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
11 April 2020
New cases

CFR 8,5 %
Indonesia
Gugus Tugas Penanganan COVID 19
Pathogenesis of the 1000 Faces Disease
- ACE 2 Receptor

- Tissue Organ ??
CYTOKINE STORM
 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.
 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
Clinical Presentation
 Covid & Lung

Subclinical
Covid &
vs Dengue
Dengue
Covid & Cardiac
Covid & Intestine
Covid & CNS
Covid & Skin
Confusing Asymptomatic Covid

Kimball A, et al. MMWR (13)69, Apr 3 2020

 CT SCAN GGO
LABORATORY CBC, CRP, LDH, SGOT, SGPT, CK

Sci China Life Sci. Mar 2020

Local Experience (PAPDI WEBINAR 20/3/2020)
A B C D E

CT scan GGO + + + + +

Leukosit , border N N N N

Trombosit N  N N, border 

Limfosit     

    
Neutrofil

CRP     

, border  
Procalcitonin N -
Tools to not overlooked

NLR Cut Off 5.8

Cong-Ying Song, et al. medRxiv preprint doi: https://doi.org/10.1101/2020.03.05.20031906.

 Tools to not overlooked

- GGO
- Bilateral Involvement

Salehi S, et al. AJR 2020; 215:1–7

 Risk Stratification

NLR Cut Off 3.13

Severity Evaluation Brescia Covid-19 Calculator
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…

Thank You