The experience of management of COVID-19: focus on the pneumonia

Abstract

Background. Coronaviruses are the RNA viruses, which have a crown-shaped outer layer. These viruses have a tropism to the respiratory epithelium. SARS-CoV (coronavirus of the severe acute respiratory syndrome), MERS-CoV (coronavirus of the Middle East respiratory syndrome) and the new coronavirus SARS-CoV-2 are the most significant coronaviruses, able to affect a human organism. Coronavirus disease (COVID-19) pathogenesis includes the coronavirus replication in the respiratory epithelium and the diffuse alveolocyte injury with the development of viral pneumonia or acute respiratory distress syndrome. The main symptoms of COVID-19 include fever (83-99 %), appetite loss (40-84 %), cough (59-82 %), fatigue (44-70 %), anosmia (15-30 %), myalgia (11-35 %). Apart from that, COVID-19 is often accompanied by coagulopathies together with venous thrombosis, myocardial infarction and disseminated intravascular coagulation syndrome. Risk factors of coagulopathies include sepsis, history of chronic obstructive pulmonary diseases and liver disorders, malignant tumors, fever and acute course of COVID-19. Objective. To describe the peculiarities of coronavirus pneumonias treatment. Materials and methods. Analysis of literature data and clinical cases from own practice. Results and discussion. 40 % of COVID-19 patients have a mild course, 40 % – moderate, 15 % – severe, and 5 % – critical. The majority of patients with lethal outcomes have at least one from the listed parameters: malignant tumor, morbid obesity, diabetes mellitus, cardiovascular diseases, diseases of kidneys and lungs, hypoalbuminemia, age >60 years old. Diagnosis of coronavirus pneumonia needs to be proved with the help of computer tomography (CT) during the initial visit or hospitalization, then in 2-3 days in case of the absence of improvement, in case of clinical condition worsening, in 5-7 days in case of no dynamics or of positive dynamics. Lung affection according to CT is divided into 4 grades according to the presence of frosted glass symptom, consolidation presence and the percentage of lung parenchyma involvement. Pathogenetic treatment, including off-label drug usage, can decrease the risk of fatal complications. Edaravone (Ksavron, “Yuria-Pharm”) is an antioxidant drug with an anti-inflammatory effect due to cytokine storm inhibition and the possibility to decrease the lung vessels’ endothelium permeability. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection (enzymes superoxiddysmutase, catalase, glutathione peroxidase). It underlines the reasonability of edaravone usage in acute respiratory distress-syndrome. Edaravone prevents the increase of permeability of lung vessels’ endotheliocytes similarly to dexamethasone, but has a lower amount of side effects. L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) are also actively studied. L-arginine improves microcirculation, promotes vasodilatation, activates Т-cell immunity, stabilizes cells’ membranes, protects cells, has an antioxidant effect, decreases the bronchial spasm and the spasm of pulmonary arteries. In turn, L-carnitine has an immunomodulatory effect, decreases the release of pro-inflammatory cytokines, has an antioxidant, anti-apoptotic and cardioprotective effects. Tivorel decreases the ability of coronaviruses to attach to the cells, counteracts their replication and decreases the endothelial dysfunction. Conclusions. 1. Pathogenetic treatment, including off-label drug usage, can decrease the unfavorable outcomes of COVID-19. 2. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection. 3. L-arginine and L-carnitine improve the microcirculation, promote vasodilatation, have an immunomodulatory, antioxidant and cardioprotective effects.