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The coronavirus pandemic has covered the whole world. Monitoring the condition of new patients and those who have recovered does not stop. Leading scientists will continue to analyze the causes of the deterioration of the clinical picture of the disease and the death of patients. Pneumonia occupies the first place among all factors of lethality.
Coronavirus pneumonia is classified as atypical community-acquired pneumonia. The defeat of the lung tissue does not occur due to traditional pathogens – pneumococcus or staphylococcus, which belong to the bacterial flora and can be associated with pathogens that seed hospital surfaces. The source of atypical inflammation of the alveoli is a mixed viral and bacterial flora.
A characteristic symptom of pneumonia in coronavirus is a combination of inflammatory processes in the lungs with damage to the structural respiratory cells – the alveoli. Alveolar tissue is affected by the type of viral alveolitis. Simultaneously with these processes, damage to the vascular bed occurs in the form of vasculitis and multiple thromboses.
The rapid development of pathogenetic mechanisms causes severe large-scale lung damage, often bilateral. Coronavirus pneumonia manifests itself in a violation of the supply of oxygen to the blood, which leads to large-scale multiple organ hypoxia. Establishing a diagnosis involves performing tests for mycoplasma, chlamydia, which can be causative agents of bacterial pneumonia.
A number of virologists and pulmonologists formulate a different view of changes in the lungs. We are talking about the development of hemosiderosis of the lungs. In this state, the virus takes on the functions of hemolysis of erythrocytes. There is a splitting of iron ions from blood cells and their deposition in the form of hemosiderin. The accumulation of iron fills the alveoli, stroma of the lungs and gives the tissues a specific rusty color. As a result, there is an impoverishment of the supply of oxygen to all internal organs.
Hemosiderin explains the blurred clinical picture in coronavirus pneumonia, which does not always coincide with the data obtained on computed tomography or radiography. In some cases, symptoms develop rapidly against the background of relative well-being. The peak of the disease occurs within 24-48 hours.
The study of pneumonia in COVID-19 is ongoing. Only additional observations will make it possible to find out whether pure inflammation of the lungs occurs or other types of lesions join it.
How does the patient feel during the illness?
Coronavirus pneumonia is not considered as an independent disease. Its appearance is characterized as a complication of infection caused by the SARS-CoV-2 virus. Identification of pneumonia during infection indicates that it has passed into a moderate or severe form.
Pneumonia may be preceded by signs that are characteristic of a milder form of COVID-19:
Temperature increase at the level of 37,5-38°C.
Pain or sore throat.
Cough without mucus or expectoration.
Loss of smell and/or taste sensations (see Coronavirus Smell Loss).
Feeling of stuffy nose.
Persistent headaches.
Weakness, fatigue during the first 2-7 days.
Temperature with coronavirus, like a litmus test, its increase, stabilization or decrease indicate a change in the patient’s condition for better or worse.
If pneumonia develops, the symptoms worsen:
The fever reaches high numbers, up to 40 ° C, is permanent, poorly responsive to drugs. Temperature is accompanied by chills.
The toxicity is on the rise. The patient experiences nausea, dry mouth. The skin becomes bluish in color. There is profuse sweating.
The cough may not be productive. If the lesion of the lungs has passed into the stage of accumulation of hemosiderin, sputum appears with a characteristic rust color.
The appearance of shortness of breath, pain in the chest, both during coughing and during quiet breathing.
Shortness of breath, as the most important symptom of pneumonia in coronavirus, should be discussed in more detail. Difficulty breathing indicates that the disease is moving into a more severe stage. With COVID-19, deep breathing is limited. Ordinary bacterial pneumonia provokes shortness of breath when the pathological process extends to one or more lung lobes. Patients in this case do not experience difficulty in breathing at rest. Coronavirus pneumonia is accompanied by severe shortness of breath, regardless of physical activity. The frequency of respiratory movements and patients reaches more than 22 per minute (the norm is from 16 to 20). At the same time, patients feel an acute lack of air, some of them compare their condition with suffocation. Dyspnea reaches its peak by 6-8 days from the moment of infection.
In some cases, doctors observe specific intestinal manifestations. They appear when the virus enters the digestive tract. Patients complain of cutting pain in the abdomen, frequent bowel movements.
Signs of increasing respiratory failure:
Cyanosis of the skin of the nasolabial triangle, lips, fingernails.
The intercostal muscles are included in the act of breathing.
The patient takes a forced position, in which he feels relief of breathing – sitting, resting his hands on the bed.
The aggravation of respiratory failure leads to oxygen starvation of the brain. Hypoxia is manifested by drowsiness, irritability. Patients experience impaired consciousness in the form of confusion, fainting, or panic attacks.
Respiratory failure is reflected in cardiac activity. There is a drop in blood pressure, an increase in heart rate (more than 90 beats per minute).
The acute period of pneumonia with COVID-19 lasts 7-10 days. If the disease is mild, then recovery occurs in about a week. A severe course entails a number of life-threatening complications.
How to check if you have lung damage?
To establish the fact of lung damage, it is best to use a pulse oximeter. These devices were previously used exclusively in the hospital, but now they have entered everyday life. A pulse oximeter shows the level of oxygen saturation in the blood. Saturation is a key parameter that is controlled in coronavirus.
To assess the degree of lung damage, you need to know the normal level of oxygen in the blood.
