АТИПИЧНЫЕ ФОРМЫ ИНФАРКТА МИОКАРДА У БОЛЬНЫХ С НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ COVID-19Лекарева И.В. 1 , Емельянова А

The complexity of timely diagnosis of giant cell arteritis (GCA), as the most common form of systemic vasculitis in the elderly, is due to the nonspecificity of clinical manifestations and the absence of specific immunological markers. New difficulties arise during the period of coronavirus infection, which manifests itself in similar syndromes and at the same time can provoke immuno-inflammatory rheumatic disease. In this regard, it is extremely important to make a correct differential diagnosis between persistent viral infection and the development of systemic vasculitis. This article presents a clinical observation demonstrating the complex process of diagnosis and differential diagnosis of GCA in the conditions of the COVID-19 pandemic. The patient was hospitalized due to a confirmed coronavirus infection. However, despite the standard therapy and the achieved eradication of the coronavirus, the symptoms characteristic of GCA and polymyalgia rheumatica (PR) persisted. A precision analysis of the clinical picture allowed us to establish that the typical manifestations of GCA and PR occurred in the period preceding COVID-19 infection. Subsequent in-depth examination made it possible to verify the diagnosis of GCA and PR based on the current classification criteria. The therapy with glucocorticoid and methotrexate made it possible to achieve remission. The presented observation will help to raise awareness of general practitioners and related specialties about the need to rule out GCA and PR in the case of prolonged unexplained fever, myalgia, headache, joint pain and swelling, transient visual disturbances, jaw claudication in elderly patients in the setting or after coronavirus infection.

Background. Rheumatic diseases (RD) of autoimmune origin are considered as an important risk factor for infectious processes due to characteristic native immune system disorder, as well as due to the adverse effect of immunosuppressants and glucocorticoids on the mechanisms of anti-infective protection.Aim. To highlight the problem of RD and concomitant viral infection which becomes critical in the era of COVID‑19.Results. According to the current national guidelines for the management of patients with COVID‑19, patients with RD represent an increased risk group for the adverse course of coronavirus infection. Presented article provides basic information on the use of interleukin‑6 (IL‑6) inhibitors in patients with COVID‑19 focusing on the benefit of this therapeutic option in those with prior RD. The article presents an analysis of two clinical cases demonstrating high efficacy and good tolerability of levilimab (Ilsira®) in the treatment of coronavirus pneumoniae in the setting of autoimmune diseases: polymyositis (PM) and rheumatoid arthritis (RA).Conclusion. Our own clinical experience confirms the feasibility of including an IL‑6 receptor inhibitor in the treatment regimen for coronavirus pneumonia in patients with RD characterized of immune inflammation.

The course and management of coronavirus infection (CI) in patients with severe comorbidity are extremely important scientific and practical issues in the era of COVID-19. Kidney transplant recipients make up one of the most vulnerable groups for CI-associated adverse outcomes. Considering the presence of comorbidities, the optimal pharmacotherapy regimens for CI and its complications have not yet been worked out for these patients. In this article, we present two clinical observations demonstrating typical manifestations of coronavirus pneumonia (CP) in kidney transplant recipients, the COVID-19 diagnostic and verification algorithm, and the therapeutic options used to achieve a favorable outcome of CP and to prevent fatal complications. Our findings confirm that in kidney transplant recipients CP is linked to increased disease severity with rapid progression of lung damage and a high risk of developing systemic complications, including thrombotic microangiopathy. It is shown that compliance with the current recommendations for a rational combination of antiviral, anti-inflammatory, anticoagulant and basic immunosuppressive agents in this group of patients provides good treatment outcomes and prevents kidney transplant failure. Two adverse outcomes in the observed group were due to associated opportunistic infection. Based on our findings and clinical data, we conclude that preemptive therapy with IL-6 inhibitors or colchicine is an effective therapeutic option in kidney transplant recipients.

The course and management of coronavirus infection (CI) in patients with severe comorbidity are extremely important scientific and practical issues in the era of COVID-19. Kidney transplant recipients make up one of the most vulnerable groups for CI-associated adverse outcomes. Considering the presence of comorbidities, the optimal pharmacotherapy regimens for CI and its complications have not yet been worked out for these patients. In this article, we present two clinical observations demonstrating typical manifestations of coronavirus pneumonia (CP) in kidney transplant recipients, the COVID-19 diagnostic and verification algorithm, and the therapeutic options used to achieve a favorable outcome of CP and to prevent fatal complications. Our findings confirm that in kidney transplant recipients CP is linked to increased disease severity with rapid progression of lung damage and a high risk of developing systemic complications, including thrombotic microangiopathy. It is shown that compliance with the current recommendations for a rational combination of antiviral, anti-inflammatory, anticoagulant and basic immunosuppressive agents in this group of patients provides good treatment outcomes and prevents kidney transplant failure. Two adverse outcomes in the observed group were due to associated opportunistic infection. Based on our findings and clinical data, we conclude that preemptive therapy with IL-6 inhibitors or colchicine is an effective therapeutic option in kidney transplant recipients.

The article discusses the issues of diagnosis and treatment of patients with a new coronavirus infection. The data on the results of the work of the infectious department No. 2 of the "Infectious hospital No. 4" of the city of Volgograd for the period from April to September 2020, the analysis of the etiotropic and pathogenetic treatment of new coronavirus infection was carried out.

ОЦЕНКА СВЯЗИ МЕЖДУ ПРОВОСПАЛИТЕЛЬНЫМИ ЦИТОКИНАМИ И СТРУКТУРНО-ФУНКЦИОНАЛЬНЫМИ НАРУШЕНИЯМИ МИОКАРДА ПРИ МЕТАБОЛИЧЕСКОМ СИНДРОМЕЕ.А.Бодрова, А

В настоящей работе для оценки связи между наличием микоплазменной и хламидийной инфекций и развитием острого коронарного синдрома было проведено количественное определение уровня антител к Chlamydia pneumoniae и Mycoplasma pneumoniae, а также был проведен анализ частоты активации воспалительных заболеваний респираторной системы у пациентов с различными формами ИБС. Было установлено, что в группе больных ОКС уровень антител к Chlamydia pneumoniae и Mycoplasma pneumoniae достоверно превышал таковой у пациентов с ХИБС и в группе контроля. Наряду с этим при ОКС острая инфекция или активация хронической инфекции респираторной системы, обусловленная Mycoplasma pneumoniae, встечались в 2 раза чаще, чем в группах сравнения. Полученные результаты подтверждают роль микоплазменной и хламидийной инфекции в патогенезе острой коронарной патологии.