Koronavirusny infection – sharply proceeding infectious pathology with mainly aerogenic mechanism of infection caused by the RNA-containing coronavirus. Damage of the top airways is specific to coronaviruses, is more rare – intestines and a stomach. Clinically the infection is shown by moderate fever and symptoms of intoxication. Diagnostics of pathological process provides detection of a virus and antibodies to the activator in blood serum. Treatment includes etiotropny antiviral medicines and means of symptomatic therapy (febrifugal, expectorant, local vasoconstrictive and others).
Koronavirusny infection – the acute viral disease extending in the airborne way. For the first time the nosology was described in 1965 at the patient with sharp rhinitis, in 1975 the coronavirus was allocated. Now the family of these viruses includes more than 30 types which are widespread everywhere, and constantly is replenished: the Middle Eastern coronavirus (MERS) was allocated to one of the last in 2015 in South Korea. It is considered to be that about 4-15% of annual cases a SARS fall to the share of this activator, the greatest number of cases of a disease is registered in winter and spring time. The epidemic of atypical pneumonia which struck China and other Asian countries in 2002-2003 received the official name of a heavy sharp respiratory syndrome (TORSO or SARS) is known.
Reasons of a koronavirusny infection
Infecting agents – the RNA-containing family of coronaviruses. In family allocate three groups of the infectious agents dangerous to the person: human coronavirus 229 E, human OS-43 virus and intestinal coronaviruses of the person. The spontaneous mutation is considered the reason of emergence of new type of a virus (SARS activator). A source of the infectious agent is the sick person (or the carrier), ways of transfer – airborne and is much more rare – contact and household, realized through kontaminirovanny by a toy coronavirus, use objects. Risk factors are the children's age, decrease in immunity and long stay in badly aired rooms with a big congestion of people.
The activator is unstable in the environment, perishes at influence of usual doses of disinfectants, ultraviolet and high temperatures. The TORSO-associated coronavirus has bigger stability out of an organism and can remain in the external environment up to 4 days. Children, HIV-positive persons, elderly people and patients reckon with a serious chronic illness (damage of lungs, diabetes, oncological processes), inhabitants of communal flats, hostels, barracks, barracks, and also medical personnel and workers of services industry as risk groups on incidence of atypical koronavirusny pneumonia.
The pathogenesis of a koronavirusny infection is studied insufficiently. After hit in the top airways coronaviruses colonize epitelialny cages noso-and rotoglotka, actively breed, destroying epiteliotsita. At insufficient immune responsiveness of an organism coronaviruses get into alveolar epiteliotsita in which cytoplasm there is a replication of the activator. Ready vireos by an ekzotsitoz settle down on an external cell membrane that are promoted merge of epiteliotsit and education by a sintsitiya. Further there is an excess propotevaniye of liquid and protein in tissue of lungs, massive destruction of surfactant and a collapse of alveoluses with sharp decrease in gas exchange. During recovery affected areas of pulmonary fabric are replaced with connecting. Immunity after the postponed disease tipospetsifichny, resistant.
Symptoms of a koronavirusny infection
The incubatory period makes 2-3 days. The onset of the illness is sharp, intoxication symptoms (weakness, a headache, causeless fatigue) are expressed poorly. Body temperature seldom reaches high figures, most often does not exceed 38 °C. The main display of a koronavirusny infection is plentiful watery transparent separated from a nose, replaced on mucous character . Are characteristic the complicated nasal breath and decrease in sense of smell. At children and the weakened faces irritation, a sore throat, rough cough without phlegm and increase in cervical lymph nodes are observed.
Coronaviruses can cause only the isolated damage of a gastrointestinal tract which is followed by nausea, vomiting, belly-aches (mainly in an epigastriya) and a liquid watery chair. The gastroenteritis usually proceeds is good-quality, without development of dehydration though in case of defeat by a coronavirus of a gastrointestinal tract of babies perhaps bystry progressing to an eksikoz. The TORSO absence of cold, high fever (more than 39 °C), painful dry cough and the progressing short wind are signs; regarding cases the so-called respiratory distress syndrome of adults resulting in heavy respiratory insufficiency develops.
