Fever and aching muscles: Possible Causes With Fever, No Fever or Chills
Have you ever wondered why your joints and muscles ache when you have the flu?
Self Care, Pain Management
Though body aches are never enjoyable, they are evidence that your body’s immune system is working.
When a virus enters your body, your immune system gets ready for battle.
As the white blood cells fight the infection, you suffer the side effects: headaches, fever, runny nose, and sore throat. Along with these symptoms, you may experience muscle weakness (myositis) and joint and muscle pain (myalgia). These side effects may be your immune system’s way of making you rest.
Your immune system, not the virus, causes muscle aches and joint pain.
During the immune response, white blood cells produce glycoproteins called interleukins. These interleukins cause the symptoms associated with colds, flu, and other bacterial or viral infections.
Richard Deem, a senior researcher, and specialist at Cedars-Sinai Medical Center in Los Angeles provided a concise explanation of the body’s immune response. In his 2001 post on the MadSci.org message board, Deem summarized the process.
According to his post, a fierce battle rages inside the body it contracts the flu virus. The immune system sends antibodies to find and bind the influenza receptors. This defensive action blocks the virus and prevents the infection from spreading to other healthy cells.
After the immune system traps the infection, it launches the next phase of the attack. The body sends T cells and white blood cells to destroy mucosal cells affected by the virus. During the assault, the white blood cells produce cytokines and interleukins. These chemicals kill abnormal cells and recruit immune cells to the infected area. This microscopic battle for wellness is intense and produces the typical flu symptoms.
In 90 percent of the influenza cases, the Interleukin-6 (IL-6) and its associated cytokines cause muscle and joint pain. Other interleukins may produce different symptoms.
You can share this information with others through a YouTube video entitled Why The Flu Causes Aches & Pain. The video presents this 50-thousand-foot view of body’s immune response in an entertaining way.
Treat your body right during the flu.
If you contract the flu, stay home, rest, and drink plenty of fluids. Give your white blood cells the resources they need to win the chemical warfare raging inside your body.
Most people feel better in 3 to 5 days, though some may feel weak and tired for up to a week.
If body aches and joint pain continue for more than a week after other flu symptoms have disappeared, make an appointment with your primary care provider or an orthopedic specialist. Your aches and pains may have another cause.
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Why do muscles, joints ache during the flu?
In the 2019-2020 flu season, nearly 56 million cases of influenza were reported, according to the Centers for Disease Control and Prevention. In many of those cases, the virus was accompanied by muscle and joint aches.
“Muscle pain is never enjoyable, and can cause alarm in patients,” says Thomas Donaldson, MD, chair of orthopaedics at Loma Linda University Health. “They can be especially frustrating for people who already experience issues with joint or bone health,” he says.
When a body is infected with a virus, the immune system works to fight the infection. Donaldson says this fight could lead you to feel muscle inflammation and weakness — called myositis — or joint and muscle pain — called myalgia. Pain manifested in the joints is called arthralgia is also a commonly associated with a fever.
What’s causing the pain?
When infected by a virus, the body mounts an immune response, sending antibodies to seek out attack the virus, blocking it from spreading further. “The pain you feel in your joints when you have the flu is due to the body’s immune response, not the actual flu,” Donaldson says. Once the antibodies have bonded with influenza, the body produces a type of protein to kill the virus. This protein is what causes the symptoms, Donaldson says.
Additionally, white blood cells produce cytokines — which are small proteins used for cell signaling — which causes inflammation in muscles and joints. “Inflammation can cause pain that feels similar to mild arthritis,” Donaldson says.
When should you seek help?
Fortunately, the aches and pains are temporary. Once the body fights the infection, the pain should subside. If symptoms are ongoing or severely worsening, there may be a more significant underlying issue, Donaldson says.
“Influenza cannot be treated with antibiotics, but prolonged viral symptoms can turn into a bacterial bronchitis and or pneumonia,” he says. “A cough producing mucas that is not clear or white may require more aggressive treatment involving antibiotics.”
While it’s common for joints to feel stiff or sore, Donaldson says you should be able to move them fully. “Even if it’s uncomfortable, you should still have full mobility of your joints,” he says. “If you lose movement or your joints are red or swollen, consider seeking medical attention.”
To learn more about what you can do to protect yourself and your family during the flu season, visit our flu page at lluh.org/flu. Loma Linda University Health Primary Care and Urgent Care locations are available for in-person or virtual visits. Appointments can be made quickly and easily online at MyChart or by calling 909-303-9939.
The Most Common Causes of Body Aches and How to Relieve Pain
While you probably know whether a bad cold or that new barre class spurred your aching joints or muscles, you might be wondering how totally different things can provoke similar types of pain.
The answer, usually, is through inflammation.
“There’s a process of inflammation that occurs when the body has an infection, and some of the inflammatory mediators that we use to fight the infection cause fever and body aches,” says Erich Voigt, MD, an otolaryngologist at NYU Langone Health.
But a slew of other behaviors and conditions can amp up your body’s inflammatory responses—like repetitive motion and stress—triggering body aches in the process, he notes. So, why exactly do different parts of your body throb and twinge? Beyond getting older, here is a closer look at the most common reasons for your body aches, why your body responds with pain in the first place, and how to find relief.
Cold and flu season is in full swing
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“The body aches related to an infection such as pharyngitis (sore throat) or flu are related to the immune system’s response to the infection,” says Stephen Parodi, MD, infectious disease expert at Kaiser Permanente. “Our body releases certain chemicals, including ones called interferons, which help fight off the infection, but also cause body aches.” What’s more, your immune system is channeling most of your body’s energy into fighting off the infection, causing you to feel super tired.
✖️Ease the aches: Take it slow and get some rest. Dr. Parodi suggests over-the-counter medications for pain relief, like acetaminophen or ibuprofen, especially if you have the flu.
“Flu tends to make people sicker than regular cold viruses, and the body aches and fevers can be higher with flu. That’s why it is so important to get vaccinated and prevent the infection altogether,” he says.
You might have mononucleosis
Typically caused by the Epstein-Barr virus (EBV), mono is a type of infection common among teenagers and young adults, usually transmitted through saliva. The symptoms of mono include extreme fatigue, sore throat, fever, and swollen lymph nodes. And because it’s infectious, like pharyngitis and flu, your immune system will have a similar inflammatory response, resulting in body aches.
✖️Ease the aches: Getting some rest, drinking lots of fluids, and taking some OTC meds for fever and pain should help you find relief, according to the Centers for Disease Control and Prevention (CDC). There’s no specific treatment plan for mono, since antibiotics can’t zap viral infections. You should still touch base with your doc to get an official diagnosis, who will be able to provide prescription meds if another infection occurs at the same time, like strep.
You went too hard during your workout
OPTP Pro-Roller Soft Density Foam Roller
Trying a new type of exercise (or even just working a muscle group you’ve ignored for a while) can make you feel sore post-sweat. That muscle soreness, specifically the delayed-onset muscle soreness (DOMS) you feel a day or two after a hard workout, is the result of small tears in your tissues, according to a study published in Clinics in Sports Medicine. This results in inflammation, which causes that can’t-sit-down-properly feeling in your legs after you’ve done one too many squats.
✖️Ease the aches: It’s nothing to be worried about; DOMS is indicative of your muscles adapting to a new activity so they can do it again. Your muscles will heal within a few days, but doing a few foam-roller exercises during your recovery period can help speed the process up. If you like a deeper pressure, try a firm foam roller like this one from Amazon. If you rather go with gentle relief, try a softer one like this one from OPTP.
You’re using one part of your body over and over
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When you repeatedly use just one part of your body—whether while working out or typing at work—a more focused body ache and concentrated pain can take the form of a repetitive motion injury. A common example? Carpal tunnel syndrome.
Doing the same motion repeatedly can cause muscles, ligaments, and tendons to become swollen and inflamed, which causes the ache. In addition to aches, you may notice a lack of strength and reduced range of motion in the affected area.
✖️Ease the aches: Strengthening exercises through physical therapy, wearing braces to keep the area stable, and occupational therapy may be needed to get the body part functioning normally again.
You feel too stressed
Psychological stress can have physical manifestations, from headaches to jaw pain to lower back pain. That’s because when you’re stressed, your body pumps out the hormone cortisol. While that’s not a problem in the short-term, a 2014 study published in the Journal of the American Physical Therapy Association concludes that chronic stress can amp up inflammation, causing muscle breakdown, pain, and fatigue, among other symptoms. Plus, your body becomes more susceptible to infection when you can’t chill out.
✖️Ease the aches: Take some time each day to do something that helps you unwind from your daily stressors. Just breathing deeply for a few minutes (or even meditating), taking a walk during your lunch break, or a hot bath after work can help rejuvenate your body and mind.
You’re not sleeping soundly
You know you need sleep to keep feeling alert, but you might not realize just how much your body really depends on it to remain ache-free. In a study published in Arthritis & Rheumatology, researchers found the number one predictor of widespread pain, especially among adults over 50, is non-restorative sleep, or disruptive sleep (typically characterized by having trouble falling asleep or insomnia, waking in the middle of the night, or feeling excessively tired throughout the day).
✖️Ease the aches: Your musculoskeletal system needs at least 6 to 8 hours of sleep each night to repair itself daily. Can’t seem to snooze soundly? These 100 ways to sleep better every night are a good place to start.
