Mesures de prévention du COVID-19
Le 8 décembre 2020, un communiqué du cabinet royal indique que le Roi Mohammed VI a donné ses hautes instructions au gouvernement pour l'adoption de la
VII. Conclusion
L’infection à SARS-CoV-2 appelée également maladie à COVID-19 est une maladie infectieuse, apparue initialement en décembre 2019 à la ville chinoise, Wuhan, puis il est rapidement devenue une pandémie et un problème majeur de santé publique à l’échelle mondiale avec des millions de cas et de décès.
Le CoV-2 appartient à la famille des β-coronavirus et est en partie lié au SARS-CoV et au MERS-SARS-CoV selon le séquençage du génome. Il peut toucher tous les âges, les hommes plus que les femmes. La principale voie de transmission est l’exposition directe et indirecte aux voies respiratoires.
Le SARS CoV-2 utilise l’enzyme de conversion de l’angiotensine 2 comme récepteur principale, qui est largement exprimé dans l’endothélium vasculaire, l’épithélium respiratoire, les monocytes alvéolaire et les macrophages.
Le tableau clinique est très variable allant de la forme asymptomatique au syndrome de détresse respiratoire aigu.
La RT-PCR est la technique de référence pour poser le diagnostic en association avec les images scannographiques.
Bien que le SARS-CoV-2 a un tropisme principalement respiratoire, mais il peut atteindre aussi le cœur et entrainer ainsi des complications cardio-vasculaires graves qui compromettent le pronostic des malades. Ainsi les principales complications cardio-vasculaires occasionnées sont le syndrome coronarien aigu, la myocardite, les arythmies cardiaques, le choc cardiogénique et les complications thrombo-emboliques artérielles et veineuses. Les traitements utilisés contre le COVID-19 peuvent aussi avoir des interactions avec le système cardiovasculaire et sont principalement pourvoyeurs de troubles de rythme cardiaque, c’est le cas de la chloroquine et de l’hydroxychloroquine, l’azithromycine et les antiviraux.
Bien que la prise en charge des patients COVID-19 graves et critiques soit importante pour réduire la mortalité de la pandémie en cours, les mesures véritablement clés résident
RESUME
Titre : COVID-19 et système cardio-vasculaire Auteur : EL BAHRI Loubna
Rapporteur : Professeur DOBLALI Taoufik
Mots-clés : COVID-19, Cœur, vaisseaux sanguins, thérapies anti SARS-CoV-2, vaccination
L’infection par le SARS-CoV-2 nommée la COVID-19 représente un problème majeur de santé publique au Maroc et à travers le monde, c’est une infection virale causée par un β-coronavirus , apparue initialement à la ville chinoise Wuhan puis devenue rapidement une pandémie avec plus de 81.908.887 cas confirmés dans le monde en date du 29 Décembre 2020 ; avec 433.029 cas confirmés au Maroc dont 7.272 de décès et 399.575 de guérisons . Très contagieuse, la transmission de la COVID-19 est interhumaine par exposition directes et indirectes aux voies respiratoires. Elle touche plus l’homme que la femme, de tout âge mais elle est plus grave chez les sujets âgés présentant des comorbidités surtout cardiovasculaires. Elle infecte les cellules hôtes présentant des récepteurs à l’angiotensine 2, comme l’épithélium respiratoire et l’endothélium vasculaire.
La présentation clinique est très polymorphe, elle peut donner un syndrome grippale, un tableau digestif avec diarrhées et vomissements, un tableau de détresse respiratoire aigue (SDRA), toutefois, elle peut être asymptomatique. Au niveau cardiaque, le virus a un double impact; en effet, l’infection sera plus grave si l’hôte possède des comorbidités cardiovasculaires, et le virus peut causer des lésions cardiovasculaires pouvant engager le pronostic vital comme le syndrome coronarien aigu, la myocardite, les arythmies cardiaque, le choc cardiogénique et les complications thrombo-emboliques. Les thérapies utilisées contre le COVID-19 peuvent avoir des effets indésirables cardiovasculaires nécessitants une surveillance particulière et une intervention rapide.
