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Долгий COVID-19
Белоцерковская Ю.Г., Романовских А.Г., Смирнов И.П., Синопальников А.И. Долгий COVID-19. Consilium Medicum. 2021; 23 (3): 261–268. DOI: 10.26442/20751753.2021.3.200805
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Belotserkovskaya YuG, Romanovskikh AG, Smirnov IP, Sinopalnikov AI. Long COVID-19. Consilium Medicum. 2021; 23 (3): 261–268. DOI: 10.26442/20751753.2021.3.200805
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Аннотация
Термин «долгий COVID-19» описывает долгосрочные последствия новой коронавирусной инфекции COVID-19. Пациенты с тяжелой формой COVID-19, нуждающиеся в госпитализации, а также те, которые наблюдаются амбулаторно с легкими клиническими формами заболевания, часто отмечают персистирующие неделями и месяцами усталость, одышку, разнообразные боли, кашель и другие респираторные и внелегочные симптомы. Общепринятые временные рамки, которые разграничивают продолжительность острой и подострой фазы инфекции от долгого COVID-19, составляют 28 дней. В статье описываются длительность и особенности течения клинических нарушений, вызванных COVID-19 и сохраняющихся после завершения острой фазы заболевания. Кроме того, приводятся имеющиеся на сегодняшний день представления о причинах долгосрочных последствий и возможностях медикаментозной и нефармакологической коррекции.
Ключевые слова: новая коронавирусная инфекция, COVID-19, долгий COVID-19, постковидный синдром, осложнения COVID-19, лечение COVID-19
Ключевые слова: новая коронавирусная инфекция, COVID-19, долгий COVID-19, постковидный синдром, осложнения COVID-19, лечение COVID-19
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The term “long COVID-19” describes the long-term effects of the novel coronavirus infection COVID-19. Patients with severe COVID-19 who require hospitalization, as well as those who are on outpatient treatment with mild clinical forms of the disease, often report persistent fatigue, shortness of breath, pain, cough and other respiratory and extrapulmonary symptoms for weeks and months. The generally accepted time frame that separates the duration of the acute and subacute phase of infection from the long COVID-19 is 28 days. The article describes the duration and the course of clinical disorders caused by COVID-19 and their persisting after the end of the acute phase of the disease. In addition, the current understanding of the causes of long-term consequences and the possibilities of drug and non-pharmacological correction are presented.
Keywords: new coronavirus infection, COVID-19, long COVID-19, post-COVID-19 syndrome, complications of COVID-19, treatment of COVID-19
Полный текст
Список литературы
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48. Klok FA, Boon GJAM, Barco S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020; 56 (1): 2001494. DOI: 10.1183/13993003.01494-2020
2. Keay L. Long-term COVID Warning: ICU Doctor Reports Having Coronavirus Symptoms for Three Months. Available at: https://news.sky.com/story/long-term-covid-warning-icu-doctor-reports-having-coronavirus-symptoms-fo.... Accessed: 19.08.2020.
3. Lokugamage A, Taylor S, Rayner C. Patients’ Experiences of ‘longcovid’ Are Missing from the NHS Narrative. Available at: https://blogs.bmj.com/bmj/2020/07/10/patients-experiences-of-longcovid-are-missing-from-the-nhs-narr... Accessed: 31.07.2020.
4. Mahase E. Covid-19: what Do We Know about “Long Covid”? BMJ. 2020; 370.
DOI: 10.1136/bmj.m2815.
5. Altmann DM, Boyton RJ. SARS-CoV-2 T-cell immunity: specificity, function, durability, and role in protection. Sci Immunol. 2020; 5 (49): eabd6160. DOI: 10.1126/sciimmunol.abd6160
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7. Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020; 324 (6): 603–5. DOI: 10.1001/jama.2020.12603
8. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network – United States, March – June 2020. MMWR. 2020; 69 (30): 993–8. DOI: 10.15585/ mmwr.mm6930e1
9. Petersen MS, Kristiansen MF, Hanusson KD, et al. Long COVID in the Faroe Islands – a longitudinal study among non-hospitalized patients. Clin Infect Dis. 2020; ciaa1792. DOI: 10.1093/cid/ciaa1792
10. Nath A. Long-Haul COVID. Neurology. 2020; 95 (13): 559–60. DOI: 10.1212/WNL.0000000000010640
11. Ritchie K, Chan D, Watermeyeret T. The cognitive consequences of the COVID-19 epidemic: collateral damage? Brain Commun. 2020; 2 (2): fcaa069. DOI: 10.1093/braincomms/fcaa069
12. Bohmwald K, Galvez NMS, Rios M, Kalergis AM. Neurologic alterations due to respiratory virus infections. Front Cell Neurosci. 2018; 12: 386. DOI: 10.3389/fncel.2018.00386
13. Gu J, Gong E, Zhang B, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005; 202: 415–24. DOI: 10.1084/jem.20050828
14. Arabi YM, Harthi A, Hussein J, et al. Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV). Infection. 2015; 43: 495–501. DOI: 10.1007/s15010-015-0720-y
15. Dahm T, Rudolph H, Schwerk C, et al. Neuroinvasion and inflammationin viral central nervous system infections. Mediators Inflamm. 2016; 2016: 8562805. DOI: 10.1155/2016/8562805
16. Miner JJ, Diamond MS. Mechanisms of restriction of viral invasion at the blood-brain barrier. Curr Opin Immunol. 2016; 38: 18–23. DOI: 10.1016/j.coi.2015.10.008