A tick infected you with Lyme disease
Yep, something as tiny as a tick can be responsible for your body aches. Blacklegged ticks infected with the bacterium Borrelia burgdorferi, to be exact. If you catch it early enough, muscle and joint aches won’t become severe, but they are early indicators of Lyme disease. Other signs of Lyme disease include fever, chills, headache, fatigue, and a bullseye-shaped rash. Diagnosis mainly takes two things into consideration: the presence of these symptoms and the possibility of your exposure to ticks. About 30,000 cases of Lyme disease are reported to the CDC annually, but researchers estimate the true number of cases each year in the US is closer to 329,000.
✖️Ease the aches: If you suspect you have Lyme, seek medical treatment ASAP. The symptoms will only become more severe over time and can lead to complications like heart problems and severe joint pain. If you test positive for Lyme, your doc will prescribe antibiotics to rid your body of the infection.
You might have arthritis
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You don’t have to be old to have arthritis, which encompasses more than 100 different conditions. Inflammatory arthritis—which includes rheumatoid arthritis and psoriatic arthritis—affects your entire body since they’re autoimmune diseases, meaning your immune system goes a bit haywire and attacks healthy cells, spurring inflammation in the process. It’s characterized by pain and stiffness after periods of inactivity, or by morning stiffness that lasts over an hour. You may also notice pain, swelling, and tenderness around your joints, according to the Arthritis Foundation.
✖️Ease the aches: First, you should touch base with your doc to pin down which specific disease could be wreaking havoc on your joints. Your treatment will be depend on the diagnosis, but it’s likely your doc will recommend lifestyle changes (both physical and emotional—say, tweaking your diet or suggesting stress management tips). Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, along with disease-modifying anti-rheumatic drugs may also be recommended to relieve pain and prevent further damage to your body.
You could be dealing with fibromyalgia
Widely misunderstood but fairly common, fibromyalgia is characterized by widespread pain in your bones, muscles, or ligaments—which affects about 10 million Americans, according to the National Fibromyalgia Association. Your brain processes pain signals abnormally, heightening your body’s experience of pain. That pain, which can develop over time or be triggered by something like surgery or infection, varies in intensity and will migrate all over the body. Most people with fibromyalgia (the bulk of whom are women) also experience chronic fatigue.
✖️Ease the aches: If a blood test confirms that you’re suffering from fibromyalgia, you’ll work with your doctor to tailor a treatment plan to your lifestyle. Medications like over-the-counter pain relievers, antidepressants (to help you relax and sleep) and anti-seizure drugs (also to ease pain) may be your first course of action, according to the Mayo Clinic. From there, physical or occupational therapy may be needed, as well as counseling if you struggle with stress.
Your body might be fighting lupus
Lupus is tricky to diagnose, but most people with this autoimmune disease experience achy joints and swelling. The Lupus Foundation of America estimates at least 1.5 million people are living with lupus in the United States. Symptoms may come and go, and can affect different organs in different people. A few other major signs to look out for include extreme fatigue, headaches, fever, a butterfly-shaped rash across the cheeks and nose, hair loss, and Raynaud’s phenomenon (a condition in which your fingers, and sometimes your toes, feel severely cold or even change color). While lupus pain typically occurs on both sides of the body at once, it tends to be more manageable than something like rheumatoid arthritis.
✖️Ease the aches: Depending on your body’s specific reaction to the disease, your doctor may recommend a variety of medications to help you manage your symptoms, including NSAIDs (to treat pain and swelling), antimalarial drugs (to reduce flare ups), corticosteroids (to fight inflammation), immunosuppressants (to keep your immune system under control in very severe cases), or biologics (to treat various symptoms).
Anisa Arsenault is a New York City-based writer and editor covering health, lifestyle, and parenting news.
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Three cases of acute myositis in adults following influenza-like illness during the h2N1 pandemic
J Neurosci Rural Pract. 2013 Jan-Mar; 4(1): 51–54.
Summer Bell Gibson
Department of Neurology, University of Utah School of Medicine, United States of America
Jennifer Juhl Majersik
Department of Neurology, University of Utah School of Medicine, United States of America
A Gordon Smith
1Department of Pathology, University of Utah School of Medicine, United States of America
Mark B Bromberg
Department of Neurology, University of Utah School of Medicine, United States of America
Department of Neurology, University of Utah School of Medicine, United States of America
1Department of Pathology, University of Utah School of Medicine, United States of America
Address for correspondence: Dr. Summer Gibson, Department of Neurology, Clinical Neurosciences Center, 175 N Medical Drive East, Salt Lake City, Utah 84132. E-mail: [email protected] : © Journal of Neurosciences in Rural Practice
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.
Acute viral myositis is a rare condition that occurs during the recovery phase of an illness, most commonly influenza. It is characterized by muscle pain and weakness with an isolated laboratory finding of elevated serum creatine kinase (CK). We describe three previously healthy patients who were hospitalized after developing myositis following influenza-like illness during the 2009 influenza A (h2N1) virus pandemic. All experienced myalgias and weakness in all four extremities, including distal upper extremities, associated with an elevated CK level that resolved along with their myalgias and weakness within one week with supportive care. These cases serve as a reminder that influenza-related myositis may have atypical characteristics depending on the strain of influenza, and clinicians should be open to this possibility when new outbreaks occur.
Keywords: h2N1, influenza, muscle weakness, myositis, viral myositis
Acute myositis is associated with multiple viruses, with influenza most commonly implicated. Viral studies show that influenza B is more likely than influenza A to cause myositis, likely due to the presence of NB protein in the membrane of influenza B, which is implicated in viral entry and may have myotrophic properties.[2–4] Viral myositis is most commonly characterized as sudden onset of muscle weakness, pain and tenderness during the early recovery phase of the virus. Symptoms are often isolated to the calf muscles, but other muscle groups are involved in one third of cases.[1,5] It is typically self-limiting, with recovery within one week of the onset of symptoms, but there are reports of rhabdomyolysis with renal failure and compartment syndrome. [6–8]
Myositis occurs only in a small percent of those affected with influenza, and is most common in children (mean age eight years), possibly because of virus tropism for immature muscle cells, which has been documented in animal studies.[2,8,9] It has, however, been reported in all age groups.[10,11] Males are more commonly affected than females (2.4:1).[2,8] It is associated with mildly to moderately elevated serum creatine kinase (CK) level. Muscle biopsy typically reveals muscle fiber degeneration and muscle necrosis with infiltration of leukocytes.[8,9] However, it is unclear whether this is due to direct infection of the muscle by the virus, myotoxic cytokines or other immunologic processes, as the viral agent has not been consistently demonstrated in biopsy.
The novel 2009 influenza A (h2N1) virus was first identified in humans in April 2009 in Mexico with the first confirmed case in Utah on May third, 2009.[12,13] The virus rapidly spread throughout the world, and the World Health Organization (WHO) declared it a pandemic on June 11, 2009.  Epidemic levels of influenza like illness were reported in Utah from October 2009 to January 2010, and h2N1 was the only influenza in circulation in Utah during this time. The symptoms include fever, cough, sore throat, runny nose, body aches, headache, chills and fatigue. The predicted prevalence of clinical influenza during the 2009 h2N1 epidemic was 12-30% of the population, compared with the typical rate of 5-15% for seasonal influenza. Influenza associated hospitalizations in Utah in 2009-2010 were highest in 5-24 year-olds followed closely by 25-49 year-olds, with 27.2% and 26.8% respectively. Additionally, myositis has been reported with h2N1 influenza.[6,7,17,18] Here we report three cases of myositis associated with influenza like illness during the pandemic, associated with distal upper extremity involvement.
A 37-year old male surgeon presented with three days of progressive muscle pain and weakness. Five days prior he had fever, myalgias and sore throat. His fever and sore throat resolved after two days, but he continued to have muscle pain that evolved into diffuse muscle weakness, greatest in his distal upper extremities. This disabled him from performing surgery. He denied any recent trauma or strenuous exercise. He also denied any medical history or medication use prior to his illness, except for ibuprofen three days prior to his presentation. He reported multiple sick contacts, including sick patients and his four-month old son.
His vital signs and general examination were normal. He had no rashes or joint pain. His forearm muscles and intrinsic muscles of the hand were tight and tender to touch. His neurological examination was notable for 5/5 strength throughout except bilateral wrist flexion and extension (4/5), finger flexion (3/5), finger extension (2/5) and thumb adduction (3/5). His reflexes and sensation were normal.
Laboratory values were generally unremarkable with the exception of CK (1,504 ng/ml). Pertinent negative virologic tests included RSV by PCR, parvovirus B19, EBV, CSF bacterial culture, HIV, Influenza A by PCR, Influenza B by PCR, and CSF Influenza by PCR.
He was given IV fluids and ibuprofen. One day after presentation, the swelling and tenderness improved. Two days later his symptoms had nearly resolved. Examination revealed only subtle 5-/5 weakness in bilateral forearms and hands. CK decreased to 752 ng/ml and serum creatinine remained stable and within normal limits. Nerve conduction and needle EMG (proximal, distal and paraspinal muscles) studies were normal. A few days later he was able to return to work, including performing surgeries.
A 25-year-old male presented with four days of progressive weakness and muscle pain. Initially he noticed myalgias in his chest and biceps. Two days prior to presentation he noticed forearm pain and hand weakness. One day prior to presentation he noticed lower extremity weakness and pain, limiting his ability to ambulate. Two weeks prior to presentation he had been prescribed amoxicillin for a sore throat and fever, however he was not tested for streptococcus or influenza at that time. He denied prior medical problems, trauma, routine medication use or recent strenuous exercise.
