Let's figure out what really helps and whether you need to take antibiotics right away for Covid-19
It is believed that the main threat from coronavirus is lung damage. How does covid infection occur, and at what point does the process become complicated by bacterial pneumonia? How to distinguish one from the other, is there a way to protect yourself in advance and prevent COVID-19 from turning into pneumonia, Vladimir Beketov, candidate of medical sciences, pulmonologist at Sechenov University, told kp.ru.
The first thing that is important to understand, the expert says, is that the new coronavirus infection is a viral infection and is included in the group of acute respiratory viral infections. The only thing that stands apart from this group is influenza. This means that COVID-19, like all respiratory viral infections that affect the upper respiratory tract and lungs, is characterized by the following phenomenon. Immune defenses in the lungs weaken. Therefore, it becomes possible for a secondary bacterial super-infection to occur approximately on the 5th – 9th day of the course of any acute respiratory viral disease.
“Since Covid is a special disease, and it does not progress as quickly as the flu, for example, the addition of a bacterial infection, as a rule, occurs with COVID-19 towards the end of the second week,” says pulmonologist Vladimir Beketov.
HOW PNEUMONIA DEVELOPES
In conditions of reduced respiratory and motor activity, when mucus moves less through the bronchi, against the background of intoxication of the body and decreased immunity, bacteria from the nasopharynx descend into the lower parts of the respiratory tract and can begin to multiply there.
Thus, bacterial bronchitis can be caused first, then bronchopneumonia with transition to pneumonia. The development of bacterial pneumonia can also be facilitated by the patient being on a ventilator for a long time. Despite compliance with all the strictest disinfection measures, ventilators are risk factors for the occurrence of ventilator-associated pneumonia.
Types of inflammatory gynecological diseases
Vulvitis
This is an inflammation of the outer part of the vulva. It occurs in females; girls are most susceptible to this inflammatory process.
Moreover, the frequency of this inflammation is due to the fact that the vulva has an anatomically accessible location for the penetration of an infectious factor.
Currently, several variants of the development of inflammation have been identified, among them infectious vulvitis of a nonspecific cause, as well as specific inflammation and strophic lesions associated with hormonal deficiency.
Symptoms of vulvitis
- General health is usually not disturbed , body temperature does not rise and there are no signs of intoxication.
- Some women do not even notice any symptoms, and inflammation is detected only when examined by a specialist.
- And also this is the presence of redness of the external genitalia , the addition of itching and burning.
- The discharge has a pathological inflammatory nature , it will depend on who provoked the process. Their number also depends on the development and degree of inflammation. In some cases, severe discomfort may occur, the urge to urinate, dysuria and pain may appear.
- During sexual intercourse, there is severe pain irritation, and subsequently women see the appearance of bloody discharge associated with damage to the mucous membrane. During inflammation of the vulva, it becomes swollen, loose and vulnerable.
Bartholinitis
This is an inflammatory lesion of the external genital tract - Bartholin's glands. Normally, they perform very important functions, aimed at producing mucus in the vaginal area, as well as lubrication to ensure full-fledged intercourse.
- The mechanism of infection is associated with the anatomical features of the location of the gland. This is due to the fact that the excretory duct is located in the vestibule of the vagina, so there is wide access for microorganisms to enter.
- There may be pathogens from the vaginal environment or from the surrounding space , due to the close anatomical connection with the rectum.
- In addition, in order for the pathogen to exhibit its pathogenic properties, it is necessary to act on provoking factors that contribute to a decrease in immunity, mainly local. These include shaving with someone else's tools or old blades, failure to comply with personal hygiene rules, and wearing tight underwear, especially made of synthetic materials.
- Inflammation is quite rare, mainly occurs between the ages of 25 and 35, and can often be combined with other inflammatory pathologies of the genital organs. It begins initially, usually acutely.
Symptoms:
- The appearance of severe painful irritation in the area of the vaginal opening.
- She cannot work normally, has difficulty sitting down and sexual intercourse is impossible.
- A formation can be palpated on the labia; the dimensions can vary, from 2-3 cm to 10 cm; the consistency at the initial stage is soft.
- The skin has an increased temperature compared to other areas.
If inflammation is not cured at this stage, then it later becomes chronic or develops complications such as cysts or abscesses.
When the disease turns into an abscess, the tumor has a dense consistency, the size is large in most cases, the shape is round or oval, and in some cases fluctuation appears. The general condition is disturbed, the temperature rises, signs of intoxication appear, sometimes it develops into fever. Inflammation of the Bartholin gland requires mandatory treatment.
Cervicitis
This is inflammation of the cervix. It is an intermediate area between the internal and external genitalia. In this case, the mucous membrane is involved in the pathological process. Since the cervix is divided into two main sections - the exocervix and endocervix.
The outer parts are predominantly stratified by squamous epithelium, while the inside is lined with cylindrical epithelium. It is the inflammation of the cylindrical epithelium that is most dangerous, since it increases the risk of its transfer to the uterus.
Cervicitis can be caused by various factors, including bacteria, viruses or fungi. The presence of provoking factors contributing to the development of inflammation is of great importance.
