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\n What you should know about COVID-19 Pneumonia \n

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What type of pneumonia is viral or bacterial?

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Pneumonia, which affects approximately one in five patients with COVID-19, has characteristic features. Normal, non-coronavirus pneumonia, develops due to the accumulation of fluid in the lungs against the background of acute respiratory infections or influenza. In this sputum, bacteria multiply, provoking the appearance of individual foci of inflammation.\nA complication of COVID-19 is a viral, not a bacterial infection, so coronavirus pneumonia has a completely different course. The virus disrupts the normal functioning of the alveoli - vesicles located on the lung walls. This leads to the development of not focal, as in the previous case, but a global lesion of both lungs. Lung tissue quickly collapses, becomes fibrous.

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Is asymptomatic inflammation of the lung tissue possible with covid, when, despite changes in the lungs, patients have neither cough, nor shortness of breath, nor fever?

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An asymptomatic or oligosymptomatic course is more typical for forms of the disease without lung damage. Indeed, computed tomography (CT) scans of the chest in patients with mild COVID-19 may show CT evidence of mild viral pneumonia. At the same time, the gas exchange function of the lungs does not suffer, the amount of oxygen delivered to the blood remains normal, and no change in therapeutic tactics is required.

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When do coronavirus symptoms usually appear, such as respiratory discomfort, shortness of breath?

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The incubation period of an infection caused by the SARS-CoV-2 virus averages 5-7 days (from 2 to 14), which means that symptoms may appear during these periods. The course of the disease can be different - from mild manifestations of a common ARVI (fever, cough, weakness, headache) to severe pneumonia with respiratory failure. It is always worth paying attention to such manifestations of the disease as shortness of breath (increase in the frequency of breathing), a feeling of lack of air, pain or a feeling of tightness in the chest at any time during the illness.

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Do lung changes occur in most patients with COVID-19?

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In most cases - up to 80% - coronavirus infection is mild, without involvement of the lungs. COVID-19 pneumonia develops in approximately 20% of cases, of which 2 to 10% can be severe. The duration of the course and the consequences of the disease depend on many factors: the volume of lung damage, concomitant diseases, the timeliness of seeking medical help, adherence to treatment recommendations, the possibility of developing complications, etc.

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Should I do a CT scan of the lungs with a coronavirus infection?

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Due to the frequent false-negative results of the primary PCR study and the absence of classic signs in SARS, computed tomography (CT) is becoming the most informative way to diagnose COVID-19.

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COVID-19 antigens, recognized as an absolute marker of infection, are detected by PCR. As for computed tomography, it does not detect the pathogen itself, but allows you to confirm or refute the presence of specific viral pneumonia.

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CT is a highly sensitive method of radiation imaging of various anatomical structures. Non-invasive, absolutely painless examination takes a few seconds, has high sensitivity and specificity. Scanning on modern tomographs with a radiation control program is carried out at a reduced radiation exposure.

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For whom is a lung CT recommended in the first place?

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Computed tomography is not performed for prophylactic purposes. The study is considered necessary when symptoms of the disease appear in the following situations:

• \nthere was contact with a patient who has a confirmed coronavirus infection (the virus was detected in a laboratory);
• there are severe symptoms and clinical signs of a respiratory disease (temperature 38 degrees and above, respiratory rate> 22 per minute, shortness of breath / cough / chest pain, blood saturation < 95% - to make a decision on inpatient treatment);
• there is a need for planned hospitalization for treatment of an illness not related to COVID-1.

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CT scan for coronavirus infection is done even if the test for COVID-19 shows a negative result, and no significant changes in the lung tissue are detected on the x-ray of the lungs (the foci may still be small) - while the patient is concerned about the above symptoms, and contact with sick in the past.

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What are the treatments for coronavirus pneumonia?

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Approaches to the treatment of COVID-19 were formed and changed as information about the course of the infection became available, understanding of the mechanisms of its development and possible consequences based on the analysis of a large number of international publications and research results, and accumulating clinical experience. A year after the start of the pandemic, there are still no etiotropic therapy drugs with proven efficacy in the arsenal of used drugs.

