ABSTRACT
Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male - 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male - 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male - 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104-11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177-18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
The emergence of mutations in the coronavirus genome provides opportunities for occurrence new strains with higher transmissibility, severity and duration of the disease poses. In 2020, a new variant of the coronavirus SARS-COV-2 - Delta was identified in India. This genetic variant has spread rapidly and became dominant in many countries, including Russia. In November 2021, a new outbreak of COVID-19 occurred in Africa driven by a variant SARS-COV-2 named later Omicron. Both variants had increased transmissibility compared to previously encountered variants and quickly, replacing its around the world. To promptly monitor the epidemiological situation in the country, to assess the spread of dominant genetic variants of the virus and to take appropriate measures, we have developed an RTâPCR reagent kit for the identification of Delta and Omicron by detecting a corresponding combination of major mutations. The minimum set of mutations was chosen which allows to differentiate Delta and Omicron variants, in order to increase the analysis productivity and reduce costs. Primers and LNA-modified probes were selected to detect mutations in the S gene, typical for the Delta and Omicron. Similar approach can be implemented for the rapid development of assays for differentiating important SARS-COV-2 variants or for other viruses genotyping for epidemiological surveillance or for diagnostic use in order to assist in making clinical decisions. It was demonstrated that the results of VOC Delta and Omicron detection and their typical mutations were concordant with genotyping based on WGS results for all 847 samples of SARS-CoV-2 RNA. The kit has high analytical sensitivity (1Ñ 103 copies/mL of SARS-CoV-2 RNA) for each of the detected genetic variants and possesses 100% analytic specificity for microorganism panel testing. The diagnostic sensitivity (95% confidence interval) obtained during pivotal trials was 91.1-100% for Omicron and 91.3-100% for Delta, while the diagnostic specificity with a 95% confidence interval was 92.2-100%. The use of a set of reagents in combination with sequencing of SARS-CoV-2 RNA as part of epidemiological monitoring made it possible to quickly track the dynamics of changes in Delta and Omicron prevalence in the Moscow region in the period from December 2021 to July 2022.
ABSTRACT
Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male - 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male - 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male - 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104-11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177-18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
The new coronavirus infection (COVID-19) has become a truly global challenge for all of humanity, and, above all, for the healthcare system. Among its most important aspects that require careful analysis are the clinical and laboratory features of the course of the disease, which make it possible to determine approaches to pathogenetic therapy in severe forms of the disease. Materials and methods. A retrospective analysis of the medical records of patients with severe COVID-19 who were hospitalized in St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin" in 2020-2022. Clinical and laboratory characteristics were assessed, including levels of C-reactive protein, interleukin-6, and fever dynamics. The criteria for prescribing drugs for pathogenetic therapy in patients with COVID-19 and their effectiveness were determined. Results. In the treatment of patients with COVID-19, it is necessary to carefully evaluate the clinical picture of the course of the disease, which is ahead of changes in laboratory parameters. The introduction of humanized antibody preparations leads to a regression of general infectious symptoms, subjective and objective manifestations of respiratory failure and, as a result, to a reduction in the length of stay of patients in the hospital. It is extremely important to timely preventive administration of drugs during the period of increasing "cytokine storm". The optimal time for prescribing drugs is 1-3 days from the moment of receipt, until the patient is transferred to a ventilator.Copyright © 2022 Authors. All rights reserved.
ABSTRACT
The new coronavirus infection (COVID-19) has become a truly global challenge for all of humanity, and, above all, for the healthcare system. Among its most important aspects that require careful analysis are the clinical and laboratory features of the course of the disease, which make it possible to determine approaches to pathogenetic therapy in severe forms of the disease. Materials and methods. A retrospective analysis of the medical records of patients with severe COVID-19 who were hospitalized in St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin” in 2020-2022. Clinical and laboratory characteristics were assessed, including levels of C-reactive protein, interleukin-6, and fever dynamics. The criteria for prescribing drugs for pathogenetic therapy in patients with COVID-19 and their effectiveness were determined. Results. In the treatment of patients with COVID-19, it is necessary to carefully evaluate the clinical picture of the course of the disease, which is ahead of changes in laboratory parameters. The introduction of humanized antibody preparations leads to a regression of general infectious symptoms, subjective and objective manifestations of respiratory failure and, as a result, to a reduction in the length of stay of patients in the hospital. It is extremely important to timely preventive administration of drugs during the period of increasing "cytokine storm”. The optimal time for prescribing drugs is 1–3 days from the moment of receipt, until the patient is transferred to a ventilator. © 2022 Authors. All rights reserved.
