INTRODUCTION. The complexity of neurosarcoidosis is due to the wide variety of clinical manifestations and variability of signs of concomitant systemic diseases. AIM. To analyze literature data on diagnostic features, clinical manifestations of neurosarcoidosis, and our experience in treating a patient with neurosarcoidosis. MATERIAL AND METHODS. A literature analysis was performed for the period from 2012–2024 28 literary sources (PubMed database) were analyzed, on the basis of which a description of the clinical manifestations and diagnostic methods of neurosarcoidosis was made. Data on the main approaches to the differential diagnosis of the disease are presented, neurological manifestations, imaging results, manifestations of spinal lesions and meningeal lesions in neurosarcoidosis are described in detail. A clinical case is presented.RESULTS AND DISCUSSION. Based on current clinic al guidelines, to diagnose neurosarcoidosis, a patient must have appropriate clinical neurological manifestations and rule out other causes. The results of the biopsy reveal the presence of signs of granulomatous inflammation, and an accurate diagnosis of neurosarcoidosis is made. Key symptoms of neurosarcoidosis in all cases include the presence of infections (tuberculosis, fungal), autoimmune diseases (vasculitis, IgG4-related diseases), lymphoma. Because neurosarcoidosis can affect any part of the nervous system, it is necessary to attempt to establish a unique differential diagnosis tailored to the clinical picture. There are no serum markers that can clearly distinguish sarcoidosis from its mimicking manifestations. Neuroimaging remains an important tool in the diagnosis of sarcoidosis. Contrast-enhanced magnetic resonance imaging is the imaging modality of choice for neurosarcoidosis because it can detect enhancement consistent with active inflammation. CASE PRESENTATION. A clinical case of neurosarcoidosis is presented: a 30-year-old man who was hospitalized with suspected intracerebral hemorrhage. Previously, there were episodes of clouding of consciousness with elements of aggressive behavior, hallucinations, and memory loss. Sarcoidosis of the lungs and skin was diagnosed about 3 months ago. Computed tomography revealed signs of stage 2 pulmonary sarcoidosis. According to the results of contrast-enhanced magnetic resonance imaging of the brain with contrast in the right temporal, frontal lobes, and in the insular lobe on the left, areas of increased T2flair signal were identified, up to 16 mm of subcortical localization, without signs of true limitation of the diffusion of water molecules. After administration of a contrast agent, leptomeningeal contrast was noted in both hemispheres of the brain and cerebellum — a probable manifestation of neuroinfection. CONCLUSION. The presented clinical example confirms a wide range of manifestations of neurosarcoidosis, for effective differential diagnosis of which it is advisable to use instrumental and laboratory diagnostic methods along with a thorough physical and neurological examination and an in-depth study of the patient’s medical history. KEYWORDS: sarcoidosis, neurosacoidosis, central nervous system, differential diagnosis, neuroimaging, autoimmune diseases

