LEČENJE KORONAVIRUSNE BOLESTI (COVID-19)
COVID-19
Sažetak
Koronavirusnu bolest (COVID-19) izaziva RNK virus teškog akutnog respiratornog sindroma 2 (SARS-CoV-2) koji je izuzetno zarazan za ljude. Primarni receptor za virus najverovatnije je angiotenzin konvertujući enzim 2. COVID-19 je respiratorna infekcija, primarno se prenosi kapljičnim putem i bliskim kontaktom sa obolelom osobom. Procenjeni reproduktivni broj (R0) je od 2-2.5 a srednje vreme inkubacije 5.2 dana, u rasponu od 1-14 dana (95% granice poverenja 4.1-7.0 dana). Najčešći simptomi obolelih su: povišena telesna temperatura, suvi kašalj, malaksalost, iskašljavanje sputuma i dispneja potom bol u grlu, glavobolja, mijalgija i artralgija, groznica i vrtoglavica i, ređe, konfuzija, rinoreja, nosna kongestija, gastrointestinalni simptomi, hemoptizije i konjuktivalna kongestija. Poznate su i inicijalne atipične manifestacije. Test lančane reakcije polimerizacije pomoću reverzne transkriptaze u realnom vremenu (rRT-PCR) je “zlatni” dijagnostički standard ali specifičnost i senzitivnost nisu definitivno utvrđeni. Najčešće komplikacije su: akutni respiratorni distres sindrom, akutno oštećenje jetre, akutno oštećenje srca i aritmije a potom sekundarne infekcije, akutna respiratorna insuficijencija, akutno oštećenje bubrega, sepsa i/ili septični šok, pneumotoraks, diseminovana intravaskularna koagulacija, akutna srčana insuficijencija i pojedinačni slučajevi rabdomiolize. Trajanje bolesti varira a kod hospitalizovanih bolesnika je procenjeno na 16-26 dana (interkvartilni opseg od 12-29 dana) dok globalna stopa mortaliteta još uvek nije poznata sa sigurnošću. Lekovi protiv SARS-CoV-2 koji se propisuju na osnovu empirijskih protokola (nelicencirana upotreba) su lopinavir/ritonavir, hlorokin i hidroksihlorokin, nitazoksanid, umifenovir, ribavirin, interferon alfa u inhalaciji dok su novi lekovi u fazama kliničkog ispitivanja remdesivir, nafamostat i favipiravir. Proverena medikamentozna profilaksa COVID-19 za sada ne postoji a vakcina protiv SARS-CoV-2 virusa još nije razvijena.
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