Vital signs and general examination were normal. He had no rashes or joint pain. Bilateral arm and forearm muscles were tight and tender. Strength was decreased bilaterally in upper and lower extremities, including wrist extension and flexion (4/5), grip strength (4-/5), hip flexion (3/5), hip extension (5-/5), knee flexion (4-/5) and knee extension (5-/5). His reflexes and sensation were normal.
Laboratory values were generally unremarkable with the exception of a CK of 3,575 ng/ml. Pertinent negative virologic tests included CSF bacterial culture, HIV, Influenza A by DFA, Influenza B by DFA, and CSF Influenza by PCR. An MRI of the cervical spine was normal.
He was given IV fluids and ibuprofen. The day following presentation his weakness continued to progress and involved truncal weakness. Needle EMG study (distal, proximal and paraspinal muscles) showed only one run of positive waves in the thoracic paraspinal muscles. Two days after presentation he had dramatic improvement. His strength returned to 5/5 except in his left upper extremity strength, which improved to 4+/5 in wrist flexion, wrist extension and finger extension. The swelling and tenderness also improved. His CK decreased to 975 ng/ml and serum creatinine remained stable and within normal limits.
A 45-year-old male presented with four days of progressive weakness and pain. He first noticed trouble manipulating small objects with his fingers. The weakness in his hand progressed to the point that he was no longer able to perform his job as a cable installer. He reported his forearms were tender to the touch. The patient’s wife had confirmed h2N1 influenza four weeks prior, requiring hospitalization. He also had a fever, cough and sore throat shortly after his wife was sick, but did not seek medical attention. He had otherwise been in his usual state of good health with no medication use or recent trauma.
Vital signs and general examination were normal. There was no evidence of skin rash. His muscles were tender to the touch. His neurological examination was notable for decreased strength to grade 4+/5 in bilateral upper extremities, hip flexors and hip extenders. Reflexes and sensory examination were normal.
Laboratory values were generally unremarkable with the exception of a CK of 600 ng/ml. Pertinent negative virologic tests included CSF bacterial culture, Influenza A by PCR, Influenza B by PCR, and CSF Influenza by PCR.
The day following admission his strength had returned to 5/5 and the muscle soreness had resolved. His CK declined to 410 ng/ml and serum creatinine remained stable and within normal limits. He had been given IV fluids and ibuprofen.
These cases have many of the classic features of influenza myositis, including; acute onset of muscle weakness, pain and tenderness during the recovery phase of the virus, laboratory abnormality of mildly to moderately elevated CK, and complete resolution occurring within one week. However these cases of viral myositis also have several unique characteristics that may be unique to h2N1; influenza-related myositis more commonly affects a younger population and typically has isolated bilateral calf involvement, while all of our patients had four extremity involvement, with more distal than proximal upper extremity involvement. While these cases only represent a small portion of those with myositis related to h2N1, the presentation pattern is stereotyped and notably benign.
Acute myositis is associated with a large number of viruses, including h2N1.[7,16–18] The cases described in this report were not virologically-confirmed influenza, but all met the World Health Organization (WHO) definition for possible h2N1 influenza-like illness and occurred when h2N1 influenza was highly prevalent in Utah during the fall and winter of 2009. Additionally, h2N1 disproportionately affects younger and healthier patients when compared to typical influenza, which is consistent with the cases described here.  The median duration of viral shedding by PCR is 5-9 days for h2N1, and given that PCR on serum for influenza was preformed 5-21 days after symptom onset, a false negative PCR is not unexpected.[21–23] According to the CDC, the sensitivity of rapid influenza testing for detecting h2N1 infection is as low as 10%. Therefore, a negative rapid influenza result, as in case number two, does not exclude h2N1 infection. Additionally, influenza by PCR on CSF is insensitive, even in cases of influenza-related encephalopathy or myositis.[24–26] For these reasons, h2N1 diagnosis during the pandemic was generally based on CDC clinical criteria in geographic regions with a heavy disease burden. According to Monto et al., the positive predictive value of typical viral symptoms (as demonstrated in all of our cases) during an influenza epidemic is about 80%. Muscle biopsy is not routinely recommended in the workup of viral myositis as a negative muscle biopsy does not exclude viral myositis[9,18] and was not performed due to the improvement of symptoms in all three cases. Given the patient profiles, symptoms, and timing during the peak of the h2N1 pandemic, we postulate that these cases were h2N1-associated viral myositis.
Recognition of this benign pattern of h2N1 myositis in adults may aid in the cost-effective and appropriate evaluation and management of future patients. These cases also serve as a reminder that influenza-related myositis may have atypical characteristics depending on the strain of influenza, which should be kept in mind in when new outbreaks occur.
Source of Support: Nil.
Conflict of Interest: None declared.
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Muscle Aches, Fatigue and Shortness of Breath
Doctor rubbing eyes feeling tired.
Image Credit: Thomas Northcut/Digital Vision/Getty Images
Muscle aches, fatigue and shortness of breath are three symptoms that often present themselves concurrently and are common to a variety of disorders or illnesses. The seasonal flu is the most common cause of this triad of symptoms, but the root of the problem may also be a more serious condition such as bronchitis, pneumonia or other viral or bacterial infection.
The flu is caused by a virus that is transmitted through droplets of mucus or spittle, and it is typically passed by sneezing or coughing in close proximity to another person. The flu is typically accompanied by a fever, which causes the muscles of the body to feel achy. The body’s attempt to fight the infection contributes to the feeling of fatigue and malaise and also contributes to shortness of breath. The symptoms associated with the flu typically begin to alleviate in just a few days. If the symptoms do not begin to subside, or if you experience persistent vomiting and diarrhea, be sure to visit your doctor ito prevent potential serious complications associated with the flu.
Acute bronchitis is typically caused by a viral infection, while chronic bronchitis may be brought on by cigarette smoking or repeated inhalation of airborne pollutants. Both types of bronchitis involve inflammation of the bronchial airways of the lungs, which contributes to the shortness of breath. Like the flu, bronchitis may also be accompanied by a fever, which could cause muscle aches and fatigue. While bronchitis typically resolves on its own without medical intervention, you should see your doctor if you experience severe coughing or a fever lasting more than three days.
Pneumonia is a serious medical condition that involves inflammation of the tissue of the lungs, making it difficult for your body to inhale oxygen and exhale carbon dioxide effectively. There are many types of pneumonia, and it is most commonly caused by a bacterial infection. It is possible, however, for certain viruses, fungi or parasites to also produce pneumonia. It is important to pay a visit to your physician if you suspect pneumonia, because he will likely need to treat the infection with some sort of antibiotic or antiviral medication.
While the combination of muscle aches, fatigue and shortness of breath may not always indicate serious trouble, it is important to see your doctor to rule out a more life-threatening cause. Conditions such as Guillain-Barre syndrome, polio and lupus can also produce the same three symptoms. Reactions to certain medications, especially ACE inhibitors or cholesterol-lowering statins, may also bring about feelings of muscle aches, fatigue and shortness of breath.
Muscle Aches | Cancer.Net
Muscle aches are a possible side effect of cancer and cancer treatment. Another term for muscle aches is myalgia. Muscle aches can occur on their own or they can be associated with other symptoms, like muscle weakness, cramps, or depression.
Muscle aches may affect a specific area in the body or affect the whole body. The muscle aches may be mild, severe, or somewhere in between. They might be constant or come and go. When untreated, muscle aches can affect your quality of life, limit how much you can do, and make other symptoms or side effects seem worse. They may even cause you to stop treatment early.
If you have muscle aches, let your health care team know. Relieving symptoms is an important part of your cancer care and treatment. This type of care is called palliative care or supportive care. It helps people with any type or stage of cancer feel better.
What causes muscle aches?
When you have cancer, the following factors can cause muscle aches:
Cancer. Certain types of cancer are more likely to cause muscle aches, including:
Tumors that start in a muscle, such as some kinds of soft-tissue sarcoma
Tumors that press against a muscle
Cancers that cause the body to make too many white blood cells, such as certain types of leukemia
Cancer treatments. When treatment ends, muscle aches usually go away. In some cases, muscle aches can be a late effect, happening months or years after treatment ends.
Treatments that may cause muscle aches include:
Some types of chemotherapy, such as docetaxel (Taxotere), ixabepilone (Ixempra), paclitaxel (Taxol), and vincristine (Vincasar PFS)
Aromatase inhibitors (AIs), such as anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
Other hormonal therapies, including fulvestrant (Faslodex), raloxifene (Evista), tamoxifen (Soltamox), and toremifene (Fareston)
Targeted therapy, such as trastuzumab (Herceptin) and T-DM1 or ado-trastuzumab emtansine (Kadcyla)
Immunotherapy, such as interferons, interleukins, and CTLA-4 and PD-1/PD-L1 inhibitors
Other medications. Medicine for cancer-related symptoms or other conditions can cause muscle aches. Some examples include:
White blood cell growth factors, which help prevent infection during cancer treatment, including filgrastim (Granix, Neupogen, Zarxio), pegfilgrastim (Fulphila, Neulasta), and sargramostim (Leukine)
Drugs to treat bone loss called bisphosphonates, such as alendronate sodium (Binosto, Fosamax), ibandronate sodium (Boniva), pamidronate (Aredia), risedronate (Actonel), and zoledronic acid (Zometa)
Cholesterol drugs, also called statins
Cancer-related side effects. Symptoms or side effects such as fatigue, muscle weakness, depression, cramps, and dehydration can cause muscle aches or make them worse. Talk with your health care team about any side effects you are experiencing so they can help provide relief.
