Organ ??
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CYTOKINE STORM
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Vascular System
The first remarkable finding was that ACE2 was present in endothelial cells from
small and large arteries and veins in all the tissues studied.
Respiratory System / LRT / URT
Marked ACE2 immunostaining was found in type I and type II alveolar epithelial
cells in normal lungs. Bronchial epithelial cells howed weak positive
In nasal and oral mucosa and the nasopharynx, ACE2 are expressied in the
basal layer of the non-keratinizing squamous epithelium.
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Digestive System
ACE2 localization in the smooth muscle cells and endothelium of vessels from
the stomach, small intestine, colon, and in smooth muscle cells of the
muscularis mucosae and the muscularis propria. ACE2 was abundantly present
in the enterocytes of all parts of the small intestine including the duodenum,
jejunum, and ileum,
Dermal System / Skin
ACE2 was present in the basal cell layer of the epidermis extending to the
basal cell layer of hair follicles
Urinary System
Abundant staining was seen in the brush border of the proximal tubular cells
Central Nervous System / Brain
The brain only revealed endothelial and smooth muscle cell staining
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Clinical Presentation
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Subclinical
Covid & Lung
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Covid vs Dengue
Covid & Dengue
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Covid & Cardiac
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Covid & Intestine
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Covid & CNS
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Covid & Skin
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Kimball A, et al. MMWR (13)69, Apr 3 2020
Confusing Asymptomatic Covid
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Sci China Life Sci. Mar 2020
CT SCAN
LABORATORY
GGO CBC, CRP, LDH, SGOT, SGPT, CK
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A B C D E
CT scan GGO + + + + +
Leukosit , border N N N N
Trombosit N N N, border
Limfosit
Neutrofil
CRP
Procalcitonin , border
N
-
Local Experience (PAPDI WEBINAR 20/3/2020)
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Tools to not overlooked
Cong-Ying Song, et al. medRxiv preprint doi: https://doi.org/10.1101/2020.03.05.20031906.
NLR Cut Off 5.8
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Salehi S, et al. AJR 2020; 215:1–7
Tools to not overlooked
- GGO
- Bilateral Involvement
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Risk Stratification
NLR Cut Off 3.13
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Severity Evaluation
Brescia Covid-19 Calculator
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Conclusion
COVID-19 is The 1000 Faces Diseases
ACE-2 Receptor is distributed in various tissue organ
Variety of Symptoms. Not Just Respiratory.
Carefully evaluate the Clinical manifestation, Laboratory pattern, and Imaging as needed
Use Tools
Important to keep updates – Informations and facts are changing so fast
Multidisciplinary TeamWork is A MUST
And Please, Pray to Allah, God Almighty…
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Thank You