HAC (Russian)
RSCI (Russian)
Ulrichsweb (Ulrich’s Periodicals Directory)
Scientific Indexing Services

The problems of COVID-19 diagnosis and treatment: a clinical case example

DOI: https://doi.org/10.29296/25877305-2020-04-04

Professor I. Samorodskaya(1, 2), MD; Professor I. Klyuchnikov(2), MD (1)National Medical Research Center for Therapy and Preventive Medicine, Moscow (2)A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow

According to the literature, the clinical picture of COVID-19 is non-specific for most patients and does not allow diagnosis of the disease outside the epidemic period. Currently, there are problems with the sensitivity and specificity of laboratory diagnostic methods and chest computed tomography for COVID-19 verification. Other laboratory and instrumental methods allow indirect evaluation of organ damage and severity of a patient’s condition. There are no proven COVID-19 treatments that suppress the activity of the virus. In many countries, patients receive off-label drugs, such as chloroquine, hydroxychloroquine, azithromycin, lopinavir-ritonavir, favipiravir, remdesivir, ribavirin, interferon, convalescent plasma, steroids, and anti-IL-6 inhibitors. The paper describes a clinical case identified during the initial stage of the COVID-19 epidemic in Russia, which shows difficulties in recognition and choice of a diagnostic and treatment algorithm. The patient received combined antibiotic therapy, hydroxychloroquine, and infusion therapy. The patient was discharged in satisfactory condition, but there are many questions when choosing drug therapy, by taking into account the lack of evidence for efficacy and the presence of side effects of drugs, the use of concomitant therapy, timely monitoring of treatment not only in the inpatient stage, but also in outpatient one.

infectious diseases
clinical case
chest computed tomography
unspecified coronavirus infection
polysegmental pneumonia