Symptoms:
- Frequently changing sexual partners without using condoms.
- The presence of sexually transmitted infections , as well as a violation of the vaginal microbiocenosis.
- Frequent hypothermia, inflammation in the vagina or uterus, as well as decreased immunity. This may be caused by the human immunodeficiency virus.
- The presence of human papillomavirus , precisely those types that are troparia to the cervix.
In most cases, cervical inflammation is asymptomatic. Therefore, it is often detected only when a woman is examined by a specialist.
Only in some cases is the presence of discharge from the genital tract. During a vaginal examination, redness of the mucous membrane, the presence of an enhanced vascular pattern, as well as focal defects of the mucous membrane are revealed. A predominantly pathological discharge appears from the external pharynx, ranging from creamy to purulent.
Cervical erosion
This is a pathological process that occurs on the outer part of the cervix. It is characterized by the presence of a defect in the mucous membrane.
This process can occur in women at any age, but the frequency increases in sexually active women.
The average age of this group is 18 - 35 years. This is due to frequent changes of sexual partners.
This pathology is especially dangerous when a human papillomavirus infection is combined with a defect in the mucous membrane.
Types 16 and 18 are considered the most dangerous; they can contribute to the development of cancer. In most cases, cervical erosion is combined with inflammation in the cervix and vagina, and may become a consequence of this process.
It is usually asymptomatic. A woman will not feel pain due to the fact that the cervix is devoid of pain receptors, which means inflammation will only manifest itself morphologically. It can only be manifested by the appearance of bloody or brown discharge, especially after sexual intercourse.
It is detected mainly when examined in the speculum by a gynecologist. You can see defects on the mucous membrane of the exocervix of the cervix; in this case, the cervix will not be uniformly smooth and pink. It appears hyperemia, hemorrhages, defects in the mucous membrane, as well as signs of an old inflammatory process.
DOES PNEUMONIA REALLY FOLLOW COVID-19?
— Recently, an analysis of statistical data shows that the medical community is mistakenly addicted to antibiotics in the treatment of a new coronavirus infection, suggesting that changes in the lungs are immediately associated not only with the virus, but also with a bacterial component. This is not true, says pulmonologist Vladimir Beketov.
According to the expert, to date, a number of reputable medical associations have issued memorandums and open letters calling on colleagues to reduce the use of antibiotics during the treatment of COVID-19, because antibiotics do not provide benefit, but in this case cause harm, including toxic damage to the liver and development of antibiotic-associated diarrhea.
— That is, we seem to be trying to treat pneumonia, which in the doctor’s mind is strongly associated with bacteria, but in fact, at the stage, while there is no secondary pneumonia associated with Covid, we are only dealing with coronavirus lung damage, which is recommended not to be called pneumonia, and call it pneumonitis (inflammation of the vascular walls of the alveoli, as well as the tissue separating the alveoli from the lungs, which is accompanied by scarring - editor's note), says pulmonologist Vladimir Beketov.
The very phenomenon of secondary bacterial pneumonia due to coronavirus is overestimated, the expert continues. Such processes develop mainly in patients with heart failure, and for them there are increased precautions, restrictions on movement, recommendations for self-isolation and treatment at home.
- Smokers are also at risk for developing bacterial pneumonia. However, if smokers with COPD receive proper inhalation treatment and are vaccinated against pneumococcus, then their risks of secondary bacterial pneumonia are also minimized, says Vladimir Beketov.
Causes of inflammation of the female genital organs
As for diseases such as vulvitis, vaginitis, cervicitis, endometritis, these are quite a lot of pathogens. These are not always specific microorganisms.
When the body's defenses decrease, opportunistic microorganisms that are normally found in the female body can also show their pathogenicity, but immune forces do not allow them to express theirs.
These include mainly staphylococcus, streptococcus, fungi of the genus Candida, and some viral particles. Of the pathogenic ones, gonococci, chlamydia, trichomonas, and others have their negative effects.
Factors contributing to inflammation
- First of all, this is the sexual transmission of both specific infections and opportunistic microorganisms.
- Violation of personal hygiene rules. Incorrect use of hygiene products.
- The presence of concomitant diseases , both inflammatory and non-inflammatory in origin.
- Using low-quality underwear that does not match the size or is made of synthetic material. Some models of underwear can cause diseases.
- Decreased immune strength of the body. One of the most common provoking factors may be foci of chronic infection or hypothermia.
- Insufficient nutrition . Especially in this case, the consumption of large amounts of simple carbohydrates and sugar is provoking.
- Diabetes mellitus is one of the provoking factors in the development of candidiasis.
Symptoms of the disease
- Among them, the most common is pain. Its characteristics can be acute or dull, aching.
- This is also a discharge from the genital tract , the nature of which varies with different inflammations, but is always pathological.
- In addition, there may be itching and burning in the genital area . In some cases, this sign of inflammation is so pronounced that it disrupts a woman’s lifestyle and leads to increased nervous excitability.
