Pulmonologist Federica Poli, head of the Covid department of the San Donato Polyclinic in Milan, explains the difference between Covid interstitial pneumonia and classic lobar pneumonia
Interstitial pneumonia: with the coronavirus Sars-CoV-2 we have now learned to know what is one of the forms of his disease, Covid-19. But interstitial pneumonia is nothing new: “Interstitial pneumonia has always accompanied viral infections such as herpes or influenza viruses. There are also interstitial pneumonia caused by so-called atypical germs or bacteria, such as legionella or chlamydia. But they can also be caused by toxic agents, radiation, chemical agents or inhalation of solvents and even some drugs, in particular some antiarrhythmics “, Dr. Federica Poli, pulmonologist at the IRCCS Policlinico San Donato in Milan, where she leads the Covid department.
How does interstitial pneumonia present?
“Interstitial pneumonia is a pneumonia that affects the lung tissue of both lung fields more widely because it affects, in addition to the alveoli, the very texture of the lung, l’interstizio precisely, that is the virtual space between the cells and the tissue that supports them. The lung is made up of the alveoli, the breathing cells into which the air is distributed, and in the midst of these cells there is a tissue that supports all this texture. The vessels that carry oxygen to the tissues also pass through this interstitial area. And here the interstitial pneumonia manifests itself ”.
What is the difference from normal pneumonia?
“The classic lobar or bacterial pneumonia typically affects one area of the lung, is localized, and is often unilateral. Interstitial pneumonia is more widespread, affecting multiple foci in both lungs ”.
Are the symptoms the same as for normal pneumonia?
“Usually yes, if it is a viral or bacterial infection interstitial pneumonia. They consist of fever, cough, fatigue, breathlessness, general malaise, asthenia. But not always all manifest themselves, especially in the case of Covid, the symptoms are not always so typical “.
Are there even mild forms of interstitial pneumonia?
“Absolutely yes: not all patients arrive at the hospital and not all require intubation. But in the case of Covid, the percentage of patients who have a severe course is high. It really depends on the patient: how much pathogen he inhaled, how much contact he had, how virulent the virus is, what the patient’s pre-existing condition is. There are many variables ”.
In the case of interstitial pneumonia, is a sports patient, non-smoker, who falls ill with Covid-19 more protected from a serious course?
“Yes, you have more reserves. The virus arrives anyway, but if an organism is healthier, more toned, trained, it can react better, even if this does not always happen ”.
How is interstitial pneumonia from Covid-19 treated?
“Currently, therapies are not particularly rich. In some cases, viral therapy with Remdesivir, an antiviral already used for Ebola, is followed to try to reduce the viral load in the early stages in patients who have not yet developed respiratory failure. This drug tries to reduce the viral load. Low molecular weight heparin is used for all patients, calibrating the dosages according to the clinical picture, age, renal function, embolic risk and the general situation of the patient. Cortisone is fundamental. It has the advantage of reducing the inflammatory cascade and immediate lung damage, preventing radical worsening. Unfortunately, it is not always enough: in some cases patients evolve anyway. To this is added an antibiotic treatment to avoid superinfections, also because it has been seen that cortisone is effective and does not cause significant immunosuppression despite the initial phase viraemia “.
Didn’t you use cortisone in the first wave?
“No, it was thought to reduce immune defenses and increase viral load. Then the guidelines changed because it was found to be effective and not immunodepressing. And today it is fundamental: it is the treatment that has probably significantly reduced mortality ”.
Follow us on our social channels!
–
28 December 2020 (modified on 28 December 2020 | 10:27)
© REPRODUCTION RESERVED
–
