{"id":4873,"date":"2021-06-11T06:00:00","date_gmt":"2021-06-11T06:00:00","guid":{"rendered":"https:\/\/www.mojemedunka.cz\/?p=4873"},"modified":"2021-06-10T17:22:10","modified_gmt":"2021-06-10T17:22:10","slug":"z-cervnove-medunky-moje-uvahy-o-covidu-klinicky-obraz","status":"publish","type":"post","link":"https:\/\/www.mojemedunka.cz\/index.php\/2021\/06\/11\/z-cervnove-medunky-moje-uvahy-o-covidu-klinicky-obraz\/","title":{"rendered":"Z \u010dervnov\u00e9 Medu\u0148ky: Moje \u00favahy o covidu: klinick\u00fd obraz"},"content":{"rendered":"\n

Z aktu\u00e1ln\u00ed \u010dervnov\u00e9 Medu\u0148ky vyb\u00edr\u00e1me pro tento t\u00fdden uk\u00e1zku z \u010dl\u00e1nku MUDr. Ludmily Elekov\u00e9, kter\u00e1 se v\u011bnuje t\u00e9matu covidu<\/strong>.<\/strong><\/em> M\u00e1te pocit, \u017ee informac\u00ed o covidu je u\u017e dost? POZOR – jde o to, jak\u00fdch informac\u00ed.<\/strong> V\u011bt\u0161inou se ve sd\u011blovac\u00edch prost\u0159edc\u00edch dozv\u00edd\u00e1me aktu\u00e1ln\u00ed po\u010det naka\u017een\u00fdch \u010di o\u010dkovan\u00fdch, p\u0159\u00edpadn\u011b r\u016fzn\u00e9 \u00favahy o tom, co n\u00e1m m\u00e1 tato epidemie uk\u00e1zat, ale v\u011bcn\u00fdch informac\u00ed, kter\u00e9 by fundovan\u011b, a p\u0159itom srozumiteln\u011b vysv\u011btlovaly chov\u00e1n\u00ed viru v populaci, v\u011bnovaly se p\u0159\u00edznak\u016fm nemoci nebo uv\u00e1d\u011bly n\u011bkter\u00e9 mo\u017enosti prevence, je o pozn\u00e1n\u00ed m\u00e9n\u011b. Proto pova\u017eujeme \u010dl\u00e1nky na\u0161\u00ed spolupracovnice, praktick\u00e9 l\u00e9ka\u0159ky MUDr. Elekov\u00e9, za d\u016fle\u017eit\u00e9 – pokud m\u00e1me n\u011b\u010demu \u010delit a vytvo\u0159it si vlastn\u00ed n\u00e1zor, je nezbytn\u00e9 m\u00edt dostatek kvalitn\u00edch informac\u00ed…<\/strong> Cel\u00fd \u010dl\u00e1nek i \u0159adu dal\u0161\u00edch u\u017eite\u010dn\u00fdch a zaj\u00edmav\u00fdch materi\u00e1l\u016f od na\u0161ich autor\u016f a spolupracovn\u00edk\u016f najdete v aktu\u00e1ln\u00edm \u010dervnov\u00e9m \u010d\u00edsle MEDU\u0147KY,<\/strong> kter\u00e9 je „v pap\u00edrov\u00e9 podob\u011b“ -:) st\u00e1le k dost\u00e1n\u00ed v obvykl\u00fdch prodejn\u00edch m\u00edstech nebo v elektronick\u00e9 podob\u011b tak\u00e9 k dispozici na emedunka.cz<\/a><\/strong> <\/p>\n\n\n\n

Z \u010dl\u00e1nku MUDr. Elekov\u00e9<\/em>:<\/p>\n\n\n\n

Prvn\u00ed zpr\u00e1vy o nov\u00e9 nemoci \u0161\u00ed\u0159\u00edc\u00ed se p\u0159ed rokem z \u010c\u00edny nazna\u010dovaly velmi v\u00e1\u017en\u00fd pr\u016fb\u011bh s oboustrann\u00fdm z\u00e1palem plic, du\u0161nost\u00ed a respira\u010dn\u00edm selh\u00e1n\u00edm. Prvn\u00ed soubor symptom\u016f uv\u00e1d\u011bl hore\u010dku nad 37,5 \u00b0C, bolesti hlavy, sval\u016f a kloub\u016f, such\u00fd ka\u0161el a du\u0161nost. V\u00fdslovn\u011b uv\u00e1d\u011bl, \u017ee r\u00fdma nepat\u0159\u00ed mezi p\u0159\u00edznaky covidu-19.<\/strong><\/p>\n\n\n\n

Nespecifick\u00e9 p\u0159\u00edznaky<\/strong>
P\u0159\u00edznaky docela nespecifick\u00e9 a \u00fazce vymezen\u00e9. Vedlo to k tomu, \u017ee mnoz\u00ed z prvn\u00edch nemocn\u00fdch byli hygienick\u00fdmi \u00fa\u0159ady odm\u00edtnuti z testov\u00e1n\u00ed, aby se posl\u00e9ze uk\u00e1zalo, \u017ee covid p\u0159ece jen maj\u00ed. Sama jsem takovou pacientku m\u011bla (p\u0159\u00edjezd z Pa\u0159\u00ed\u017ee, kter\u00e1 v t\u00e9 dob\u011b je\u0161t\u011b nebyla na seznamu rizikov\u00fdch oblast\u00ed a velmi nen\u00e1padn\u00e9 p\u0159\u00edznaky). Vloni na ja\u0159e bylo nemocn\u00fdch m\u00e1lo a klinick\u00fd obraz se velmi li\u0161il.
