Abstract
The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision,
but increasing information suggests some analogies with the major viral outbreaks
in the last century, and a general warning has been issued on the possibility that
coinfections can make the differential diagnosis and treatment difficult, especially
in tropical countries. Some reports have noted that the presence of high dengue antibodies
can give a false-negative result when testing for severe acute respiratory syndrome
coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap
among different pathogens. However, strong clinicopathologic correlation might provide
some clues to address differentials. Waiting for laboratory and instrumental results,
the timing and distribution of skin lesions is often pathognomonic. Histopathologic
findings characterize certain reaction patterns and provide insights on pathogenetic
mechanisms. Unfortunately, skin assessment, especially invasive examinations such
as biopsy, takes a back seat in severely ill patients. A literature retrieval was
performed to collect information from other epidemics to counteract what has become
the most frightening disease of our time.
Abbreviation:
(COVID-19) (coronavirus 2019 disease), (WHO) (World Health Organization), (SARS) (severe acute respiratory syndrome coronavirus), (Sars-Cov-2) (novel coronavirus), (MERS) (Middle East Respiratory Syndrome), (R0) (basic reproductive number), (MIS) (multisystem inflammatory syndrome), (IgA) (immunoglobulin A), (ACE-2) (Angiotensin‐converting enzyme 2), (DENGV) (Dengue virus), (TTP) (thrombotic thrombocytopenic purpura), (vWF) (von Willebrand factor), (CD1a) (cluster of diffentiation 1-a), (RT-PCR) (reverse transcription polymerase chain reaction), (CHIKV) (Chikungunya virus), (E1, E2) (envelope glycoprotein), (IFN-I) (interferon-type-I), (ZIKV) (Zika virus), (EBOV) (Ebola virus)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinics in DermatologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- What can we learn from previous pandemics to reduce the frequency of emerging infectious diseases like COVID-19?.Glob Transit. 2020; 2: 202-220
- Emergent diseases in emergent countries: we must study viral ecology to prevent new epidemics.Braz J Infect Dis. 2016; 20: 403-404
- Developing vaccines for SARS-CoV-2 and future epidemics and pandemics: applying lessons from past outbreaks.Health Secur. 2020; 18: 241-249
- Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics.Lancet Infect Dis. 2020; 20: e238-e244
Adhanom T. WHO Director-General's opening remarks at the media briefing on COVID-19—11 March 2020. World Health Organization. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020. Accessed May 2, 2021.
European Centre for Disease Prevention and Control. Novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK—sixth update 2020, 20 March 2020. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf. Accessed May 2, 2021.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) 2019. Available at: https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed May 2, 2021.
Coronavirus Resource Center of the John Hopkins University. COVID-19 Dashboard by the Center for Systems Science for Engineering (CSSE) at Johns Hopkins University (JHU). Available at: https://coronavirus.jhu.edu/map.html. Accessed May 2, 2021.
- Viral exanthems.Curr Opin Infect Dis. 2015; 28: 139-150
- Lessons from dermatology about inflammatory responses in Covid-19.Rev Med Virol. 2020; 30: e2130
- Contemporary infectious exanthems: an update.Future Microbiol. 2017; 12: 171-193
- The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned?.Int J Epidemiol. 2020; 49: 717-726
- COVID-19, SARS and MERS: are they closely related?.Clin Microbiol Infect. 2020; 26: 729-734
- The novel zoonotic COVID-19 pandemic: an expected global health concern.J Infect Dev Ctries. 2020; 14: 254-264
- SARS-CoV, Mers-CoV and COVID-19: what differences from a dermatological viewpoint?.J Eur Acad Dermatol Venereol. 2020; 34: e581-e582
- Insight into 2019 novel coronavirus—an updated interim review and lessons from SARS-CoV and MERS-CoV.Int J Infect Dis. 2020; 94: 119-124
- Emerging coronaviruses: genome structure, replication, and pathogenesis.J Med Virol. 2020; 92: 418-423
- The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2.Nat Microbiol. 2020; 5: 536-544
- Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan.Emerg Microbes Infect. 2020; 9: 221-236
- Pathological findings of COVID-19 associated with acute respiratory distress syndrome.Lancet Respir Med. 2020; 8: 420-422
- A comprehensive literature review on the clinical presentation, and management of the pandemic coronavirus disease 2019 (COVID-19).Cureus. 2020; 12: e7560
- Dysregulation of immune response in patients with COVID-19 in Wuhan, China.Clin Infect Dis. 2020; 71: 762-768
World Health Organization. Weekly epidemiological update. Available at. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200928-weekly-epi-update.pdf?sfvrsn=9e354665_6. Accessed May 2, 2021.
