Русский
Features of the course of pseudomembranous colitis in patients infected with SARS-CoV-2
DOI: https://dx.doi.org/10.18565/therapy.2022.4.71-76
Eremina E.Yu., Gerasimenko I.V., Lityushkina M.I., Strokova O.A.
N.P. Ogarev National Research Mordovia State University, Saransk
Purpose: to analyze and identify the features of the course of pseudomembranous colitis in patients infected with SARS-CoV-2.
Material and methods. The analysis was carried out on the basis of questionnaires, including information on the course and treatment of COVID-19, comorbidity, clinical symptoms of pseudomembranous colitis, results of colonoscopy, fecal ELISA for C. difficile toxins.
Results and conclusion. 396 questionnaires of patients hospitalized with COVID-19 complicated by pseudomembranous colitis were analyzed. The maximum number of patients (36%) was recorded at the age of 60–69 years; women (65%) predominated in the structure of patients. The onset of symptoms of intestinal dyspepsia, in most cases (67%), was observed on the 10–20th day from the onset of COVID-19, and in 78,5% of cases, a recurrent course of colitis was observed. In 81% of cases, pseudomembranous colitis developed against the background of antibiotic therapy, and in 67% of cases, its development was combined with the appointment of proton pump inhibitors. Mortality from pseudomembranous colitis against the background of SARS-CoV-2 was very high (25,5%) and increased with increasing age of the patient, reaching a maximum (51,7%) in the group of patients over 80 years old. In 99%, the cause of deaths was the development of multiple organ failure against the background of concomitant pathology. Severe course of viral pneumonia in deceased patients was observed only in 17% of cases, which indicates the leading role of intestinal damage in the development of multiple organ failure syndrome in patients with pseudomembranous colitis against the background of infection with the SARS-CoV-2 virus.
Literature
1. Guan W., Ni Z., Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18): 1708–20. https://dx.doi.org/.1056/NEJMoa2002032.
2. Jin X., Lian J.-S., Hu J.-H. et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020; 69(6): 1002–9. https://dx.doi.org/10.1136/gutjnl-2020-320926.
3. Pan L., Mu M., Yang P. et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020; 115(5): 766–73. https://dx.doi.org/10.14309/ajg.0000000000000620.
4. Zhou P., Yang X. L., Wang X. G. et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin. bioRxiv. 2020. https://dx.doi.org/10.1101/2020.01.22.914952.
5. Hung I.F., Cheng V.C., Wu A.K. Viral loads in clinical specimens and SARS manifestations. Emerg Infect Dis. 2004; 10(9): 1550–57. https://dx.doi.org/10.3201/eid1009.040058.
6. Trottein F., Sokol H. Potential causes and consequences of gastrointestinal disorders during a SARS-CoV-2 infection. Cell Rep. 2020; 32(3): 107915. https://dx.doi.org/10.1016/j.celrep.2020.107915.
7. Matsumoto M., Kibe R., Ooga T. et al. Cerebral low-molecular metabolites influenced by intestinal microbiota: A pilot study. Front Syst Neurosci. 2013; 7: 9. https://dx.doi.org/10.3389/fnsys.2013.00009.
8. Cryan J.F., Dinan T.G. Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci. 2012; 13(10): 701–12. https://dx.doi.org/10.1038/nrn3346.
9. Macfarlane S., Dillon J.F. Microbial biofilms in the human gastrointestinal tract. J Appl Microbiol. 2007; 102(5): 1187–96. https://dx.doi.org/10.1111/j.1365-2672.2007.03287.x.
10. Шульпекова Ю.О. Антибиотик-ассоциированная диарея. Русский медицинский журнал. 2007; 3: 467. [Shulpekova Yu.O. antibiotic associated diarrhea. Russkiy meditsinskiy zhurnal = Russian Medical Journal. 2007; 3: 467 (In Russ.)].
11. Koh A., de Vadder F., Kovatcheva-Datchary P., Backhed F. et al. From dietary fiber to host physiology: Short-chain fatty acids as key bacterial metabolites. Cell. 2016; 165(6): 1332–45. https://dx.doi.org/10.1016/j.cell.2016.05.041.
12. Kow C.S., Hasan S.S. Use of proton pump inhibitors and risk of adverse clinical outcomes from COVID-19: A meta-analysis. J Intern Med. 2021; 289(1): 125–28. https://dx.doi.org/10.1111/joim.13183.
13. Luxenburger H., Sturm L., Biever P. et al. Treatment with proton pump inhibitors increases the risk of secondary infections and ARDS in hospitalized patients withCOVID-19: Coincidence or underestimated risk factor? J Intern Med. 2021; 289(1): 121–24. https://dx.doi.org/10.1111/joim.13121.
14. Еремина Е.Ю. Желудочно-кишечные симптомы у инфицированных SARS-CoV-2: акцент на повышенную проницаемость слизистой оболочки. Медицинский алфавит. 2021; 20: 13–20. [Eremina E.Yu. Gastrointestinal symptoms in SARSCoV 2 infected: emphasis on increased mucosal permeability. Meditsinskiy alfavit = Medical Alphabet. 2021; 20: 13–20 (In Russ.)]. https://dx.doi.org/10.33667/2078-5631-2021-20-13-20.
15. 1Viana S.D., Nunes S., Reis F. ACE2 imbalance as a key player for the poor outcomes in COVID-19 patients with age-related comorbidities – Role of gut microbiota dysbiosis. Ageing Res Rev. 2020; 62: 101123. https://dx.doi.org/10.1016/j.arr.2020.101123.
16. Jonsson A.L., Backhed F. Role of gut microbiota in atherosclerosis. Nat Rev Cardiol. 2017; 14(2): 79–87. https://dx.doi.org/10.1038/nrcardio.2016.183.
About the Autors
Elena Yu. Eremina, Dr. med. habil., professor, head of the Department of propaedeutics of internal diseases, N.P. Ogarev National Research Mordovia State University. Address: 430005, Saransk, 68 Bol`shevistskaya Str.
E-mail: eeu61@mail.ru
Irina V. Gerasimenko, PhD in Medicine, associate professor of the Department of propaedeutics of internal diseases, N.P. Ogarev National Research Mordovia State University. Address: 430005, Saransk, 68 Bol`shevistskaya Str.
E-mail: gerasimenkoi@list.ru. ORCID: https://orcid.org/0000-0002-4008-4689
Marina I. Lityushkina, PhD in Medicine, associate professor of the Department of propaedeutics of internal diseases, N.P. Ogarev National Research Mordovia State University. Address: 430005, Saransk, 68 Bol`shevistskaya Str.
E-mail: litjushkina@rambler.ru
Olga A. Strokova, PhD in Medicine, associate professor of the Department of propaedeutics of internal diseases, N.P. Ogarev National Research Mordovia State University. Address: 430005, Saransk, 68 Bol`shevistskaya Str.
E-mail: strokovaoa@rambler.ru
Similar Articles