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With COVID-19 pneumonia, non-drug methods occupy an important place - prone position (lying on the stomach) as an independent therapeutic measure, oxygen therapy, options for hardware respiratory support. In all cases of coronavirus infection, it is necessary to monitor the amount of fluid consumed.

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Taking into account the mechanisms of the development of the disease, the pharmacotherapy algorithm for COVID-19 pneumonia includes antiviral drugs, drugs for the prevention of thrombosis, hormonal anti-inflammatory therapy, and if there are signs of a bacterial infection, antibiotics.

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Despite the algorithmization of therapeutic approaches, which is undoubtedly important in epidemic conditions, the volume of pharmacotherapy and the choice of specific drugs from each group are determined by the doctor, and only based on the specific clinical situation and the individual characteristics of the patient.

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Do patients with pneumonia caused by coronavirus always need to be treated in the hospital?

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At home, it is possible to treat non-severe pneumonia in a person without risk factors, if there are conditions that ensure isolation and adherence to treatment recommendations, as well as medical (including remote) control.

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Is it possible to do inhalation with coronavirus pneumonia?

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With a coronavirus infection, inhalations (steam inhalations, nebulizer therapy), as aerosol-forming procedures, should be abandoned. Exceptions are dosing inhalation devices - aerosol and powder, used for constant basic therapy and emergency care for chronic diseases - bronchial asthma and chronic obstructive pulmonary disease.

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Nebulizer therapy should be used only for health reasons, taking precautions for the spread of infection through an aerosol (isolation of the patient during inhalation, ventilation after inhalation, surface treatment with antiseptics).

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How to restore the lungs after coronavirus pneumonia?

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Basic rules of rehabilitation:

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1. Perform aerobic exercise in a sitting position or even lying down and reclining. You can do the exercise bicycle, loads on the hands are required. If additional weight is used when training hands, then the principle here is this - less weight - more repetitions. You can train on an exercise bike, but you need to start from a more horizontal position. It is important that the exercises should be regular and with a fairly high frequency - from 4 to 6 days a week. Increase the load smoothly and gradually.
2. With active cardio loads, you will probably have to wait a long time. In any case, you need to start with walking. Then gradually you can use the bike. But the best thing is to walk and walk, breathe fresh air. Improving gas exchange is also rehabilitation!
3. We eat right! In this case, this means: eat in small portions, pay attention to the fact that there were enough calories, no rigid diets. The body needs both proteins and fats. Carbohydrates are also important, but sweets should be replaced with a lot of fiber (vegetables, greens). This normalizes digestion and increases the emotional background.
4. Sleep after an illness is necessary for at least 7 hours. We ventilate the bedroom before going to bed, slow down physical activity 2-3 hours before bedtime. If there is such an opportunity, then before going to bed it is better to take a walk and not overeat, finish dinner 1.5 - 2 hours before bedtime.
5. Try not to use gadgets right before going to bed, because it causes overexcitation of the nervous system. Don\'t take your phone to bed with you. Because if you woke up in the middle of the night, and you have a phone at hand, the likelihood that you will start reading something is high. And as soon as you read something, the brain has already rebuilt to other activities.
6. We are all now in a state of stress, both those who have been ill and those who have not been ill. A feature of this infection is hypoxia, oxygen starvation. This may be a prerequisite for the development of anxiety, post-traumatic stress disorder, depression. In such cases, psychological support is needed - seek qualified help.
7. Control your vitamin D levels. If the analyzes reveal its insufficiency, it will be necessary to take it additionally.
8. Alcohol is excluded. Yes, some doctors from Italy, for example, write that a glass of wine would not hurt. But in the early stages of rehabilitation, alcohol is contraindicated. Since the vessels were subject to a serious attack of the virus during the illness, it is not worth exposing them to an alcohol load during the rehabilitation period.