INTRODUCTION. Legionnaires' disease may be manifested by neurological symptoms along with lung damage. Cerebellar ataxia and dysarthria are rare extrapulmonary manifestations of legionellosis. These symptoms significantly reduce the quality of life of patients. AIM. To analyze the literature data on neurological manifestations of legionellosis and to present a clinical case of Legionnaires' disease manifestation with neurological symptoms. MATERIAL AND METHODS. We performed an analysis of the available literature. Twenty-four Russian and international literature sources (PubMed databases) were evaluated, describing the characteristics and prevalence of neurological manifestations in Legionnaires' disease. We also described the main theories of the pathogenesis of these clinical manifestations. Our clinical case is presented. RESULTS AND DISCUSSION. As of today, few cases of Legionnaires' disease with cerebellar symptoms have been described. Dysarthria and ataxia are the most frequent manifestations of cerebellar dysfunction in legionellosis. Cases where neurologic symptoms persisted after the resolution of pneumonia have been described previously. There are also reports of manifestation of Legionnaires' disease with cerebellar ataxia. The pathophysiology of cerebellar involvement is unknown. There are hypotheses of toxin-mediated and immune-mediated mechanisms. Recent studies have shown that L. pneumophila can activate receptors responsible for enacting the inflammasome pathway. This mechanism promotes cell death that occurs to remove the intracellular pathogen, which may be responsible for central nervous system dysfunction. CASE PRESENTATION. A 48-year-old woman was hospitalized with a suspected stroke. She works in diamond production and is in contact with aerosolized liquids. Four days before hospitalization she complained of a headache, and in the evening before she lost consciousness. Slurred speech, unsteadiness, and inability to walk were noted. At hospitalization, no instrumental evidence of stroke was obtained. Inflammatory markers were elevated. Chest computer tomography showed infiltrative changes. The rapid test for antigenuria (L. pneumophila) was positive, and community-acquired legionellosis was confirmed. Levofloxacin was administrated. After discharge, dysarthria, dysphagia, and instability in the Romberg pose persisted. CONCLUSION. The example of this clinical observation demonstrates that in rare cases Legionnaires' disease can manifest as other diseases, which requires a certain vigilance of doctors of different specialities in order to timely diagnose the disease. KEYWORDS: Legionnaires' disease, legionellosis, community-acquired pneumonia, central nervous system, infectious disease

Aim. To analyze dynamic of incidence and mortality of COVID-19 and clinical and epidemiological characteristics of adult patients with a new coronavirus infection during the early period of the Omicron SARS-COV-2 distribution in Russia. Materials and Methods. We conducted a retrospective analysis of the dynamics of COVID-19 incidence and mortality in Russia until 2023. Study included patients aged ≥18 years with a laboratory-confirmed diagnosis of COVID-19, detected in the period from 01/02/2022 to 14/03/2022 (n = 3 582 688) in 85 regions of Russia. Participants were included regardless their COVID-19 vaccination history. Results. We identified 6 periods of rise and decline in the COVID-19 incidence until 2023 in Russia. The 5th (January–July 2022) and the 6th (August-November 2022) periods were associated with the spread of the Omicron SARS-CoV-2. The median age of patients in the early period of Omicron spreading was 49 (36–62) years, 62.7% were women. The largest proportion of patients were represented by the age groups 30–39 and 40–49 years (19.2% each), the lowest – 18–29 years (12.3%). Proportion of patients with mild disease was 90.0%, moderate – 8.5%, severe – 0.9%, extremely severe – 0.6%. Hospitalization rate, proportion of patients treated in the intensive care unit and rate of invasive mechanical ventilation were 7.6%, 9.5% and 6.7% respectively. The median period from the onset of symptoms to the diagnosis was 2 (1–3) days, median of duration of the disease was 8 (6-10) days and median duration of hospitalization was 10 (7–14) days. The median age of the deceased patients was 77 (69–84) years, of which 50.8% were women, 72.6% were persons ≥70 years old. One or more concomitant diseases were detected among 8.7% of patients who became ill and 75.8% of those who died. The probability of hospitalization, admission to the ICU, IMV and death in patients with one or more concomitant diseases were 24.5, 3.2, 3.5 and 35.8 times higher, respectively, compared with patients without concomitant diseases. Conclusion. In the early period of the spread of the Omicron variant in Russia, among adult patients with COVID-19, excluding their vaccine history, the frequency of severe and extremely severe forms of infection was 1.5%. The elderly age and the presence of concomitant diseases remained key risk factors for the development of adverse outcomes of the COVID-19

Ceftobiprole medocaril is a fifth-generation cephalosporin (anti-MRSA cephem) with a broad spectrum of antibacterial activity. Ceftobiprole is active against gram-positive bacteria, including strains resistant to other beta-lactams, such as methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, as well as gram-negative bacteria such as Pseudomonas aeruginosa. The purpose of this review is to consider the mechanism of action and safety profile of ceftobiprole, as well as to summarize the results of clinical studies of the drug. Possible areas of clinical use of ceftobiprole for infections of the skin and soft tissues, complicated staphylococcal bacteremia, infective endocarditis, as well as communityacquired and nosocomial pneumonia are given. Summarizing the available information, ceftobiprole can be considered as the most important antibacterial drug for the treatment of severe pneumonia not associated with mechanical ventilation, skin and soft tissue infections, as well as a part of combination antimicrobial therapy for infective endocarditis.

