COVID-19: респираторная инфекция, вызванная новым коронавирусом: новые данные об эпидемиологии, клиническом течении, ведении пациентов

Белоцерковская Ю.Г., Романовских А.Г., Смирнов И.П. COVID-19: респираторная инфекция, вызванная новым коронавирусом: новые данные об эпидемиологии, клиническом течении, ведении пациентов. Consilium Medicum. 2020; 22 (3): 12–20. DOI: 10.26442/20751753.2020.3.200092

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Belotserkovskaia Yu.G., Romanovskikh A.G., Smirnov I.P. COVID-19: a respiratory infection caused by new coronavirus: new data on epidemiology, clinical course, and patients management. Consilium Medicum. 2020; 22 (3): 12–20. DOI: 10.26442/20751753.2020.3.200092

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Аннотация

В настоящее время весь мир переживает пандемию новой коронавирусной инфекции COVID-19, вызванной вирусом SARS-CoV-2. Анализ генома SARS-CoV-2 показал значительное сходство с ранее идентифицированным штаммом коронавируса, который вызвал вспышку атипичной пневмонии или тяжелого острого респираторного синдрома в 2003 г. Все возрастные группы восприимчивы к вирусу, при этом пожилые пациенты с сопутствующими заболеваниями более подвержены тяжелому течению болезни. Основные клинические проявления – лихорадка, кашель, астения. Часть пациентов характеризуются одышкой и гипоксемией, которые могут быстро (в течение 1 нед) прогрессировать с развитием острого респираторного дистресс-синдрома, септического шока, метаболического ацидоза, нарушения коагуляционной функции и синдрома полиорганной дисфункции. Всем пациентам для уточнения диагноза и наблюдения за развитием болезни рекомендуется выполнять компьютерную томографию органов грудной клетки. Рентгенография органов грудной клетки обладает недостаточной информативностью, а потому ее выполнение нецелесообразно.
В большинстве случаев изменения в легочной ткани характеризуются множественными участками уплотнения легочной ткани по типу «матового стекла» и интерстициальными изменениями. К сожалению, в настоящее время не получено данных об убедительной эффективности какого-либо противовирусного лечения. Для своевременного выявления признаков тяжелого течения и осложнений необходим постоянный мониторинг жизненно важных показателей и лабораторных показателей. Изучаются наиболее значимые факторы риска тяжелого, прогрессирующего течения и неблагоприятного исхода. В настоящем обзоре представлены известные эпидемиологические данные, особенности диагностики и клинического течения, факторы риска неблагоприятного исхода, возможности этиотропного и патогенетического лечения и профилактики.

Ключевые слова: острые респираторные инфекции, новый коронавирус, COVID-19, SARS-CoV-2.

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At present time there is an ongoing pandemic of a new coronavirus COVID-19 infection caused by SARS-CoV-2 virus. The analysis of SARS-CoV-2 genome showed significant similarity to formerly identified coronavirus strain that caused a breakout of atypical pneumonia or severe acute respiratory syndrome in 2003. All group ages were vulnerable to the virus, but senior patients with multiple comorbid disorders were more susceptible to severe disease course development. Main clinical symptoms include fever, cough, and asthenia. Some patients develop shortness of breath and hypoxemia that can quickly (in 1 week) progress to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulation dysfunction, and multisystemic dysfunction syndrome. It is recommended to perform chest computer tomography in all patients for diagnosis establishment and in disease course follow-up. As chest X-ray lacks informational value, its use is unreasonable. In most cases pulmonary tissue changes are characterized with multiple areas of tissue induration called ground-glass opacity and interstitial changes. Unfortunately, at present there is no convincing data on effectiveness of any antiviral treatment. Constant monitoring of vital parameters and laboratory findings is required for timely detection of signs of severe course and complications development. The most significant factors of severe progressive disease course and unfavorable outcome are being studied. The present review includes available epidemiological data, characteristic features of diagnostics and clinical course, unfavorable outcome risk factors, and possibilities of etiotropic and pathogenic treatment and prevention.

