SARS in adults
SARS pandemics became infamous in 2002 after the outbreak of a new viral infection in the United States, China, Canada, Hong Kong and 30 other countries. The new coronavirus also causes SARS. How it manifests itself and why it is dangerous – we will find out together with an expert

The term SARS has been used since the 30s. This is not quite the inflammation of the lungs that occurs with classical pneumonia. Often these diseases become the causes of epidemics.

What is SARS

SARS is an inflammation not of the lung sacs themselves, where the exchange of gases takes place, but of the connective tissue surrounding them (the skeleton of the lungs). In addition, atypical pneumonias are called because they are not caused by bacteria, as in the “classic” disease, but by viruses, chlamydia, mycoplasmas, or even rarer pathogens.

Often there are outbreaks of SARS, especially viral ones. They were in 1960, 2002-2003, then in 2015 and at the end of 2019, when the most serious epidemics provoked by coronaviruses arose.

Causes of SARS in adults

Atypical inflammation in the lungs can be caused by various pathogens – mycoplasma, coxiella, chlamydia, legionella. A significant role in the occurrence of SARS is played by viruses – influenza A or B, parainfluenza of the first, second and third types, Ebstein-Barr virus, RS virus, hantavirus, coronaviruses and pathogens of leptospirosis and tularemia.

The main problem with these pneumonias is that they are not treated with antibiotics (if they are viruses) or require special types of antibiotics (if they are mycoplasmas and other pathogens).
Elena Zaryanova Candidate of Medical Sciences, pulmonologist of the highest category, somnologist

SARS can be contracted through contact with people at work or in public places. The main route of transmission is through communication, coughing or sneezing with droplets of saliva and mucus. The incubation period depends on the type of infection – it lasts from 3 to 10 days, with coronavirus – up to 14 days.

Symptoms of SARS in adults

Symptoms of the disease may vary depending on the type of pathogen.

Mycoplasma pneumonia. Often has a mild or moderate course. Characteristic symptoms are low prolonged temperature, dry cough up to 2-3 weeks, weakness, weakness, headache and malaise. Usually both lungs are affected, but the percentage of damage is small.

Chlamydial pneumonia. It starts as an acute respiratory viral infection, then the temperature rises, there are pains in the body, dry cough, swollen lymph nodes in the neck. Both lungs are affected, shortness of breath occurs on exertion, shortness of breath. Often the course is similar to bronchitis and asthma.

Legionella pneumonia (legionnaires’ disease). It often happens in the summer, in people who sit under the air conditioner for a long time. The lobe of the lung, the bronchi are affected. It proceeds hard, with a high temperature up to 40 ° C, toxicosis, severe chills, headache. Cough at first dry, then with mucus or purulent sputum. Typical shortness of breath, nausea with vomiting, diarrhea, abdominal pain, tachycardia, kidney damage.

Severe acute respiratory syndrome or atypical viral pneumonia. Usually occurs with coronavirus infection, affects both lungs with cobblestone or ground-glass effect on CT. Typical fever, cough, mostly dry, general malaise, severe weakness, decreased appetite, increasing shortness of breath, palpitations, decreased pressure. Also, there is a cytokine storm, increased blood clotting with thrombosis, cerebrovascular accident, heart problems.

Causative agents of SARS in adults

Although SARS is a whole group of diseases in which inflammation of the lungs occurs, 4 types of pathogens are most common:

  • mycoplasmas are microorganisms that do not have a typical cell wall, they belong to bacteria, but have some signs of viruses;
  • chlamydia are intracellular parasites that infect lung tissue;
  • legionella – pathogenic bacteria that cause pneumonia and “legionnaires’ disease”;
  • coronaviruses – provoke outbreaks of pneumonia, damage to internal organs, thrombosis, cytokine storm.

Treatment of SARS in adults

All types of SARS require the attention of doctors. They are identified and treated differently, so you should always contact a specialist at the first sign of lung problems.

Diagnostics

The basis for the diagnosis of atypical pneumonia is the patient’s complaints and external examination, changes in the lungs that the doctor hears when listening to the chest with a phonendoscope. However, only in this way it is extremely difficult to determine pneumonia. Additionally needed:

  • blood and urine tests, sputum cultures,
  • PCR study to detect viruses or mycoplasmas, chlamydia;
  • radiography of the lungs;
  • CT scan of the lungs to determine the percentage of lung tissue damage and a typical pattern of changes;
  • additional tests to detect lesions in other organs (ECG, ultrasound, MRI).