Pr\u00e1v\u011b velk\u00e1 variabilita p\u0159\u00edznak\u016f je typick\u00e1 pro prvn\u00ed pr\u016fchod nemoci populac\u00ed. S p\u0159\u00edchodem podzimu a rozjezdem epidemie se uk\u00e1zalo, \u017ee klinick\u00fd obraz je na jednu stranu nespecifick\u00fd (hore\u010dka, b\u011b\u017en\u00e9 vir\u00f3zov\u00e9 p\u0159\u00edznaky), na druhou stranu m\u00e1 covid p\u00e1r velmi specifick\u00fdch p\u0159\u00edznak\u016f. T\u00edm nejn\u00e1padn\u011bj\u0161\u00edm je \u00fapln\u00e1 a mnohdy dlouhodob\u00e1 ztr\u00e1ta \u010dichu a chuti. P\u0159ich\u00e1z\u00ed n\u00e1hle, n\u011bkdy jde o jedin\u00fd p\u0159\u00edznak, jindy je sou\u010d\u00e1st\u00ed bohat\u011bj\u0161\u00ed symptomatologie. N\u011bkte\u0159\u00ed pacienti ztratili \u010dich od za\u010d\u00e1tku nemoci, dokonce i p\u0159i negativn\u00edm testu, jin\u00ed t\u0159eba a\u017e za t\u00fdden nebo za deset dn\u00ed. Trv\u00e1n\u00ed tohoto p\u0159\u00edznaku se velmi li\u0161ilo, od n\u011bkolika dn\u016f a\u017e po n\u011bkolik m\u011bs\u00edc\u016f.
Ztr\u00e1ta \u010dichu je opravdu zvl\u00e1\u0161tn\u00ed p\u0159\u00edznak, naprosto nezn\u00e1m\u00fd u jin\u00fdch nemoc\u00ed. Je to jin\u00e9, ne\u017e kdy\u017e m\u00e1me ucpan\u00fd nos u r\u00fdmy. Pacienti s covidem r\u00fdmu v\u011bt\u0161inou nem\u011bli a nos m\u011bli pr\u016fchodn\u00fd, ztr\u00e1ta \u010dichu byla \u00fapln\u00e1. N\u011bkte\u0159\u00ed schv\u00e1ln\u011b \u010dichali k velmi pachov\u011b v\u00fdrazn\u00fdm a\u017e dr\u00e1\u017ediv\u00fdm l\u00e1tk\u00e1m, ani\u017e by cokoli c\u00edtili. P\u0159esto\u017ee to je p\u0159\u00edznak nep\u0159\u00edjemn\u00fd a otravn\u00fd, pacienti ho nepova\u017euj\u00ed za z\u00e1va\u017en\u00fd, dokonce se vyrojila spousta vtip\u016f na toto t\u00e9ma (nap\u0159. dom\u00e1c\u00ed test na covid z kone\u010dn\u00edku).
Jen\u017ee ztr\u00e1ta \u010dichu ukazuje na vstup viru do mozku a po\u0161kozen\u00ed \u010dichov\u00e9ho nervu. Virus se z nosn\u00ed dutiny p\u0159es \u010dichov\u00fd nerv dostal pravd\u011bpodobn\u011b a\u017e do mozku. Nemocn\u00ed obvykle nem\u011bli jin\u00e9 nervov\u00e9 p\u0159\u00edznaky, n\u011bkte\u0159\u00ed ale m\u011bli velmi silnou, a\u017e migr\u00e9novou bolest hlavy, kter\u00e1 nepochybn\u011b znamenala z\u00e1n\u011btlivou reakci mozku. Jak\u00e9 budou n\u00e1sledky nemoci u t\u011bch, kte\u0159\u00ed jen ztratili \u010dich, jinak nemocn\u00ed v z\u00e1sad\u011b nebyli, teprve zjist\u00edme. Ztr\u00e1ta \u010dichu se u covidu uv\u00e1d\u00ed s v\u00fdskytem kolem 8 %. Moje zku\u0161enost z podzimu 2020 je jin\u00e1. Na podzim \u010dich ztratila v\u011bt\u0161ina m\u00fdch pacient\u016f nemocn\u00fdch covidem. V lednov\u00e9 a pozd\u011bj\u0161\u00ed vln\u011b to byl p\u0159\u00edznak naopak m\u00e9n\u011b \u010dast\u00fd. Ztr\u00e1ta \u010dichu ukazuje, \u017ee virus je neurotropn\u00ed, napad\u00e1 i autonomn\u00ed nervov\u00fd syst\u00e9m, co\u017e se projev\u00ed v\u011bt\u0161inou po odezn\u011bn\u00ed akutn\u00ed f\u00e1ze a je sou\u010d\u00e1st\u00ed tzv. dlouh\u00e9ho covidu.