At the timely request for medical care and in time the begun treatment the koronavirusny infection proceeds is good-quality. The most widespread complication is accession of a secondary inflammation (most often the bacterial nature) with development of sinusitis, tonsillitis, otitises, bronchitis and pneumonia. At the TORSO complications arise because of the progressing insolvency of a respiratory path. The most terrible of them ‒ the thrombembolia of a pulmonary artery, myocarditis, perikardit, spontaneous pheumothorax, heart failure and violations of a rhythm of heart. There are data on detection of coronaviruses in cerebrospinal fluid for patients with multiple sclerosis.
At suspicion of a koronavirusny infection consultation of the infectiologist, otorhinolaryngologist and therapist, pulmonologist – after emergence of symptoms of damage of lungs, the gastroenterologist – in the presence of a gastroenteritis is obligatory. Diagnostics of a nosology is carried out by the laboratory and tool methods including:
- Clinical and biochemical blood test. In the general blood test the leykopeniye, a limfotsitopeniye and thrombocytopenia, anemia, acceleration of SOE are observed. At accession of secondary bacterial flora appears . Biochemical indicators reflect increase in activity of nuclear heating plant, ALT, kreatinfosfokinaza, decrease in content of the general protein and a gipoalbuminemiya, is rare - a gipoglobulinemiya.
- Identification of infectious agents. To allocate the activator from nasal separated, phlegms, washing waters, emetic masses, a liquid chair of the patient by means of PTsR it is possible from first days of a disease. In dynamics (at primary address of the patient and 2 weeks later) blood IFA on existence of antibodies to a coronavirus is carried out. The minimum growth of a caption of antibodies for confirmation of the diagnosis – double. Becomes the most informative IFA in 10 and more days from the first clinical manifestations. For the purpose of differential diagnostics apply a bacteriological research of excrements and a koprogramma.
- Radiodiagnosis. At emergence of symptoms of pneumonia the X-ray analysis of bodies of a thorax is carried out, the multispiral computer tomography is less often used (for an exception of similar pathologies). A radiological picture are usually characterized by unilateral interstitsialny defeat or bilateral focal drain pneumonia.
Differential diagnostics is carried out with other SARS, flu, Ku's fever, pnevmotsistozy, tuberculosis, legionellosis, ornithosis, mycoplasmosis, bacterial rinofaringita, bronchitis and pneumonia. It is necessary to differentiate this pathology with viral diarrheas, salmonellosis, food toksikoinfektion, dysentery, an enteroviral infection.
Treatment of a koronavirusny infection
Therapy out of complications assumes out-patient treatment. It is recommended to limit contacts with people around, whenever possible to isolate the patient in the certain room, to provide daily damp cleaning and airing of the room. A special diet it is not developed; it is necessary to give preference to easy, but rich dishes, to exclude fried, fat, alcohol, to adhere to frequent fractional food and to increase the use of liquid, mainly boiled water of room temperature.
Treatment means etiotropny (, medicines of interferon) and symptomatic therapy (vasoconstrictive drops in a nose, use of sprays and solutions for irrigation of a back wall of a throat, febrifugal, expectorant means; at a gastroenteritis solutions for an oral regidratation and sorbents are recommended). Application of antibiotics without clinical manifestations and bacteriological confirmation is not recommended. In the presence of complications of a koronavirusny disease it is preferred as medicines with a broad spectrum of activity.
Identification or suspicion on the TORSO is the indication for hospitalization in an infectious hospital. Therapy of atypical pneumonia under the protocol of WHO is carried out in the conditions of chambers of intensive therapy with use of a combination of antibiotics (, , amoxicillin with clavulanic acid) with antiviral means () and glucocorticosteroids (methylprednisolonum). For patients about the TORSO, among other, perspective medicines are the means containing surfactant.
Forecast and prevention
In the absence of complications within 7-10 days there comes the absolute recovery. The natural susceptibility of people to coronaviruses low, and infection occurs only at long close contact (most often in life). At severe defeat of pulmonary fabric (TORSO) the lethality reaches 20-38% of cases. From among the persons about the TORSO which came to hospitals on late terms of a disease or having the accompanying pathologies and age 45 years are more senior, the lethality increases on average by 9,5%. Fibrous changes in lungs can serve as the reason of further development of chronic respiratory insufficiency and constant violations of warm activity.
Means of specific prevention of a koronavirusny infection (vaccine) are not developed. For prevention of a disease maintaining a healthy lifestyle, a hardening, feasible physical activity and the balanced food is recommended. Important methods are use in cold season of disposable medical masks, avoiding of mass actions in the enclosed space, trips in the crowded public transport, daily airing and regular damp cleaning.