Relevance. During and after the COVID-19 pandemic, viruses have become a more common cause of pulmonary infections in adults; therefore, the distinction between viral lung injury and community-acquired bacterial pneumonia is of increasing importance. Aim. Development of a model for differentiating community-acquired bacterial pneumonia and viral lung injury, including COVID-19. Materials and methods. This retrospective case–control study included 300 adult patients with viral lung injury and 100 adult patients with community-acquired bacterial pneumonia. Clinical, laboratory, and instrumental data were analyzed, significant factors were selected by which the samples differed, and a model was developed using logistic regression to distinguish between community-acquired bacterial pneumonia and viral lung damage, including COVID-19. Results. The developed model included the following parameters: total protein level, neutrophil/lymphocyte index, heart rate, unilateral infiltration on CT or chest x-ray, vasopressor prescription in the first 24 h of hospitalization, altered level of consciousness, chills, and fatigue. The model had the following characteristics: AUC = 0.94 (0.92–0.96), AUC_PR = 0.84 (0.76 to 0.92), prediction accuracy — 90%, sensitivity — 76%, specificity — 95%, positive predictive value — 83 %. Conclusion. The use of this model can facilitate the differential diagnosis of community-acquired bacterial pneumonia and viral lung injury, including COVID-19, in adults in general wards and intensive care units.

Objective. To study the etiology of community-acquired pneumonia (CAP) in adult hospitalized patients after the COVID-19 pandemic. Materials and Methods. The prospective multicenter study included patients 18 years and older with confirmed diagnosis of CAP admitted to 6 hospitals in different regions of Russia from July to November 2023. Etiology was confirmed by respiratory samples (sputum, tracheal aspirate) culture, blood culture (severe cases), and urinary antigen tests (Legionella pneumophila serogroup 1, Streptococcus pneumoniae). Mycoplasma pneumoniae, Chlamydia pneumoniae, and common respiratory viruses were identified using the real-time polymerase chain reaction (PCR) in respiratory samples. Qualitative PCR for S. pneumoniae and Haemophilus influenzae DNA tests were also applied. Results. Altogether 152 patients were enrolled, and significant CAP pathogens were identified in 96 (63%) cases; the median age of patients with verified etiology of CAP was 45 [34.8; 66] years, comorbidity index was 0.5 (0; 3.0) points. The most frequently detected pathogens were M. pneumoniae – 42 (44%), rhinovirus – 23 (24%), S. pneumoniae – 17 (18%) and SARS-CoV-2 – 13 (14%). Coinfection was registered in 22% of cases, the most common associations were M. pneumoniae + rhinovirus – 5 (3.3%), S. pneumoniae + rhinovirus – 3 (2%). Pneumococcal bacteremia was detected in 1 patient. In most patients CAP was non-severe; 17 (18%) patients required admission to the ICU. Hospital mortality was 7%. Conclusions. M. pneumoniae, respiratory viruses (mainly rhinovirus and SARS-CoV-2), and S. pneumoniae were the predominant CAP pathogens in hospitalized adults with CAP in the first months after the COVID-19 pandemiс. The use of an integrated approach to etiological diagnosis can significantly increase the proportion of patients with an established etiology of CAP.