- A disturbance in the general condition may also occur ; it is expressed in the manifestation of intoxication associated with the inflammatory process, an increase in body temperature and, in some cases, a change in the functioning of organs and systems.
Forms of the disease
Firstly, I share all inflammation of the female genital organs for the reason that contributes to its formation:
- Bacterial
- Fungal
- Viral.
These are also the stages of inflammation development:
- Acute
- Subacute
- Chronic
- Latent.
How to suppress too much inflammation
2K 2 min.
Russian scientists, together with American colleagues, have discovered that certain proteins can prevent the development of too much inflammation during infections. Protective interferon proteins trigger signal transmission when an infection enters the body and determine the cell’s decision: the start of the inflammatory process or cell death. Such inflammation can be dangerous in some diseases and in the case of a severely weakened body. The results of the study will help develop new approaches to protecting patients. The research was supported by the Russian Science Foundation.
Project manager and one of the authors of the article Alexander Poltorak
Photo: From personal archive
Project manager and one of the authors of the article Alexander Poltorak
Photo: From personal archive
“There are many bacterial infections in which excessive inflammatory signaling can interfere with healing and even worsen the patient's condition. Therefore, understanding these mechanisms is very important and in the future can save many lives,” commented Alexander Poltorak, Candidate of Chemical Sciences, head of the laboratory of molecular genetics of innate immunity at the Institute of High Biomedical Technologies of Petrozavodsk State University.
In immunology, much attention is paid to inflammation, which plays the role of the body’s protective response to damage and foreign microorganisms that enter. In certain situations, doctors have to suppress or stimulate this reaction, but excessive inflammation can be harmful to the health and even life of the patient.
Project manager and one of the authors of the article Alexander Poltorak
Photo: From personal archive
Project manager and one of the authors of the article Alexander Poltorak
Photo: From personal archive
In addition to inflammation, cell death plays a critical role in protecting the body from infection. For example, one of its programmable types, necroptosis, is accompanied by inflammation and an immune response. The decaying cell releases previously synthesized inflammatory substances, which in large quantities can cause harm to the body. The process of necroptosis itself is triggered if the regulators of non-inflammatory cell death are blocked. This occurs when specific agents bind to death receptors on the surface of the membrane, through which the cell receives the “order” to self-destruct.
An important role in necroptosis is played by enzymes that transfer phosphoric acid between proteins and thus regulate their activity. They are called protein kinases (RIPKs). During necroptosis, RIPK1 activates RIPK3. The complex of these two enzymes and a protein adapter triggers a further cascade of reactions, which leads to the destruction of the cell membrane and the leakage of aggressive cell contents into the surrounding space.
However, in biology there is no one universal mechanism; shifts, changes in regulation and other activation pathways are always possible. Therefore, Russian scientists, together with foreign colleagues, studied how RIPK1 and RIPK3 affect the synthesis of immune cytokine proteins, which are very important in the functioning of the immune system. This way they were able to better understand the role of these enzymes in protecting the body from infections. Scientists conducted a study on humans and laboratory mice, in which they studied macrophages—immune cells capable of actively capturing and digesting bacteria. In animals they were obtained from bone marrow, and in humans - from peripheral blood mononuclear cells. The study authors induced various reactions in the cells and observed the inflammatory response.
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Protective interferon proteins trigger signal transmission when an infection enters the body and determine the cell’s decision: the start of the inflammatory process or cell death
Photo: Courtesy of Alexander Poltorak / Courtesy of Alexander Poltorak
Protective interferon proteins trigger signal transmission when an infection enters the body and determine the cell’s decision: the start of the inflammatory process or cell death
Photo: Provided by Alexander Poltorak
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Protective interferon proteins trigger signal transmission when an infection enters the body and determine the cell’s decision: the start of the inflammatory process or cell death
Photo: Courtesy of Alexander Poltorak / Courtesy of Alexander Poltorak
Protective interferon proteins trigger signal transmission when an infection enters the body and determine the cell’s decision: the start of the inflammatory process or cell death
Photo: Provided by Alexander Poltorak
During the study, they found that protective interferon proteins trigger signal transmission when an infection enters the body and determine the cells’ decision: the initiation of an inflammatory process or necroptosis. If these signals do not reach the cell, then necroptosis does not occur and a sustained inflammatory response occurs, which depends on RIPK1 and RIPK3. These substances, scientists realized, are necessary for the activation of proteins that trigger and regulate the synthesis of inflammatory agents of the immune system. But interferons, which transmit a signal into the cell, can inhibit the process, thereby suppressing inflammation and at the same time promoting necroptosis.
The work was carried out jointly with colleagues from Tufts University (USA).
Based on materials from the article Constitutive Interferon Attenuates RIPK1/3-Mediated Cytokine Translation; Hayley I. Muendlein, Joseph Sarhan, Beiyun C. Liu, Wilson M. Connolly, Stephen A. Schworer, Irina Smirnova, Amy Y. Tang6 Vladimir Ilyukha, Jodie Pietruska, Soroush Tahmasebi, Nahum Sonenberg, Alexei Degterev, Alexander Poltorak; Cell Reports, March 2021