Bien que la prise en charge des patients COVID-19 soit importante pour réduire la mortalité de la pandémie en cours, les mesures véritablement clés résident dans la prévention, la surveillance et l’intervention rapide.
Summary
Title: COVID-19 and cardiovascular system Author: EL BAHRI Loubna
Doctoral Supervisor: Professor DOBLALI Taoufik
Keys words: COVID-19, Heart, blood vessels, prevention, anti SARS-CoV-2 therapies
The SARS-CoV-2 infection called COVID-19 constitute a major public health problem in Morocco and around the world, it’s a viral infection caused by a β-coronavirus, which initially appeared in the Chinese city of Wuhan then quickly became a pandemic, with more than 81,908,887 confirmed cases worldwide as of December 29, 2020; with 433,029 confirmed cases in Morocco including 7,272 of deaths and 399,575 of recoveries.
COVID-19 is highly contagious; transmission is human-to-human through direct and indirect exposure to the respiratory tract. It affects men more than women, of all ages, but is more serious in elderly subjects with co-morbidities, especially cardiovascular.
It infects host cells with angiotensin 2 receptors, such as the respiratory epithelium and vascular endothelium.
The clinical presentation is very polymorphic, it can give a flu-like syndrome, diarrhea and vomiting, an acute respiratory distress (ARDS), however, it can be asymptomatic.