Druh\u00fdm d\u016fle\u017eit\u00fdm p\u0159\u00edznakem je extr\u00e9mn\u00ed \u00fanava. Ve srovn\u00e1n\u00ed s ch\u0159ipkou nebo jinou vir\u00f3zou je covidov\u00e1 \u00fanava mnohem siln\u011bj\u0161\u00ed a del\u0161\u00ed. Pr\u016fm\u011brn\u00e1 doba, po kterou moji pacienti museli opravdu le\u017eet, byla 7-10 dn\u00ed. I pot\u00e9 byli velmi unaven\u00ed, vy\u010derpalo je nap\u0159\u00edklad sprchov\u00e1n\u00ed, oh\u0159\u00e1t\u00ed j\u00eddla, naskl\u00e1d\u00e1n\u00ed n\u00e1dob\u00ed do my\u010dky apod. \u00danava ustupuje velmi pomalu, pr\u016fm\u011brn\u00e1 d\u00e9lka pracovn\u00ed neschopnosti v zimn\u00ed vln\u011b byla kolem 3-4 t\u00fddn\u016f u p\u0159ev\u00e1\u017en\u011b kancel\u00e1\u0159sk\u00fdch pracovn\u00edk\u016f. Patofyziologick\u00fd podklad \u00fanavy nen\u00ed zn\u00e1m. Velmi pravd\u011bpodobn\u011b to je d\u016fsledek posti\u017een\u00ed nervov\u00e9 soustavy, u mnoha pacient\u016f do\u0161lo k reaktivaci herpetick\u00fdch vir\u016f, chlamydi\u00ed a dal\u0161\u00edch nitrobun\u011b\u010dn\u00fdch infekc\u00ed, kter\u00e9 samy o sob\u011b zp\u016fsobuj\u00ed \u00fanavu.<\/p>\n\n\n\n

Zm\u011bny v pr\u016fb\u011bhu nemoci <\/strong>
B\u011bhem uplynul\u00e9ho covidov\u00e9ho roku pozoruji prom\u011bnlivost pr\u016fb\u011bhu nemoci. Na ja\u0159e 2020 jsem m\u011bla p\u0159\u00edpad\u016f jen p\u00e1r a nelze z nich nic vyvodit. Podzimn\u00ed vlna byla charakteristick\u00e1 ztr\u00e1tou \u010dichu a celkem lehk\u00fdm pr\u016fb\u011bhem. Objevilo se n\u011bkolik z\u00e1pal\u016f plic, ale byly to superinfekce bakteriemi. Pacienti se celkem dob\u0159e zotavovali. Hor\u0161\u00ed byla vlna po V\u00e1noc\u00edch. \u010cich u\u017e tolik pacient\u016f neztratilo, ale byli mnohem v\u00edc unaven\u00ed a du\u0161n\u00ed, nemoc trvala d\u00e9le. Jakmile nemocn\u00fd mus\u00ed do postele a p\u00e1r dn\u00ed le\u017e\u00ed, mus\u00ed po\u010d\u00edtat se zhruba m\u011bs\u00edc trvaj\u00edc\u00ed pracovn\u00ed neschopnost\u00ed.
Du\u0161nost ukazuje, \u017ee virus nenapad\u00e1 d\u00fdchac\u00ed cesty stejn\u011b jako jin\u00e9 respira\u010dn\u00ed viry. B\u011b\u017en\u00fd z\u00e1pal plic je z\u00e1n\u011btem sliznice d\u00fdchac\u00edch cest a nastane, pokud je n\u011bkter\u00e1 pr\u016fdu\u0161ka ucpan\u00e1 sekretem, kter\u00fd nem\u016f\u017ee odt\u00e9kat a za z\u00e1tkou se mno\u017e\u00ed bakterie nebo viry. Napaden\u00e1 je pouze mal\u00e1 izolovan\u00e1 \u010d\u00e1st plic, na rentgenu to je vid\u011bt jako lo\u017eiskov\u00e9 zast\u00edn\u011bn\u00ed. Pacient m\u00e1 ka\u0161el, teplotu a je zchv\u00e1cen\u00fd, ale neb\u00fdv\u00e1 du\u0161n\u00fd, proto\u017ee zbytek plic m\u016f\u017ee d\u00fdchat. Lze si to p\u0159edstavit, jako kdy\u017e uschne jen jedna v\u011btev stromu, zbytek stromu d\u00fdch\u00e1.
Covidov\u00fd z\u00e1pal plic je z\u00e1n\u011bt plicn\u00edch skl\u00edpk\u016f – alveolitis. Virus se v\u00e1\u017ee na ACE2 receptory plicn\u00edch a c\u00e9vn\u00edch bun\u011bk, dojde k relaxaci sval\u016f c\u00e9v, zv\u00fd\u0161en\u00e9 propustnosti c\u00e9vn\u00ed st\u011bny a otoku plic. Otok plic je nahromad\u011bn\u00ed tekutiny v plicn\u00edch skl\u00edpc\u00edch. Kysl\u00edk m\u00e1 probl\u00e9m se p\u0159es tekutinu a oteklou tk\u00e1\u0148 skl\u00edpk\u016f dostat ke krvink\u00e1m, kysli\u010dn\u00edk uhli\u010dit\u00fd m\u00e1 probl\u00e9m se dostat ven. \u010clov\u011bk se dus\u00ed. V metafo\u0159e stromu by to byla situace, kdy by byly napadeny listy stromu v cel\u00e9 jeho korun\u011b. Covidov\u00fd z\u00e1pal plic je poh\u00e1n\u011bn imunitn\u00ed reakc\u00ed hostitele, na JIP kon\u010d\u00ed lid\u00e9 s v\u00fdraznou imunitn\u00ed reakc\u00ed, s v\u00fdrazn\u00fdm z\u00e1n\u011btem.