Key words: acute respiratory infections, new coronavirus, COVID-19, SARS-CoV-2.

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[Prilozhenie k pis'mu Rospotrebnadzora ot 25.01.2020 №02/877-2020-27. Predvaritel'nye rekomendatsii po preduprezhdeniiu rasprostraneniia novoi koronavirusnoi infektsii (2019-nCoV) v meditsinskikh organizatsiiakh (in Russian).]

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1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle [published January 16, 2020]. J Med Virol 2020. DOI: 10.1002/jmv.25678
2. Wuhan Municipal Health Commission. Report of clustering pneumonia of unknown etiology in Wuhan City. Published December 31, 2019. Accessed January 31, 2020. http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989
3. Zhu N, Zhang D, Wang W et al. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019 [published January 24, 2020]. N Engl J Med 2020; 382: 727–33. DOI: 10.1056/NEJMoa2001017
4. World Health Organization. Novel coronavirus (2019-nCoV): situation report – 39. Accessed February 28, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200228-sitrep-39-covid-19.p...
5. Chen N, Zhou M, Dong X et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study [published January 29, 2020]. Lancet 2020. DOI: 10.1016/S0140-6736(20)30211-7
6. Van Doremalen N, Bushmaker T, Morris DH et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020 Mar 17. DOI: 10.1056/NEJMc2004973
7. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China. Lancet 2020.
8. Zhang H, Kang Z, Gong H et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. bioRxiv 2020. https://doi.org/10.1101/2020.01.30.927806
9. Cheng-wei Lu, Xiu-fen Liu, Zhi-fang Jia. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet 2020; 395 (10224): e39. DOI: 10.1016/S0140-6736(20)30313-5
10. Mahase E. China coronavirus: what do we know so far? BMJ 2020; 368: m308.
11. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet 2020; 395. Issue 10225: 689–97.
12. Lu R, Zhao X, Li J et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020. DOI: 10.1016/S0140-6736(20)30251-8
13. Sahrabi C et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surgery 2020. https://doi.org/10.1016/j.ijsu.2020.02.034
14. Kannan S et al. COVID-19 (Novel Coronavirus 2019) - recent trends. Eur Rev Med Pharmacol Sci 2020; 24 (4): 2006–11. DOI: 10.26355/eurrev_202002_20378
15. Cascella M, Rajnik M, Cuomo A et al. Features, Evaluation and Treatment Coronavirus (COVID-19). Last Update: March 20, 2020. https://www.ncbi.nlm.nih.gov/books/NBK554776/
16. WHO. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Geneva: WHO; 2020. [Accessed on 1 March 2020.] https://www.who.int/docs/default-source/ coronaviruse/who-china-joint-mission-on-covid-19-nal-report.pdf
17. Korea Centers for Disease Control & Prevention (KCDC). The updates of COVID-19 in Republic of Korea as of 26 February, 2020. Osong, Republic of Korea: KCDC; 2020. [Accessed on 1 March 2020.] https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030&act=view&list_no=366352
18. Wang D, Hu B, Hu C et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020.
19. Qingmei H, Qingqing L, Shenhe J, Liangshun Y. Recent insights into 2019-nCoV: a brief but comprehensive review. J Infect 2020. DOI: https://doi.org/10.1016/j.jinf.2020.02.010
20. Commun Dis Intell 2020; 44. https://doi.org/10.33321/cdi.2020.44.14
21. Dawei Wang et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus – Infected Pneumonia in Wuhan, China. JAMA 2020. DOI: 10.1001/jama.2020.1585
22. Ai T, Yang Z, Hou H et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020: 200642. DOI: 10.1148/radiol.2020200642
23. Lin X et al. Novel Coronavirus Pneumonia Outbreak in 2019: Computed Tomographic Findings in Two Cases. Korean J Radiol 2020; 21 (3): 365–8. DOI: 10.3348/kjr.2020.0078. Epub 2020 Feb 11.
24. Wei J et al. 2019 Novel Coronavirus (COVID-19) Pneumonia: Serial Computed Tomography Findings. Korean J Radiol 2020. https://doi.org/10.3348/kjr.2020.0112