The aim was to study changes in the respiratory system, cardiovascular system, functional and psychoemotional status of adult patients after inpatient treatment for COVID-19 (COronaVIrus Disease 2019). Methods. This cohort prospective observational study recruited patients with COVID-19 and lung damage. Transthoracic echocardiography, lung ultrasound, ECG, dyspnea assessment using mMRC and Borg scales, 6-minute walk test, and pulmonary function tests were performed 3 months after discharge from hospital. Psychoemotional status was assessed using MFI-20 international asthenia test, Spielberger–Hanin situational anxiety scale, Beck depression scale, MMSE cognitive function assessment scale. A standard set of statistical tools was used to describe and compare the data. The differences were considered statistically significant at p < 0.05. Results. A total of 51 patients were enrolled, including 29 (55.8%) women, the median age 64.5 (60.0 – 70.0) years. The most frequent complaints at 3 months after the hospital discharge were weakness (88.2%) and mild (62.7%) to moderate (29.4%) dyspnea. There was a decrease in the lung tissue lesions compared to inpatient treatment (14.5 vs 23.0 points), but the lung ultrasound found consolidates in 78.4% of the patients. The degree of lung tissue lesions correlated with the functional status of the patients. Decreased diffusion lung capacity (DLCO) was the most frequent functional disorder. It was detected in 23.1% of the patients and accompanied by decreased 6-minute walk test distance and increased volume of lung lesions according to the ultrasound. The threshold value of ultrasound score indicative of the abnormal lung diffusion capacity was 24.5 at the stage of inpatient treatment and 15.5 points at 3 months after discharge from hospital. A mental status assessment at 3 months after discharge from hospital showed that asthenia persisted in all patients. Their anxiety and depression statistically significantly decreased, and the cognitive status improved. Conclusion. The majority of adult patients who had COVID-19 with lung damage still have complaints, lung tissue changes of varying severity at 3 months after discharge from hospital. A significant proportion of the patients also had psychoemotional disorders, abnormalities in the performance of functional tests, and impaired DLCO. Lung ultrasound can be considered an informative non-invasive method of assessing severity of the lung tissue damage, allowing to predict impaired gas transport function of the lungs.

ABSTRACT AIM. To investigate chronic pain syndromes in old age and evaluate the clinical significance of substance P in this pathology. MATERIAL AND METHODS. The study enrolled 68 patients over the age of 75 years with the presence of musculoskeletal pain of any origin for at least 3 months. The mean age of the patients reached 81.9 ± 5.8 years (from 75 to 100 years), most of them were women (85.3%). In this study, the severity of pain was assessed using a visual analogue scale (VAS), and the type of pain was analyzed using questionnaires and scales: DN4, PainDetect, Fibromyalgia Identification Questionnaire (FIRST), Central Sensitization Questionnaire, McGill Pain Questionnaire. The blood concentration of substance P was determined by enzyme immunoassay. RESULTS AND DISCUSSION. The severity of pain syndrome on the VAS scale reached 6.3 ± 2.2 points. The mean scores for DN4 were 3.9 ± 2.1 points, and for PainDetect — 14.7 ± 9.4 points. The mean value of the FIRST questionnaire for diagnosing fibromyalgia was 3.5 ± 1.6 points, and the McGill questionnaire was 69.8 ± 43.7 points. The mean value of the central sensitization scale reached 44.3 ± 16.7 points. Pain syndrome was more severe in women: the mean VAS value in women was 6.4 ± 2.3, in men — 5.1 ± 1.2 points (p = 0.02). The severity of the neuropathic component of the pain syndrome in women was also higher: DN4 scores in women were 4.0 ± 2.1, and in men — 2.9 ± 1.7 points (p = 0.08), and PainDetect — 15.7 ± 9.4 and 8.6 ± 6.4 points, respectively (p = 0.02). The mean values of the screening questionnaire for diagnosing fibromyalgia in women reached 3.7 ± 1.5 points, and in men — 2.7 ± 1.5 points (p = 0.07). In the group of women, the mean McGill questionnaire scores were 74.2 ± 45.2, in men — 45.3 ± 23.6 points (p = 0.006). The mean values of the central sensitization questionnaire for women were: 46.1 ± 16.3, and for men — 34.2 ± 15.5 points (p = 0.03). However, no significant differences in the severity of depression were recorded in women and men: 6.2 ± 2.8 and 5.0 ± 3.4 points, respectively (p = 0.3). The mean concentration of substance P in the study group was 222.6 ± 92.9 pg/ml, varying from 74 to 529 pg/ml. In men, the mean blood concentration of substance P reached 267.1 ± 85.2 pg/ml, in women — 214.2 ± 92.7 pg/ml (p = 0.02). An inverse correlation was registered between the blood concentration of substance P and the age of patients (r = −0.31; p = 0.02). No significant relationships were found between the blood concentration of substance P and the values of all pain questionnaires. Significant correlations were registered between VAS and DN4 (r = 0.29; p = 0.01), PainDetect (r = 0.41; p = 0.004), McGill questionnaire (r = 0.53; p < 0.0001) and central sensitization questionnaire (r = 0.3; p = 0.01). There was no significant correlation between the severity of pain according to VAS and the severity of depression (r = 0.16; p = 0.21). The severity of depression correlated with indicators of DN4 (r = 0.31; p = 0.01), FIRST (r = 0.26; p = 0.03), McGill questionnaire (r = 0.29; p = 0.02) and central sensitization questionnaire (r = 0.5; p < 0.0001). There was a direct correlation between the age of patients and indicators of DN 4 (r = 0.24; p = 0.05) and the central sensitization questionnaire (r = 0.25; p = 0.04). CONCLUSION. The study results suggest the presence of severe chronic pain syndrome of various types in old patients and longlivers. Significant relationships were found between pain indicators assessed using different scales and questionnaires. In this study, no significant correlations were established between the blood concentration of substance P and pain parameters. KEYWORDS: pain, old age, substance P, questionnaires, scales, neuropathic, depression