Velmi rychle se uk\u00e1zalo, \u017ee sou\u010d\u00e1st\u00ed klinick\u00e9ho obrazu je posti\u017een\u00ed c\u00e9v. Souvis\u00ed to samoz\u0159ejm\u011b s t\u00edm, \u017ee virus vstupuje do bun\u011bk p\u0159es ACE2 receptory, jeho c\u00edlov\u00fdm org\u00e1nem jsou c\u00e9vy. U covidu doch\u00e1z\u00ed k \u010dast\u00e9mu a z\u00e1va\u017en\u00e9mu po\u0161kozen\u00ed c\u00e9v, k jejich z\u00e1n\u011btu \u2013 vaskulitid\u011b, zm\u011bn\u00e1m krevn\u00ed sr\u00e1\u017elivosti. Z\u00e1n\u011bt c\u00e9v vede ke zv\u00fd\u0161en\u00ed sr\u00e1\u017elivosti a\u017e tromb\u00f3z\u00e1m. M\u016f\u017ee k tomu doj\u00edt i p\u0159i leh\u010d\u00edm pr\u016fb\u011bhu, u v\u00e1\u017en\u011bji nemocn\u00fdch je to prakticky jist\u00e9. Progn\u00f3za v\u00e1\u017en\u011b nemocn\u00fdch se za\u010dala zlep\u0161ovat, jakmile se do l\u00e9\u010dby p\u0159idaly protisr\u00e1\u017eliv\u00e9 l\u00e9ky a l\u00e9ky moduluj\u00edc\u00ed imunitn\u00ed reakci.  
Receptory ACE2, jimi\u017e virus vstupuje do bun\u011bk, jsou sou\u010d\u00e1st\u00ed renin-angiotensinov\u00e9ho syst\u00e9mu reguluj\u00edc\u00edho krevn\u00ed tlak zm\u011bnou nap\u011bt\u00ed sval\u016f c\u00e9v. Jsou hojn\u00e9 ve v\u0161ech tk\u00e1n\u00edch, kter\u00e9 se pod\u00edlej\u00ed na regulaci krevn\u00edho pr\u016ftoku a kter\u00e9 jsou hojn\u011b prokrven\u00e9: bu\u0148ky vnit\u0159n\u00edho povrchu c\u00e9v, srdce, ledviny, j\u00e1tra, mozek, pl\u00edce. Hustota ACE2 receptor\u016f a jejich aktivita se pod\u00edl\u00ed na z\u00e1va\u017enosti covidu. Ohro\u017een\u00e9 podskupiny lid\u00ed \u2013 ob\u00e9zn\u00ed, diabetici, kardiaci, hypertonici \u2013 maj\u00ed zv\u00fd\u0161enou expresi t\u011bchto receptor\u016f na sv\u00fdch bu\u0148k\u00e1ch. Je zaj\u00edmav\u00e9, \u017ee t\u011b\u017ek\u00fdm pr\u016fb\u011bhem covidu nejsou v\u00fdrazn\u011bji ohro\u017eeni nemocn\u00ed s chronick\u00fdmi plicn\u00edmi nemocemi, nap\u0159\u00edklad astmatici nebo ku\u0159\u00e1ci, ale ani pacienti na n\u011bkter\u00fdch typech imunosupresivn\u00ed l\u00e9\u010dby. Vstup viru do bun\u011bk p\u0159es ACE2 receptory a jeho vliv na c\u00e9vy vymezuje rizikov\u00e9 skupiny, kter\u00e9 jsou ve srovn\u00e1n\u00ed s jin\u00fdmi nemocemi vyhran\u011bn\u00e9. V\u011bk s\u00e1m o sob\u011b v\u00fdznamn\u00fdm rizikov\u00fdm faktorem nen\u00ed, mnoho senior\u016f p\u0159ekonalo covid bez v\u011bt\u0161\u00edch pot\u00ed\u017e\u00ed. Rizikov\u00fdm faktorem je sp\u00ed\u0161e celkov\u00fd zdravotn\u00ed stav a p\u0159\u00edtomnost inzul\u00ednov\u00e9 rezistence a jej\u00edch komplikac\u00ed. S postupuj\u00edc\u00edm v\u011bkem stoup\u00e1 procento lid\u00ed, kte\u0159\u00ed t\u011bmito nemocem trp\u00ed, ale zdrav\u00fd senior m\u016f\u017ee b\u00fdt v mnohem men\u0161\u00edm riziku t\u011b\u017ek\u00e9ho covidu ne\u017e ob\u00e9zn\u00ed mlad\u00fd hypertonik a diabetik. Hustota ACE2 receptor\u016f je vy\u0161\u0161\u00ed v c\u00e9v\u00e1ch pr\u00e1v\u011b t\u011bchto nemocn\u00fdch. Inzul\u00ednov\u00e1 rezistence a diabetes tak\u00e9 vedou k z\u00e1n\u011btu endotelu \u2013 ateroskler\u00f3za je d\u016fsledkem snahy t\u011bla zhojit tento z\u00e1n\u011bt \u2013 proto nemocn\u00ed, kte\u0159\u00ed ji\u017e z\u00e1n\u011bt c\u00e9v maj\u00ed, jsou pro covid rizikov\u011bj\u0161\u00ed.
