Pathogenesis of COVID-19:
After the virus enters the body, it needs a special receptor to help it enter the cell. This receptor is called (Angiotensin Converting Enzymes_2) Symbolized by ACE_2. The ACE_2 is present on the surface of the alveolar cells in the lung.
We have 3 types of alveolar cells:
- Type1: Responsible for gas exchange.
- Type2: It is responsible for producing “surfactant” which is a mixture of proteins and fats that reduce the surface tension of the alveoli.
- Type3: Dust cell, which is macrophages.
The ACE_2 is found on type2 of these cells. Corona virus envelope contains proteins called spikes and special (S_Spike) that help the virus bind to ACE_2.
When the above association occurs, the genetic material of the virus enters the cell and the cell is harnessed to produce viral proteins, thus the virus multiplies and the cell dies.
When (type 2 alveolar cells)die, they release substances called specific inflammatory mediators.
These substances stimulate the existing immune cells “macrophages” and when they stimulate the macrophages, they secrete 3 immune substances called “cytokines” which are:
- Interleukin_1 (IL_1)
- Interleukin_6 (IL_6)
- Tumor Necrosis Factor (TNF_α).
These three substances, when they reach the bloodstream, cause the symptoms associated with infection with Corona virus.
First – at the level of lungs:
- These substances cause expansion of the blood
vessels surrounding the vesicle, as well as increased permeability of the wall
of these vessels
- Capillary permeability increased. and thus leads to “alveolar edema”, which leads to hypoxia and shortness of breath.
- The loss of surfactant leads to an increase in the surface tension of the vesicle and consequently leads to Alveolar collapse. It also leads to Hypoxia and shortness of breath.
- These three substances also lead to an increase
in the flow of “neutrophils” cells to the place of the viral
infection as an immune response. Neutrophils cells kill some viruses by
secreting two substances such as:
- Reactive Oxygen Species “ROS”
But the above articles also destroy some of the alveolar cells responsible for gaseous exchange and cause a condition called consolidation that causes cough symptoms.
Second: At the CNS level:
The three substances “IL_1, IL_6, TNF” go to the “hypothalamus” and thus increase the body temperature and cause the symptoms of “Fever”.
Third: In the case of severe “SIRS” will occur
Systemic inflammatory response syndrome. That lead to septic shock. Also “MODS” Multiple organ dysfunction syndrome. Especially the kidney and kidney failure.
- Mode of onset & Progress
- Precipitating factor ( If available)
- Stage of the disease.
- The predominant suffering in the patient – Intensity.
- Accompanying symptoms– Chill, sweat, body pain, weakness, mental state, thirst.
- Thermal state & Tongue appearance.
- Coryza, Throat irritation, loss of smell or taste, sore throat.
- Cough- Type of cough – Constant, concussive, hard, barking, whooping, retching, hacking etc
- Respiration – Accelerated, gasping, impeded etc..
- Fever- Stage, special features
- Complicated stage: – Collapse, shock, sinking, weakness, convulsions, acidosis, Thrombosis, sepsis, Hypertension.
|1st Stage:||2nd Stage:||3rd stage:||Intercurrent :-|
| Aconite |
Dr. A. Alphonse Immanuvel., MD(Hom)
Department of Organon of Medicine and Homoeopathic Philosophy