- Cutaneous manifestations in SARS-CoV-2 infection (COVID-19): a French experience and a systematic review of the literature.J Eur Acad Dermatol Venereol. 2020; 34: e686-e689
- Clinical characteristics of coronavirus disease 2019 in China.N Engl J Med. 2020; 382: 1708-1720
- Cutaneous manifestations in COVID-19: a first perspective.J Eur Acad Dermatol Venereol. 2020; 34: e212-e213
- Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.Br J Dermatol. 2020; 183: 71-77
- COVID-19 and cutaneous manifestations: a systematic review.J Eur Acad Dermatol Venereol. 2020; 34: 2505-2510
- The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries.J Am Acad Dermatol. 2020; 83: 1118-1129
- Cutaneous signs in COVID-19 patients: a review.Dermatol Ther. 2020; 33: e13549
- Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms.Inflamm Res. 2020; 69: 745-756
- Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue.Br J Dermatol. 2020; 183: 431-442
- Clinical and histopathological features and potential pathological mechanisms of skin lesions in COVID-19: review of the literature.Dermatopathology (Basel). 2020; 7: 3-16
- Cutaneous manifestations and considerations in COVID-19 pandemic: a systematic review.Dermatol Ther. 2020; 33: e13986
- Hyperinflammatory shock in children during COVID-19 pandemic.Lancet. 2020; 395: 1607-1608
- Special dermatological presentation of paediatric multisystem inflammatory syndrome related to COVID-19: erythema multiforme.BMJ Case Rep. 2020; 13e236986
- An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study.Lancet. 2020; 395: 1771-1778
- Acral cutaneous lesions in the time of COVID-19.J Eur Acad Dermatol Venereol. 2020; 34: e346-e347
- Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients.Eur Acad Dermatol Venereol. 2020; 34: e291-e293
- Chilblains is a common cutaneous finding during the COVID-19 pandemic: a retrospective nationwide study from France.J Am Acad Dermatol. 2020; 83: 667-670
- A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection.J Eur Acad Dermatol Venereol. 2020; 34: 2620-2629
- Histologic features of long-lasting chilblain-like lesions in a pediatric COVID-19 patient.J Eur Acad Dermatol Venereol. 2020; 34: e365-e368
- Coronavirus (COVID-19) infection-induced chilblains: a case report with histopathologic findings.JAAD Case Rep. 2020; 18: 489-492
- Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus..J Pathol. 2004; 203: 631-637
- SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases.Br J Dermatol. 2020; 183: 729-737
- Assessment of acute acral lesions in a case series of children and adolescents during the COVID-19 pandemic.JAMA Dermatol. 2020; 156: 992-997
- No evidence of SARS-CoV-2 infection by polymerase chain reaction or serology in children with pseudo-chilblain.Br J Dermatol. 2020; 183: 784-785
- Evaluation of chilblains as a manifestation of the COVID-19 pandemic.JAMA Dermatol. 2020; 156: 998-1003
- Are chilblain-like acral skin lesions really indicative of COVID-19? A prospective study and literature review.J Eur Acad Dermatol Venereol. 2020; 34: e445-e447
- Thrombotic occlusive vasculopathy in skin biopsy from a livedoid lesion of a COVID-19 patient.Br J Dermatol. 2020; 183: 591-593
- Acro-ischaemia in hospitalized COVID-19 patients.J Eur Acad Dermatol Venereol. 2020; 34: e455-e457
- Late onset of acral necrosis after SARS-CoV-2 infection resolution.J Eur Acad Dermatol Venereol. 2020; 34: e448-e449
- [Acral ischaemia with multiple microthromboses and imminent gangrene in a 73-year-old woman with COVID-19].Ugeskr Laeger. 2020; 182 (V05200379 [in Danish])
- A generalized purpuric eruption with histopathologic features of leucocytoclastic vasculitis in a patient severely ill with COVID-19.J Eur Acad Dermatol Venereol. 2020; 34: e579-e581
- Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases.Transl Res. 2020; 220: 1-13
- Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients.J Thromb Thrombolysis. 2020; 50: 580-586
- [Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia].Zhonghua Xue Ye Xue Za Zhi. 2020; 41 ([in Chinese]): 302-307
- Introductory histopathological findings may shed light on COVID-19 paediatric hyperinflammatory shock syndrome.J Eur Acad Dermatol Venereol. 2020; 34: e665-e667
- Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital.Clin Exp Dermatol. 2020; 45: 872-875
- Comment on ‘Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital.’ Pseudo herpetic Grover disease seems to appear in patients with COVID-19 infection.Clin Exp Dermatol. 2020; 45: 896-898