ABSTRACT
The new coronavirus infection (COVID-19) has become a truly global challenge for all of humanity, and, above all, for the healthcare system. Among its most important aspects that require careful analysis are the clinical and laboratory features of the course of the disease, which make it possible to determine approaches to pathogenetic therapy in severe forms of the disease. Materials and methods. A retrospective analysis of the medical records of patients with severe COVID-19 who were hospitalized in St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin" in 2020-2022. Clinical and laboratory characteristics were assessed, including levels of C-reactive protein, interleukin-6, and fever dynamics. The criteria for prescribing drugs for pathogenetic therapy in patients with COVID-19 and their effectiveness were determined. Results. In the treatment of patients with COVID-19, it is necessary to carefully evaluate the clinical picture of the course of the disease, which is ahead of changes in laboratory parameters. The introduction of humanized antibody preparations leads to a regression of general infectious symptoms, subjective and objective manifestations of respiratory failure and, as a result, to a reduction in the length of stay of patients in the hospital. It is extremely important to timely preventive administration of drugs during the period of increasing "cytokine storm". The optimal time for prescribing drugs is 1-3 days from the moment of receipt, until the patient is transferred to a ventilator.Copyright © 2022 Authors. All rights reserved.
ABSTRACT
The genotype of the SARS-CoV-2 virus pathogen plays an important role in the epidemiological and clinical characteristics of a new coronovirus infection. There are no published data on the morphological features of lesions caused by different virus genotypes. The aim of the study was to evaluate clinical, laboratory and morphological changes depending on the genotype of the SARS-CoV-2 virus. Materials and methods. A retrospective analysis of the medical records of 39 patients with COVID-19 with a severe course of the disease, which ended in death, who were hospitalized at the St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin" in 2020-2022. Clinical and laboratory characteristics were assessed, including determination of the virus genotype, levels of leukocytes, lymphocytes, alanine aminotransferase, creatinine, ferritin, C-reactive protein, D-dimer, interleukin-6. Macro- and microscopic changes were assessed, including immunohistochemical examination of the lungs and other organs using sera to CD14 68, 163, type 1 and 3 collagen. The preparations were digitized on a Panoramic scanner, morphometric studies were carried out using the SlideViewer program, including the quantitative determination of the content of CD68+ macrophages in 12 cases. Results. In all patients, the disease was complicated by the development of pneumonia, the majority had concomitant diseases (94.6%). The average time of hospitalization was 19.0+/-1.6 days, the average time of stay in the intensive care unit was 7.7+/-1.2 days. The analysis, depending on the genotype of the SARS-CoV-2 virus, showed a statistical difference between the age of patients, the length of stay in the intensive care unit and the level of lymphocytes. Differences in the average duration of hospitalization, the level of laboratory parameters were not revealed. Histopathological picture in all examined was approximately the same. The content of CD68+ macrophages per unit area in different genotypes did not differ, but varied significantly within the same genotype. Conclusion. Thus, it was not possible to identify significant differences between the changes caused by different genotypes of the new coronavirus, which can probably be explained by the fact that mutations do not include genome regions that are relevant to virulence factors, although further research is needed.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
The genotype of the SARS-CoV-2 virus pathogen plays an important role in the epidemiological and clinical characteristics of a new coronovirus infection. There are no published data on the morphological features of lesions caused by different virus genotypes. The aim of the study was to evaluate clinical, laboratory and morphological changes depending on the genotype of the SARS-CoV-2 virus. Materials and methods. A retrospective analysis of the medical records of 39 patients with COVID-19 with a severe course of the disease, which ended in death, who were hospitalized at the St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin" in 2020-2022. Clinical and laboratory characteristics were assessed, including determination of the virus genotype, levels of leukocytes, lymphocytes, alanine aminotransferase, creatinine, ferritin, C-reactive protein, D-dimer, interleukin-6. Macro- and microscopic changes were assessed, including immunohistochemical examination of the lungs and other organs using sera to CD14 68, 163, type 1 and 3 collagen. The preparations were digitized on a Panoramic scanner, morphometric studies were carried out using the SlideViewer program, including the quantitative determination of the content of CD68+ macrophages in 12 cases. Results. In all patients, the disease was complicated by the development of pneumonia, the majority had concomitant diseases (94.6%). The average time of