Search

Introduction. Over the past two years, the world has faced a serious problem ��� the emergence of a highly contagious and virulent new type of coronavirus ��� SARS-CoV-2, which causes acute respiratory disease - COVID-19. Disease with COVID-19 can have medical consequences that last from weeks to months after microbiological recovery. Manifestations and symptoms, as well as laboratory parameters that persist for several weeks after acute COVID-19 disease and do not return to a healthy baseline, can potentially be consider long-term consequences of the disease. Manifestations of "Post-syndrome" are chronic fatigue syndrome (ME/CFS), headache, prolonged low-grade fever, swollen lymph nodes, joint pain, respiratory disorders (dyspnea, shortness of breath), loss of smell and/or taste, hair loss, sweating, nausea. After an acute episode of SARS-CoV-2, some patients develop myalgic encephalomyelitis, a so-called chronic fatigue syndrome that prevents patients from returning to work and lifestyle for months after microbiological recovery. Convalescents may experience long-term side effects resembling the symptoms of chronic fatigue syndrome: persistent fatigue, diffuse myalgia, depressive symptoms and sleep disturbances. The SARS-CoV-2 virus is known to cross the blood-brain barrier to the hypothalamus through the olfactory tract. The probable pathogenesis corresponds to typical signs in patients with CFV / ME, including lymphatic drainage disorders from microglia in the brain. One of the main ways of lymphatic drainage of the brain passes through the perivascular spaces along the olfactory nerves through the lattice bone (os ethmoidale) to the nasal mucosa. Such disorders lead to the accumulation of pro-inflammatory agents, especially post-infectious cytokines such as interferon-gamma and interleukins. These mediators may affect the neurological control of the "glymphatic system". Their accumulation in the central nervous system and can lead to symptoms of chronic fatigue syndrome and other manifestations of Post-COVID syndrome. The pathogenesis of virus-associated arthritis is only partially understood, but one of the mechanisms that should mediate the activation of the inflammatory process is molecular mimicry, which is responsible for inducing autoimmune reactions in predisposed individuals. Clinical case. Patient N. 25 years old without special comorbidities became ill with COVID-19 on September 15, 2020, was ill for 10 days, was treated on an outpatient basis in Medical Center X with a diagnosis of COVID-19 (U07.1), viral pneumonitis combined with bilateral lower lobe pneumonia. Respiratory failure - 0 (PCR test for SARS-CoV-2 positive on the day of treatment). Two weeks after microbiological recovery, the patient returned to the clinic with complaints of headache, impaired concentration, panic attacks associated with shortness of breath, prolonged low-grade fever, enlarged lymph nodes of 5 groups (posterior cervical, cervical, submandibular, supraclavicular, axillary lymph nodes) on palpation in size from 10 mm (posterior cervical, cervical, supraclavicular and inguinal) to 30 mm (submandibular), joint pain of 4 groups (elbow, knee, wrist and fingers). After laboratory and clinical examination, the diagnosis was: secondary immune dysfunction (by cell type), post-COVID syndrome, reactive arthritis (mild). Erbisol drugs were recommended as a therapeutic strategy. After treatment (day 25), the patient felt well, during the laboratory examination all immunological parameters returned to normal, there were no complaints. Recommendations for a healthy lifestyle were given and maintenance vitamin therapy was prescribed for 3 months. Conclusion. All the effects of COVID-19 have not been yet sufficiently identified and studied, but there have been many reports of cases of Post-COVID syndrome. It is necessary to study the mechanisms of development of this condition, but already we need effective therapeutic approaches based on understanding the immunological mechanisms of post-viral inflammation. In such circumstances, it is advisable to use known immunocorrection therapy used in the treatment of such secondary autoimmune disorders and post-infectious immune disorders., {"references":["1.