Druh\u00e1 rizikov\u00e1 skupina jsou lid\u00e9 s v\u00fdraznou z\u00e1n\u011btlivou reakc\u00ed, kter\u00e1 rozto\u010d\u00ed spir\u00e1lu prudk\u00e9ho z\u00e1n\u011btu, a pr\u00e1v\u011b to je dovede na JIP nebo ARO. Proto pacienti na imunosupresivech, kte\u0159\u00ed maj\u00ed zv\u00fd\u0161en\u00e9 riziko infekc\u00ed, zvl\u00e1daj\u00ed covid kupodivu dob\u0159e. Podobn\u011b astmatici u\u017e\u00edvaj\u00edc\u00ed inhala\u010dn\u00ed kortikoidy \u2013 ty tlum\u00ed z\u00e1n\u011btliv\u00e9 procesy, kter\u00e9 po\u0161kozuj\u00ed pl\u00edce…<\/p>\n\n\n\n

Cel\u00fd \u010dl\u00e1nek si p\u0159e\u010dtete v \u010dervnov\u00e9 Medu\u0148ce.<\/em><\/strong>
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Z aktu\u00e1ln\u00ed \u010dervnov\u00e9 Medu\u0148ky vyb\u00edr\u00e1me pro tento t\u00fdden uk\u00e1zku z \u010dl\u00e1nku MUDr. Ludmily Elekov\u00e9, kter\u00e1 se v\u011bnuje t\u00e9matu covidu. M\u00e1te pocit, \u017ee informac\u00ed o covidu je u\u017e dost? POZOR – jde o to, jak\u00fdch informac\u00ed. V\u011bt\u0161inou se ve sd\u011blovac\u00edch prost\u0159edc\u00edch dozv\u00edd\u00e1me aktu\u00e1ln\u00ed po\u010det naka\u017een\u00fdch \u010di o\u010dkovan\u00fdch, p\u0159\u00edpadn\u011b r\u016fzn\u00e9 \u00favahy o tom, co n\u00e1m m\u00e1 tato epidemie uk\u00e1zat, ale v\u011bcn\u00fdch informac\u00ed, kter\u00e9 by fundovan\u011b, a p\u0159itom srozumiteln\u011b vysv\u011btlovaly chov\u00e1n\u00ed viru v populaci, v\u011bnovaly se p\u0159\u00edznak\u016fm nemoci nebo uv\u00e1d\u011bly n\u011bkter\u00e9 mo\u017enosti prevence, je o pozn\u00e1n\u00ed m\u00e9n\u011b. Proto pova\u017eujeme \u010dl\u00e1nky na\u0161\u00ed spolupracovnice, praktick\u00e9 l\u00e9ka\u0159ky MUDr. Elekov\u00e9, za d\u016fle\u017eit\u00e9 – pokud m\u00e1me n\u011b\u010demu \u010delit a vytvo\u0159it si vlastn\u00ed n\u00e1zor, je nezbytn\u00e9 m\u00edt dostatek kvalitn\u00edch informac\u00ed… Cel\u00fd \u010dl\u00e1nek i \u0159adu dal\u0161\u00edch u\u017eite\u010dn\u00fdch a zaj\u00edmav\u00fdch materi\u00e1l\u016f od na\u0161ich autor\u016f a spolupracovn\u00edk\u016f najdete v aktu\u00e1ln\u00edm \u010dervnov\u00e9m \u010d\u00edsle MEDU\u0147KY, kter\u00e9 je „v pap\u00edrov\u00e9 podob\u011b“ -:) st\u00e1le k dost\u00e1n\u00ed v obvykl\u00fdch prodejn\u00edch m\u00edstech nebo v elektronick\u00e9 podob\u011b tak\u00e9 k dispozici na emedunka.cz Z \u010dl\u00e1nku MUDr. Elekov\u00e9: Prvn\u00ed zpr\u00e1vy o nov\u00e9 nemoci \u0161\u00ed\u0159\u00edc\u00ed se p\u0159ed rokem z \u010c\u00edny nazna\u010dovaly velmi v\u00e1\u017en\u00fd pr\u016fb\u011bh s oboustrann\u00fdm z\u00e1palem plic, du\u0161nost\u00ed a respira\u010dn\u00edm selh\u00e1n\u00edm. Prvn\u00ed soubor symptom\u016f uv\u00e1d\u011bl hore\u010dku nad 37,5 \u00b0C, bolesti hlavy, sval\u016f a kloub\u016f, such\u00fd ka\u0161el a du\u0161nost. V\u00fdslovn\u011b uv\u00e1d\u011bl, \u017ee r\u00fdma nepat\u0159\u00ed mezi p\u0159\u00edznaky covidu-19. Nespecifick\u00e9 p\u0159\u00edznakyP\u0159\u00edznaky docela nespecifick\u00e9 a \u00fazce vymezen\u00e9. Vedlo to k tomu, \u017ee mnoz\u00ed z prvn\u00edch nemocn\u00fdch byli hygienick\u00fdmi \u00fa\u0159ady odm\u00edtnuti z testov\u00e1n\u00ed, aby se posl\u00e9ze uk\u00e1zalo, \u017ee covid p\u0159ece jen maj\u00ed. Sama jsem takovou pacientku m\u011bla (p\u0159\u00edjezd z Pa\u0159\u00ed\u017ee, kter\u00e1 v t\u00e9 dob\u011b je\u0161t\u011b nebyla na seznamu rizikov\u00fdch oblast\u00ed a velmi nen\u00e1padn\u00e9 p\u0159\u00edznaky). Vloni na ja\u0159e bylo nemocn\u00fdch m\u00e1lo a klinick\u00fd obraz se velmi li\u0161il.Pr\u00e1v\u011b velk\u00e1 variabilita p\u0159\u00edznak\u016f je typick\u00e1 pro prvn\u00ed pr\u016fchod nemoci populac\u00ed. S p\u0159\u00edchodem podzimu a rozjezdem epidemie se uk\u00e1zalo, \u017ee