К вопросу дифференциальной диагностики внебольничной пневмонии и поражения легких при респираторных вирусных инфекциях, включая COVID-19

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.

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