Nosocomial pneumonia is one of the most common healthcare-associated infections and the most frequent in intensive care unit (ICU) patients. The clinical and economic consequences of nosocomial pneumonia are very significant, especially for ventilated patients. In this article we present several clinical observations that demonstrate the difficulties of antibacterial therapy of nosocomial pneumonia and ventilator-associated pneumonia in adults in multidisciplinary hospitals in Moscow, which are due to both patient characteristics and profile of circulating pathogens.

Objective. To evaluate prescribing patterns of antimicrobials and quantify them in relation to quality indicators in Russian multi-field hospitals. Materials and Methods. Point Prevalence Survey of Antimicrobial Consumption as a part of an international Global-PPS project was conducted in 8 multi-field hospitals in different Russian cities (Krasnoyarsk, Moscow, Omsk, Saratov, Smolensk, Ulan-Ude, Yakutsk) during the period from May till December 2021. Case records of patients who received therapeutic or prophylactic systemic antimicrobial agents were analyzed. Local practices of antimicrobials’ utilization were evaluated in relation to quality indicators defined by the study protocol. Results. Common mistakes requiring a prompt intervention included low adherence to clinical guidelines, absence of stop/review dates in the medical records, extended duration of surgical prophylaxis, III generation cephalosporin’s overuse and low rate of targeted therapy. Conclusions. The results of the project can be valuable for the improvement to antimicrobial utilization approaches at the study centers as well as for monitoring of antimicrobial stewardship programs’ implementation.

Cefodizime is a third–generation cephalosporin for parenteral use that has become available for the first time in the Russia. This paper reviews the use of this antibiotic in clinical practice based on the current data on antimicrobial resistance in pathogens causing lower respiratory tract infections and the results of completed clinical studies of its efficacy and safety.