Other factors. Other things can cause muscle aches, including reasons unrelated to your cancer diagnosis. Possible causes for muscle aches include:
Overuse of a muscle through activities, sports, or work
Muscle injuries caused by accidents, such as a fall
Getting an infection (such as the flu or COVID-19) with a virus or bacteria
Diseases such as polymyalgia rheumatica, lupus, and fibromyalgia
Poor blood supply to the affected muscle
Hormone disorders such as an underactive thyroid gland (hypothyroidism)
Changes in electrolyte (blood chemistry) levels, such as magnesium or potassium
How do doctors find the cause of muscle aches?
Your doctor will ask about your symptoms and medical history. They will also ask questions such as:
Where do you ache?
Do the muscle aches stop and start? If so, when?
How long have you had them?
Is the pain dull, sharp, or some other description?
What makes your muscles feel better? Worse?
Do the aches cause problems with your everyday activities?
What other symptoms, such as muscle weakness, do you have?
If your cancer treatment is causing muscle aches, your doctor may recommend a different treatment, having treatments less often, or getting a lower dose.
If they are unsure about the cause of your muscle aches or if your muscle aches do not go away or get worse, you may need additional tests to help find the cause. These can include:
Blood tests. They can show an infection, dehydration, or another condition that can cause muscle aches.
Computed tomography (CT or CAT) scan. This scan makes a 3-dimensional image of the inside of the body.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields to produce detailed images of the body.
Bone scan. You may have this test if your doctor thinks the problem may be related to your bones.
Contact your doctor right away if you develop additional symptoms, such as:
These can be signs of serious medical conditions that need immediate attention.
How are muscle aches treated and managed?
When possible, doctors treat the condition that is causing the muscle aches. Below are some possible treatment options.
Medication. There are medications that can help make muscle aches feel better. Your health care team may recommend or prescribe medications, including:
Over-the-counter pain medicines, such as ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol)
Your health care team may also recommend self-care and support methods of treating muscle aches. You may decide to do some of these methods in addition to medication or instead of medication for mild or moderate muscle aches. Some of these practices you can do on your own. Others require you to work with a licensed or certified specialist. Talk with your health care team before trying these methods.
Some self-care and support methods you can use to treat muscle aches are:
Massage. A massage therapist who has experience working with people with cancer can do a gentle therapeutic massage that may help ease muscle pain. You or your caregiver can also do simple massage at home.
Physical therapy. A physical therapist can treat muscle problems and teach you how to relieve pain using simple exercises or devices.
Exercise. Gentle exercise, along with stretching and strengthening, may help loosen muscles and increase blood flow.
Heat and cold. Hot or cold compresses, heating pads, or ice packs may help decrease discomfort from muscle aches. Talk with your health care team about how long and how often to apply heat or cold.
Relaxation techniques. Gentle breathing or meditation exercises can help you relax and reduce muscle tension. This can help muscles ache less.
Track the results of the techniques you use to find out which ones manage your muscle aches best. You can use a chart like the one in the ASCO Answers Managing Cancer-Related Pain booklet (PDF) to track your pain.
Questions to ask the health care team
Could my muscle aches be caused by cancer? Or is it caused by something else?
When should I call you if I develop muscle aches or if my muscle aches get worse?
How should I keep track of my muscle aches?
What treatments do you recommend for my muscle aches?
Do you recommend other types of supportive care for muscle aches?
Are there things I can do at home to ease my muscle aches?
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Medline Plus: Muscle Aches
7 causes of muscle aches
If you’re sore after exercise, your muscle pain is easily explained. If it arises out of the blue, it could be one of these causes.
Almost everyone knows what muscle pain feels like. Whether it’s sore pecs and deltoids after a weightlifting session or aching muscles from an illness like the flu or Rocky Mountain spotted fever, it’s hard to make it through life without muscle aches every now and then. In most cases, such as with exercise or illness, the causes of muscle aches are easy to identify. But sometimes, the answers aren’t so simple, and muscle aches can become chronic and life-altering. That’s when it’s time to see a healthcare provider and figure out what’s really going on.
7 causes of muscle aches
Part of the reason muscle pain, or myalgia, is so common is because it has so many causes, both physical and emotional, and it can involve single muscles, groups of muscles, or even someone’s entire body. Treating muscle pain correctly depends on the cause, so it’s important to get the correct diagnosis if the cause isn’t readily apparent. Here are some of the most common causes of muscle aches, pains, and soreness.
1. Exercise and activity
If you play sports, lift weights, jog, hike, bike, or even work in your garden, chances are you’re familiar with the connection between muscle overuse and pain. Your muscles could be straining or cramping in the middle of a workout or a long run—a condition called acute muscle soreness —and the next day, you might feel even worse.
“Let’s say you haven’t done anything all week, and you’re the weekend warrior, and then, two days later you feel like you got hit by a Mack truck. Well, that’s something called delayed-onset muscle soreness,” says Naresh Rao, DO, the founder and CEO of MAX Sports Health and head physician for the U.S. men’s water polo team.
Acute muscle soreness is most often caused by a buildup of lactic acid, which is produced by your muscles when your body breaks down carbohydrates to use for energy (glycolysis) in excess of the available oxygen. This is often the case during intense workouts when the muscles need more oxygen than your lungs and blood can provide. The lactic acid can build up quickly, leading to acute muscle soreness during or immediately after the activity. People who suffer from claudication, which is pain caused by too little blood flow to the muscles during exercise, may also experience acute muscle soreness. The pain typically goes away when they stop exercising. Whereas the build up of lactic acid can occur in healthy individuals, claudication can be a sign of a vascular problem and should be evaluated by a doctor.
Delayed-onset muscle soreness, which was once thought to be caused by lactic acid, as well, is actually the result of tiny injuries to your muscle fibers. When your muscles are called on to do more than they’re accustomed to, they can suffer microscopic damage that can lead, a day or two later, to inflammation, stiffness, and muscle soreness.
Fortunately, activity-related muscle aches usually resolve quickly and, in most cases, aren’t something to worry about. “Muscle pain that occurs after exercise is pretty normal in most people,” says David Dickoff, MD, a neurologist and assistant clinical professor of neurology with Mount Sinai Hospital. “In fact, it’s often a good feeling, a feeling people like to have. It’s a sense of fatigue in the muscles that lets you know that you had a good, aggressive day of skiing, or a nice softball game, or a nice long walk.”
2. Stress, anxiety, and tension
When you’re stressed out or anxious, your muscles can tense up suddenly or for long periods of time. The American Psychological Association calls this “almost a reflex reaction to stress—the body’s way of guarding against injury or pain.” Long periods of tension due to chronic stress can lead to muscle aches, which is why many stressed-out people suffer from shoulder, neck, and back pain. Muscle tension can also contribute to joint pain and other stress-related conditions like migraine headaches and mental health issues.
To help alleviate stress-related muscle aches, physicians often recommend simple at-home measures such as getting more exercise, taking breaks from sitting at a desk to get up and move around, meditation and other relaxation techniques, and gentle stretching. You can also make ergonomic modifications like upgrading to a better chair or working at a standing desk. If it’s possible, getting more sleep may also help ease muscle pain. Meditating for up to 30 minutes before bedtime has been shown to help some people sleep better.
When muscles are extended or flexed beyond what they’re used to, they can begin to tear. In many cases, when the tears are microscopic and don’t involve the larger muscle, the resulting muscle strain, or pulled muscle, is a simple injury that resolves immediately or in a day or two. However, more serious cases, which can involve a partial or complete tear of the entire muscle, can be extremely painful and often debilitating. Sprains, which involve connective tissue like ligaments and tendons, can also cause sore or painful muscles.
When a bone gets broken or a muscle, joint, or soft tissue gets injured, the muscles surrounding the injured area are often affected, as well. This may occur as the body tries to compensate for the injured part of your body, which might not be working the way it should. The additional strain on the surrounding muscles and bones will often lead to significant muscle spasms and soreness.
4. Underlying medical conditions
Many types of illnesses, infections, and autoimmune diseases can cause muscle pain, but the biggest culprit is one that most people wouldn’t guess.
Dr. Dickoff says with restless leg syndrome, or RLS, patients often mistake the uncomfortable feeling as “cramps”—even though they’re not truly cramps. “Restless leg syndrome is a really important consideration for patients with myalgias,” he says, “because it can be genetic, and it may be present in up to 15% of the population, which means that in America some 35 million people may experience RLS.”
RELATED: RLS treatments and medications
Immune system diseases, such as lupus and multiple sclerosis, can cause arthritis (inflammation of the joints), or myositis, an inflammation of the skeletal muscles you use to move your body. This can lead to muscle pain, fatigue, and muscle weakness. Muscle pain due to inflammation is also a common symptom of many bacterial and viral infections, such as coronavirus, viruses that cause the common cold, the flu, malaria, and the illnesses Lyme disease and Rocky Mountain spotted fever, both of which result from a tick bite.
Another common cause of myalgia is dehydration, which forces your body to pull fluids out of your tissues, leading to body aches and pains. Less common causes include high blood pressure, which can lead to circulation problems, limiting blood flow to muscles, and rapid weight loss, which can cause dehydration and thereby muscle cramps.
