medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-11-34-39medalphabet-2020Research ArticleСтатьиКлинический случай в амбулаторной практике: острый тонзиллит на фоне COVID-19Clinical case in outpatient practice: acute tonsillitis against background of COVID-19https://orcid.org/0000-0002-4293-3285ОрловаН. В.OrlovaN. V.

Орлова Наталья Васильевна, д.м.н., проф, проф. кафедры

eLIBRARY SPIN: SPIN‑код: 8775–1299 

Москва

Orlova Natalia V. 

Moscow

vrach315@yandex.ruЛомайчиковВ. В.LomaychikovV. V.

Ломайчиков Валерий Валерьевич, ассистент кафедры 

Москва

Lomaichikov Valery V.  

Moscow

lomaychikov@yandex.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава РоссииРоссияRussian National Research Medical University n.a. N.I. PirogovRussian Federation202115062021111Современная поликлиника (2)3439Copyright © Орлова Н.В., Ломайчиков В.В., 20212021Орлова Н.В., Ломайчиков В.В.Orlova N.V., Lomaychikov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2020

За прошедший период пандемии COVID‑19 был накоплен опыт о путях распространения инфекции, сформированы новые подходы к лечению, созданы препараты для вакцинопрофилактики. Сведения о COVID‑19 пополняются новыми данными об особенностях клинического течения, включая редкие проявления заболевания. Клинические симптомы COVID‑19 характеризуются значительным разнообразием и обусловлены тропностью вируса SARS‑CoV‑2 к различным тканям. В статье описан клинический случай COVID‑19. При невыраженном интоксикационном синдроме у пациентки выявлен сопутствующий острый тонзиллит. В статье приведен обзор литературы по клиническим симптомам COVID‑19 и механизмам их развития. Рассмотрена дифференциальная диагностика вирусного и бактериального тонзиллита, эффективность антибактериальной терапии тонзиллита цефиксимом. Клинический случай иллюстрирован фотографиями.

Over the past period of the COVID‑19 pandemic, experience has been gained on the ways of spreading the infection, new approaches to treatment have been formed, and preparations for vaccine prevention have been created. Information about COVID‑19 is updated with new data on the features of the clinical course, including rare manifestations of the disease. The clinical symptoms of CAVID‑19 are characterized by a significant variety and are due to the tropism of the SARS‑CoV‑2 virus to various tissues. The article describes a clinical case of COVID‑19. With severe intoxication syndrome, the patient was found to have concomitant acute tonsillitis. The article provides a review of the literature on the clinical symptoms of COVIND‑19 and the mechanisms of their development. The differential diagnosis of viral and bacterial tonsillitis is considered. Efficacy of antibacterial therapy of tonsillitis with cefixime. The clinical case is illustrated with photos.