17. Hopkins RO, Weaver LK, Pope D, et al. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999; 160: 50–6.
18. Hopkins RO, Weaver LK, Collingridge D, et al. Two-year cognitive, emotional and quality of life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005; 171: 340–7. DOI: 10.1164/rccm.200406-763OC
19. Mikkelsen ME, Christie JD, Lanken PN, et al. The adult respiratory distress syndrome cognitive outcomes study. Am J Respir Crit Care Med. 2012; 185: 1307–15. DOI: 10.1164/rccm.201111-2025OC
20. Adhikari NKJ, Tansey CM, McAndrews MP, et al. Self-reported depressive symptoms and memory complaints in survivors five years after ARDS. Chest. 2011; 140: 1484–93. DOI: 10.1378/chest.11-1667
21. Hopkins RO, Gale SD, Weaver LK. Brain atrophy and cognitive impairment in survivors of acute respiratory distress syndrome. Brain Inj. 2006; 20: 263–71. DOI: 10.1080/02699050500488199
22. Han S, Mallampalli RK. The acute respiratory distress syndrome: from mechanism to translation. J Immunol. 2015; 194 (3): 855–60. DOI: 10.4049/jimmunol.1402513
23. Matthay MA, Zemans RL. The acute respiratory distress syndrome: pathogenesis and treatment. Annu Rev Pathol Mech Dis. 2011; 6: 147–63. DOI: 10.1146/annurev-pathol-011110-130158
24. Du L, Zhao J, Shi Y, et al. A report of 4 cases of severe acute respiratory syndrome patients with suicide tendency. Acad J Second Mil Med Univ. 2003; 24: 636–7.
25. Jeong H, Yim HW, Song YJ, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016; 38: e2016048. DOI: 10.4178/epih.e2016048
26. Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ASC Chem Neurosci. 2021; 12 (4): 573–80. DOI: 10.1021/acschemneuro.0c00793
27. Marciszewski KK, Meylakh N, Di Pietro F, et al. Changes in Brainstem Pain Modulation Circuitry Function over the Migraine Cycle. J Neurosci. 2018; 38 (49): 10479–88. DOI: 10.1523/JNEUROSCI.1088-18.2018
28. Chong CD, Plasencia JD, Frakes DH, Schwedt TJ. Structural Alterations of the Brainstem in Migraine. Neuroimage Clin. 2017; 13: 223–7. DOI: 10.1016/j.nicl.2016.10.023
29. Callard F, Perego E. How and Why Patients Made Long Covid. Social Sci Med. 2021; 268: 113426. DOI: 10.1016/j.socscimed.2020.113426
30. Perrin R, Riste L, Hann M, et al. Into the Looking Glass: Post-Viral Syndrome Post COVID-19. Med Hypotheses. 2020; 144: 110055. DOI: 10.1016/j.mehy.2020.110055
31. Raveendran AV. Long COVID-19: Challenges in the diagnosis and proposed diagnostic criteria. Diabetes Metab Syndr. 2021; 15 (1): 145–6. DOI: 10.1016/j.dsx.2020.12.025
32. Greenhalgh T, Knight M, A’Courte C, et al. Management of post-acute covid-19 in primary care. BMJ. 2020; 370: m3026. DOI: 10.1136/bmj.m3026
33. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Временные методические рекомендации. Версия 10 (08.02.2021). Министерство здравоохранения Российской Федерации [Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (COVID-19). Vremennye metodicheskie rekomendatsii. Versiia 10 (08.02.2021). Ministerstvo zdravookhraneniia Rossiiskoi Federatsii (in Russian)].