Other illnesses and conditions that can cause muscle pain include:
- Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
- Certain cancers, such as sarcomas and leukemia
- Chronic fatigue syndrome
- Compartment syndrome
- Muscular dystrophy
- Myofascial pain syndrome
- Peripheral artery disease
- Rheumatoid arthritis
- Spinal muscular atrophy
- Thyroid disorders
If you have persistent muscle aches without an obvious cause, it may be a good idea to talk to a healthcare provider about these conditions.
Characterized by the Centers for Disease Control (CDC) as “a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress,” fibromyalgia affects about 4 million adults in the U.S. The exact cause of fibromyalgia isn’t known, but people with the condition experience numerous muscle-related symptoms like widespread pain and stiffness, tingling or numbness in the hands and feet, and pain in the face and jaw, including temporomandibular joint (TMJ) syndrome.
“Fibromyalgia manifests with multiple pains in various areas,” says Dr. Rao. “You pretty much have what we call trigger points. There’s a whole map of them all over your body, and if you have multiple ones affected, ranging from hip pain to shoulder pain, and your elbows hurt, and all your muscles hurt, then it could definitely be a sign that you want to get that checked out.”
Fibromyalgia can often be treated effectively through medications and self-help measures like exercise, stress-management techniques, good sleep habits, and cognitive behavioral therapy (CBT), which can help treat underlying mental health issues like depression or anxiety.
6. Polymyositis or polymyalgia rheumatica
Taking its name from the Greek words poly (many), myo (muscle), and itis (inflammation), polymyositis is an inflammatory disease that causes chronic inflammation and muscle weakness, especially in the muscles closest to the center of the body, like the thighs, hips, back, neck, and shoulders. According to The Myositis Association, the muscle weakness associated with polymyositis usually happens over days, weeks, or months and can affect your ability to walk, run, climb stairs, or get back up after a fall.
Polymyalgia rheumatica (or PMR) is a similar inflammatory muscle disease whose name means, literally, “many muscle pain that flows.” Polymyalgia rheumatica causes muscle pain and stiffness, particularly in the shoulders and hips.
“Polymyositis simply means you have inflammation in many muscles,” says Dr. Dickoff. “Polymyalgia means that you have aching in many muscles [as the actual muscles in PMR are normal].”
The causes of polymyositis and polymyalgia rheumatica aren’t known, and there are no cures, but treatment with medications, physical therapy, lifestyle changes, and home remedies can help ease symptoms and help weakened muscles regain some of their strength.
Myositis (inflammation of muscle cells) is a side effect of a number of medications and therapies, including chemotherapy, radiation therapy, statins used to lower cholesterol, and high blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors. If you’re on a new medication or undergoing chemo or radiation therapy, and you experience muscle pain, be sure to seek out a healthcare provider’s medical advice before stopping your treatment.
When to see a doctor for muscle pain
In most cases, if muscle pain is related to increased activity or a minor injury, it should go away shortly and can probably be treated at home with simple measures. But if your muscle pain lasts for more than three days or you have severe, unexplained muscle pain, make an appointment to see a medical professional as soon as you can.
“Muscle aches where you have loss of motion should be a red flag,” says Dr. Rao. “For example, you may have a little neck tension, but if you feel like you can’t move your neck without sharp pain, that’s important. And another one is if the pain is just out of control. We use the scale of 0 being no pain and 10 being the worst pain you’ve ever had. Once you start getting to 5 or 6, and if it’s been lasting more than one or two days, you definitely want to have someone take a look.”
Other symptoms that warrant a call to the doctor include:
- Any sign of infection, such as swelling or redness around the sore muscle
- A tick bite or a rash, especially the telltale bullseye rash of Lyme disease
- Muscle pain that might be caused by a medication you’re taking
- Poor circulation in the affected area (usually causes a red, purple, or blue skin color and a colder temperature).
- Sudden weight gain or water retention (urinating less frequently)
Call 911 or get yourself to a hospital emergency room if you experience any of the following along with your muscle pain:
- Trouble breathing or dizziness
- Extreme muscle weakness (especially one sided)
- High fever
- Very stiff neck or severe headache
How to treat muscle aches
Muscle pain and soreness from activity, exercise, or minor injury often requires little more in the way of treatment than the tried and true RICE (rest, ice, compression, elevation) method. Give your sore muscles time to recover, put an ice pack on them, keep the affected area elevated, and you should recover just fine. Many people also get relief from over-the-counter anti-inflammatory pain relievers like Advil (ibuprofen), Tylenol (acetaminophen), aspirin, and Aleve (naproxen).
If at-home measures alone aren’t enough to treat muscle pain, doctors may prescribe stronger pain-relieving medications, including:
Regular exercise and gentle stretching can help restore muscle tone and ease soreness. If you don’t get much exercise, start a new regimen slowly and build up to more intense activity over time to avoid exercise-induced muscle pain. Massages can be effective at relieving pain, as well, especially pain caused by overuse or fibromyalgia. Relaxation techniques, acupuncture, meditation, yoga, staying well hydrated, and getting more and better sleep may also help. Work with your healthcare provider to find the method that works best for you.
What is Trichinosis
Trichinosis (trichinellosis; synonym: trichinosis) – acute helminthiasis in humans and mammals, the important medical and social significance of which is due to the severity of clinical manifestations, often disability, and in some cases, death. The invasion is characterized by fever, muscle pain, facial edema, skin rashes, high eosinophilia, and in severe cases – damage to the myocardium, lungs, and central nervous system.
What provokes / Causes of Trichinosis:
Trichinella – small, almost filamentous helminths (thrix – hair), covered with a cross-striated cuticle. The body of T. spiralis is rounded, somewhat narrowed anteriorly. The length of a mature male is 1.2-2 mm with a width of 0.04-0.05 mm. The length of a mature female before fertilization is 1.5-1.8 mm, after fertilization, its length increases to 4.4 mm.
Established the existence of two types of foci of trichinosis: natural and synanthropic.Natural foci are primary in origin. Trichinella can parasitize in the body of 57 species of wild and domestic animals, the basis of the circulation of the pathogen is alimentary connections. In these foci, parasites circulate among wild animals (wild boars, badgers, raccoon dogs, brown and polar bears, foxes, coons, minks, ferrets, etc. ), marine mammals (whales, sea seals) due to predation or eating carrion. In synanthropic foci, Trichinella spp. Circulate among domestic animals (pigs, cats, dogs), rodents (mice, rats) also by eating each other or falling.In addition, synanthropic foci are replenished with hunting trophies – trichinosis wild animals.
There is a direct and inverse relationship between natural and synanthropic foci. Invasion from natural foci is brought into synanthropic foci in two ways: by a person who hunts invaded wild animals and feeds their remains to domestic animals, and wild synanthropic ones (rats, mice), which migrate to natural foci in spring and return back in autumn. As a result, mixed natural synanthropic foci are created.
In the muscles of animals, the larvae remain invasive for years, and in cadaveric material they die under the influence of very high or low temperatures (-40, -50 ° C), they can tolerate the conditions of the Arctic zone.
The source of invasion for humans are domestic and wild animals affected by trichinosis. Most often these are pigs, wild boar, brown and polar bears, nutria, badger, fox, for some ethnic groups – dogs.
Mechanism of infection oral.The susceptibility of people to trichinosis is very high. In order to get a serious illness, it is enough to eat 10-15 g of Trichinosis meat. Infection usually occurs when eating raw or insufficiently cooked meat of animals affected by trichinosis, most often meat, lard, ham, bacon loin, brisket, sausage made from infested pork, as well as meat of wild animals affected by trichinella (bear, wild boar, badger ).
The incidence of trichinosis is usually of a group nature.Members of one family, persons participating in one festive feast, a hunting meal, who have used meat of the same Trichinosis animal that have not undergone preliminary sanitary and veterinary control, fall ill.
Trichinella larvae die when the temperature inside a piece of meat reaches at least 80 ° C. Salting and smoking meat does not affect encapsulated larvae.
The seasonal nature of group flares has been established. In synanthropic foci, they are in most cases associated with the autumn period – the period of slaughtering pigs and preparing meat products.
Outbreaks of trichinosis in natural foci are associated with the hunting season – the autumn-winter period. Due to the existing poaching, they can occur at any time of the year.
The formation of foci of trichinosis is facilitated by improper management of pig breeding: free keeping of pigs, their vagrancy, access to pigsties of rodents, cats, dogs.
Life cycle of Trichinella
Trichinella are viviparous helminths.An important biological feature is also the fact that one and the same organism becomes first the final and then the intermediate host. Trichinella have a variety of hosts besides humans. They parasitize many mammals – pigs, wild boars, bears, wolves, foxes, badgers, dogs, cats, as well as rodents, insectivores and marine mammals.
In the mature stage, helminths parasitize in the wall of the small intestine, and in the larval stage, in the striated muscles, except for the heart muscle.
A person becomes ill with trichinosis when eating pork or wild meat infected with encapsulated larvae. In the process of digestion, the larvae are released from the capsules and within an hour they are introduced into the mucous membrane, reaching the submucous layer of the small intestine.
In a day, they turn into males and females. Sexually mature individuals with the help of the head stylet attach to the intestinal mucosa, where they then copulate.
In the body of various animals, the female Trichinella parasitizes from 10 to 56 days, giving birth from 200 to 2000 live larvae.During the entire period of parasitism in the human intestine (no more than 42-56 days), one female gives birth to an average of 1500 larvae.