COVID‑19тонзиллитдифференциальная диагностикалечениеCOVID‑19tonsillitisdifferential diagnosistreatmentReferencesWorld Health Organization. 11 march 2020. httph://www.int/ru/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefingon-covid-19.World Health Organization. 11 march 2020. httph://www.int/ru/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefingon-covid-19.Eliezer M, Hautefort C, Hamel AL, Verillaud B, Herman P, Houdart E, Eloit C. Sudden and complete olfactory loss function as a possible symptom of COVID-19 [published online ahead of print, 2020 Apr 8].Eliezer M, Hautefort C, Hamel AL, Verillaud B, Herman P, Houdart E, Eloit C. Sudden and complete olfactory loss function as a possible symptom of COVID-19 [published online ahead of print, 2020 Apr 8].JAMA Otolaryngol Head Neck Surg. 2020. DOI: 10.1001/jamaoto.2020.0832. https://doi.org/10.1001/jamaoto.2020.0832.JAMA Otolaryngol Head Neck Surg. 2020. DOI: 10.1001/jamaoto.2020.0832. https://doi.org/10.1001/jamaoto.2020.0832.Временные методические рекомендации Минздрава России «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)» версия 10 (8.02.2021). Vremennyye metodicheskiye rekomendatsii Minzdrava Rossii ‘Profilaktika. diagnostika i lecheniye novoy koronavirusnoy infektsii (COVID-19)’ versiya 10 (8.02.2021).Временные методические рекомендации Минздрава России «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)» версия 10 (8.02.2021). Vremennyye metodicheskiye rekomendatsii Minzdrava Rossii ‘Profilaktika. diagnostika i lecheniye novoy koronavirusnoy infektsii (COVID-19)’ versiya 10 (8.02.2021).Chen X, Liao B, Cheng L. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020 Sep; 104 (18): 7777–7785.Chen X, Liao B, Cheng L. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020 Sep; 104 (18): 7777–7785.Garcia-Vidal C., Sanjuan G., Moreno-Garcia E. Incidence of co-infections and superinfections in hospitalised patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2020 [Epub ahead of print]. https://doi.org/10.1016/j.cmi.2020.07.041.Garcia-Vidal C., Sanjuan G., Moreno-Garcia E. Incidence of co-infections and superinfections in hospitalised patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2020 [Epub ahead of print]. https://doi.org/10.1016/j.cmi.2020.07.041.Benmalek R, Mechal H, Choukrallah H. Bacterial co-infections and superinfections in COVID-19: a case report of right heart infective endocarditis and literature review. Pan Afr Med J. 2020 May 20; 35 (Suppl 2):40.Benmalek R, Mechal H, Choukrallah H. Bacterial co-infections and superinfections in COVID-19: a case report of right heart infective endocarditis and literature review. Pan Afr Med J. 2020 May 20; 35 (Suppl 2):40.Hughes S., Troise O., Donaldson H. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary care setting. Clin Microbiol Infect. 2020; 26: 1395–1399.Hughes S., Troise O., Donaldson H. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary care setting. Clin Microbiol Infect. 2020; 26: 1395–1399.Rawson T.M., Moore L.S.P., Castro-Sбnchez E. et al. COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother. 2020; 75: 1681–1684.Rawson T.M., Moore L.S.P., Castro-Sбnchez E. et al. COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother. 2020; 75: 1681–1684.Mirzaei R, Goodarzi P, Asadi M. Bacterial co-infections with SARS-CoV-2. IUBMB Life. 2020 Oct; 72 (10): 2097–2111.Mirzaei R, Goodarzi P, Asadi M. Bacterial co-infections with SARS-CoV-2. IUBMB Life. 2020 Oct; 72 (10): 2097–2111.Langford B.J., So M., Raybardhan S. et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020; 26: 1622–1629.Langford B.J., So M., Raybardhan S. et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020; 26: 1622–1629.Zhu N, Aylin P, Rawson T. Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves. Clin Microbiol Infect. 2021 Feb 16: S1198–743X(21)00082–3.Zhu N, Aylin P, Rawson T. Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves. Clin Microbiol Infect. 2021 Feb 16: S1198–743X(21)00082–3.Клинические рекомендации Министерства здравоохранения Российской Федерации «Острый тонзиллофарингит», 2016 год. Klinicheskiye rekomendatsii Ministerstva zdravookhraneniya Rossiyskoy Federatsii ‘Ostryy tonzillofaringit’, 2016.Клинические рекомендации Министерства здравоохранения Российской Федерации «Острый тонзиллофарингит», 2016 год. Klinicheskiye rekomendatsii Ministerstva zdravookhraneniya Rossiyskoy Federatsii ‘Ostryy tonzillofaringit’, 2016.Kasenomm P, Piirsoo A, Kull M, Kull M, Mikelsaar M. Selection of indicators for tonsillectomy in adults with recurrent tonsillitis. BMC Ear Nose Throat Disord, 2005. 5: 7.Kasenomm P, Piirsoo A, Kull M, Kull M, Mikelsaar M. Selection of indicators for tonsillectomy in adults with recurrent tonsillitis. BMC Ear Nose Throat Disord, 2005. 5: 7.Skoulakis C, Tigiroglou E, Gkarelis K, Klapsa D, Damani A et al. Level of Streptococcus pyogenes in patients with recurrent tonsillitis and tonsillar hypertrophy. Scand. J. Infect Dis, 2008. 