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

DOI: https://doi.org/10.29296/25877305-2020-04-04
Issue: 
4
Year: 
2020

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.

Keywords: 
infectious diseases
pulmonology
clinical case
COVID-19
chest computed tomography
unspecified coronavirus infection
polysegmental pneumonia



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