The virus has a double impact on the cardiovascular system, the infection will be more intense if the host has cardiovascular co-morbidities and the virus can cause life-threatening cardiovascular lesions, such as acute coronary syndrome, myocarditis, cardiac arrhythmias, cardiogenic shock and thromboembolics complications. The therapies used against COVID-19 can have adverse cardiovascular effects requiring special monitoring and rapid intervention.
While the management of COVID-19 patients is important in reducing mortality from the ongoing pandemic, the truly key measures lie in prevention, surveillance and rapid response.
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ناﻮﻨﻌﻟا ﺪﯿﻓﻮﻛ : -19 و ﺐﻠﻘﻟا زﺎﮫﺟ و ﺔﯿﻋوﻷا ﺔﻳﻮﻣﺪﻟا ﻒﻟﺆﻤﻟا : ﻰﻨﺒﻟ يﺮﺤﺒﻟا رﺮﻘﻤﻟا : ذﺎﺘﺳﻷا ﻖﯿﻓﻮﺗ ﻲﻟﻼﺑود ﻟا تﺎﻤﻠﻜ ﺔﯿﺳﺎﺳﻷا ﺪﯿﻓﻮﻛ : -19 ,ﺐﻠﻘﻟا , ﺔﯿﻋوﻷا ,ﺔﻳﺎﻤﺣ ,ﺔﻳﻮﻣﺪﻟا ﺔﻳودﻷا ةدﺎﻀﻣ سرﺎﺴﻠﻟ فﻮﻛ 2 ىوﺪﻋ ﻞﻜﺸﺗ سوﺮﯿﻓ ﺎﻧورﻮﻛ ﺪﯿﻓﻮﻛ ةﺎﻤﺴﻤﻟا -19 ةﺮھﺎظ ﻲﻓ ةﺮﯿﺒﻛ ﺔﯿﺤﺻ ﻌﻟا ﻲﻓو بﺮﻐﻤﻟا ﻢﻟﺎ هﺮﺳﺄﺑ ﺔﻤﺟﺎﻧ ﺔﯿﺳوﺮﯿﻓ ىوﺪﻋ ﺎﮫﻧإ ، ﻦﻋ ﻟا سوﺮﯿﻔ ﻰﻤﺴﻤﻟا ﺎﻧورﻮﻛ ﺔﻨﻳﺪﻣ ﻲﻓ ةﺮﻣ لوﻷ ﺮﮫظ يﺬﻟا ﺔﯿﻨﯿﺼﻟا نﺎھوو ، ءﺎﺑو ﺢﺒﺻأ ﺎﻣ نﺎﻋﺮﺳ ﻢﺛ رﻮﻤﻌﻤﻟا عﺎﻘﺑ ﻞﻛ ﻲﻓ ﺎﯿﺸﻔﺘﻣ , ﻦﻣ ﺮﺜﻛأ ﻊﻣ 81908887 ﺔﻟﺎﺣ ﻦﻣ اًرﺎﺒﺘﻋا ﻢﻟﺎﻌﻟا ءﺎﺤﻧأ ﻊﯿﻤﺟ ﻲﻓ ةﺪﻛﺆﻣ 29 ﺮﺒﻤﺴﻳد 2020 ، ﺖﻐﻠﺑ ﻦﯿﺣ ﻲﻓ بﺮﻐﻤﻟﺎﺑ تﺎﺑﺎﺻﻹا دﺪﻋ 433029 ﺔﻟﺎﺣ ةﺪﻛﺆﻣ ﺎﮫﻨﻣ 7272 و ةﺎﻓو ﺔﻟﺎﺣ 399575 ﺔﻟﺎﺣ .ءﺎﻔﺷ ﻞﻘﺘﻨﺗ نﺎﺴﻧإ ﻦﻣ ﺎﻧورﻮﻛ سوﺮﯿﻓ ىوﺪﻋ ﻦﻣ ﺮﺧﻷ لﻼﺧ لﺎﺼﺗا ثوﺪﺣ ﺮﺷﺎﺒﻣ ﺮﯿﻏو ﺮﺷﺎﺒﻣ ﺎﺑ زﺎﮫﺠﻟ ﻲﺴﻔﻨﺘﻟا ﺺﺨﺸﻠﻟ .