40: 899–903.Skoulakis C, Tigiroglou E, Gkarelis K, Klapsa D, Damani A et al. Level of Streptococcus pyogenes in patients with recurrent tonsillitis and tonsillar hypertrophy. Scand. J. Infect Dis, 2008. 40: 899–903.Franks TJ, Chong PY, Chui P, Galvin JR, Lourens RM. Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from Singapore. Hum Pathol 2003. 34: 743–748. DOI: 10.1016/S0046–8177(03)00367–8.Franks TJ, Chong PY, Chui P, Galvin JR, Lourens RM. Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from Singapore. Hum Pathol 2003. 34: 743–748. DOI: 10.1016/S0046–8177(03)00367–8.Tse G-K, To K-F, Chan P-S, Lo AWI, Ng K-C, Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS). J Clin Pathol. 2004. 57: 260–265. DOI: 10.1136/jcp.2003.013276.Tse G-K, To K-F, Chan P-S, Lo AWI, Ng K-C, Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS). J Clin Pathol. 2004. 57: 260–265. DOI: 10.1136/jcp.2003.013276.The Unrecognized Threat of Secondary Bacterial Infections with COVID-19. Vaillancourt M, Jorth P.mBio. 2020 Aug 7; 11 (4): e01806–20. DOI: 10.1128/mBio.01806–20. PMID: 32769090.The Unrecognized Threat of Secondary Bacterial Infections with COVID-19. Vaillancourt M, Jorth P.mBio. 2020 Aug 7; 11 (4): e01806–20. DOI: 10.1128/mBio.01806–20. PMID: 32769090.Chiappini E., Regoli M., Bonsignori F. et al. Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther. 2011; 33 (1): 48–58.Chiappini E., Regoli M., Bonsignori F. et al. Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther. 2011; 33 (1): 48–58.Casey J. R., Pichichero M. E. The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis. Diagn Microbiol Infect Dis. 2007; 57 (Suppl. 3): 39–45.Casey J. R., Pichichero M. E. The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis. Diagn Microbiol Infect Dis. 2007; 57 (Suppl. 3): 39–45.Shulman S., Bisno A., Clegg H. Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America (IDSA). Clinical Infectious Diseases. 2012.Shulman S., Bisno A., Clegg H. Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America (IDSA). Clinical Infectious Diseases. 2012.Altamim S., Khalil A., Khalaiwi K. A. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev. 2009; 1: CD004872.Altamim S., Khalil A., Khalaiwi K. A. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev. 2009; 1: CD004872.Casey J. R., Pichichero M. E. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics. 2004. Vol. 113, N4, p. 866–882.Casey J. R., Pichichero M. E. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics. 2004. Vol. 113, N4, p. 866–882.Дронов И.А., Геппе Н.А., Малявина У.С. Проблемы выбора антибактериальной терапии при стрептококковом тонзиллофарингите у детей. Лечащий врач № 1, 2014. Dronov I.A. Geppe N.A. Malyavina U.S. Problemy vybora antibakterialnoy terapii pri streptokokkovom tonzillofaringite u detey. Lechashchiy vrach N1, 2014.Дронов И.А., Геппе Н.А., Малявина У.С. Проблемы выбора антибактериальной терапии при стрептококковом тонзиллофарингите у детей. Лечащий врач № 1, 2014. Dronov I.A. Geppe N.A. Malyavina U.S. Problemy vybora antibakterialnoy terapii pri streptokokkovom tonzillofaringite u detey. Lechashchiy vrach N1, 2014.Геппе Н. А., Дронов И. А., Малявина У. С., Афонина Е. Ю. Применение цефиксима для эмпирической терапии внебольничных инфекций дыхательных путей у детей. Педиатрия. 2010, № 6, с. 108–113. Geppe N. A. Dronov I. A. Malyavina U. S. Afonina E. Yu. Primeneniye tsefiksima dlya empiricheskoy terapii vnebolnichnykh infektsiy dykhatelnykh putey u detey. Pediatriya. 2010. N6. P. 108–113.Геппе Н. А., Дронов И. А., Малявина У. С., Афонина Е. Ю. Применение цефиксима для эмпирической терапии внебольничных инфекций дыхательных путей у детей. Педиатрия. 2010, № 6, с. 108–113. Geppe N. A. Dronov I. A. Malyavina U. S. Afonina E. Yu. Primeneniye tsefiksima dlya empiricheskoy terapii vnebolnichnykh infektsiy dykhatelnykh putey u detey. Pediatriya. 2010. N6. P. 108–113.Приказ Министерства здравоохранения Российской Федерации № 1205н от 20.12. 2012 «Об утверждении стандарта первичной медико-санитарной помощи при остром тонзиллите».Приказ Министерства здравоохранения Российской Федерации № 1205н от 20.12. 2012 «Об утверждении стандарта первичной медико-санитарной помощи при остром тонзиллите».World Health Organization. Clinical management of COVID-19. 2020. https://www.who.int/publications/i/item/clinical-management-of-covid-19. Prikaz Ministerstva zdravookhraneniya Rossiyskoy Federatsii N1205n ot 20.12. 2012 ‘Ob utverzhdenii standarta pervichnoy mediko-sanitarnoy pomoshchi pri ostrom tonzillite’.World Health Organization. Clinical management of COVID-19. 2020. https://www.who.int/publications/i/item/clinical-management-of-covid-19. Prikaz Ministerstva zdravookhraneniya Rossiyskoy Federatsii N1205n ot 20.12. 2012 ‘Ob utverzhdenii standarta pervichnoy mediko-sanitarnoy pomoshchi pri ostrom tonzillite’.

The authors declare that there are no conflicts of interest present.