Modern treatments

Mycoplasma pneumonia is treated with macrolide antibiotics (erythromycin or azithromycin), or in some cases clindamycin is prescribed. The course should last at least 7-10 days. Chlamydial pneumonia is treated with macrolides and tetracycline antibiotics, the course lasts at least 10-14 days. If these drugs do not help, prescribe Doxycycline or fluoroquinolones (Ofloxacin). Pneumonia caused by Legionella is treated with intravenous antibiotics – Doxycycline, Ofloxacin, Rifampicin. Sometimes the patient needs a ventilator, as often the lungs are very badly damaged. Often, against the background of antibiotics, hormones are also used (corticosteroids in a short course).

There is no specific treatment for viral pneumonia. There is evidence of the effectiveness of Favipiravir and Remdesavir, but they are used in severe cases. They also use hormones, drugs that prevent cytokine storms, blood-thinning agents.

The general treatment for all SARS is symptom management:

  • antipyretic drugs (Nurofen, Ibuklin, Paracetamol, Teraflu, Coldact, Coldrex);
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  • preparations for thinning sputum (ACC, Ambroxol, Ambrobene, Bromhexine);
  • vitamins (ascorbic acid and vitamin D);
  • drinking plenty of fluids or giving intravenous fluids;
  • bed rest, good sleep;
  • oxygen support for severe shortness of breath.
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Prevention of SARS in adults at home

To prevent coronavirus pneumonia, vaccines have been developed that are vaccinated in adults. For other forms of infections, only non-specific prevention is necessary – you need to wear a mask in public places, avoid people who have colds, and do not stay under air conditioners for a long time.

Popular questions and answers

With SARS, complications may well develop, and it is more difficult to predict them than with the “classic” course of pneumonia. She told us more about what SARS can threaten, how dangerous it is, pulmonologist Elena Zaryanova.

How dangerous is SARS?

Atypical pneumonias are usually distinguished by the smoothing of “typical” symptoms, they occur with a small amount of sputum discharge, no changes on plain radiographs, slight leukocytosis, low body temperature, the predominance of secondary symptoms in the clinical picture – headache, muscle pain, sore throat, weakness (which resembles cold symptoms caused by viral respiratory infections).

Previously, known bacterial pathogens of “atypical” pneumonia, such as Mycoplasma pneumoniae и Chlamydophila pneumoniae, Legionella pneumophila, were considered as viruses, in connection with which “atypical” pneumonia was called “non-bacterial”. However, despite the fact that today these atypical pathogens are recognized as bacteria, they all have “atypical” features (lack of a cell wall in mycoplasma, intracellular parasitism of chlamydia, etc.), which affects their sensitivity only to certain groups of antibacterial drugs ( macrolides, fluoroquinolones, doxycycline) and therefore requires correct identification of the pathogen.

What are the possible complications of SARS?

Prolonged stay in the body of atypical microorganisms, their intracellular localization, like viruses, can lead to the formation of bronchial hyperreactivity, transient narrowing of the airways in response to external stimuli and the development of bronchial asthma.

In clinical practice, atypical pneumonia also includes pneumonia that is difficult to treat with antibacterial drugs, has a protracted nature of respiratory symptoms and persists for a long time – more than 20 days. In such cases, it is necessary to correct the diagnosis and exclude the presence of other diseases in the patient, such as tuberculosis, malignant neoplasms of the lungs, thromboembolism of small branches of the pulmonary artery and other possible pathologies that, in the absence of correctly and timely prescribed treatment, can lead to death.

When to call a doctor at home for SARS?

Of the “atypical” pneumonias, legionella pneumonia is the most severe, which is characterized by significant damage to the lungs. The defeat of the lungs in “legionnaires’ disease” sometimes proceeds in the form of acute alveolitis. The disease in these cases is characterized by an acute onset, fever, headache, asthenia, dry cough, followed by an increase in shortness of breath.

Late diagnosis of “legionnaires’ disease” and, as a consequence, late initiation of antibiotic therapy leads to a risk of death. Mortality in various outbreaks ranges from 8 to 40%. In severe cases, patients die from increasing respiratory failure, the development of respiratory distress syndrome and multiple organ failure.

Is it possible to treat SARS with folk remedies?
As with bacterial “typical” pneumonias, there is no talk of folk remedies as the first line of treatment for SARS. Folk remedies can only be used as additional methods to alleviate some of the symptoms of the disease.

On the part of medical personnel, careful monitoring of the patient’s condition and immediate hospitalization is required if his condition worsens. It should be noted that the course of etiotropic antibiotic therapy for “atypical” pneumonia caused by mycoplasma, chlamydia and legionella is longer than for the treatment of “typical” bacterial pneumonia and lasts from 14 to 21 days.

For the treatment of any pneumonia, the accurate identification of the pathogen and the timely administration of the appropriate antibacterial drug are crucial.

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