klinick\u00fd obraz je na jednu stranu nespecifick\u00fd (hore\u010dka, b\u011b\u017en\u00e9 vir\u00f3zov\u00e9 p\u0159\u00edznaky), na druhou stranu m\u00e1 covid p\u00e1r velmi specifick\u00fdch p\u0159\u00edznak\u016f. T\u00edm nejn\u00e1padn\u011bj\u0161\u00edm je \u00fapln\u00e1 a mnohdy dlouhodob\u00e1 ztr\u00e1ta \u010dichu a chuti. P\u0159ich\u00e1z\u00ed n\u00e1hle, n\u011bkdy jde o jedin\u00fd p\u0159\u00edznak, jindy je sou\u010d\u00e1st\u00ed bohat\u011bj\u0161\u00ed symptomatologie. N\u011bkte\u0159\u00ed pacienti ztratili \u010dich od za\u010d\u00e1tku nemoci, dokonce i p\u0159i negativn\u00edm testu, jin\u00ed t\u0159eba a\u017e za t\u00fdden nebo za deset dn\u00ed. Trv\u00e1n\u00ed tohoto p\u0159\u00edznaku se velmi li\u0161ilo, od n\u011bkolika dn\u016f a\u017e po n\u011bkolik m\u011bs\u00edc\u016f.Ztr\u00e1ta \u010dichu je opravdu zvl\u00e1\u0161tn\u00ed p\u0159\u00edznak, naprosto nezn\u00e1m\u00fd u jin\u00fdch nemoc\u00ed. Je to jin\u00e9, ne\u017e kdy\u017e m\u00e1me ucpan\u00fd nos u r\u00fdmy. Pacienti s covidem r\u00fdmu v\u011bt\u0161inou nem\u011bli a nos m\u011bli pr\u016fchodn\u00fd, ztr\u00e1ta \u010dichu byla \u00fapln\u00e1. N\u011bkte\u0159\u00ed schv\u00e1ln\u011b \u010dichali k velmi pachov\u011b v\u00fdrazn\u00fdm a\u017e dr\u00e1\u017ediv\u00fdm l\u00e1tk\u00e1m, ani\u017e by cokoli c\u00edtili. P\u0159esto\u017ee to je p\u0159\u00edznak nep\u0159\u00edjemn\u00fd a otravn\u00fd, pacienti ho nepova\u017euj\u00ed za z\u00e1va\u017en\u00fd, dokonce se vyrojila spousta vtip\u016f na toto t\u00e9ma (nap\u0159. dom\u00e1c\u00ed test na covid z kone\u010dn\u00edku).Jen\u017ee ztr\u00e1ta \u010dichu ukazuje na vstup viru do mozku a po\u0161kozen\u00ed \u010dichov\u00e9ho nervu. Virus se z nosn\u00ed dutiny p\u0159es \u010dichov\u00fd nerv dostal pravd\u011bpodobn\u011b a\u017e do mozku. Nemocn\u00ed obvykle nem\u011bli jin\u00e9 nervov\u00e9 p\u0159\u00edznaky, n\u011bkte\u0159\u00ed ale m\u011bli velmi silnou, a\u017e migr\u00e9novou bolest hlavy, kter\u00e1 nepochybn\u011b znamenala z\u00e1n\u011btlivou reakci mozku. Jak\u00e9 budou n\u00e1sledky nemoci u t\u011bch, kte\u0159\u00ed jen ztratili \u010dich, jinak nemocn\u00ed v z\u00e1sad\u011b nebyli, teprve zjist\u00edme. Ztr\u00e1ta \u010dichu se u covidu uv\u00e1d\u00ed s v\u00fdskytem kolem 8 %. Moje zku\u0161enost z podzimu 2020 je jin\u00e1. Na podzim \u010dich ztratila v\u011bt\u0161ina m\u00fdch pacient\u016f nemocn\u00fdch covidem. V lednov\u00e9 a pozd\u011bj\u0161\u00ed vln\u011b to byl p\u0159\u00edznak naopak m\u00e9n\u011b \u010dast\u00fd. Ztr\u00e1ta \u010dichu ukazuje, \u017ee virus je neurotropn\u00ed, napad\u00e1 i autonomn\u00ed nervov\u00fd syst\u00e9m, co\u017e se projev\u00ed v\u011bt\u0161inou po odezn\u011bn\u00ed akutn\u00ed f\u00e1ze a je sou\u010d\u00e1st\u00ed tzv. dlouh\u00e9ho covidu.Druh\u00fdm d\u016fle\u017eit\u00fdm p\u0159\u00edznakem je extr\u00e9mn\u00ed \u00fanava. Ve srovn\u00e1n\u00ed s ch\u0159ipkou nebo jinou vir\u00f3zou je covidov\u00e1 \u00fanava mnohem siln\u011bj\u0161\u00ed a del\u0161\u00ed. Pr\u016fm\u011brn\u00e1 doba, po kterou moji pacienti museli opravdu le\u017eet, byla 7-10 dn\u00ed. I pot\u00e9 byli velmi unaven\u00ed, vy\u010derpalo je nap\u0159\u00edklad sprchov\u00e1n\u00ed, oh\u0159\u00e1t\u00ed j\u00eddla, naskl\u00e1d\u00e1n\u00ed n\u00e1dob\u00ed do my\u010dky apod. \u00danava ustupuje velmi pomalu, pr\u016fm\u011brn\u00e1 d\u00e9lka pracovn\u00ed neschopnosti v zimn\u00ed vln\u011b byla kolem 3-4 t\u00fddn\u016f u p\u0159ev\u00e1\u017en\u011b kancel\u00e1\u0159sk\u00fdch pracovn\u00edk\u016f. Patofyziologick\u00fd podklad \u00fanavy nen\u00ed zn\u00e1m. Velmi pravd\u011bpodobn\u011b to je d\u016fsledek posti\u017een\u00ed nervov\u00e9 soustavy, u mnoha pacient\u016f do\u0161lo k reaktivaci