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THE SPECIAL SIGNIFICANCE OF THE DIAGNOSTIC ALGORITHM FOR THE CLINICAL MORPHOLOGY OF RESPIRATORY DISEASES IN COVID-19
Kutlikova G.M.
Kutlikova Go 'zalMuhammadjonovna - Candidate of Medical Sciences, Associate Professor, DEPARTMENT OF GENERAL PRACTICE HUNTING № 2, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: the new coronavirus SARS-CoV-2 is a single-stranded RNA-containing virus, belongs to the Coronaviridae family, belongs to the Beta-CoV B lineage. The virus is assigned to group II pathogenicity, as are some other representatives of this family (SARS-CoV virus, MERS-CoV). The SARS-CoV-2 coronavirus is presumably a recombinant virus between a bat coronavirus and an unknown coronavirus of unknown origin. The genetic sequence of SARS CoV-2 is at least 79% similar to the sequence of SARS-CoV. The article describes in detail and illustrates the features of upper respiratory tract lesions in COVID-19 patients identified during autopsies. Keywords: respiratory lesions, clinical morphology, diagnostic algorithm, COVID-19.
ОСОБОЕ ЗНАЧЕНИЕ ДИАГНОСТИЧЕСКОГО АЛГОРИТМА КЛИНИЧЕСКОЙ МОРФОЛОГИИ РЕСПИРАТОРНЫХ ЗАБОЛЕВАНИЙ ПРИ COVID-19
Кутликова Г.М.
Кутликова Гузал Мухаммаджоновна - кандидат медицинских наук, доцент, кафедра врачей общей практики № 2, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: новый коронавирус SARS-CoV-2 представляет собой одноцепочечный РНК-содержащий вирус, относится к семейству Coronaviridae, относится к линии Beta-CoV B. Вирус отнесен ко II группе патогенности, как и некоторые другие представители этого семейства (вирус SARS-CoV, MERS-CoV). Коронавирус SARS-CoV-2 предположительно является рекомбинантным вирусом между коронавирусом летучих мышей и неизвестным по происхождению коронавирусом. Генетическая последовательность SARSCoV-2 сходна с последовательностью SARS-CoV по меньшей мере на 79%. В статье подробно описаны и проиллюстрированы особенности поражения верхних дыхательных путей у больных COVID-19, выявленные при вскрытиях.
Ключевые слова: поражения органов дыхания, клиническая морфология, алгоритм диагностики, COVID-19.
UDC 616:796/799
Relevance. Late 2019 in the People's Republic of China (PRC) there was an outbreak of a new coronavirus infection with an epicenter in the city of Wuhan (Hubei province), the causative agent of which was given provisional name 2019-nCoV [6, 8].
World Health Organization (WHO) February 11, 2020 gave the official name of the infection caused by the new coronavirus - COVID-19 ("Coronavirus disease 2019") [4, 7].
International Virus Taxonomy Committee 11 February 2020assigned the official name to the causative agent of the infection - SARS-CoV-2 [3,5].The emergence of COVID-19 has put before specialists health care tasks associated with the rapid diagnosis and provision of medical care to patients [2, 6]. Currently, information about epidemiology, clinical features, prevention and treatment of this diseases are limited [4, 7].
It is known that the most common clinical manifestation the new variant of coronavirus infection is bilateral pneumonia, in 3 - 4% of patients the development of acute respiratory distress syndrome (ARDS) [1, 5]. Based on the results of serological and phylogenetic analysis coronaviruses are divided into four genera: Alphacoronavirus, Betacoronavirus, Gammacoronavirus and Deltacoronavirus. Natural hosts of most of the currently known coronaviruses are mammals [3].
Until 2002, coronaviruses were considered agents causing mild diseases of the upper respiratory tract (with extremely rare deaths). At the end of 2002, the coronavirus appeared (SARS-CoV), the SARS causative agent that causes SARS in people. This virus belongs to the genus Betacoronavirus. Natural bats serve as a reservoir for SARS-CoV, intermediate hosts - camels and Himalayan civets [6]. In total, during the epidemic period of 37 countries around the world have more than 8000 cases, of which 774 with fatal. Since 2004, new cases of SARS, caused by SARSCoV is not registered.