Objective. To assess the practice of using antibiotics (AB) by the population of various regions of the Russian Federation (RF), by studying attitudes, behavior and knowledge about AB. Materials and Methods. The survey was conducted from February to June 2022 as part of a multicenter qualitative study in the form of a semi-structured interview among respondents from 18 to 74 years old who used systemic ABs of any group with or without a doctor's prescription for the treatment of symptoms of a confirmed or probable infectious disease for 3 months prior to the study. Individual inclusion criteria or respondents were developed for each of the participating centers (8 Federal Districts (FD) of the RF, Moscow, St. Petersburg), considering gender, age, education and place of residence to ensure the representativeness of the sample of the general population. Results. The study interviewed 300 respondents. Among them are 151 interviews with respondents who have a prescription for AB. A variety of reasons were identified for which the respondents did not go to the doctor: lack of time, fear of contact with additional infections in health facilities, positive experience with the use of a particular AB, confidence in the free purchase of AB in a pharmacy without a prescription. The data obtained testify to the high level of confidence of the interviewees in the experience and advice of others in the matter of starting AB therapy. A large role in the spread of resistance to AB belongs to the non-compliance of pharmacy workers with the requirements for the prescription sale of AB. As a rule, the respondents had no difficulty in purchasing AB without a doctor's prescription. Among ABs, combinations of penicillins with beta-lactamase inhibitors, penicillins, and macrolides were in greatest demand. An insufficient level of knowledge about the mechanism of action and indications for the use of AB was revealed. Data were obtained on the insufficient percentage of coverage of the population with information campaigns on the rational use of AB. A significant impact of the COVID-19 pandemic on an increase in the incidence of AB self-treatment has been demonstrated. Conclusions. The problem of excessive and irrational use of AB among the population in the RF still exists despite the ongoing measures. A lack of knowledge about antibiotics and low awareness of the problem of antimicrobial resistance were identified, and factors contributing to self-medication were identified. The data obtained can serve as a basis for the development of future initiatives to ensure the proper use of AB and, therefore, help to reduce the rate of selection of resistant microorganisms in the regions of the RF.

A rare clinical case of native aortic valve infective endocarditis (IE) caused by Klebsiella pneumoniae in a 56-year old man without known risk factors predisposing to the development of IE is presented. Diagnosis of IE in this patient was a challenge due to the lack of recent interventions that could be considered as a source of bacteremia, scarce clinical manifestation and absence of typical complications. Aortic valve vegetation was detected by transesophageal echocardiography. K. pneumoniae isolate was susceptible to all antibiotics tested. Antibacterial therapy (cefepime 6 g/day IV for 2 weeks in the hospital followed by ceftriaxone 4 g/day IM and cefixime 400 mg/day PO, a total of 4 weeks as an outpatient) resulted in a complete resolution of IE signs and symptoms, laboratory abnormalities as well as vegetation size decrease. Surgical treatment was not required in this patient.

The purpose of the expert council was to determine the place of cefpodoxime in the ABT algorithms for upper and lower respiratory tract infections and to form a consensus position on its use in clinical practice. Based on the available data, the possibility of including cefpodoxime in national guidelines for the treatment of rhinosinusitis, acute tonsillopharyngitis, community-acquired pneumonia (CAP), as well as infectious exacerbations of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) is being considered.

Community-acquired pneumonia (CAP) is a common acute infectious disease in adults. Diabetes mellitus (DM) increases the incidence of CAP and worsens the prognosis. In this regard, the assessment of the current practice of CAP management in patients with concomitant DM and its compliance with clinical guidelines is of great interest. Purpose. To study the current practice of CAP treatment in adult patients with concomitant type 2 DM in a multidisciplinary hospital and evaluate its compliance with the national clinical guidelines. Methods. A cross-sectional observational study was carried out in a pulmonology department of a republican clinical hospital. The study recruited adult patients with a confirmed diagnosis of CAP and previously diagnosed type 2 DM. For each case, demographic characteristics, the severity of CAP, the presence and nature of complications, systemic antibiotic therapy (ABT) and compliance with 16 quality indicators (QI) were recorded. The quality indicators described the adequacy of examination, treatment and secondary prevention of CAP in the presence of concomitant DM. QIs were chosen based on the national clinical guidelines for CAP and algorithms for specialized medical care for patients with DM. Results. Altogether, 48 patients with the average age of 63.9 ± 10.5 years were enrolled. 81% of patients had mild CAP. The severity criteria were assessed in 60% of the patients, prognosis – in 17% of the patients. X-ray examination, pulse oximetry and complete blood count were performed on time in 100% of the cases. A total of 19% of patients had a culture of respiratory specimens. A blood culture was performed in 11,11% of the cases of severe CAP (SCAP). Rapid urine tests for pneumococcal and legionella antigens have not been used. Glycemia was monitored daily in 27% of the patients. ABT was initiated on time in 100% of the patients. Conclusion. Low adherence to many QIs, insufficient control of glycemia and correction of sugar-lowering therapy in the treatment of hospitalized patients with CAP and concomitant type 2 DM were observed, which can worsen clinical outcomes.