25. Bernheim A, Mei X, Huang M et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology 2020; p. 200463. doi: 10.1148/radiol.2020200463
26. Rodrigues JCL et al. An update on COVID-19 for the radiologist - A British society of Thoracic Imaging statement, Clinical Radiology. https://doi.org/10.1016/j.crad.2020.03.003
27. Wei Liu et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chinese Med J 2020. DOI: 10.1097/CM9.0000000000000775
28. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19). China, 2020. China CDC Weekly. Accessed February 20, 2020. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51
29. Yang J et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis 2020. DOI: https://doi.org/10.1016/j.ijid.2020.03.017
30. Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (2019-nCoV). Vremennye metodicheskie rekomendatsii. Versiia 4 (27.03.2020). Ministerstvo zdravookhraneniia Rossiiskoi Federatsii (in Russian).
31. Centers for Disease Control and Prevention 2019 Novel Coronavirus (2020) https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html. World Health Organization Coronavirus Disease 2019 (COVID-19) Situation Report – 46 (2020).
32. World Health Organization Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses (2013).
33. World Health Organization WHO Global Epidemiological Surveillance Standards for Influenza (2014).
34. Jin et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Med Res 2020; 7: 4. https://doi.org/10.1186/s40779-020-0233-6
35. Kui L, Fang Y-Y, Deng Y et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl) 2020. DOI: 10.1097/CM9.0000000000000744
36. World Health Organization. Clinical management of severe acute respiratory infection when Novel coronavirus (2019-nCoV) infection is suspected: Interim Guidance. 28 January 2020. WHO/nCoV/Clinical/2020.3
37. Chan KS, Lai ST, Chu CM et al. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicenter retrospective matched cohort study. Hong Kong Med J 2003; 9 (6): 399–406.
38. Chu CM, Cheng VC, Hung IF et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004; 59 (3): 252–6.
39. Lai ST. Treatment of severe acute respiratory syndrome. Eur J Clin Microbiol Infect Dis 2005; 24 (9): 583–91.
40. Brigitte M, Arti B, Stephan A et al. MERSCOV disease associated ARDS – a case report. Crit Care Med 2015; 43 (12): 308.
41. Gautret P, Lagier J-C, Parola P et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of anopen-label non-randomized clinical trial. Int J Antimicrob Agents 2020. DOI: https://doi.org/10.1016/j.ijantimicag.2020
42. Vincent MJ, Bergeron E, Benjannet S et al. Virol. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virology J 2005.
43. World Health Organization. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts. 2020. https://www.who.int/publications-detail/home-care-forpatients-with-suspected-novel coronavirus-(ncov)-infection-presenting-with-mildsymptoms-and-management-of-contacts. Accessed 24 Jan 2020.
44. Wang Y, Lin LK. An advice guideline recommended by central south hospital for the suspected patients of novel coronavirus (2019-nCoV) infected pneumonia and their close contacts as at home quarantine 2020. https://mp.weixin.qq.com/s/xFO10WAFB9OUnM7VN92R2w
45. Prilozhenie k pis'mu Rospotrebnadzora ot 25.01.2020 №02/877-2020-27. Predvaritel'nye rekomendatsii po preduprezhdeniiu rasprostraneniia novoi koronavirusnoi infektsii (2019-nCoV) v meditsinskikh organizatsiiakh (in Russian).

Авторы

Ю.Г. Белоцерковская*, А.Г. Романовских, И.П. Смирнов

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
belo-yuliya@yandex.ru

________________________________________________

Yuliya G. Belotserkovskaia*, Anna G. Romanovskikh, Igor P. Smirnov

Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*belo-yuliya@yandex.ru

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Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.