hospitalization was 19.0+/-1.6 days, the average time of stay in the intensive care unit was 7.7+/-1.2 days. The analysis, depending on the genotype of the SARS-CoV-2 virus, showed a statistical difference between the age of patients, the length of stay in the intensive care unit and the level of lymphocytes. Differences in the average duration of hospitalization, the level of laboratory parameters were not revealed. Histopathological picture in all examined was approximately the same. The content of CD68+ macrophages per unit area in different genotypes did not differ, but varied significantly within the same genotype. Conclusion. Thus, it was not possible to identify significant differences between the changes caused by different genotypes of the new coronavirus, which can probably be explained by the fact that mutations do not include genome regions that are relevant to virulence factors, although further research is needed.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
The genotype of the SARS-CoV-2 virus pathogen plays an important role in the epidemiological and clinical characteristics of a new coronovirus infection. There are no published data on the morphological features of lesions caused by different virus genotypes. The aim of the study was to evaluate clinical, laboratory and morphological changes depending on the genotype of the SARS-CoV-2 virus. Materials and methods. A retrospective analysis of the medical records of 39 patients with COVID-19 with a severe course of the disease, which ended in death, who were hospitalized at the St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin” in 2020-2022. Clinical and laboratory characteristics were assessed, including determination of the virus genotype, levels of leukocytes, lymphocytes, alanine aminotransferase, creatinine, ferritin, C-reactive protein, D-dimer, interleukin-6. Macro- and microscopic changes were assessed, including immunohistochemical examination of the lungs and other organs using sera to CD14 68, 163, type 1 and 3 collagen. The preparations were digitized on a Panoramic scanner, morphometric studies were carried out using the SlideViewer program, including the quantitative determination of the content of CD68+ macrophages in 12 cases. Results. In all patients, the disease was complicated by the development of pneumonia, the majority had concomitant diseases (94.6%). The average time of hospitalization was 19.0±1.6 days, the average time of stay in the intensive care unit was 7.7±1.2 days. The analysis, depending on the genotype of the SARS-CoV-2 virus, showed a statistical difference between the age of patients, the length of stay in the intensive care unit and the level of lymphocytes. Differences in the average duration of hospitalization, the level of laboratory parameters were not revealed. Histopathological picture in all examined was approximately the same. The content of CD68+ macrophages per unit area in different genotypes did not differ, but varied significantly within the same genotype. Conclusion. Thus, it was not possible to identify significant differences between the changes caused by different genotypes of the new coronavirus, which can probably be explained by the fact that mutations do not include genome regions that are relevant to virulence factors, although further research is needed. © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
The genotype of the SARS-CoV-2 virus pathogen plays an important role in the epidemiological and clinical characteristics of a new coronovirus infection. There are no published data on the morphological features of lesions caused by different virus genotypes. The aim of the study was to evaluate clinical, laboratory and morphological changes depending on the genotype of the SARS-CoV-2 virus. Materials and methods. A retrospective analysis of the medical records of 39 patients with COVID-19 with a severe course of the disease, which ended in death, who were hospitalized at the St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin" in 2020-2022. Clinical and laboratory characteristics were assessed, including determination of the virus genotype, levels of leukocytes, lymphocytes, alanine aminotransferase, creatinine, ferritin, C-reactive protein, D-dimer, interleukin-6. Macro- and microscopic changes were assessed, including immunohistochemical examination of the lungs and other organs using sera to CD14 68, 163, type 1 and 3 collagen. The preparations were digitized on a Panoramic scanner, morphometric studies were carried out using the SlideViewer program, including the quantitative determination of the content of CD68+ macrophages in 12 cases. Results. In all patients, the disease was complicated by the development of pneumonia, the majority had concomitant diseases (94.6%). The average time of hospitalization was 19.0+/-1.6 days, the average time of stay in the intensive care unit was 7.7+/-1.2 days. The analysis, depending on the genotype of the SARS-CoV-2 virus, showed a statistical difference between the age of patients, the length of stay in the intensive care unit and the level of lymphocytes. Differences in the average duration of hospitalization, the level of laboratory parameters were not revealed. Histopathological picture in all examined was approximately the same. The content of CD68+ macrophages per unit area in different genotypes did not differ, but varied significantly within the same genotype. Conclusion. Thus, it was not possible to identify significant differences between the changes caused by different genotypes of the new coronavirus, which can probably be explained by the fact that mutations do not include genome regions that are relevant to virulence factors, although further research is needed.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