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\n What you should know about viral pneumonia \n

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Viral pneumonia is an acute inflammation of the respiratory sections of the lungs caused by viral pathogens, occurring with a syndrome of intoxication and respiratory disorders. In childhood, viral pneumonia accounts for about 90% of all cases of pneumonia. In the structure of adult morbidity, bacterial pneumonia predominates, and viral pneumonias account for 4–39% of the total number (people over 65 years of age are more likely to get sick). The frequency of occurrence of viral pneumonia is closely related to the epidemiological outbreaks of SARS - their rise occurs in the autumn-winter period. In pulmonology, primary viral pneumonia (interstitial with a benign course and hemorrhagic with a malignant course) and secondary (viral-bacterial pneumonia - early and late) are distinguished.

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Causes of viral pneumonia

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The spectrum of causative agents of viral pneumonia is extremely wide. The most common etiological agents are influenza A and B viruses, parainfluenza, adenovirus. Individuals with immunodeficiencies are more susceptible to viral pneumonia caused by the herpes virus and cytomegalovirus. Pneumonias initiated by enteroviruses, hantavirus, metapneumovirus, Epstein-Barr virus are less commonly diagnosed. SARS-associated coronavirus is the causative agent of severe acute respiratory syndrome, better known as SARS. In young children, viral pneumonias are often caused by respiratory syncytial virus, measles, and varicella.

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Primary viral pneumonia manifests itself in the first 3 days after infection, and after 3-5 days the bacterial flora joins, and the pneumonia becomes mixed - viral-bacterial. Persons at increased risk of viral pneumonia include young children, patients over 65 years of age, people with weakened immune systems, cardiopulmonary pathology (heart defects, severe arterial hypertension, coronary artery disease, chronic bronchitis, bronchial asthma, pulmonary emphysema) and others. associated chronic diseases.

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The transmission of viruses is carried out by airborne droplets when breathing, talking, sneezing, coughing; a contact-household route of infection through contaminated household items is possible. Viral particles penetrate into the respiratory sections of the respiratory tract, where they are adsorbed on the cells of the bronchial and alveolar epithelium, causing its proliferation, infiltration and thickening of the interalveolar septa, round cell infiltration of the peribronchial tissue. In severe forms of viral pneumonia, hemorrhagic exudate is found in the alveoli. Bacterial superinfection significantly aggravates the course of viral pneumonia.

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Symptoms of viral pneumonia

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Depending on the etiological agent, viral pneumonia can occur with varying degrees of severity, complications, and outcomes. Inflammation of the lungs usually joins from the first days of SARS.\nThus, the defeat of the respiratory sections of the respiratory tract is a frequent companion of adenovirus infection. The onset of pneumonia in most cases is acute, with high fever (38-39°), cough, severe pharyngitis, conjunctivitis, rhinitis, and painful lymphadenopathy. The temperature in adenoviral pneumonia lasts for a long time (up to 10-15 days), it is characterized by large daily fluctuations. Frequent, short cough, shortness of breath, acrocyanosis, various wet rales in the lungs are characteristic. In general, adenoviral pneumonia is distinguished by a long-term preservation of clinical and radiological changes, a tendency to a recurrent course and complications (pleurisy, otitis media).

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The incidence of viral pneumonia against the background of influenza increases significantly during periods of epidemics of a respiratory infection. In this case, against the background of typical symptoms of SARS (fever, severe weakness, myalgia, catarrh of the upper respiratory tract), noticeable shortness of breath, diffuse cyanosis, cough with rusty sputum, wheezing in the lungs, chest pain when inhaling. In children, general toxicosis, anxiety are expressed, vomiting, convulsions, meningeal signs may occur. Influenza pneumonia is usually bilateral, as evidenced by auscultatory findings and x-ray picture (focal opacities in both lungs).\nMild cases of viral pneumonia caused by the influenza virus are characterized by mild symptoms and end in recovery. Severe forms occur with constant high fever, respiratory failure, collapse. Among the complications are frequent influenza encephalitis and meningitis, otitis, pyelonephritis. The addition of a secondary bacterial infection often leads to lung abscesses or pleural empyema. Possible death during the first week of the disease.