\tHannah Ritchie EO-O, Diana Beltekian, Edouard Mathieu, Joe Hasell, Bobbie Macdonald, Charlie Giattino, and Max Roser. Coronavirus Pandemic (COVID-19). 2021.","2.\tTenforde MW, Kim SS, Lindsell CJ, [et al.], Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly Rep 2020.69.30. 993–8.","3.\tTownsend L, Dowds J, O'Brien K, [et al.], Persistent Poor Health Post-COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity. Ann Am Thorac Soc. 2021.","4.\tGemelli Against C-P-ACSG, Post-COVID-19 global health strategies: the need for an interdisciplinary approach .Aging Clin Exp Res 2020. 32.8.1613–20.","5.\tGreenhalgh T, Knight M, A'Court C, Buxton M, Husain L, Management of post-acute covid-19 in primary care . BMJ 2020. 370. m3026.","6.\tChen Q, Allot A, Lu Z, LitCovid: an open database of COVID-19 literature. Nucleic Acids Res 2021. 49.D1. D1534–D40.","7.\tXiong Q, Xu M, Li J, [et al.], Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study .Clin Microbiol Infect 2021. 27.1. 89–95.","8.\tGoertz YMJ, Van Herck M, Delbressine JM, [et al.], Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res 2020. 6.4..","9.\tCarfi A, Bernabei R, Landi F, Gemelli Against C-P-ACSG, Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; 324.6.603–5.","10.\tTownsend L, Dyer AH, Jones K, [et al.], Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020. 15.11. e0240784.","11.\tNeufeld KJ, Leoutsakos JS, Yan H, [et al.], Fatigue Symptoms During the First Year Following ARDS. Chest 2020. 158.3. 999–1007.","12.\tWostyn P, COVID-19 and chronic fatigue syndrome: Is the worst yet to come? Med Hypotheses.2021.146. 110469.","13.\tVink M, Vink-Niese A, Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome. Healthcare (Basel) 2020. 8.4.","14.\tGasparotto M, Framba V, Piovella C, [et al.], Post-COVID-19 arthritis: a case report and literature review. Clin Rheumatol. 2021 .15.1-6. doi: 10.1007/s10067-020-05550-1","15.\tLamprecht B, Is there a post-COVID syndrome? Pneumologe (Berl). 2020.8.1-4. doi: 10.1007/s10405-020-00347-0","16.\tPerrin R, Riste L, Hann M, [et al.], Into the looking glass: Post-viral syndrome post COVID-19. Med Hypotheses. 2020.144.110055. doi: 10.1016/j.mehy.2020.110055. Epub 2020 Jun 27.","17.\tGarg P, Arora U, Kumar A, [et al.], The \"post-COVID\" syndrome: How deep is the damage? J Med Virol. 2021 .93.2.673-674. doi: 10.1002/jmv.26465. Epub 2020 Sep 29.","18.\tNikolaenko AN, Bazyka DA, Drannik GN [et al.], The effect of Erbisol class drugs on the production of cytokines and the expression of surface markers of blood cells in healthy donors and cancer patients. Eurasian Journal of Oncology. 2016. 4. 1. 79-89.","19.\tFesenkova VY, Drannik GM, Dryanskaya VE, [et al.], In vitro study of the effect of erbisol preparations on the production of interleukin-2 and γ-interferon by T-helpers and type of healthy donors. Laboratory diagnostics. 2003. 2. P. 37 – 40.","20.\tGirina OM, Vitik LD, Romanyuk LI, [et al.], Optimization of treatment of polynosis patients by using extra Erbisol.Collection of scientific works of NMAPE named after PL Shupik. Kyiv. 2006. 15. 2. 206-211.","21.\tKornilina EM, Nikolaenko AN, Vovk AD, [et al.], Characteristics of blood leucocytes phenotype in patients with chronic hepatitis with the dynamics of treatment with ERBISOL® ULTRAPHARM. Immunology and allergology. 2006. 4. 69-71.","22.\tDrannik GN, Kurchenko AI, Fesenkova VY, [et al.], Study of the influence of erbisol® class preparations on cytokin production by peripheral blood mononuclears of healthy donors and oncological pain. Bulletin of Pharmacology and Pharmacy. 2006. 7. P. 29-32.","23.\tBazyka D, Gladkiy A, Kornilina E, Nikolaenko A, specific features of the effect of preparations of the erbisol class on the expression of surface markers of blood cells in healthy donors and patients with immunodepression in determines and literature cell. Bulletin of Pharmacology and Pharmacy. 2009. 1. 39-47.","24.\tLazarev KL, Sataeva TP, Prospects of application of immunomodulators of embryonic origin as inhibitors of the epithelial-mesenchimal transformation phenomenon // Crimean Journal of Experimental and Clinical Medicine. 2012. 2. 1-2.5-6. 83-85.","25.\tNemirovska NV, Dynamics of changes in immunological status and lipid exchange in patients with polynosis with gallbladder cholesterosis on the background of treatment. Asthma and allergies. 2013. 1. 50-54"]}