ABSTRACT
Background. Hypokalemia is a common electrolyte complication among hospitalized patients with pneumonia caused by a new coronavirus SARS-CoV-2. Hyperactivation of the renin-angiotensin-aldosterone system (RAAS) is suggested as a possible cause of hypokalemia in patients with COVID-19. Objective. To investigate the RAAS activity in COVID-19 patients with and without hypokalemia and its possible association with treatment outcomes. Design and methods. The cross-sectional cohort study included 172 patients with COVID-19 pneumonia. Potassium, aldosterone and venous renin were measured in 77 patients. The differences in the levels of acute phase proteins, the degree of lung damage and the severity of COVID-19 were compared between patients with and without hypokalemia. Results. Hypokalemia was found in 19 of 77 patients (25%): the median potassium level in hypokalemia and eukalemia group was 3,1 [2,8-3,3] and 4,1 [3,9-4,5] mmol/L, respectively (p = 0,001). Plasma aldosterone and renin levels in patients with and without hypokalemia did not differ significantly: aldosterone 76,0 [57,7-121,5] and 70,9 [26,3-113,8] pg/ml (p = 0,23), renin 17,0 [8,5-47,2] and 11,0 [6,5-38,1] pg/ml (p = 0,35), respectively. Differences in the degree of lung tissue damage, acute phase proteins, severity of COVID-19, length of hospitalization and mortality in patients with and without identified electrolyte disturbances were also not significant. Conclusions. Our results showed that there were no laboratory signs of RAAS hyperactivation in COVID-19 patients with registered hypokalemia. Identification of the cause and clinical significance of hypokalemia among patients with COVID-19 needs to be specified. © 2021 All-Russian Public Organization Antihypertensive League. All rights reserved.
ABSTRACT
Among the problems associated with a new coronavirus infection, the possibility of its occurrence in pregnant women plays an important role. Until now, there is very little data on perinatal COVID-19, and there are no descriptions of structural changes in the afterbirth at all. Material and methods. A clinical and morphological analysis of 6 cases in which women with verified COVID-19 gave birth in an infectious hospital was performed. In all cases, the placenta was examined in detail morphologically using antibodies to the nucleoprotein and spike (S1 subunit spike protein) SARS-CoV-2. COVID-19 Results. It is shown that the clinical course of COVID-19 in pregnant women may be different, three were in the intensive care unit, including one was shown to be on a ventilator. 4 children were born at term, 2 children prematurely (at 31-33 weeks of pregnancy). The condition of children in 5 nab. was assessed as satisfactory, only one child in serious condition was transferred to a children’s hospital. Intrauterine infection with the polymerase chain reaction documented in a single observation. When histological examination of the afterbirth in all observations, both in the maternal and fetal parts, changes characteristic of RNA viral infection was detected. Both of the studied antigens were found in moderate amounts in IHC. Conclusions. Intrauterine transplacental infection with a new coronavirus is certainly possible. Its frequency and clinical significance require further comprehensive study.
ABSTRACT
The new coronavirus infection (COVID-19) has become a truly global challenge for all of humanity, and, above all, for the healthcare system. Among its most important aspects requiring careful analysis are the clinical and laboratory features of the course of the disease, which make it possible to determine approaches to pathogenetic therapy in severe forms of the disease. Materials and methods. A retrospective analysis of medical records of patients (n = 31) of severe COVID-19 patients who were hospitalized in St. Petersburg City Clinical Hospital for Infectious Diseases named after S.P. Botkin”in March – May 2020. Clinical and laboratory characteristics were evaluated, including the level of ferritin, C-reactive protein, D-dimer, interleukin-6, depending on the severity of the disease. The criteria for the appointment of a recombinant humanized monoclonal antibody to the human receptor for interleukin-6 (INN – tocilizumab) in patients with a severe course of the disease and its effectiveness are determined. Results. In the treatment of severe patients with COVID-19, it is necessary to carefully evaluate the clinical picture of the course of the disease, which may be ahead of changes in laboratory parameters. The introduction of tocilizumab leads to a rapid regression of general infectious symptoms, subjective and objective manifestations of respiratory failure and, as a consequence, a decrease in the duration of hospitalization. It is extremely important that the drug is administered in a timely manner during the rise of the “cytokine storm”. The time for optimal administration of tocilizumab begins from 8-9 days from the onset of the disease, until the patient is transferred to mechanical ventilation.