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Parainfluenza pneumonia often affects newborns and young children. It has a small-focal (less often confluent) character and proceeds against the background of catarrhal phenomena. Respiratory disorders and intoxication syndrome are moderate, body temperature usually does not exceed subfebrile values. Severe forms of viral pneumonia with parainfluenza in children occur with severe hyperthermia, convulsions, anorexia, diarrhea, and hemorrhagic syndrome. A feature of respiratory syncytial pneumonia is the development of severe obstructive bronchiolitis. The defeat of the lower parts of the respiratory tract is marked by an increase in body temperature up to 38–39 ° C, a deterioration in the general condition. Due to spasm and blockage of small bronchi with mucus and desquamated epithelium, breathing becomes sharply difficult and rapid, cyanosis of the nasolabial and periorbital region develops. The cough is frequent, wet, but due to the increased viscosity of sputum, it is unproductive. With this type of viral pneumonia, attention is drawn to the discrepancy between intoxication (moderately expressed) and the degree of respiratory failure (extremely pronounced).

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Enteroviral pneumonia, the causative agents of which are Coxsackie and ECHO viruses, proceed with poor physical and radiological data. In the clinical picture, concomitant meningeal, intestinal, and cardiovascular disorders come to the fore, making diagnosis difficult.

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Diagnosis and treatment of viral pneumonia

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Correctly recognizing the etiological form of pneumonia and identifying the pathogen will help a thorough study of the anamnesis, epidemiological situation, assessment of physical and laboratory and radiological data. Viral pneumonia usually develops during periods of epidemic outbreaks of SARS, occurs against the background of catarrhal syndrome, and is accompanied by signs of respiratory failure of varying severity. On auscultation, fine bubbling rales are heard in the lungs.

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An x-ray of the lungs reveals an increase in the interstitial pattern, the presence of small focal shadows more often in the lower lobes. The study of sputum, tracheal aspirate or bronchial washings by the method of fluorescent antibodies helps to confirm the viral etiology of pneumonia. In the blood in the acute period, there is a fourfold increase in antibody titers to the viral agent.

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A comprehensive assessment of objective data by a pulmonologist will allow to exclude atypical, aspiration pneumonia, obliterating bronchiolitis, heart attack-pneumonia, bronchogenic cancer, etc.

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Hospitalization for viral pneumonia is indicated only for children under 1 year old, patients of the older age group (from 65 years old), and those with severe concomitant diseases (COPD, heart failure, diabetes mellitus). Patients are prescribed bed rest, drinking plenty of water, fortified, high-calorie meals.

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Etiotropic therapy is prescribed depending on the viral pathogen: rimantadine, Tamiflu, Relenza - for influenza pneumonia, acyclovir - for herpes viral pneumonia, ganciclovir - for cytomegalovirus infection, ribavirin - for respiratory syncytial pneumonia and hantavirus damage, etc. Antibacterial agents are added only with a mixed nature of pneumonia or the development of purulent complications. As a symptomatic treatment, expectorants, antipyretics are used. In order to facilitate the discharge of sputum, medicinal inhalations and drainage massage are carried out. With severe toxicosis, intravenous infusion of solutions is carried out; with the development of respiratory failure - oxygen therapy.

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Forecast and prevention of viral pneumonia

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In most cases, viral pneumonia ends in recovery within 14 days. In 30-40% of patients, a protracted course of the disease is noted with the preservation of clinical and radiological changes for 3-4 weeks, followed by the development of chronic bronchitis or chronic pneumonia. Morbidity and mortality from viral pneumonia is higher among young children and elderly patients.

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Prevention of viral pneumonia is closely related to the immunization of the population, primarily preventive seasonal vaccination against influenza and the most dangerous childhood infections. Nonspecific measures to strengthen immunity include hardening, vitamin therapy. During periods of outbreaks of acute respiratory viral infections, it is necessary to take personal precautions: if possible, exclude contacts with patients with respiratory infections, wash hands more often, ventilate the room, etc. These recommendations especially concern the contingent of increased risk for the development and complicated course of viral pneumonia. Where can i buy bactrim

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