In 2012, the world faced the new MERS coronavirus (MERS-CoV), the causative agent of Middle East respiratory syndrome, also belonging to the genus Betacoronavirus. The main natural the reservoir of MERS-CoV coronaviruses are single humped camels (dromedaries). From 2012 to January 31, 2020, 2519 cases were registered coronavirus infection caused by the MERS-CoV virus, of which 866 ended in death. All cases of the disease geographically associated with the Arabian Peninsula (82% of cases registered in Saudi Arabia). Currently MERS-CoV continues to circulate and cause new cases of the disease [2, 6].
The novel SARS-CoV-2 coronavirus is single-stranded RNA virus, belongs to the family Coronaviridae, belongs to the line Beta-CoV B. The virus is assigned to group II pathogenicity, like some other members of this family (SARS-CoV virus, MERS-CoV). The SARS-CoV-2 coronavirus is suspected to be a recombinant virus between bat coronavirus and unknown in origin coronavirus [1,4]. Genetic SARSCoV-2 sequence is similar to SARS-CoV sequence at least 79%.
The entrance gate of the pathogen is the epithelium of the upper respiratory tract and epithelial cells of the stomach and intestines [3]. The initial stage of infection is the penetration of SARS-CoV-2 into target cells that have type II angiotensin-converting enzyme (ACE2) receptors.
ACE2 receptors are present on the cells of the respiratory tract, kidneys, esophagus, bladder, ileum, heart, central nervous system. But the main and rapidly attainable target is alveolar cells II type (AT2) lungs, which determines the development of pneumonia [5,7]. Also discusses the role of CD147 in SARS-CoV-2 cell invasion. It has been established that the dissemination of SARS-CoV-2 from the systemic blood flow or through the plate of the ethmoid bone (Lamina cribrosa) can lead to brain damage. Changes in smell (hyposmia) in a patient at an early stage of the disease may indicate damage to the central nervous system, and edema of the mucous membrane of the nasopharynx. Purpose of the study. Study of the morphology of lung lesions in COVID-19 based on analysis of autopsy data. Materials and research methods. Investigated the results of 200 autopsies (121 deceased men and 79 women; mean age 68.5 ± 15.63 years), a unique number of autopsies for COVID-19, held in Moscow from March 20 to May 22, 2020.
Research results. Specific to COVID-19 pathological changes in the lungs, different in their prevalence, were identified in all the deceased and consisted in the development of diffuse alveolar damage (DAP) in combination with vascular damage the bed of the lungs (microangiopathy, thrombosis, in some cases destructive-productive vasculitis) and alveolar-hemorrhagic syndrome, mainly in the first, exudative, phase of DAP. Such viral interstitial pneumonia with vascular and hemorrhagic component and was a morphological substrate of ARDS.
Clinical manifestations of acute respiratory infection (body temperature above 37.5 ° C and one or more signs: cough, dry or with scanty sputum, shortness of breath, chest congestion cell, blood oxygen saturation according to pulse oximetry data, pain in throat, runny nose and other catarrhal symptoms, weakness, headache, anosmia, diarrhea) in the presence of at least one of the epidemiological signs:
- return from a foreign trip 14 days before the appearance symptoms;
- having close contacts in the last 14 days with a person, monitored for COVID-19, which subsequently got sick;
- having close contacts in the last 14 days with a person who laboratory confirmed diagnosis of COVID-19;
- work with patients with confirmed and suspicious cases of COVID-19.
The presence of clinical manifestations of severe pneumonia, with characteristic changes in the lungs according to computed tomography or plain chest x-ray (see paragraph 3.1 and Appendix 1 of these recommendations) regardless of the results of a single laboratory test for the presence of RNA SARS-CoV-2 and epidemiological history.
A suspicious case of COVID-19 if it is impossible to conduct laboratory research for the presence of SARS-CoV-2 RNA.
Conclusion. Revealed pathomorphological features inflammatory process in COVID-19 (priority of endothelial damage with micro- and macrothrombus formation, relatively late development of the exudative phase of inflammation and a tendency to develop pulmonary fibrosis) predetermine a longer duration of therapy and the need for respiratory rehabilitation, mainly aimed at pulmonary recruitment.
At the same time, the results obtained raise a number of relevant questions about the feasibility and duration of the use of a number medicines.
References / Список литературы
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