It takes a great deal of need for me to speculate about such serious circumstances, but if I feel an observation could help I do it. It is the inflammation that makes recovering the patient worse. The virus is literally turning normal body chemistry into an enemy.
...Inflammatory (click here) responses in the peripheral and central nervous systems play key roles in the development and persistence of many pathological pain states [1]. Certain inflammatory cytokines in spinal cord, dorsal root ganglion (DRG), injured nerve or skin are known to be associated with pain behaviors and with the generation of abnormal spontaneous activity from injured nerve fibers or compressed/inflamed DRG neurons.
Int Anesthesiol Clin. Author manuscript; available in PMC 2009 Nov 30.
Published in final edited form as:
Int Anesthesiol Clin. 2007 Spring; 45(2): 27–37.
Cytokines are small secreted proteins released by cells have a specific effect on the interactions and communications between cells. Cytokine is a general name; other names include lymphokine (cytokines made by lymphocytes), monokine (cytokines made by monocytes), chemokine (cytokines with chemotactic activities), and interleukin (cytokines made by one leukocyte and acting on other leukocytes). Cytokines may act on the cells that secrete them (autocrine action), on nearby cells (paracrine action), or in some instances on distant cells (endocrine action).
It is common for different cell types to secrete the same cytokine or for a single cytokine to act on several different cell types (pleiotropy). Cytokines are redundant in their activity, meaning similar functions can be stimulated by different cytokines. They are often produced in a cascade, as one cytokine stimulates its target cells to make additional cytokines. Cytokines can also act synergistically or antagonistically (Figure 1)....
There it is. I am not surprised it is in the Lancet either.
March 16, 2020
Puja Mehta, Daniel F McAuley, Michael Brown, Emilie Sanchez, Rachel S Tattersall, Jessica J Manson, et al.
...Current management of COVID-19 is supportive, (click here) and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality.
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Secondary haemophagocytic lymphohistiocytosis (sHLH) is an under-recognised, hyperinflammatory syndrome characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is most commonly triggered by viral infections
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and occurs in 3·7–4·3% of sepsis cases.
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Cardinal features of sHLH include unremitting fever, cytopenias, and hyperferritinaemia; pulmonary involvement (including ARDS) occurs in approximately 50% of patients.
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A cytokine profile resembling sHLH is associated with COVID-19 disease severity, characterised by increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α....
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