Cytokine storm in coronavirus

Cytokine storm is a phrase that is actively used in the lexicon when discussing a new coronavirus infection. This condition was first described in detail only about 10 years ago. Let’s try together with the expert to figure out what kind of reaction it is and when it occurs.

Что такое цитокиновый шторм простыми словами

A cytokine storm is a systemic inflammatory response that is life-threatening. With it, the level of cytokines in the blood rises – proteins that are responsible for the connection of body cells with each other.

Under normal circumstances, cytokines control infection and prevent pathogens from multiplying. In the event of a failure, too many of them are produced and our immunity redirects its forces not to pathogens, but to its own cells, attacking internal organs.

Interesting Cytokine Storm Facts

Цитокиновый шторм могут спровоцировать:

• viral infections (avian flu, swine flu, new coronavirus infection);
• organ transplantation;
• sepsis;
• oncology (more often in the terminal stages);
• IVF (in vitro fertilization);
• pancreatic necrosis, severe forms of bronchial asthma.

Causes of Cytokine Storm in Coronavirus

At the moment, there is no exact understanding of the causes of the cytokine storm.

Possible reasons for this reaction:

• неадекватное восприятие организмом инфекции;
• excessive activity of pathogens;
• uncontrolled infection.

The reason for all these conditions is a feedback failure in the body. This leads to excessive release of cytokines.

Symptoms of a cytokine storm in coronavirus

The main symptoms of a cytokine storm in coronavirus are:

• increased body temperature (usually 38,5 degrees);
• decreased appetite;
• headache;
• fatigue;
• muscle and joint pain;
• diarrhea;
• rash.

This condition is quite unstable and can lead to the development of multiple organ failure:

• массивное свертывание крови или массивное кровотечение;
• dyspnea;
• decreased oxygen levels in the blood;
• lowering blood pressure.

При дальнейшем прогрессировании симптомов цитокинового шторма наблюдается развитие почечной и печеночной недостаточности.

With a large number of circulating cytokines, neurological disorders also appear, which can be noticed a few days after the beginning of the storm: hallucinations, confusion, epileptic seizures.

Treatment of cytokine storm in coronavirus

Treatment of the cytokine storm in COVID-19 is very important. Incorrectly selected therapy can lead to irreparable complications. All therapy is divided into specific, which is carried out only in a hospital, and non-specific, which is restorative and can be done at home on its own.

Diagnostics

There are no specific diagnostic methods that will accurately help identify a cytokine storm. A holistic approach is needed that includes:

• общий анализ крови — помогает оценить ответ организма на воспалительный процесс (при цитокиновом шторме наблюдается снижение лейкоцитов и тромбоцитов);
• coagulogram – a violation of blood coagulation processes (a predisposition to bleeding or thrombosis);
• CRP (C-reactive protein) is a non-specific marker of inflammation;
• Ferritin is an intracellular depot of iron in the body and a marker of inflammation (it increases with coronavirus due to blood clotting and lack of oxygen);
• ASAT, ALAT, bilirubin, LDH – evaluate organ damage;
• определение цитокинов: ИЛ-6, ФНО.
• blood gas analysis – there is a decrease in the concentration of oxygen in the blood and a shift in pH to the acid side;
• pulse oximetry – a method for determining the degree of oxygen saturation of the blood;
•  лучевая диагностика – для оценки прогрессирования воспалительных процессов (при коронавирусе использование КТ).

Modern treatments

The main treatments for cytokine storm are divided into:

• medications (hormonal drugs, monoclonal antibodies, Janus kinase inhibitors).
• экстакорпоральные – изменение состава и свойств крови вне организма человека с помощью специальных приборов (плазмаферез, плазмофильтрация, гемосорбция).

In addition to specific therapy, prevention and treatment of concomitant conditions is also carried out:

• противовирусная терапия;
• antibacterial drugs;
• профилактика кровотечения и тромбообразования (антикоагулянты, гемостатики);
• метаболические средства (нормализуют обменные процессы в организме, активируют тканевый обмен, коррекция ацидоза, гипоксии).

The best drugs for cytokine storm

Since the specific treatment of a cytokine storm in case of covid is carried out only in a hospital, we will list the drugs recommended for taking during a mild course of a coronavirus infection, as well as for the prevention of complications and during the rehabilitation period after an illness.

1. Корилип

The drug is a metabolic agent and belongs to the group of vitamins and vitamin-like agents in various combinations.

What is included:

• Cocarboxylase is an element involved in carbohydrate metabolism. Necessary for the synthesis of vitamin B1. With insufficient concentration of cocarboxylase in the body, acids accumulate, which leads to acidosis (pH shift to the acid side);
• Alpha Lipoic Acid is a natural antioxidant. Also, this substance prevents metabolic acidosis and loss of energy by cells, which is characteristic of a new coronavirus infection.