The larvae penetrate through the intestinal mucosa into the lymph, then the blood vessels and are carried by the blood stream throughout the host’s body. On the 5-8th day, the larvae enter the skeletal striated muscles. With the help of the hyaluronidase secreted by them, they penetrate into the sarcolemma of the muscle fiber, where their further development occurs, already in the body, which has become an intermediate host for the pathogen.In 18-20 days after infection, the larva in the muscles lengthens to 0.8 mm, reaches the invasive stage and begins to coagulate.
Pathogenesis (what happens?) During Trichinosis:
The pathogenesis of trichinosis is complex, representing a complex of pathological reactions, the trigger of which is the pathogen.
As you know, the entire biological cycle of Trichinella occurs in the body of one host, in this case, a human, in which the successive stages of helminth growth have different localization: the invasive larva in the lumen, and then in the mucous membrane of the small intestine; growing and then adult in the tissue of the small intestine; migratory larva – in the bloodstream and lymph; muscle larva – in striated muscles. As a result, the products of metabolism and partial decay, especially of larval and growing individuals, get directly into the tissues. They are parasitic antigens with high sensitizing activity.
The allergic nature of trichinosis underlies its pathogenesis. NN Ozeretskovskaya distinguishes three phases of the development of the pathological process: enzymatic-toxic (1-2 weeks after infection), allergic (from the end of the 2nd -3-4 weeks after infection) and immunopathological.
The enzymatic-toxic phase is associated with the penetration of invasive Trichinella larvae into the intestinal mucosa and the formation of adult helminths, under the influence of enzymes and metabolites of which an inflammatory reaction develops in the intestine.
The second – allergic phase trichinosis – is characterized by the occurrence of general allergic manifestations in the form of fever, myalgia, edema, skin rashes, conjunctivitis, catarrhal pulmonary syndrome, etc. By the end of the first week, mature trichinella adults begin to hatch young larvae, which migrate through the lymph and blood into the striated muscles. The suppressed defense reaction of the host due to the immunosuppressive action of the adult parasites does not impede the active circulation of the larvae.
However, by the end of the second – in the third week of the disease, the level of specific antibodies in the infected person’s serum increases and a violent allergic reaction develops.
Violent allergic inflammation in the small intestine contributes to the death of adult Trichinella, the formation of granulomas around the Trichinella larvae in the muscles, from which fibrous capsules subsequently form, preventing the entry of parasite antigens into the host’s body.
The severity of immunological reactions depends on the dose of antigen and immunoreactivity of the host organism, on the degree of adaptation of the parasite to the host. An increase in the dose of infection causes an increase in the intensity of intestinal and muscle invasion, which in turn leads to an increase in the severity of the disease, suppression of immunological processes. This is accompanied by systemic damage to organs and tissues as a result of sensitization of the body not only by the products of the metabolism of helminths, but also by the products of the decay of damaged or destroyed tissues of the host.This phase is manifested by fever, muscle pain, edema, conjunctivitis, and respiratory problems.
Immunopathological phase of trichinosis, usually associated with intense infection, is characterized by the appearance of allergic systemic vasculitis and severe organ damage.
Nodular infiltrates appear in the myocardium, brain, lungs, liver and other organs. Trichinosis is complicated by severe allergic diffuse focal myocarditis, meningoencephalitis, focal pneumonia and other equally severe organ lesions that can be combined with each other, accompanied by high fever, severe muscle pain, skin rashes, and the spread of edema.
By 5-6 weeks after infection, the inflammatory process in the parenchymal organs is replaced by dystrophic disorders, which recover slowly, over 6-12 months.
Symptoms of Trichinosis:
Typical clinical manifestations of trichinosis are fever, mainly remitting type, facial edema, muscle pain, skin rashes, high eosinophilia.
At a low intensity of invasion, its subclinical, asymptomatic course is possible, when the only sign indicating infection is an eosinophilic blood reaction.
Clinically pronounced variants of trichinosis differ in the severity of the course, the duration of the incubation period, the duration of the fever and the outcome. In accordance with this, in the generally accepted clinical classification, the following four forms of invasion are distinguished: erased, mild, moderate and severe.
During the invasion, the following periods are distinguished: incubation, acute manifestations, complications, convalescence and relapses.
The incubation period of trichinosis is on average 10 – 25 days.However, when infected with natural strains of the pathogen, the incubation period is extended to 40 – 45 days. It has been established that the duration of incubation is inversely proportional to the severity of the course of the disease: in severe cases it is 7-10 days, and in especially malignant cases it is reduced to 3-1.
With erased form of trichinosis , the incubation period lasts from 4 to 5 weeks. This form of invasion proceeds without pronounced symptoms and is difficult to diagnose. The main symptoms of the disease: subfebrile fever, mild muscle pain, pasty face, malaise.In peripheral blood, eosinophilia is up to 7 – 12% against the background of a normal leukocyte count. The duration of the disease is no more than one week, during which time all manifestations, except for eosinophilia, disappear.
An erased and subclinical course of invasion is recorded in 20-30% of those infected with trichinosis in each outbreak.
With mild trichinosis , the incubation period lasts 4 – 5 weeks.
The disease begins acutely with an increase in temperature to 38 – 39 ° C, headache, malaise. The temperature quickly drops to subfebrile and lasts for 1 week. Pain in the calf, lumbar, masticatory muscles, swelling of the eyelids, puffiness of the face (“puffiness”) appear from the first days of the disease and are more pronounced. Eosinophilia of the peripheral blood is within 10 – 20%.
All painful phenomena can go away on their own within 1-2 weeks. Moderate blood eosinophilia persists for up to 1 to 3 months.
With moderate trichinosis , the incubation period lasts from 2 to 3 weeks.This form of invasion is characterized by more pronounced symptoms corresponding to the syndrome of common allergic manifestations.
Characterized by an acute onset of the disease with an increase in temperature to 39 – 40 ° C. At a high level, it remains for several hours, then at a level of 38 – 38.5 ° C during the first week, passing into subfebrile for the second.
The febrile period is accompanied by intense pain in the gastrocnemius, lumbar, occipital, and chewing muscles.
Severe edema of the eyelids of the face, puffiness, conjunctivitis were noted as characteristic symptoms.In some patients, against the background of fever, skin rashes of a maculopapular or hemorrhagic nature appear.
Approximately 1/3 of patients develop bronchopulmonary pathology. Clinical symptoms in such patients are manifested by inflammation of the upper respiratory tract, bronchitis, pneumonia, pleurisy. A feature of pulmonary pathology in trichinosis, as in other helminthiasis, is the migratory nature of “volatile” infiltrates during X-ray and auscultatory examinations.
During fever, symptoms of damage to the cardiovascular system increase: tachycardia, deafness of heart sounds, systolic murmur at the apex. On the ECG, changes are determined that reflect metabolic or dystrophic disorders. Patients complain of palpitations and shortness of breath that appear with any physical exertion.
In some patients, the disease is accompanied by symptoms of lesions of the gastrointestinal tract. Abdominal pain, nausea, vomiting, diarrhea are noted by 20 – 25% of patients.
Enlargement of lymph nodes and spleen, more often observed in children, confirms the involvement of the reticuloendothelial system in the process.
Dysproteinemia is revealed: on the one hand, there is general hypoproteinemia and hypoalbuminemia, on the other, an increase in alpha-2-globulins and gamma-globulins. A characteristic symptom is aldolazemia up to 25 – 40 E, ESR, slowed down in the initial period of the disease, at the height of fever, eosinophilia increases to 25 – 40% against the background of leukocytosis.
Clinical manifestations in moderate trichinosis reach a maximum by the end of the first week, the disease ends in 3-4 weeks. Residual effects in the form of asthenization of muscle pain can persist for 1-2 months, and eosinophilia is even longer. After treatment with glucocorticoid hormones, the duration of the acute phase is reduced, but the recovery period is delayed up to 4-6 months.
A mild and moderate course of trichinosis is recorded in 50-60% of those infected in each outbreak.
With severe trichinosis , the incubation period is short – 7-10 days, with a particularly severe course it is reduced to 3-1 days.
The disease often begins atypically, resembling the flu, acute respiratory infections, food poisoning, typhus or typhoid fever. From the first days of the disease, the phenomena of general intoxication, damage to the central nervous system are expressed. The temperature, gradually increasing to 40-41 ° C, lasts for 2-3 weeks. Severe headaches, delirium, agitation, insomnia, the phenomenon of meningism against the background of increasing muscle pain and severe edema accompany the fever.
Muscle pains become widespread. They arise in the gastrocnemius, eye, masticatory muscles, and then spread to the muscles of the lower back, shoulder girdle, become intense and often in these cases are accompanied by contractures, limitation of mobility until the patient is completely immobilized.
Edema spreads to the trunk and limbs, as well as loose tissue of internal organs, the lining of the brain and the parenchyma. This leads to functional disorders of the central nervous system, chemosis, exophthalmos, diplopia and other manifestations.
On the skin of the face, trunk, extensor surfaces of the extremities, polymorphic rashes of an erythematous-papular nature appear, and in especially severe cases, hemorrhagic rashes of the type of hemorrhagic vasculitis.
This form of trichinosis is characterized by varied, severe, often with a poor prognosis, organ and systemic pathologies.
Cardiovascular pathology often occurs, which is manifested by hypotension, tachycardia and rhythm disturbances. There is a muffling of heart sounds, signs of heart failure – a picture of myocarditis.The ECG in almost all patients shows diffuse changes in the myocardium, coronary disorders with the development of circulatory failure.