Community-acquired pneumonia is one of the most common acute infectious diseases that has a significant share in the structure of mortality from respiratory diseases. It is extremely important to select rational antibiotic therapy which ensures optimal clinical efficacy, improved outcome, reduced rate of antibiotic resistance selection, and minimization of side effects.Methods. The target audience of these clinical recommendations are therapists, general practitioners, pulmonologists, anesthesiologist-resuscitators, and clinical pharmacologists. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scale of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. The clinical recommendations also contain comments and explanations to these theses, algorithms for the diagnosis and treatment, and reference materials on the use of antibacterial drugs and microbiological (culture) tests.Conclusion. The presented clinical guidelines cover current information about the etiology, clinical manifestations, diagnosis and treatment tactics for community-acquired pneumonia. The presented clinical guidelines have been approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021.

With the development of the coronavirus pandemic and its decline, bacterial pathogens will again play a significant role in the epidemiology of community-acquired pneumonia (CAP). Numerous studies have already examined clinical, laboratory, and instrumental indicators that allow differential diagnosis between viral infection and bacterial pneumonia. The role of conventional (e.g., C-reactive protein, procalcitonin, leukocytes) and novel laboratory markers (e.g., MxA1 protein, progranulin, copeptin) was revealed. Differences in lung CT and ultrasound findings were noted. The aim of this publication is to present data on the differential diagnosis between pulmonary involvement in viral infections, including COVID-19 ( COronaVIrus Disease 2019), and bacterial CAP. Conclusion. Despite numerous studies, distinguishing bacterial CAP from viral lung injury, including that associated with COVID-19 infection, without microbiologic testing is a challenging task that requires a combined assessment of clinical data, laboratory data, and modern imaging studies. Obviously, express testing will be of particular interest in this case.

ЦЕЛЬ Обновленных клинических рекомендаций состоит в представлении специалистам, в первую очередь анестезиологам-реаниматологам, современных, основанных на методах доказательной медицины данных по этиологии, эпидемиологии, способах диагностики, лечения и профилактики тяжелой внебольничной пневмонии у взрослых. При подготовке настоящего документа использованы и адаптированы научные исследования высокого уровня доказательности, систематические обзоры и метаанализы, рекомендации Американского общества инфекционных заболеваний/Американского торакального общества (IDSA/ATS), Европейского респираторного общества/Европейского общества интенсивной терапии/Европейского общества клинической микробиологии и инфекционным заболеваниям/Латиноамериканского торакального общества (ERS/ESICM/ESCMID/ALAT) и прочих ведущих профессиональных сообществ. Подробно представлены современные рекомендации по дифференцированной антибиотикотерапии пациентов с тяжелой внебольничной пневмонией (ТВП) в зависимости от наличия у них факторов риска инфицирования определенными микроорганизмами, приведены схемы этиотропной терапии при установленном возбудителе. Значительный раздел рекомендаций посвящен респираторной терапии при ТВП, сформулирован ступенчатый алгоритм лечения острой дыхательной недостаточности в зависимости от ее стадии. Детально охарактеризованы наиболее эффективные и безопасные режимы инвазивных и неинвазивных способов респираторной поддержки. В качестве методов адъювантной терапии названы глюкокортикостероиды при невозможности стабилизировать показатели гемодинамики на фоне адекватной гидратации и вазопрессорной поддержки, а также парентеральные антикоагулянты с целью предупреждения тромбоэмболических осложнений. Для профилактики ТВП у пациентов высокого риска предложены антипневмококковые и противогриппозные вакцины. Представлены критерии оценки качества медицинской помощи.