The norm is determined according to age:
In persons younger than 50 years – 98-99%.
People aged 50 to 60 years – 96-98%.
Persons from 60 to 70 years old – 93-94%.
Smokers, people over 70 years old – 90%.
Deviations from the norm indicate an inflammatory process in the lung tissue.
* A pulse oximeter is an easy-to-use device that allows you to easily and quickly determine the level of saturation at home.
To do this, you must follow simple rules:
Take a comfortable position.
Put the pulse oximeter on the nail phalanx of the index finger.
Take a deep breath and hold your breath.
Evaluate the result after 12-15 seconds.
If the normal level for your age is 96%, and after holding your breath, the device shows 99%, then there is an alveolar reserve in the lungs. The body uses this reserve during deep breathing, which means normal functioning and a healthy state of the lungs.
What does the doctor check?
When working with patients who are suspected of having cornavirus pneumonia, doctors are guided by the recommendations of WHO and the Ministry of Health. The main hardware diagnostic method is computed tomography (CT) and radiography. Let’s say right away, the expediency of taking pictures is determined by the doctor. CT scans and X-rays are not performed for everyone in a row, since there may simply be no indications for this. Fortunately, coronavirus is not always accompanied by pneumonia. X-ray data may not correspond to what the doctor hears during auscultation.
Computed tomography shows the degree of lung damage:
CT1 is a single focus, the lesion is not more than 25%.
CT2 – moderate with damage from 25 to 50%.
CT3 – areas of compaction, fusion of foci, damage from 50 to 75% are determined.
CT4 is a critical condition with a lesion of more than 75%. Diffuse changes make the lungs look like minced meat.
CT is used to determine the dynamics of the disease, the effectiveness of the treatment.
Specific changes in coronavirus pneumonia on CT:
The lesions are round in shape, which most often form closer to the pleura and in the lower segments.
Cobblestone pavement “- the lobes of the lungs look like a cracked road, due to the thickening of the interlobar spaces.
Consolidation – appears if the alveoli are filled with fluid.
Air bronchogram – the lumen of the bronchus is visualized, which passes through the compacted part of the lung.
X-rays show what pulmonologists call “ground glass syndrome”. In healthy lungs, the dark surface of the lungs filled with oxygen is visualized. Light areas are determined in case of compaction, inflammation of the alveolar septa, with a clear pattern of the bronchi, blood vessels, and also with fluid accumulations in the alveoli.
Indications for hardware diagnostics of the lungs are:
During auscultation, the respiratory rate exceeds 22 per minute. Suspicion of a severe form of the disease – more than 30 DD per minute.
Pulse oximetry shows saturation below 95%. If the oxygen level drops below 93%, the patient is said to be in a serious condition.
Drop in pressure.
Impaired renal function.
Changes in the blood test – a drop in the level of leukocytes, high levels of C-reactive protein.
Testing for the SARS-CoV-2 virus is not always accurate. If the patient has an inflammatory process in the lungs in full swing, there is practically no pathogen in the nasopharynx. The biomaterial is often free of the pathogen. The most effective is the study of the material obtained during bronchoscopy. Unfortunately, this procedure is rather complicated in technical terms, it requires some preparation of the patient. To make a diagnosis, they usually donate blood for antibodies that appear in the first days of the disease.
Given the fact that the pandemic has caused an increased demand for the CT procedure, not every patient can undergo it in a timely manner. It is much easier to do an ultrasound of the lungs. Ultrasound machines are available in every clinic, which greatly simplifies the diagnosis. The ultrasound method does not show a complete picture of the lungs, but it is guaranteed to visualize about 70% of their surface. Ultrasound diagnostics has no contraindications and can be repeated many times at short time intervals.
Complications
In older patients with severe, chronic pathologies, coronavirus pneumonia can cause life-threatening complications:
Cytokine storm is a condition that is most often fatal.
Acute respiratory failure is accompanied by a sharp drop in the level of oxygenation, asthma attacks, convulsions, impaired consciousness, and often leads to hypoxic coma.
Respiratory distress syndrome is one of the types of respiratory failure, in which pulmonary edema, hypoxia develops.
Septic shock – develops with large-scale blood poisoning with viral, bacterial toxins. Accompanied by a sharp drop in blood pressure, high fever, convulsions, internal and external bleeding, dysfunction of the kidneys, liver, intestines.
Multiple organ failure is a condition in which body systems are simultaneously or sequentially affected. The clinic of multiple organ disorders is extremely severe, accompanied by pulmonary edema, compensatory tachycardia, ascites, dyspepsia, impaired consciousness up to coma.
A few years after recovery, a distant complication may appear – pulmonary fibrosis. This condition is characterized by the replacement of alveolar tissue with connective tissue, which necessarily leads to chronic respiratory failure.
Principles of therapy
Treatment for coronavirus pneumonia depends on the severity of the clinical picture. All drugs are prescribed on the basis of laboratory tests, CT results. Mandatory appointment:
Antiviral drugs.
Interferons.
detox solutions.
Vitamin Complexes.
In some cases, the use of antibacterial, glucocorticoid, non-steroidal anti-inflammatory drugs is practiced. Depending on the characteristics of the clinic, symptomatic agents are prescribed.
For easier breathing and strengthening the lungs, both respiratory and non-respiratory gymnastics for the lungs are done. It is done during illness, and after, and is also useful for the prevention of disease.
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