  1. WHO Director-General’s statement on IHR Emergency Committee on Novel Coronavirus (2019-nCoV). URL: https://www.who.int/dg/speeches/detail/who-director-general-s-statement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov)
  2. COVID-19 coding in ICD-10. Available at: https://www.who.int/classifications/icd/COVID-19-coding-icd10.pdf?ua=1
  3. Case definitions WHO periodically updates the Global Surveillance for human infection with coronavirus disease (COVID-19) / Geneva: WHO; 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200323-sitrep-63-covid-19.pdf?sfvrsn=d97cb6dd_2
  4. Remuzzi A., Remuzzi G. COVID-19 and Italy: what next? // Lancet. – 2020; 395: 1225–28. https://doi.org/10.1016/S0140-6736(20)30627-9
  5. Pisano G.P., Sadun R., Zanini M. Lessons from Italy’s Response to Coronavirus. Available at: https://hbr.org/2020/03/lessons-from-italys-response-to-coronavirus
  6. Loeffelholz M.J., Tang Y.W. Laboratory diagnosis of emerging human coronavirus infections – the state of the art // Emerg. Microbes Infect. – 2020; 9 (1): 747–56. DOI: 10.1080/22221751.2020.1745095.
  7. Guidance on the use of COVID-19 rapid diagnostic tests. Available at: https://www.itg.be/E/Article/guidance-on-the-use-of-covid-19-rapid-diagnostic-tests
  8. Parodi E., Jewkes S., Cha S. et al. Italy and South Korea Virus Outbreaks Reveal Disparity in Deaths and Tactics. Available at: https://www.medscape.com/viewarticle/926697
  9. Zheng Ye, Yun Zhang, Yi Wang, et al. Chest CT Manifestations of New Coronavirus Disease 2019 (COVID-19): A pictorial review // Eur. Radiol. – 2020. https://doi.org/10.1007/s00330-020-06801-0
  10. Lee E.Y.P., Ng M.Y., Khong P.L. COVID-19 pneumonia: what has CT taught us? // Lancet. Infect. Dis. – 2020; 20 (4): 384–5. DOI: 10.1016/S1473-3099(20)30134-1.
  11. Gattinoni L., Coppola S., Cressoni M. et al. Covid-19 Does Not Lead to a «Typical» Acute Respiratory Distress Syndrome [published online ahead of print, 2020 Mar 30] // Am. J. Respir. Crit. Care Med. – 2020. DOI: 10.1164/rccm.202003-0817LE.
  12. Wu C., Chen X., Cai Y. et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China // JAMA Intern Med. – 2020; e200994. DOI: 10.1001/jamainternmed.2020.0994.
  13. Bischof E., Chen G., Ferretti M.T. Understanding COVID-19 new diagnostic guidelines – a message of reassurance from an internal medicine doctor in Shanghai // Swiss Med. Wkly. – 2020; 150: w20216. https://doi.org/10.4414/smw.2020.20216
  14. Wynants L., Calster B.V., Bonten M.M.J. et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal // BMJ. – 2020; 369: m1328. DOI: 10.1136/bmj.m1328.
  15. Zhou F., Yu T., Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study // Lancet. – 2020; 395 (10229): 1054–62. DOI: 10.1016/S0140-6736(20)30566-3.
  16. Sheridan C. Coronavirus and the race to distribute reliable diagnostics // Nat. Biotechnol. – 2020; 38 (4): 382–4. DOI: 10.1038/d41587-020-00002-2.
  17. Curti L. et al. An ultrasensitive, rapid, and portable coronavirus SARS-CoV-2 sequence detection method based on CRISPR-Cas12 // BioRxiv. Journal. – 2020; Preprint. https://doi.org/10.1101/2020.02.29.971127.
  18. Patel R., Babady E., Theel E.S. et al. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS-CoV-2/COVID-19 // mBio. – 2020; 11 (2): e00722-20. DOI: 10.1128/mBio.00722-20.
  19. Zhengtu Li, Yongxiang Yi. Xiaomei Luo. Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis // J. Med. Virol. – 2020. https://doi.org/10.1002/jmv.25727.
  20. Moskovskie vrachi predlozhili vkljuchit' bol'nitsy dlja lechenija koronavirusa i pnevmonii v edinuju sistemu [Moskovskie vrachi predlozhili vklyuchit’ bol’nitsy dlya lecheniya koronavirusa i pnevmonii v edinuyu sistemu (in Russ.)]. URL: https://mosgorzdrav.ru/ru-RU/news/default/card/3748.html
  21. Bai H.X. et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT // Radiology. – 2020; 200823. DOI: 10.1148/radiol.20200823.
  22. Salehi S., Abedi A., Balakrishnan S. et al. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients [published online ahead of print, 2020 Mar 14] // AJR Am. J. Roentgenol. – 2020; 1–7. DOI:10.2214/AJR.20.23034.
  23. Wenzhong Liu, Hualan Li. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism // ChemRxiv. – 2020; Preprint. https://doi.org/10.26434/chemrxiv.11938173.v5
  24. Vincent M.J., Bergeron E., Benjannet S. et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread // Virol. J. – 2005; 2: 69. https://doi.org/10.1186/1743-422X-2-69
  25. Pacheco R.L., Riera R. Hydroxychloroquine and chloroquine for COVID-19 infection. Rapid systematic review. http://dx.doi.org/10.17267/2675-021Xevidence.v2i1.2843. URL: https://www5.bahiana.edu.br/index.php/evidence/article/view/2843
  26. Gautret P., Lagier J.C., Parola P. et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial [published online ahead of print, 2020 Mar 20] // Int. J. Antimicrob. Agents. – 2020; 105949. DOI: 10.1016/j.ijantimicag.2020.105949.
  27. Goodman J.L., Borio L. Finding Effective Treatments for COVID-19: Scientific Integrity and Public Confidence in a Time of Crisis // JAMA. – 2020. Published online April 16. DOI: 10.1001/jama.2020.6434.
  28. Assessment of Evidence for COVID-19-Related Treatments, provided by the American Society of Health-System Pharmacists at: https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx
  29. Sanders J.M., Monogue M.L., Jodlowski T.Z. et al. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review // JAMA. – 2020. Published online April 13. DOI: 10.1001/jama.2020.6019.
  30. Kalil A.C. Treating COVID-19 – Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics // JAMA. – 2020. Published online March 24. DOI:10.1001/jama.2020.4742.
  31. Zhang Q., Wang Y., Qi C. et al. Clinical trial analysis of 2019-nCoV therapy registered in China // J. Med. Virol. – 2020. Published online February 18. DOI: 10.1002/jmv.25733.
  32. Vremennye metodicheskie rekomendatsii po profilaktike, diagnostike i lecheniju novoj koronavirusnoj infektsii (COVID-19). Pjataja versija [Vremennye metodicheskie rekomendatsii po profilaktike, diagnostike i lecheniyu novoi koronavirusnoi infektsii (COVID-19). Pyataya versiya (in Russ.)] URL: https://www.rosminzdrav.ru/ministry/med_covid19