A new research paper discusses the association of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with morbilliform skin rash. These findings also provided evidence of the early circulation of SARS-CoV-2 in Northern Italy prior to the start of the coronavirus disease 2019 (COVID-19) pandemic.
Introduction
In December 2019, SARS-CoV-2 was first isolated in China following reports of hospitalized patients experiencing atypical pneumonia. Soon after, molecular evolutionary experiments revealed that SARS-CoV-2 likely spilled over to humans from a bat reservoir; however, its original spillover mechanism remains debatable.
Despite the lack of a definitive timeline on when SARS-CoV-2 initially emerged, previous evolutionary studies indicate that the virus likely circulated in China for several months before the first outbreak was recorded in Wuhan, China. Soon after, an increasing number of cases were reported in several European and North American countries by mid-January 2020.
Italy was the first European country to report sustained SARS-CoV-2 community transmission. This country subsequently became the epicenter of the epidemic in Europe, with Lombardy being the most affected.
The SARS-CoV-2 strain that circulated in Lombardy, as well as much of Europe soon after its initial detection in Italy, differed from the Wuhan-Hu-1 strain, which was the reference genome originally identified in China. In fact, some of the different mutations present within this strain included A23403G (Spike D614G), C14408T (RdRp P323L), and C3037T (synonymous). This strain, which has since been named B.1 in Pangolin and 20A in NextStrain, is often referred to as the DG1111 haplotype and comprises an αβ mutational signature.
Several studies suggest that SARS-CoV-2 was circulating in many nations prior to its official detection. In fact, SARS-CoV-2 ribonucleic acid (RNA) has been detected in wastewater samples obtained in Brazil and Northern Italy in 2019.
SARS-CoV-2 was also detected in the respiratory samples of a French patient with hemoptysis, the lungs and blood of a patient in Milan who died of acute circulatory insufficiency, and oropharyngeal swabs of a Lombardy child with suspected measles in December 2019. Viral RNA and antigens have also been detected in paraffin-embedded skin biopsies of women in Milan with dermatosis in November 2019.
Several skin manifestations have been reported in patients diagnosed with COVID-19. These manifestations can occur at any stage of the disease.
In addition to the variable duration, prognosis, and severity of these dermatological effects, these symptoms can even occur in the absence of the common respiratory symptoms of COVID-19, thus causing diagnosis to be even more challenging.
In 2019, suspected measles and rubella cases were two times higher as compared to the average of the previous two years. Moreover, the percentage of suspected cases that tested negative increased from 30% to 70% during the first wave of the pandemic and 100% by 2021.
The increased incidence of both measles and rubella, combined with the skin manifestations associated with COVID-19, led the researchers of the current study to investigate whether COVID-19 could cause morbilliform skin eruptions.
Conclusion
The current study confirms that SARS-CoV-2 was circulating in Northern Italy by late 2019, as confirmed by the presence of SARS-CoV-2 genetic material in several urine and oropharyngeal swab samples. Importantly, none of the samples that tested positive for SARS-CoV-2 were obtained from patients with a history of international travel.
The study findings also suggest an association between morbilliform eruptions and SARS-CoV-2 infection. However, future studies are needed to better understand the relationship between this type of skin rash and COVID-19.
Future retrospective studies in areas with early SARS-CoV-2 circulation that utilize metagenomic methods are needed to accurately determine the evolutionary history and time of SARS-CoV-2 emergence.
Source:
https://www.news-medical.net/news/20220830/Italian-study-finds-SARS-CoV-2-in-clinical-samples-collected-before-December-2019.aspx