Respiratory organs suffer: bronchitis with an asthmatic component, focal bronchopneumonia with a volatile nature of infiltrates and other disorders are detected in such patients quite often.
One of the variants of the severe course of trichinosis is abdominal syndrome, in which, against the background of fever and other manifestations of the disease, abdominal pain, nausea, vomiting, loose stools with mucous-bloody impurities occur.
Necrotic ulcerative lesions of the stomach and intestines with perforation and bleeding can be fatal. Dystrophic disorders of the liver are benign in nature, they disappear without a trace with corrective therapy.
Kidney function, as a rule, is not impaired, proteinuria and cylindruria are detected as a reaction to fever.
Symptoms of lesions of the central nervous system, characteristic of meningoencephalitis, encephalomyelitis, often occur.Patients are worried about severe headaches, insomnia, in severe cases, delirium, convulsions, mental disorders, epileptic seizures.
Organ and systemic lesions can cause death. The main cause of death in trichinosis is acute allergic myocarditis. In these cases. The patient suddenly has attacks of acute cardiac dysfunction with tachycardia, arrhythmia, hypotension, and the ECG reflects diffuse myocardial damage and coronary pathology.
In second place among the causes of mortality in trichinosis is pneumonia, sometimes accompanied by astmoid bronchitis, pleurisy. Infiltrates are resistant to antibiotics, but quickly disappear with the appointment of glucocorticoid hormones.
A terrible complication, which ranks third among the causes of death in patients with trichinosis, is damage to the central nervous system. This complication, like pulmonary syndrome, is more common in men. Psychoses, severe hysteria, epileptiform seizures, paresis and paralysis indicate deep diffuse focal lesions of the brain and spinal cord associated with the development of nonspecific vasculitis, less often with thrombosis of large vessels.
In some patients, phlebitis, thrombosis of the vessels of the extremities occur as a result of violations of hemostasis, the coagulation system, intravascular coagulation.
Organ lesions more often develop at 3-4 weeks, less often at 2-5 weeks after infection.
Eosinophilia reaches 25-40% against the background of leukocytosis. However, in very severe forms in the terminal period, it sharply decreases to aneosinophilia. A severe course of trichinosis is recorded in 10-30% of those infected in each outbreak.
Clinical and laboratory data indicate a milder course of trichinosis in children, a lesser severity of their allergic manifestations, less damage to the cardiovascular system.
The incubation period for trichinosis in children is usually longer than in adults. Temperature reaction is less pronounced, short – up to two weeks – fever is more common than long-term remitting.
The main clinical manifestations of trichinosis – edema, muscle and pain syndromes – are also less pronounced in children than in adults.Mild forms of the disease, more often erased and subclinical, prevail.
Laboratory indicators in children are characterized by less eosinophilia, a lower percentage of positive C-reactive protein. There is an opinion that the milder course of trichinosis in children compared with adults is due to the pronounced immunological activity of the child’s body and, as a consequence, to the limitation of the development of immunopathological manifestations, with which one cannot but agree. In addition, what matters is, as a rule, the lower intensity of infection of children.
However, in no way can one exclude the possibility of a malignant course of invasion in children with the development of severe allergic myocarditis, meningoencephalitis, even with an unfavorable outcome.
There are clinical observations that indicate a milder course of trichinosis in pregnant women. Clinical criteria for severity, such as the height and duration of fever, the intensity and duration of muscle pain, the prevalence, location and time of edema persistence, are less pronounced.Complications are less common and are also less pronounced.
Thus, the above observations indicate that trichinosis does not disrupt the course of pregnancy and does not affect the development of the fetus.
Prevention of trichinosis
You should not buy meat products without a stamp on carcasses and hams!
Heading health: asthenia – Official website of the Administration of St. Petersburg
Asthenia translated from Greek means powerlessness.This is a condition characterized by a rapid depletion of the nervous system, a decrease in the ability to prolonged mental and physical stress. Asthenia, which occurs in both children and the elderly, is often accompanied by tearfulness, irritability, drowsiness, or insomnia.
Often, fatigue by others and by the patient himself is perceived as a common occurrence, so patients often resort to self-medication. However, the cause of fatigue or, more precisely, asthenia, that is, abnormal, spontaneous weakness that occurs without a previous load, must necessarily be clarified, since this symptom may be a manifestation of organic pathology. A general practitioner who is able to assess this complaint plays a major role in the examination and treatment of patients with asthenia. Knowing well his patients, their medical history and, therefore, having an idea of the process that served as the basis for the onset of asthenia, the general practitioner, like no one else, is able to accurately identify an organic disease or clinical anomaly, the presence of which the patient neglects, to help the patient remember certain symptoms or the fact of taking non-prescribed medications; such a doctor can conduct an examination and, as a result, comprehensively assess the clinical condition of the patient.
How to identify asthenia? Asthenia is not just fatigue. Fatigue is a normal feeling of lethargy caused by physical exertion. This is a physiological condition that goes away after rest. Asthenia is a pathological, spontaneous lethargy that occurs without exertion, continues for a long time and does not go away after rest.
How to determine the cause of asthenia?
If asthenia is accompanied by fever, weight loss, sweating, joint pain, itching, coughing, a complete clinical examination is necessary, since these disorders definitely indicate an organic disease.If the patient was self-medicating, then asthenia may be the result of the use of diuretics, laxatives, or drugs that lower blood pressure. Knowledge of the lifestyle and personality traits of an asthenic patient is important for the diagnosis of functional asthenia caused by nervous tension, overwork, too long a working day, hyperactivity (including sports), insomnia, etc. Various diseases of the muscular and nervous system are responsible for the onset of organic muscle weakness, which can be mistaken for asthenia.
How and with whom to be examined if I am constantly worried about weakness? The scope of research and its focus depends on the age and lifestyle of the patient. In a young patient with unfavorable living conditions, functional asthenia should be suspected and tested. An elderly patient or a patient of any age whose health condition is deteriorating should be examined quickly. Tuberculosis often causes asthenia and prolonged fever, which is why a fluorographic examination is mandatory once a year.Diabetes mellitus is often accompanied by long-term weakness, so it is important to determine the blood sugar level. Studying thyroid hormone levels can also shed light on the possible cause of asthenia. Asthenia is sometimes the only symptom in the presence of tumors, in this regard, the examination of elderly patients should be especially careful.
Can an infection cause asthenia? Asthenia is often observed with anicteric form of acute viral hepatitis A, B, C or with exacerbation of chronic viral hepatitis.With HIV infection before the development of AIDS symptoms, isolated asthenia is noted, which is sometimes the first sign of the disease.
What is Chronic Fatigue Syndrome? Chronic fatigue syndrome (CFS) raises many questions; it is understood as severe asthenia, lasting more than 6 months, and associated with fever, muscle pain, nausea, mood and sleep disorders, sweating, cervical lymphadenopathy; sometimes these symptoms follow well-known infections: mononucleosis, entero- or poliovirus infections, etc. p. The symptoms of Chronic Fatigue Syndrome can be:
1. Progressive or prolonged fatigue, especially pronounced after any physical activity that was previously easily tolerated.
2. Low temperature fever.
3. Frequent sore throat.
4. Soreness in the lymph nodes.
5. Muscle weakness.
6. Myalgia – muscle pain.
7. Sleep disorder (insomnia or, on the contrary, drowsiness).
eight.An unusual headache.
9. Migratory arthralgia – joint pain.
10. Neuropsychiatric disorders – increased sensitivity to bright light, visual disturbances (spots in front of the eyes), forgetfulness, irritability, indecision, decreased mental activity and the ability to concentrate.
Does this disease develop in children in the same way as in adults?
Symptoms in children and adults are similar.Fatigue also manifests itself, creating insurmountable difficulties that arise with any stress. But often children with CFS have to face the problem of mistrust on the part of adults – relatives, teachers, doctors. After all, a child, as a rule, outwardly looks completely healthy, but at the same time complains of constant fatigue, unwillingness to go to school. Conversations in the presence of a child – whether he is really sick or deftly feigns an illness – harm his psyche, he stops sharing his difficulties with adults, refuses the help of a doctor, which only aggravates the disease.It is very important at this moment to provide the child with not only medical, but also psychological assistance. Failure to independently overcome fatigue, get rid of other symptoms, return to a normal active lifestyle and study can lead to the development of personality complexes in a child, sow in him a feeling of self-doubt and self-doubt.
Do the symptoms of the disease appear immediately? No. At the first stage, the patient’s condition is very similar to the symptoms of the most banal ARVI. On the second, the first nine signs of the listed eleven appear. They do not have to be observed all at once. At this stage, long-term remissions occur, which deceptively calm both the patient and the doctor. At the third stage, the disease manifests itself already in a severe, stable form. Then two more symptoms are added to the first nine signs: the patient complains of neuropsychiatric disorders and depression.
Can the use of drugs lead to asthenia? Beta-blockers, drugs that lower blood pressure, sleeping pills, tranquilizers can cause asthenia.Sometimes, when taking several medications at the same time, it can be difficult to find out which drug is causing the symptom.
I often have a bad mood, and I get tired quickly, what could it be? Your condition may be associated with mental disorders (reactive neurosis, hypochondria, depression), sleep disorders (chronic insomnia, anxiety neurosis, shift work) or physical overload (excessive exercise in sports). The exact answer will be given by the doctor after the necessary examination.