The advantages of the drug is that Korilip is allowed during pregnancy, children under 1 year old and the elderly. This is especially true, since pregnant women and children do not receive the required dose of vaccination and their body does not produce enough antibodies against coronavirus infection.

Indications:                        

• hypoxia (reduced oxygen content in tissues);
• симптомы интоксикации;
• viral or bacterial infections;
• stressful situations;
• increased mental or physical activity.

Contraindications:

• hypersensitivity to the components of the drug;
• ректальные кровотечения.

The drug is released in the form of rectal suppositories. This form is an advantage over other forms of drugs: there is no effect on the gastrointestinal tract, there is no possibility of overdose.

2. Mildronate

The drug belongs to metabolic agents. The active ingredient is meldonium. Its main task is to normalize the processes of oxygen delivery and consumption by cells. In addition, Mildronate:

• improves performance;
• активирует тканевый и гуморальный иммунитет;
• has a tonic effect on the central nervous system.

Indications:

• with violations of cerebral blood supply;
• increased mental and / or physical activity;
• chronic heart failure.

Contraindications:

• an allergic reaction to the components of the drug;
• pregnancy and lactation;
• serious diseases of the liver and / or kidneys.

3. Cytoflavin

Metabolic drug, the main substances of which are vitamins.

• Succinic acid is an antioxidant, improves tissue respiration, reduces the toxic effects of certain drugs.
• Vitamin B2 is an antioxidant, participates in protein and fat metabolism, ensures the restoration of the nervous and cardiovascular systems.
• Nicotinamide – stimulates blood circulation, has anti-inflammatory properties.

Indications:

• circulatory disorders (after heart attacks, atherosclerosis, encephalopathy);
• fatigue;
• increased physical and/or mental activity.

Contraindications:

• allergy to the components of the drug;
• pregnancy and lactation;
• serious diseases of the digestive tract;
• gout.

4. Триметазидин МВ

Metabolic drug of the antioxidant group. The main function is the normalization of cellular processes in a state of hypoxia.

The active substance is trimetazadine.

Key features include:

• decrease in the severity of acidosis;
• protection of cells from ischemia.

Indications:

• vascular disorders (dizziness, tinnitus – a frequent occurrence of post-covid syndrome).

Contraindications:

• hypersensitivity to the components of the drug;
• serious diseases of the central nervous system (Parkinson’s disease, tremor);
• kidney failure;
• pregnancy and lactation;
• age to 18 years.

5. Actovegin

The drug belongs to the group of angioprotectors, antioxidants, microcirculation correctors, regenerators.

The drug ensures the normalization of energy metabolism in cells, reduces the concentration of uric acid (which prevents the development of acidosis), improves blood flow.

Indications:

• снижение памяти, повышенная утомляемость;
• violation of microcirculation processes;
• damage to peripheral nerves (paralysis, impaired sensitivity, vegetative vascular disorders).

Contraindications:

• an allergic reaction to the components of the drug;
• heart failure in the stage of decompensation;
• kidney failure;
• age to 18 years.

During pregnancy and lactation, use the drug only after consulting a doctor.

Prevention of cytokine storm in coronavirus at home

There is no specific prevention of cytokine storm. Since the main mechanism for the development of this condition is the hyperreactivity of the immune system, the risk of infection with COVID-19 should be reduced. So all prevention is the prevention of the disease of a new coronavirus infection:

• carrying out vaccination and revaccination according to the schedule;
• лечение сопутствующих заболеваний (особенно тех, кто усугубляет течение ковида: сахарный диабет, ХОБЛ, аутоиммунные заболевания);
• taking additional drugs to activate metabolic processes in the body (vitamins, metabolic drugs);
• compliance with the rules of personal hygiene;
• wearing masks and gloves;
• ограничение посещения мест с большим скоплением людей (магазины, кинотеатры, выставки).

When the first symptoms of the disease appear, you should seek medical help. This will allow you to start treatment at an early stage and avoid complications.

Popular questions and answers

We discussed important issues related to the cytokine storm in coronavirus, with therapist Tatyana Pomerantseva.

Sources:

1. Interim clinical recommendations “Coronavirus infection”, version 14, dated 27.12.2021/XNUMX/XNUMX;
2. 2000-2022. REGISTER OF DRUGS OF RUSSIA® RLS
3. “Cytokine storm: causes and consequences” Potapnev M.P., 2021
4. Molecular mechanisms of the “cytokine storm” in acute infectious diseases / Shipilov M.V.// General Medicine. — 2013.
5. The level of cytokines in the secretion of the oral cavity in children with bronchial asthma / Abadjidi M.A., Lukushkina E.F., Madinskaya I.V.//Cytokine and inflammation. – 2002. – No. 3.
6. Hypercytokinemia in severe COVID-19/ John B.Moore., Carl H.June// Science.-2020., Vol.368, Issue 6490.