herpetick\u00fdch vir\u016f, chlamydi\u00ed a dal\u0161\u00edch nitrobun\u011b\u010dn\u00fdch infekc\u00ed, kter\u00e9 samy o sob\u011b zp\u016fsobuj\u00ed \u00fanavu. Zm\u011bny v pr\u016fb\u011bhu nemoci B\u011bhem uplynul\u00e9ho covidov\u00e9ho roku pozoruji prom\u011bnlivost pr\u016fb\u011bhu nemoci. Na ja\u0159e 2020 jsem m\u011bla p\u0159\u00edpad\u016f jen p\u00e1r a nelze z nich nic vyvodit. Podzimn\u00ed vlna byla charakteristick\u00e1 ztr\u00e1tou \u010dichu a celkem lehk\u00fdm pr\u016fb\u011bhem. Objevilo se n\u011bkolik z\u00e1pal\u016f plic, ale byly to superinfekce bakteriemi. Pacienti se celkem dob\u0159e zotavovali. Hor\u0161\u00ed byla vlna po V\u00e1noc\u00edch. \u010cich u\u017e tolik pacient\u016f neztratilo, ale byli mnohem v\u00edc unaven\u00ed a du\u0161n\u00ed, nemoc trvala d\u00e9le. Jakmile nemocn\u00fd mus\u00ed do postele a p\u00e1r dn\u00ed le\u017e\u00ed, mus\u00ed po\u010d\u00edtat se zhruba m\u011bs\u00edc trvaj\u00edc\u00ed pracovn\u00ed neschopnost\u00ed.Du\u0161nost ukazuje, \u017ee virus nenapad\u00e1 d\u00fdchac\u00ed cesty stejn\u011b jako jin\u00e9 respira\u010dn\u00ed viry. B\u011b\u017en\u00fd z\u00e1pal plic je z\u00e1n\u011btem sliznice d\u00fdchac\u00edch cest a nastane, pokud je n\u011bkter\u00e1 pr\u016fdu\u0161ka ucpan\u00e1 sekretem, kter\u00fd nem\u016f\u017ee odt\u00e9kat a za z\u00e1tkou se mno\u017e\u00ed bakterie nebo viry. Napaden\u00e1 je pouze mal\u00e1 izolovan\u00e1 \u010d\u00e1st plic, na rentgenu to je vid\u011bt jako lo\u017eiskov\u00e9 zast\u00edn\u011bn\u00ed. Pacient m\u00e1 ka\u0161el, teplotu a je zchv\u00e1cen\u00fd, ale neb\u00fdv\u00e1 du\u0161n\u00fd, proto\u017ee zbytek plic m\u016f\u017ee d\u00fdchat. Lze si to p\u0159edstavit, jako kdy\u017e uschne jen jedna v\u011btev stromu, zbytek stromu d\u00fdch\u00e1.Covidov\u00fd z\u00e1pal plic je z\u00e1n\u011bt plicn\u00edch skl\u00edpk\u016f – alveolitis. Virus se v\u00e1\u017ee na ACE2 receptory plicn\u00edch a c\u00e9vn\u00edch bun\u011bk, dojde k relaxaci sval\u016f c\u00e9v, zv\u00fd\u0161en\u00e9 propustnosti c\u00e9vn\u00ed st\u011bny a otoku plic. Otok plic je nahromad\u011bn\u00ed tekutiny v plicn\u00edch skl\u00edpc\u00edch. Kysl\u00edk m\u00e1 probl\u00e9m se p\u0159es tekutinu a oteklou tk\u00e1\u0148 skl\u00edpk\u016f dostat ke krvink\u00e1m, kysli\u010dn\u00edk uhli\u010dit\u00fd m\u00e1 probl\u00e9m se dostat ven. \u010clov\u011bk se dus\u00ed. V metafo\u0159e stromu by to byla situace, kdy by byly napadeny listy stromu v cel\u00e9 jeho korun\u011b. Covidov\u00fd z\u00e1pal plic je poh\u00e1n\u011bn imunitn\u00ed reakc\u00ed hostitele, na JIP kon\u010d\u00ed lid\u00e9 s v\u00fdraznou imunitn\u00ed reakc\u00ed, s v\u00fdrazn\u00fdm z\u00e1n\u011btem.Velmi rychle se uk\u00e1zalo, \u017ee sou\u010d\u00e1st\u00ed klinick\u00e9ho obrazu je posti\u017een\u00ed c\u00e9v. Souvis\u00ed to samoz\u0159ejm\u011b s t\u00edm, \u017ee virus vstupuje do bun\u011bk p\u0159es ACE2 receptory, jeho c\u00edlov\u00fdm org\u00e1nem jsou c\u00e9vy. U covidu doch\u00e1z\u00ed k \u010dast\u00e9mu a z\u00e1va\u017en\u00e9mu po\u0161kozen\u00ed c\u00e9v, k jejich z\u00e1n\u011btu \u2013 vaskulitid\u011b, zm\u011bn\u00e1m krevn\u00ed sr\u00e1\u017elivosti. Z\u00e1n\u011bt c\u00e9v vede ke zv\u00fd\u0161en\u00ed sr\u00e1\u017elivosti a\u017e tromb\u00f3z\u00e1m. M\u016f\u017ee k tomu doj\u00edt i p\u0159i leh\u010d\u00edm pr\u016fb\u011bhu, u v\u00e1\u017en\u011bji nemocn\u00fdch je to prakticky jist\u00e9. Progn\u00f3za v\u00e1\u017en\u011b nemocn\u00fdch se za\u010dala zlep\u0161ovat, jakmile se do l\u00e9\u010dby p\u0159idaly protisr\u00e1\u017eliv\u00e9 l\u00e9ky a l\u00e9ky moduluj\u00edc\u00ed imunitn\u00ed reakci.  