The article reviews the literature on community-acquired pneumonia. Own results of study on the features of clinical, laboratory, and instrumental manifestations of community-acquired pneumonia during epidemic of the new coronavirus infection of COVID-19 are given.
The article presents literature data on changes in laboratory parameters in new coronavirus infection COVID-19 and the results of our own researches. It was found that in the first three days after hospitalization, most patients had normocytosis, a normal number of lymphocytes. In the mild form, there were slightly more people with normal or with an increased number of leukocytes, granulocytes, but in moderate course, leukopenia, lymphopenia, granulocytosis and granulocytopenia, thrombocytosis, thrombocytopenia were registered more often. At the same time, in the mild form, there were more patients with an increased number of band neutrophils. In mild course, there were no individuals with an increased number of band neutrophils after 3 days in the hospital. Leukocytosis, lymphopenia, granulocytosis were no longer detected after 6 days in the hospital; during this period, the number of patients with leukopenia, thrombocytopenia also decreased significantly, most people had normocytosis. In patients with moderate-to-severe course, leukocytosis and leukopenia were observed for a longer period than with the mild course, even after 10 days in hospital. Most patients had normocytosis. By the sixth day of hospital stay, there were more individuals with granulocytosis (no such patients were registered at a later date), with an increased number of band neutrophils. After 6 days, there was greater number of patients with lymphocytosis, thrombocytosis and lymphocytopenia.
On an example of a clinical case in a patient with drug addiction, the reviewed clinical and chest X-ray features of community-acquired pneumonia, the diagnostic algorithms and the differential diagnostics are based on the recommendations of the Ukrainian Association of Pulmonology. The treatment strategy of the patient in the conditions of an ambulatory are described. Community-Acquired pneumonia acquired by intravenous drug use is characterized by a severe course, febrile body temperature, severe specific lung disease. On the example of this clinical case, the importance of express diagnostics of pneumonia at the ambulatory stage wasconfirmed to determine the correct tactics of patient management.
This article provides a review of the literature on the symptoms, laboratory blood values of critically ill patients who recovered and those who died of the new coronavirus disease COVID-19. Physicians should consider the following when predicting the course of the disease: in the first 3 days after admission, patients who recovered were slightly more likely to have leukocytosis and leukopenia, normal and increased lymphocyte counts; there were more individuals with increased number of band neutrophils, and patients who subsequently died were more likely to have normocytosis, granulocytosis, lymphopenia, thrombocytopenia, and higher erythrocyte sedimentation rate. The evaluation of laboratory indices in dynamics is of great importance for the prognosis: patients who recovered, on day 4–6 had a less pronounced growth of leukocytes and subsequently, on the contrary, their reduction; on day 4–6 of hospital stay, there was a decrease in the number of lymphocytes with subsequent growth; high creatine phosphokinase values at the beginning of hospitalization decreased significantly from day 7–9 to reference values; from the time of hospitalization, there was a decrease in lactate dehydrogenase content; the average prothrombin index tended to decrease, but within normal limits. Patients who died later, already from day 4–6 had an increase in leukocyte count, a decrease in lymphocyte level; thrombocytopenia was registered more often, which persisted with time and decreased significantly, especially after 9 days; in all periods of observation, erythrocyte sedimentation rate was higher (median of 30–40 mm/h); from day 7, there were significant fluctuations in maximum creatine phosphokinase values with their significant increase; at the beginning of hospitalization, these patients had higher lactate dehydrogenase levels compared to the first group and maintained their advantages during all periods of observation with significant fluctuations of maximal values; when comparing these patients by observation periods, there were slight fluctuations in the prothrombin index, which most often registered in about 80 % of patients with a subsequent increase after day 9, but within normal limits; also, at the beginning of hospitalization, there were significant fluctuations in the minimum prothrombin index towards very low rates.
This article presents a review of the literature and data from a personal study concerning the clinical manifestations of new coronavirus infection in patients hospitalized during the COVID-19 epidemic depending on their age. It was found that most patients complained about dry or low-productive cough, moderate general weakness. The patients aged 18–30 years old more frequently experienced no cough. The patients aged 31–40 years old significantly more frequently complained about dry cough (p < 0.05). Low-productive cough was less frequent but typical in all age groups and more frequent in patients aged 51–60 years. Moist cough was more frequent in patients over 60 years. Chest pain was registered in patients over 60 years (p < 0.05). The frequency of dyspnea was found to increase with age. More often dyspnea was registered in patients older than 60 years old. No dyspnea was noted in young patients aged 18–30 years. Half of the patients aged 18–30 years had no fever. At hospitalization, the average temperature was within normal or subfebrile, which predominated in patients aged 41–50 years (p < 0.05). The frequency of febrile fever increased in patients with age. There was no significant difference in the frequency of pyretic temperature among all age groups. The patients aged over 30 years complained more about moderate weakness, and patients aged over 40 years complained more about severe weakness. Younger patients more often complained about a sore throat, while older patients had practically no symptoms (p > 0.05). Thoracic pain was significantly more frequently registered in patients older than 60 years old. Young patients aged 18–30 years and 31–40 years had no chest pain.
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