key: cord-0878490-id1kdyvf
authors: Cicco, Sebastiano; Vacca, Angelo; Cittadini, Antonio; Marra, Alberto M.
title: Long-Term Follow-Up May be Useful in Coronavirus Disease 2019 Survivors to Prevent Chronic Complications
date: 2020-07-21
journal: Infect Chemother
DOI: 10.3947/ic.2020.52.3.407
sha: 8ae504cd21d119cc530bfca2031e570c833243c8
doc_id: 878490
cord_uid: id1kdyvf

nan

These findings are at some extent similar to lung biopsies of non-specific interstitial pneumonia (NSIP) or autoimmune interstitial lung disease (ILD) [6] . Moreover, despite both need high-flow oxygen, the COVID-19 patient presents an increased ventilation compliance [2] , and ventilation outcome seems to be similar to pneumonia respiratory failure in ILD [7] . According to the previous severe acute respiratory syndrome (SARS), the first coronavirus lung fatal infection known, some further considerations should be add. Clinical observation from patients affected by SARS, reports an increase of lung fibrosis after recovery from the infection [8] . In these patients, the hyperactivation of epidermal growth factor receptor signalling has been indicated in response to the acute lung injury [9] . In SARS infected mice, immune response appears affected by a Th2 bias as a result in deficiency of IFN production due to signal transducer and activator of transcription 1 deficiency. These mice are also prone to fibrosis as a consequence of infection [9] . Moreover, recent data had indicated that patients with ILD other than idiopathic pulmonary fibrosis (IPF) have a subsequent clinical course similar to patients with untreated IPF [6] . In this prospective, an early detection of ILD may be useful for a better treatment and prognosis.

On the other hand, venous thromboembolism (both as deep vein thrombosis and pulmonary embolism) may often complicate COVID-19 [10] . Speculation on an activation of coagulation process directly in pulmonary capillaries may be possible. The micro-thrombi in small lung capillaries might lead to a small vessels vasculopathy through hyperperfusion of nonobstructed lung segments, as in chronic thromboembolic pulmonary hypertension (CTEPH).

The immunological and clinical alterations are red flags for the future. The spread of COVID-19 in general population may be a trigger for an increase in lung rare disease such as NSIP or CTEPH (Fig. 1) . It is reasonable to expect chronic complications in COVID-19 survivors and a long-term follow-up of patients may be something to take into consideration. Due to the 408 https://icjournal.org https://doi.org/10.3947/ic.2020.52.3.407

The need of a follow-up for COVID19 complications multiorgan involvement in COVID-19, multi-disciplinary team (including internist, infectious disease specialist, immunologist, pulmonologist, and cardiologist) is mandatory for an adequate follow-up and treatment. Despite all patients might need controls after remission, it could be reasonable to be stricter on patients recovered after a moderate-to-severe form of this disease or those who will present a reduced lung capacity during efforts. The results may be particularly important considering the asymptomatic patients and women, because their follow-up could be the key in better understand and treat COVID-19 and lung rare diseases.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

COVID-19 pneumonia: different respiratory treatments for different phenotypes?

A pathological report of three COVID-19 cases by minimally invasive autopsies

Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19

The natural history of progressive fibrosing interstitial lung diseases

Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

Correlation of high-resolution CT, symptoms, and pulmonary function in patients during recovery from severe acute respiratory syndrome

The role of epidermal growth factor receptor (EGFR) signaling in SARS coronavirus-induced pulmonary fibrosis

Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels

The authors thanks to dr. Christel Cariddi, Department of Anaesthesia, University of Bari Aldo Moro, for her precious support and fruitful discussions.