Clinical observation of the long-term course of COVID-19 infection in a patient with an immunodeficiency condition
https://doi.org/10.21518/ms2024-149
Abstract
The new coronavirus infection caused by the SARS-CoV-2 virus has become a real challenge for the world’s population. Despite the fact that vaccines have been developed and the effectiveness of antiviral drugs has been demonstrated, COVID-19 continues to be an urgent problem. SARS-CoV-2 is genetically modified due to the accumulation of mutations, new strains with high virulence appear that distort the immune response. In addition, it has been shown that the virus can persist in the body for a long time, which ensures the maintenance of an inflammatory response and causes the persistence and recurrence of symptoms after acute infection, especially in certain groups of patients. The article presents a clinical case of a long-term course of new coronavirus infection with predominant lung damage in the form of interstitial changes and persistent inflammation for 7 months from the moment of diagnosis against the background of an immunodeficiency condition due to the patient’s lymphoma in remission after polychemotherapy, exclusion of pulmonary embolism and progression of lymphoproliferative disease. The article highlights the difficulties of determining the criteria for a post-COVID and the features of its treatment using long-term therapy with systemic glucocorticosteroids, inhalation administration of tauractant (Surfactant-BL) in comparison with the dynamic assessment of total ventilation disorders and dynamic control of MSCT of the chest organs. Thus, the importance of identifying risk factors for the progression of COVID-19-associated conditions in patients with different comorbid backgrounds and identifying criteria for the development of new long-COVID treatment strategies is emphasized.
About the Authors
N. A. NikolaevaRussian Federation
Nadezhda A. Nikolaeva - Postgraduate Student, Assistant of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
O. O. Voronkova
Russian Federation
Olga O. Voronkova - Cand. Sci. (Med.), Assistant of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
S. M. Glukhova
Russian Federation
Sofia M. Glukhova - Resident of the Student Scientific Group of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
P. A. Nagornaya
Russian Federation
Polina A. Nagornaya - Resident of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
E. F. Rogova
Russian Federation
Elena F. Rogova - Pulmonologist, Head of the Pulmonology Department at Hospital Therapy Clinic, University Clinical Hospital No. 1, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
A. S. Lishuta
Russian Federation
Alexey S. Lishuta - Cand. Sci. (Med.), Professor of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
M. V. Kozhevnikova
Russian Federation
Maria V. Kozhevnikova - Cand. Sci. (Med.), Professor of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
Yu. N. Belenkov
Russian Federation
Yuri N. Belenkov - Acad. RAS, Dr. Sci. (Med.), Professor, Head of the Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).
8, Bldg. 2, Trubetskaya St., Moscow, 119991
References
1. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91–95. https://doi.org/10.1016/j.ijid.2020.03.017.
2. Chams N, Chams S, Badran R, Shams A, Araji A, Raad M et al. COVID-19: A Multidisciplinary Review. Front Public Health. 2020;8:383. https://doi.org/10.3389/fpubh.2020.00383.
3. Ignatova GL, Petukhova AYu, Novikova LN, Sereda VP, Teplova NV, Mubarakshina OA. Lung lesions in post-COVID syndrome: Conclusion of the Council of Experts dated April 26, 2022. Pulmonologiya. 2022;32(5):774–781. (In Russ.) https://doi.org/10.18093/0869-0189-2022-32-5-774-781.
4. Kupriyanov SV, Semenova YuV, Semenova LM. A New coronavirus infection. Today’s view of the pandemic. Acta Medica Eurasica. 2021;(3):48–59. (In Russ.) https://doi.org/10.47026/2413-4864-2021-3-48-59.
5. Belotserkovskaya YuG, Romanovskikh AG, Smirnov IP, Sinopalnikov AI. Long COVID-19. Consilium Medicum. 2021;23(3):261–268. (In Russ.) Available at: https://consilium.orscience.ru/2075-1753/article/view/95464.
6. Morrow A, Gray SR, Bayes HK, Sykes R, McGarry E, Anderson D et al. Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21. Trials. 2022;23(1):660. https://doi.org/10.1186/s13063-022-06632-y.
7. Management of patients with long-COVID and post-COVID complications (including antiviral/immunomodulatory therapy). Algorithms for diagnosis and treatment. Therapy. 2023;9(4S):34–50. (In Russ.) Available at: https://therapy-journal.ru/ru/archive/article/43385.
8. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428–455. https://doi.org/10.1111/all.14657.
9. Radaeva OA, Balykova LA, Zaslavskaya KYa, Taganov AV, Bely PA, Kostina YuA et al. Study of Long-Term Clinical and Pathogenetic Effects of Favipiravir-Based Anti-Viral Drug in Patients with Metabolic Syndrome in Post-COVID Period. Pharmacy & Pharmacology. 2022;10(2):217–228. https://doi.org/10.19163/2307-9266-2022-10-2-217-228.
10. Choi YJ, Seo YB, Seo JW, Lee J, Nham E, Seong H et al. Effectiveness of Antiviral Therapy on Long COVID: A Systematic Review and Meta-Analysis. J Clin Med. 2023;12(23):7375. https://doi.org/10.3390/jcm12237375.
11. Avdeev SN, Chikina SYu, Nagatkina OV. Idiopathic pulmonary fibrosis: a new international clinical guideline. Pulmonologiya. 2019;29(5):525–552. (In Russ.) https://doi.org/10.18093/0869-0189-2019-29-5-525-552.
12. Vorobyeva OV. Combined therapy of COVID-19 infection consequences. Doctor.Ru. 2021;20(5):13–19. (In Russ.) https://doi.org/10.31550/1727-2378-2021-20-5-13-19.
13. RECOVERY Collaborative Group. Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2022;399(10325):665–676. https://doi.org/10.1016/S0140-6736(22)00163-5.
14. Bautin AE, Avdeev SN, Seyliev AA, Shvechkova MV, Merzhoeva ZM, Trushenko NV et al. Inhalation surfactant therapy in the integrated treatment of severe COVID-19 pneumonia. Tuberculosis and Lung Diseases. 2020;98(9):6–12. (In Russ.) https://doi.org/10.21292/2075-1230-2020-98-9-6-12.
15. Shapovalov KG, Lukyanov SА, Konnov VА, Rozenberg OА. Exogenous surfactant in the late respiratory phase of COVID-19. Tuberculosis and Lung Diseases. 2021;99(5):7–13. (In Russ.) https://doi.org/10.21292/2075-1230-2021-99-5-7-13.
16. Schousboe P, Wiese L, Heiring C, Verder H, Poorisrisak P, Verder P, Nielsen HB. Assessment of pulmonary surfactant in COVID-19 patients. Crit Care. 2020;24(1):552. https://doi.org/10.1186/s13054-020-03268-9.
17. Ayoubkhani D, Bermingham C, Pouwels KB, Glickman M, Nafilyan V, Zaccardi F et al. Trajectory of long covid symptoms after COVID-19 vaccination: community based cohort study. BMJ. 2022;377:e069676. https://doi.org/10.1136/bmj-2021-069676.
Review
For citations:
Nikolaeva NA, Voronkova OO, Glukhova SM, Nagornaya PA, Rogova EF, Lishuta AS, Kozhevnikova MV, Belenkov YN. Clinical observation of the long-term course of COVID-19 infection in a patient with an immunodeficiency condition. Meditsinskiy sovet = Medical Council. 2024;(9):133-142. (In Russ.) https://doi.org/10.21518/ms2024-149