ABSTRACT
Recently, vitamin D deficiency is considered as a risk factor for the incidence and severity of new coronavirus infection. The aim of this work was to evaluate the vitamin D level of patients with COVID-19 hospitalized with community-acquired pneumonia and compare the value of 25(OH)D in blood serum with the clinical manifestations of the disease. Results. Included are 80 patients aged 18 to 94 years (mean age 53,2 ± 15,7 years), 43 (53,8%) men;with severe course – in 25 (31,3%) patients (12 males), and moderate – in 55 people (68,7%) (31 males). Half of the severely ill patients were obese, and among the deceased patients, the number of obese people was 61,5%, which was significantly higher than the discharged ones – 14,9% (p<0,001). Diabetes mellitus and cardiovascular diseases occurred with the same frequency, regardless of the severity of the disease. Analysis of the outcomes of coronavirus infection in these patients showed mortality in 52,0% of cases in severe patients. Serum 25(OH)D level ranged from 3,0 to 88,8 ng / ml (16,7 ± 12,7 ng / ml). It was found that in patients with severe course, the level of 25(OH)D blood was significantly lower (11.9 ± 6.4 ng / ml) and vitamin D deficiency was more common than in patients with moderate to severe course of the disease (18,5 ± 14,0 ng / ml, p = 0,027). The same pattern was revealed in patients with a fatal outcome, where the level of 25(OH)D was 10,8 ± 6,1 ng / ml, compared with this indicator in patients discharged from the hospital (17,8 ± 13,4 ng / ml) (p = 0,02). Conclusions. Vitamin D deficiency and obesity have been found to increase the risk of severe course and death of coronavirus infection.
ABSTRACT
Relevance of the problem of a new COVID-19 coronavirus infection is obvious. Among its most important aspects that require special study, are pathogenesis and morphological changes in severe forms of the disease. Material and methods. The analysis of 18 autopsy observations was carried out. Along with routine assessment of macro - and microscopic changes, immunohistochemical studies of lungs and other organs were performed using sera against antigens CD2,3,4,5,7, 20,31,34, 56,57,69;the presence of Fe2+and Fe3+ was detected in the lungs and liver. Results. Structural changes in the lungs may be associated with cytopathic and cytoproliferative effects of the virus with damage to both the ciliary and alveolar epithelium, as well as the formation of hyaline membranes. Cellular infiltration is mainly represented by suppressor populations of T-lymphocytes and macrophages. Endothelial damage, vascular thrombosis of vessels of different calibers, and hemorrhages were detected. Many organs (lymph nodes, spleen, intestines, brain, adrenal glands) show changes that may indicate generalization of viral infection, and infiltration of CD8+ lymphocytes in the kidneys, liver, adrenal glands, pericardium, and intestines indicates a probable autoimmune component of pathogenesis. In the liver and lungs deceased from COVID-19 only small clusters of Fe3+ and Fe2+granules were detected, which can be associated (including in our control observation) with liver damage in malaria.
ABSTRACT
During the COVID-19 pandemic, the efforts of many researchers around the world are aimed at finding preventive and prophylactic measures as well as therapeutic agents against SARS-CoV-2. Recent studies have showed that vitamin D deficiency could be one of many factors associated with the development and severity of acute respiratory infections, and vitamin D could be used for prevention and treatment of these patients. This review summarizes data about the role of vitamin D in the pathogenesis and prevention of respiratory viral infections, including new coronavirus infection as well as mechanisms for reducing the risk of infection with vitamin D therapy. Probably, this review will be of interest for endocrinologists and other specialists. Copyright © 2020 All-Russian Public Organization Antihypertensive League. All rights reserved.