Do living conditions influence the onset of asthenia? The living conditions of the elderly can be associated with excessive and even intolerable stress. The need to climb to the 5th floor in a building without an elevator, living alone, caring for a sick family member, worrying about the divorce of your own child – all these are difficult and insidious situations that lead to overstrain and breakdowns. Family doctors often encounter them in practice. At the same time, it is obvious that the source of pathology is not the human body, but the conditions of his life.To return the patient to a state of harmony, the joint help of a doctor, social worker, and psychologist is required. The use of drugs in this situation is limited.
Can vitamins help to overcome asthenia? Regardless of the cause of asthenia, vitamins, trace elements, adaptogens and other drugs are used for treatment. In our opinion, Gerimax, which contains all vitamins and trace elements in combination with ginseng, copes with this task better than other multivitamins.
What’s new in asthenia treatment? Great hopes in the drug treatment of the disease are pinned on the new drug Enerion, which affects the reticular formation of the brain. Scientific studies have proven the effectiveness of enerion in relation to enhancing physical, mental performance, improving sexual function. Perhaps the use of the drug will solve many problems of fatigue of students, accountants, computer scientists, managers. No less benefit is a properly organized day, good sleep and rest, quitting smoking.Fasting is also a cause of asthenia, so you need to analyze your diet.
90,000 Inflammatory myopathies: dermatomyositis / polymyositis V.A. Nasonova
Inflammatory myopathies: dermatomyositis / polymyositis
What are inflammatory myopathies: dermatomyositis / polymyositis?
Inflammatory myopathies (dermatomyositis, polymyositis) are a group of rare autoimmune diseases characterized by inflammation of the striated muscles with the development of weakness in the shoulder and pelvic girdle, trunk; swallowing disorders may develop. It is also possible to damage the skin, joints, internal organs.
With dermatomyositis / polymyositis, the following symptoms may occur
Muscle weakness that progresses over several weeks or months (difficulty walking up stairs, getting up from a chair or squatting, combing your hair, taking off clothes over your head, changing your body position from horizontal to vertical).
Muscle pain (similar to pain after intense physical activity).
Rash on the face, on the back of the hands (over the small joints), as well as over the large joints (knee, elbow), in the neckline and shawl, on the outer surfaces of the thighs. In similar areas, ulcers may form. Cracks on the lateral surfaces of the fingers.
Swelling around the eyes.
Swallowing disorders: choking when ingesting liquid or viscous food, getting liquid in the nose, stuck food in the throat.
Change of voice – hoarseness and / or nasalness.
Dyspnoea on exertion, dry cough or cough with a small amount of viscous phlegm.
Pain and swelling of the joints. Discoloration of fingers in the cold.
It is well known that in some patients with dermatomyositis and, less often, with polymyositis, the cause of the development of autoimmune disease may be a malignant tumor.Therefore, patients undergo a thorough examination to exclude a malignant tumor.
To confirm the diagnosis, laboratory tests are prescribed – a biochemical blood test to detect increased levels of muscle enzymes, primarily creatine phosphokinase (CPK). Approximately 1/3 of patients have myositis-specific antibodies – a-Jo-1, which are also of great diagnostic value. Needle electromyography is performed to detect signs of muscle damage and assess the activity of the process.In difficult cases, a muscle biopsy may be required. Also, patients with inflammatory myopathies often undergo computed tomography of the chest organs to detect signs of interstitial pneumonia.
Who should consult a rheumatologist?
Progressive weakness in the muscles of the shoulder and pelvic girdle.
Presence of periorbital edema, a mauve rash on the face, over small and large joints, in the décolleté and shawl area, intensifying in the sun.
Presence of interstitial pneumonia and muscle weakness and / or joint pain and / or skin changes – redness over the joints and cracks in the fingers.
Increase in the level of “muscle” enzymes, primarily CPK.
Treatment of inflammatory myopathies
The goal of the treatment of inflammatory myopathies is to restore muscle strength, improve and stabilize lung function (if they are damaged), eliminate skin rashes and heal skin defects, and relieve arthritis. With dermatomyositis and polymyositis, muscle strength is restored very slowly, over several months.
The key to the success of VM treatment is the cooperation of the patient and the doctor, strict adherence to recommendations, as well as careful attention to their well-being, monitoring the analyzes and keeping a diary.
Specialists dealing with diagnostics and treatment at the institute: employees laboratory of microcirculation and inflammation
Make an appointment with a specialist:
90,000 The Ministry of Health of Argentina spoke about the side effects after Sputnik.The main thing from the report
Photo author, Donat Sorokin / TASS
The Argentine Ministry of Health has published a report on the side effects of the Russian Sputnik vaccine, which has been used in the country since the beginning of the year. Argentina is the second among foreign countries to allow this vaccine to be used at home, and now more than 11 million people have been vaccinated with it.
The data released by Argentina are especially valuable because Russia does not publish information on the side effects of any of the locally produced vaccines.There is also no official portal with statistics on vaccinated – statements mentioning the number of vaccinated are only periodically made by Russian departments.
The report is based on data received up to 31 July this year. In Argentina, Sputnik and AstraZeneca are the two most popular vaccines, with nearly equal numbers of people vaccinated.
A total of 11.37 million doses of Sputnik, 11.1 million doses of AstraZeneca and 9.7 million doses of Chinese Sinopharm were administered to the country’s population.
In the seven months since the start of mass vaccination, the national health system has recorded 50 463 reports of side effects (156. 8 cases per 100 thousand).Of these, 1.99% (1004 cases) were considered severe side effects – that is, requiring hospitalization.
Cases of serious side effects after Sputnik – less than 1% of the total. 38 669 cases of side effects after the Russian vaccine were considered mild.
Most of the reports on certain side effects came from Sputnik, AstraZeneca – 2999 reports, Sinopharm – 2384. Another 3535 cases were not associated with any of the vaccines.
Published in Argentina and the distribution of the number of severe side effects depending on the vaccine:
- Sputnik – 0.66 cases per 100 thousand doses
- AstraZeneca – 0.41 cases per 100 thousand doses
- Sinopharm – 0.16 cases per 100 thousand doses
72% of reported adverse events were from women, and the average age of reported adverse events was 42.4 years for both sexes.
The report highlights that the response of the surveillance system to side effects at the start of vaccination was very high due to the fact that vaccines were introduced in a pandemic and were all new. That is, the medical staff was trained to detect side effects and quickly notify them.
Although the number of doses of vaccines people received increased over time, the number of reports of severe side effects remained low, the Argentine Ministry of Health notes.
What did you most often complain about?
Most often, after the “Sputnik” recorded headache or pain in the muscles / joints – (136.2 cases per 100 thousand).There were also cases of fever with headache and / or pain in muscles and joints (128.5 cases), local reaction without fever (most likely, redness at the injection site – BBC ) – 26.9 cases per 100 thousand.
Fever was less common – 16.5 cases per 100 thousand, local pain – 11.4 cases, local reaction with fever – eight cases, gastrointestinal tract reactions with or without fever – six cases, and the same number of allergies.
Very rare side effects of Sputnik are local adenopathies (swollen lymph nodes – BBC ) – there were 0.83 cases per 100 thousand, anaphylaxis (0.10 per 100 thousand), metallic taste in the mouth (0.08) and hyperthermia (0.05).
Nine cases were classified by the Argentine Ministry of Health as undefined, that is, they could not be accurately associated with vaccination. These include three cases of Guillain-Barré syndrome (an acute autoimmune inflammatory reaction), five of various thrombocytopenias, and one case of pericarditis (an inflammatory lesion of the serous membrane of the heart).
The authors of the report emphasize that as new information becomes available, the data on side effects may change and be revised.
At the end of August, Argentine scientists released a preprint of the study, which concluded that the neutralizing activity of antibodies after vaccination with “Sputnik” among those who had not previously been sick with coronavirus has been growing for six months.
Researchers took serum samples 42 days after Sputnik vaccination and found that they were less effective in neutralizing beta and gamma strains than the original Wuhan version. However, 120 days after vaccination, the situation changed: the neutralizing activity against “alpha”, “beta”, “gamma” and “delta” was higher compared to the Wuhan variant.
For the lambda variant (found in Peru at the end of last summer), the neutralizing activity was slightly lower.
Scientists have summed up that although the levels of IgG antibodies to the virus fall over time, the effectiveness of neutralizing the virus in vaccinated (and not previously ill) increases.
This suggests that antibody maturation occurs after vaccination for several months. These are preliminary findings, the study has not yet received reviews from reviewers.
Problems with supplies
In Argentina, according to statistics, more than 60% are already vaccinated with the first dose and 33% are fully vaccinated.
At the end of June it was reported that the country had problems with the second component of Sputnik – it had not been received for several months.It was reported that the Argentine authorities are negotiating with Russia to get the shipment of the second component, as many Argentines, who received the first vaccine in March-April, were still waiting for the second injection in June.
After Argentina threatened to break the contract, Russia sent a batch of vaccine to the country, but it contained only 400 thousand doses out of the expected 18.7 million. The Russian authorities then said that domestic consumption was a priority for them.
“It is not possible to satisfy absolutely all the demand abroad immediately, but after the expiration of time, all obligations will be fulfilled,” said Dmitry Peskov, the presidential press secretary.
In Argentina, they started their own production of the vaccine, and also announced that they could replace the second injection with AstraZeneca or CanSino vaccines, which also use an adenoviral vector.