pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2022-4161pulmo-4161Research ArticleОБЗОРЫREVIEWК вопросу дифференциальной диагностики внебольничной пневмонии и поражения легких при респираторных вирусных инфекциях, включая COVID-19Differential diagnosis of community-acquired pneumonia and lung damage in respiratory viral infections, including COVID-19https://orcid.org/0000-0002-2124-0623СтрелковаД. А.StrelkovaD. A.

Стрелкова Дарья Александровна – ассистент кафедры госпитальной терапии № 2

119991, Москва, ул. Трубецкая, 8, стр. 2

тел.: (495) 609-14-00

Daria A. Strelkova, Assistant, Department of Hospital Therapy No.2

ul. Trubetskaya 8, build. 2, Moscow, 119991

tel.: (495) 609-14-00

dashastrelkova@gmail.comhttps://orcid.org/0000-0002-9004-7114ИргискинА. А.IrgiskinA. A.

Иргискин Артем Андреевич – студент

119991, Москва, ул. Трубецкая, 8, стр. 2

тел.: (495) 609-14-00

Artem A. Irgiskin, Student

ul. Trubetskaya 8, build. 2, Moscow, 119991

tel.: (495) 609-14-00

irgiskinartem@gmail.comhttps://orcid.org/0000-0002-3329-7846РачинаС. А.RachinaS. A.

Рачина Светлана Александровна – д. м. н., профессор Российской академии наук, заведующая кафедрой госпитальной терапии № 2 Федерального государственного автономного образовательного учреждения высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет), руководитель отдела фармакоэкономики и фармакоэпидемиологии Межрегиональной ассоциации общественных объединений «Межрегиональная ассоциация по клинической микробиологии и антимикробной химиотерапии»

119991, Москва, ул. Трубецкая, 8, стр. 2; 214019, Смоленск, ул. Крупской, 28

тел.: (495) 434-53-00

Svetlana A. Rachina, Doctor of Medicine, Professor of the Russian Academy of Sciences, Head of Department оf Hospital Therapy No.2, Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Head of the Department of Pharmacoeconomics and Pharmacoepidemiology, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy

ul. Trubetskaya 8, build. 2, Moscow, 119991; ul. Krupskoy 28, Smolensk, 214019

tel.: (495) 434-53-00

svetlana.ratchina@antibiotic.ruФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); Межрегиональная ассоциация общественных объединений «Межрегиональная ассоциация по клинической микробиологии и антимикробной химиотерапии»РоссияFederal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Interregional Association for Clinical Microbiology and Antimicrobial ChemotherapyRussian Federation202330122022335670678Copyright © Стрелкова Д.А., Иргискин А.А., Рачина С.А., 20232023Стрелкова Д.А., Иргискин А.А., Рачина С.А.Strelkova D.A., Irgiskin A.A., Rachina S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/4161

С развитием пандемии коронавирусной инфекции и снижении заболеваемости значительную роль в эпидемиологии внебольничных пневмоний (ВП) вновь начнут играть бактериальные возбудители. В ходе многочисленных исследований уже изучены клинические, лабораторные и инструментальные показатели, позволяющие провести дифференциальную диагностику между вирусной инфекцией и бактериальной пневмонией. Выявлена роль классических (например, С-реактивный белок, прокальцитонин, лейкоциты) и новых (например, белок MxA1, програнулин, копептин) лабораторных маркеров. Обнаружены различия в рентгенологической картине по данным компьютерной томографии и сонографических паттернах при ультразвуковом исследовании легких. Целью обзора явилось представление данных о дифференциальной диагностике между поражением легких при вирусных инфекциях, включая COVID-19 (COronaVIrus Disease 2019), и бактериальной ВП. Заключение. Несмотря на многочисленные исследования, вопрос дифференциации бактериальной ВП и вирусного поражения легких, в т. ч. связанного с короновирусной инфекцией, без проведения микробиологических исследований является сложной задачей, при решении которой требуется совокупная оценка не только клинических и лабораторных данных, но и современных визуализирующих исследований. Особый интерес при этом, видимо, будут представлять экспресс-тесты.

With the development of the coronavirus pandemic and its decline, bacterial pathogens will again play a significant role in the epidemiology of community-acquired pneumonia (CAP). Numerous studies have already examined clinical, laboratory, and instrumental indicators that allow differential diagnosis between viral infection and bacterial pneumonia. The role of conventional (e.g., C-reactive protein, procalcitonin, leukocytes) and novel laboratory markers (e.g., MxA1 protein, progranulin, copeptin) was revealed. Differences in lung CT and ultrasound findings were noted. The aim of this publication is to present data on the differential diagnosis between pulmonary involvement in viral infections, including COVID-19 (COronaVIrus Disease 2019), and bacterial CAP. Conclusion. Despite numerous studies, distinguishing bacterial CAP from viral lung injury, including that associated with COVID-19 infection, without microbiologic testing is a challenging task that requires a combined assessment of clinical data, laboratory data, and modern imaging studies. Obviously, express testing will be of particular interest in this case.

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