34. Медицинская реабилитация при новой коронавирусной инфекции (COVID-19). Временные методические рекомендации. Версия 2 (31.07.2020). Министерство здравоохранения Российской Федерации [Meditsinskaia reabilitatsiia pri novoi koronavirusnoi infektsii (COVID-19). Vremennye metodicheskie rekomendatsii. Versiia 2 (31.07.2020). Ministerstvo zdravookhraneniia Rossiiskoi Federatsii (in Russian)].
35. British Thoracic Society. British Thoracic Society guidance on respiratory follow up of patients with a clinico-radiological diagnosis of COVID-19 pneumonia. 2020. Available at: https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidan... Accessed: 11.05.2020.
36. George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. Lancet Respir Med 2020; 8 (8): 807–815. DOI: 10.1016/S2213-2600(20)30225-3
37. Pan F, Ye T, Sun P, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. 2020; 295 (9): 715–21.
DOI: 10.1148/radiol.2020200370
38. Hui DS, Wong KT, Antonio GE, et al. Long-term sequelae of SARS: physical, neuropsychiatric, and quality-of-life assessment. Hong Kong Med J. 2009; 15 (Suppl. 8): 21–3. Available at: https://pubmed.ncbi.nlm.nih.gov/20393208/ Accessed: 11.05.2020
39. Lam MH-B, Wing Y-K, Yu MW-M, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med. 2009; 169: 2142–7. DOI: 10.1001/archinternmed.2009.384
40. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011; 11: 37. DOI: 10.1186/1471-2377-11-37
41. Cillóniz C, Rodríguez-Hurtado D, Torres A. Characteristics and management of community-acquired pneumonia in the era of global aging. Med Sci (Basel). 2018; 6: 35.
DOI: 10.3390/medsci6020035 pmid: 29710871
42. Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017; 4 (4): CD003200. DOI: 10.1002/14651858.CD003200.pub7
43. Torjesen I. NICE cautions against using graded exercise therapy for patients recovering from covid-19. BMJ. 2020; 370. DOI: 10.1136/bmj.m2912
44. Barker-Davies RM, O’Sullivan O, Senaratne KPP, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020; 54 (16): 949–59. DOI: 10.1136/bjsports-2020-102596
45. Varatharaj A, Thomas N, Ellul MA, et al. CoroNerve Study Group. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020; 7 (10): 875–82. DOI: 10.1016/S2215-0366(20)30287-X
46. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020; 7: 300–2. DOI: 10.1016/S2215-0366(20)30073-0
47. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020; 52. DOI: 10.1016/j.ajp.2020.102066
48. Klok FA, Boon GJAM, Barco S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020; 56 (1): 2001494. DOI: 10.1183/13993003.01494-2020
________________________________________________
1. Perego E, 2020. Available at: https://twitter.com/elisaperego78/status/1263172084055838721?s=20. Accessed: 31.07.2020.
2. Keay L. Long-term COVID Warning: ICU Doctor Reports Having Coronavirus Symptoms for Three Months. Available at: https://news.sky.com/story/long-term-covid-warning-icu-doctor-reports-having-coronavirus-symptoms-fo.... Accessed: 19.08.2020.
3. Lokugamage A, Taylor S, Rayner C. Patients’ Experiences of ‘longcovid’ Are Missing from the NHS Narrative. Available at: https://blogs.bmj.com/bmj/2020/07/10/patients-experiences-of-longcovid-are-missing-from-the-nhs-narr... Accessed: 31.07.2020.
4. Mahase E. Covid-19: what Do We Know about “Long Covid”? BMJ. 2020; 370.
DOI: 10.1136/bmj.m2815.
5. Altmann DM, Boyton RJ. SARS-CoV-2 T-cell immunity: specificity, function, durability, and role in protection. Sci Immunol. 2020; 5 (49): eabd6160. DOI: 10.1126/sciimmunol.abd6160
6. Sacks B. COVID Long-Haulers Are Organizing and Demanding Better Care – and They Just Got A Meeting with the WHO. BuzzFeed News. 2020. Available at: https://www.buzzfeednews.com/article/briannasacks/covid-long-haulers-who-coronavirus. Accessed: 23.08.2020.
7. Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020; 324 (6): 603–5. DOI: 10.1001/jama.2020.12603
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Авторы
Ю.Г. Белоцерковская*, А.Г. Романовских, И.П. Смирнов, А.И. Синопальников
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*belo-yuliya@yandex.ru
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*belo-yuliya@yandex.ru
________________________________________________
Yulia G. Belotserkovskaya*, Anna G. Romanovskikh, Igor P. Smirnov, Alexander I. Sinopalnikov
Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*belo-yuliya@yandex.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.