بﺎﺼﻤﻟا ﻪﻧا ﻆﺣﻼﻤﻟا ﻦﻣو ،ءﺎﺴﻨﻟا ﻦﻣ ﺮﺜﻛأ لﺎﺟﺮﻟا ﺐﯿﺼﻳ ﺢﺋاﺮﺸﻟا ﻒﻠﺘﺨﻣ ﺲﻤﻳو ﺔﻳﺮﻤﻌﻟا ، ﻦﯿﻨﺴﻤﻟا ﻰﺿﺮﻤﻟا ﺪﻨﻋ ةرﻮﻄﺧ ﺮﺜﻛأ نﻮﻜﻳ ﻪﻨﻜﻟو ﺔﺻﺎﺧ ،ﺔﻨﻣﺰﻣ ضاﺮﻣﺄﺑ ﻦﯿﺑﺎﺼﻤﻟا ﺎﮫﻨﻣ ضاﺮﻣأ ﻦﯿﻳاﺮﺸﻟاو ﺐﻠﻘﻟا . ﺔﻣﺎﻋ ﺎﮫﺿاﺮﻋأ ﺺﺨﻠﺘﺗ ﺑ ﺔﮫﯿﺒﺷ ﺔﻣزﻼﺘﻤ اﺰﻧﻮﻠﻔﻧﻷﺎﺑ ءﻲﻘﻟاو لﺎﮫﺳﻹا , , و ﺔﯿﺴﻔﻨﺘﻟا ﺔﻘﺋﺎﻀﻟا ,ةدﺎﺤﻟا ضاﺮﻋأ نوﺪﺑ ﺮﻤﺗ نأ ﺎﮫﻨﻜﻤﻳ ﺎﻤﻛ تﻻﺎﺤﻟا ﺾﻌﺑ ﻲﻓ . ﻠﻟ نﻮﻜﻳ ، ﺐﻠﻘﻟا ىﻮﺘﺴﻣ ﻰﻠﻋ سوﺮﯿﻔ ﻦﻜﻤﻳو ،ﺔﻨﻣﺰﻣ ﺔﯿﺒﻠﻗ ضاﺮﻣأ ﻦﻣ ﻲﻧﺎﻌﻳ ﺾﻳﺮﻤﻟا نﺎﻛ اذإ ةﺪﺷ ﺮﺜﻛأ نﻮﻜﺗ ىوﺪﻌﻟا نﻷ ﻚﻟذو .جودﺰﻣ ﺮﯿﺛﺄﺗ ﻲﻓ سوﺮﯿﻔﻟا ﺐﺒﺴﺘﻳ نأ ،تﻮﻤﻟا ﻰﻟإ نﺎﯿﻀﻔﻤﻟا ﺔﻳﻮﻣﺪﻟا ﺔﯿﻋوﻷاو ﺐﻠﻘﻟا ىﻮﺘﺴﻣ ﻰﻠﻋ راﺮﺿأ ﻞﺜﻣ او ﺐﻠﻘﻟا تﺎﺑﺮﺿ مﺎﻈﺘﻧا مﺪﻋو ﺐﻠﻘﻟا ﺔﻠﻀﻋ بﺎﮫﺘﻟاو ةدﺎﺤﻟا ﻲﺟﺎﺘﻟا نﺎﻳﺮﺸﻟا ﺔﻣزﻼﺘﻣ و ﺔﯿﺒﻠﻘﻟا ﺔﻣﺪﺼﻟ .ﺔﻳﻮﻣﺪﻟا تﺎﻄﻠﺠﻟا ﺪﯿﻓﻮﻛ ضﺮﻣ ﺪﺿ ﺔﻣﺪﺨﺘﺴﻤﻟا تﺎﺟﻼﻌﻠﻟ نﻮﻜﻳ نأ ﻦﻜﻤﻳ -19 ﺐﻠﻘﻟا ﻰﻠﻋ ﺔﯿﺒﻠﺳ رﺎﺛآ ﺔﻳﻮﻣﺪﻟا ﺔﯿﻋوﻷاو ﻚﻟﺬﻟ ﺔﺒﻗاﺮﻣ ﺐﻠﻄﺘﺗ ﺎﻳدﺎﻔﺗ ﺔﻣزﻼﻟا ﺔﯿﺒﻄﻟا ﺔﻳﺎﻋﺮﻟا ﻢﮫﺤﻨﻣو ﺎﮫﺑ ﻦﯿﺑﺎﺼﻤﻟا صﺎﺨﺷﻷا ﻲﺒﻄﻟا ﻢﻗﺎﻄﻠﻟ ﻊﻳﺮﺴﻟا ﻞﺧﺪﺘﻟا ﻲﻋﺪﺘﺴﺗ ﻲﺘﻟا ﺔﯿﺒﻧﺎﺟ ضاﺮﻋأ يﻷ . ﻚﻠﺗ ﺔﻠﯿﻔﻛ تﻼﺧﺪﺘﻟا ، ﺮﻤﺘﺴﻤﻟا ءﺎﺑﻮﻟا ﻦﻋ ﺔﻤﺟﺎﻨﻟا تﺎﯿﻓﻮﻟا ﻦﻣ ﺪﺤﻟا ﻲﻓ ﻊﻣ ﺪﻳاﺰﺘﺗ ﻚﻔﻨﺘﻟ ﻲﺘﻟاو عﺎﺒﺗإ ﺐﺠﻳ ﻚﻟﺬﻟ ﺖﻗﻮﻟا روﺮﻣ تاءاﺮﺟإ ﺔﺑﺎﺠﺘﺳﻻاو ﺔﺒﻗاﺮﻤﻟاو ﺔﻳﺎﻗﻮﻟا ﺔﺤﺼﻟا ةرازو تﺎﻤﯿﻠﻌﺘﻟ ﺔﻳﺎﻗﻮﻟا نﻻ جﻼﻋ ﻞﻀﻓأ .ANNEXE 1 :
Réalisation du prélèvement nasopharyngé :
Maintenir la tête du patient inclinée en arrière
Puis insérer l’écouvillon dans la narine et le pousser délicatement le plus loin possible, parallèlement au palais.
Mettre l’écouvillon dans le tube avec milieu de transport en le cassant à l’aide de l’encoche indiquée (= emballage primaire). Veillez à bien refermer le tube de façon étanche.
La tige restante doit être éliminée dans un container DASRI.
Figure 53: Procédure de réalisation d’un prélèvement oro-pharyngé.
Figure 54: Ecouvillons pour prélèvement naso-pharayngé et oro-pharayngé.
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