- Histology of skin lesions establishes that the vesicular rash associated with COVID-19 is not ‘varicella-like.’.J Eur Acad Dermatol Venereol. 2020; 34: e559-e561
- High expression of ACE2 on keratinocytes reveals skin as a potential target for SARS-CoV-2.J Invest Dermatol. 2021; 141: 206-209.e1
- SARS-CoV-2 PCR testing of skin for COVID-19 diagnostics: a case report.Lancet. 2020; 396: 598-599
- COVID-19 chilblain-like lesion: immunohistochemical demonstration of SARS-CoV-2 spike protein in blood vessel endothelium and sweat gland epithelium in a polymerase chain reaction-negative patient.Br J Dermatol. 2020; 183: 778-780
- Insights from unusual aspects of the 1918 influenza pandemic.Travel Med Infect Dis. 2015; 13: 217-222
- Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis.Lancet. 2006; 368: 2211-2218
- Dating the emergence of pandemic influenza viruses.Proc Natl Acad Sci U S A. 2009; 106: 11709-11712
- Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus.Proc Natl Acad Sci U S A. 2014; 111: 8107-8112
- Pathogenic responses among young adults during the 1918 influenza pandemic.Emerg Infect Dis. 2012; 18: 201-207
- Is antigenic sin always “original?” Re-examining the evidence regarding circulation of a human H1 influenza virus immediately prior to the 1918 Spanish Flu.PLoS Pathog. 2015; 11e1004615
- Association between the 2008-09 seasonal influenza vaccine and pandemic H1N1 illness during Spring-Summer 2009: four observational studies from Canada.PLoS Med. 2010; 7e1000258
- Clinical manifestations of pandemic (H1N1) 2009 in the ambulatory setting.J Infect Dev Ctries. 2011; 5: 658-663
- Observations on influenza and its complications.BMJ. 1919; 1: 3-5
- Influenzo-pneumococcal and influenzo-streptococcal septicaemia: epidemic influenzal “pneumonia” of highly fatal type and its relation to “purulent bronchitis.”.Lancet. 1919; 193: 1-11
- History of the Great War based on official documents. Medical services.Diseases of the war. 1923; 2: 1-621
- The pathology of influenza virus infections.Annu Rev Pathol. 2008; 3: 499-522
- Pandemic influenza and secondary pneumonia at camp Fremont, Calif.JAMA. 1918; 71: 2138-2144
- Coinfection, coepidemics of COVID-19, and dengue in dengue-endemic countries: a serious health concern.J Med Virol. 2021; 93: 161-162
- COVID-19 can present with a rash and be mistaken for dengue.J Am Acad Dermatol. 2020; 82: e177
- Diagnosis of COVID-19 in a dengue-endemic area.Am J Trop Med Hyg. 2020; 103: 1220-1222
- Silva Junior GBD. Thrombotic thrombocytopenic purpura associated with dengue and chikungunya virus coinfection: case report during an epidemic period.Rev Inst Med Trop Sao Paulo. 2018; 60: e48
- Fatal case of chikungunya and concomitant thrombotic thrombocytopenic purpura in French Guiana during air flight medical evacuation.J Travel Med. 2017; 24 (10.1093/jtm/tax028)
- Dengue virus infection triggering thrombotic thrombocytopenic purpura in pregnancy.Am J Trop Med Hyg. 2015; 93: 1028-1030
- Manifestações neurológicas de dengue: estudo de 41 casos [Neurological manifestations of dengue: study of 41 cases].Arq Neuropsiquiatr. 2005; 63 ([in Portuguese]): 488-493
- Diagnosis and management of dengue.BMJ. 2009; 339: b4338
- Dengue and aplastic anemia: a rare association.Travel Med Infect Dis. 2009; 7: 118-120
- A dengue infection without bleeding manifestation in an adult with immune thrombocytopenic purpura.Trop Med Health. 2016; 44: 36
- Clinical features of 62 imported cases of dengue fever in Japan.Am J Trop Med Hyg. 2006; 75: 470-474
- Cutaneous manifestations in patients of dengue fever.J Pak Assoc Dermatol. 2012; 22: 320-324
- Mucocutaneous manifestations of dengue fever.Indian J Dermatol. 2010; 55: 79-85
- Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory features: application of logistic regression analysis.J Clin Virol. 2006; 35: 147-153
- Dermatological manifestations of dengue fever.J Ayub Med Coll Abbottabad. 2012; 24: 52-54
- Clinical significance of skin rash in dengue fever: a focus on discomfort, complications, and disease outcome.Asian Pac J Trop Med. 2016; 9: 713-718
- A florid skin rash in a returning traveller.Clin Exp Dermatol. 2007; 32: 779-781
- Human skin Langerhans cells are targets of dengue virus infection.Nat Med. 2000; 6: 816-820
- Skin histopathology and immunopathology are not of prognostic value in dengue haemorrhagic fever.Br J Dermatol. 2008; 158: 836-837
- Systemic infections mimicking thrombotic thrombocytopenic purpura.Am J Hematol. 2011; 86: 743-751