Receptory ACE2, jimi\u017e virus vstupuje do bun\u011bk, jsou sou\u010d\u00e1st\u00ed renin-angiotensinov\u00e9ho syst\u00e9mu reguluj\u00edc\u00edho krevn\u00ed tlak zm\u011bnou nap\u011bt\u00ed sval\u016f c\u00e9v. Jsou hojn\u00e9 ve v\u0161ech tk\u00e1n\u00edch, kter\u00e9 se pod\u00edlej\u00ed na regulaci krevn\u00edho pr\u016ftoku a kter\u00e9 jsou hojn\u011b prokrven\u00e9: bu\u0148ky vnit\u0159n\u00edho povrchu c\u00e9v, srdce, ledviny, j\u00e1tra, mozek, pl\u00edce. Hustota ACE2 receptor\u016f a jejich aktivita se pod\u00edl\u00ed na z\u00e1va\u017enosti covidu. Ohro\u017een\u00e9 podskupiny lid\u00ed \u2013 ob\u00e9zn\u00ed, diabetici, kardiaci, hypertonici \u2013 maj\u00ed zv\u00fd\u0161enou expresi t\u011bchto receptor\u016f na sv\u00fdch bu\u0148k\u00e1ch. Je zaj\u00edmav\u00e9, \u017ee t\u011b\u017ek\u00fdm pr\u016fb\u011bhem covidu nejsou v\u00fdrazn\u011bji ohro\u017eeni nemocn\u00ed s chronick\u00fdmi plicn\u00edmi nemocemi, nap\u0159\u00edklad astmatici nebo ku\u0159\u00e1ci, ale ani pacienti na n\u011bkter\u00fdch typech imunosupresivn\u00ed l\u00e9\u010dby. Vstup viru do bun\u011bk p\u0159es ACE2 receptory a jeho vliv na c\u00e9vy vymezuje rizikov\u00e9 skupiny, kter\u00e9 jsou ve srovn\u00e1n\u00ed s jin\u00fdmi nemocemi vyhran\u011bn\u00e9. V\u011bk s\u00e1m o sob\u011b v\u00fdznamn\u00fdm rizikov\u00fdm faktorem nen\u00ed, mnoho senior\u016f p\u0159ekonalo covid bez v\u011bt\u0161\u00edch pot\u00ed\u017e\u00ed. Rizikov\u00fdm faktorem je sp\u00ed\u0161e celkov\u00fd zdravotn\u00ed stav a p\u0159\u00edtomnost inzul\u00ednov\u00e9 rezistence a jej\u00edch komplikac\u00ed. S postupuj\u00edc\u00edm v\u011bkem stoup\u00e1 procento lid\u00ed, kte\u0159\u00ed t\u011bmito nemocem trp\u00ed, ale zdrav\u00fd senior m\u016f\u017ee b\u00fdt v mnohem men\u0161\u00edm riziku t\u011b\u017ek\u00e9ho covidu ne\u017e ob\u00e9zn\u00ed mlad\u00fd hypertonik a diabetik. Hustota ACE2 receptor\u016f je vy\u0161\u0161\u00ed v c\u00e9v\u00e1ch pr\u00e1v\u011b t\u011bchto nemocn\u00fdch. Inzul\u00ednov\u00e1 rezistence a diabetes tak\u00e9 vedou k z\u00e1n\u011btu endotelu \u2013 ateroskler\u00f3za je d\u016fsledkem snahy t\u011bla zhojit tento z\u00e1n\u011bt \u2013 proto nemocn\u00ed, kte\u0159\u00ed ji\u017e z\u00e1n\u011bt c\u00e9v maj\u00ed, jsou pro covid rizikov\u011bj\u0161\u00ed.Druh\u00e1 rizikov\u00e1 skupina jsou lid\u00e9 s v\u00fdraznou z\u00e1n\u011btlivou reakc\u00ed, kter\u00e1 rozto\u010d\u00ed spir\u00e1lu prudk\u00e9ho z\u00e1n\u011btu, a pr\u00e1v\u011b to je dovede na JIP nebo ARO. Proto pacienti na imunosupresivech, kte\u0159\u00ed maj\u00ed zv\u00fd\u0161en\u00e9 riziko infekc\u00ed, zvl\u00e1daj\u00ed covid kupodivu dob\u0159e. Podobn\u011b astmatici u\u017e\u00edvaj\u00edc\u00ed inhala\u010dn\u00ed kortikoidy \u2013 ty tlum\u00ed z\u00e1n\u011btliv\u00e9 procesy, kter\u00e9 po\u0161kozuj\u00ed pl\u00edce… Cel\u00fd \u010dl\u00e1nek si p\u0159e\u010dtete v \u010dervnov\u00e9 Medu\u0148ce.<\/p>\n","protected":false},"author":3,"featured_media":4911,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,13,10],"tags":[],"class_list":["post-4873","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medunka","category-pece-o-telo","category-zdravi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/4873","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/comments?post=4873"}],"version-history":[{"count":6,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/4873\/revisions"}],"predecessor-version":[{"id":4933,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/4873\/revisions\/4933"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media\/4911"}],"wp:attachment":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media?parent=4873"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/categories?post=4873"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/tags?post=4873"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}