- Dengue, zika and chikungunya: emerging arboviruses in the new world.West J Emerg Med. 2016; 17: 671-679
- Infection with chikungunya virus in Italy: an outbreak in a temperate region.Lancet. 2007; 370: 1840-1846
- Prevalence of asymptomatic zika virus infection: a systematic review.Bull World Health Organ. 2018; 96: 402-413D
- Cutaneous manifestations of chikungunya fever: observations from an outbreak at a tertiary care hospital in southeast Rajasthan, India.Indian Dermatol Online J. 2017; 8: 336-342
- Experience of perinatal and neonatal chikungunya virus (CHIKV) infection in a tertiary care neonatal centre during outbreak in north India in 2016: a case series.J Trop Pediatr. 2019; 65: 169-175
- Chikungunya in infants and children: is pathogenesis increasing?.Viruses. 2019; 11: 294
- Atypical mucocutaneous manifestations in neonates and infants with chikungunya fever in the municipalities of Cúcuta, Los Patios and Villa del Rosario, Norte de Santander, Colombia, 2014..Biomedica. 2016; 36 ([in Spanish]): 368-377
- Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India.Int J Dermatol. 2008; 47: 154-159
- Resurgence of chikungunya.Trans R Soc Trop Med Hyg. 2008; 102: 308-309
- Cutaneous manifestations of chikungunya during a recent epidemic in Clicut, north Kerala, south India.Indian J Dermatol Venereol Leprol. 2010; 76: 671-676
- Cutaneous manifestations of chikungunya fever.Indian Pediatr. 2012; 49: 51-53
- Unusual facial melanosis in viral fever.Indian J Dermatol. 2007; 52: 116-117
- Immunoglobulin therapy in a patient with severe chikungunya fever and vesiculobullous lesions.Front Immunol. 2019; 10: 1498
- Chikungunya associated with cutaneous ulcerations.Clin Exp Dermatol. 2008; 33: 463-464
- Isolated nail pigmentation associated with chikungunya: a hitherto unreported manifestation.Skin Appendage Disord. 2018; 4: 312-314
- Tropism of the chikungunya virus..Viruses. 2019; 11: 175
- Chikungunya fever presenting as life threatening thrombotic thrombocytopenic purpura.J Assoc Physicians India. 2017; 11765: 96-100
- The European Zika Surveillance Network. Surveillance of Zika virus infection in the EU/EEA, June 2015 to January 2017.Euro Surveill. 2017; 22: 17-00254
- Sexual transmission of Zika virus and other flaviviruses: a living systematic review.PLoS Med. 2018; 15e1002611
- Zika virus and sexual transmission: a new route of transmission for mosquito-borne flaviviruses.Yale J Biol Med. 2017; 90: 325-330
- Implication of sexual transmission of Zika on dengue and Zika outbreaks.Math Biosci Eng. 2019; 16: 5092-5113
- Investigating the sexual transmission of Zika virus.Lancet Glob Health. 2018; 6: e24-e25
- Cutaneous manifestations of the Zika virus.J Am Acad Dermatol. 2016; 74: 1286-1287
- Cutaneous manifestations of Zika.J Cutan Med Surg. 2020; 24: 220
- Cutaneous manifestations of Zika in Peru.J Cutan Med Surg. 2020; 24: 33-40
- Cutaneous features of Zika virus infection: a clinicopathological overview.Clin Exp Dermatol. 2019; 44: 13-19
- Cutaneous manifestations of filovirus infections.Int J Dermatol. 2012; 51: 1037-1043
- The next epidemic—lessons from Ebola.N Engl J Med. 2015; 372: 1381-1384
- The Ebola outbreak, 2013-2016: old lessons for new epidemics.Philos Trans R Soc Lond B Biol Sci. 2017; 37220160297
- Case fatality rate for Ebola virus disease in west Africa.Lancet. 2014; 384: 1260
- Fruit bats as reservoirs of Ebola virus.Nature. 2005; 438: 575-576
- Cutaneous manifestations of the Ebola virus.Dermatol Online J. 2015; 21 (13030/qt7429f9vf)
- Ebola hemorrhagic fever in Kikwit, Democratic Republic of Congo: clinical observations in 103 patients.J Infect Dis. 1999; 1: S1-S7
- Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses.J Pathol. 2015; 235: 153-174
- A novel immunohistochemical assay for detection of Ebola virus in skin: implications for diagnosis, spread, and surveillance of Ebola hemorrhagic fever.J Infect Dis. 1999; 179: S36-S47
- COVID-19: a critical care perspective informed by lessons learnt from other viral epidemics.Anaesth Crit Care Pain Med. 2020; 39: 163-166
Article info
Publication history
Published online: June 17, 2021
Footnotes
Founds: None
Copyright: The authors certify that the manuscript is original, never submitted to other journal for publication before. All authors contributed equally to the manuscript and had the opportunity to revise and approve the final text.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
