Respiratory manifestations of post-COVID syndrome

Overcoming infection with coronavirus disease 2019 (COVID-19) can lead to the persistence of various symptoms in some patients. The complex of symptoms causally related to severe acute respiratory coronavirus 2 infection is called post-COVID syndrome. One of the most common respiratory complications is pulmonary fibrosis, especially after critical course of the disease. In some patients, ho-wever, only the peripheral airways are affected by the air-trapping seen on high-resolution computed tomography scans. Less common respiratory complications include sarcoidosis and pneumatoceles. This narrative review summarizes current knowledge about pulmonary involvement as part of post-COVID syndrome.

Pulmonary complications following COVID-19 infection.

In the relatively short period of time since December 2019, hundreds of millions of people globally have been infected with SARS-CoV-2, irrespective of their age, gender or ethnicity. Over that time, numerous mutations of various degrees of virulence and patho-genicity have occurred. The course of COVID-19 infection, an acute disease caused by the virus, is rather varied, ranging from asym-ptomatic or symptoms of common viral respiratory diseases to critical, with multiorgan failure and high mortality in high-risk patients. The overall mortality of the disease is 1-2 %. Unlike other viral respiratory diseases, this infection is often associated with frequent and rather diverse clinical manifestations developing after the acute phase of the infection, that is, more than 28 days after its onset. These complications are observed in both individuals with mild illness treated at home and inpatients with severe to critical illness. They develop both early after acute infection and some time after recovering from the disease. This rather heterogeneous group of pathologies may affect various organs and organ systems, with respiratory tract involvement being the most common and one of the most serious complications. Severe respiratory post-COVID-19 complications often include respiratory tract infections, in particular pneumonia.Copyright © 2022, Trios spol. s.r.o.. All rights reserved.

The use of extracorporeal membrane oxygenation in the treatment of critical course of pneumonia

Extracorporeal membrane oxygenation is the highest form of resuscitation care in management of patients with respiratory failure. In the case of acute respiratory distress syndrome, the veno-venous setting is more often used. ECMO support enables, in case of lung function failure, to obtain the necessary time for the onset of the causal treatment effect or is used as a bridge to transplantation Mortality of the patients varies according to the underlying cause and presence of risk factors (e.g., age, complications or comorbid diseases). The onset of the COVID-19 pandemic has led to a significant increase in the need for ECMO. The quality of life of patients after ECMO is significantly reduced, but most patients do not experience permanent disability. © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Network analysis uncovers relationship between immune profiles and severity of COVID-19

Introduction: Despite the growing number of studies on COVID-19, interpreting the data and extracting meaning from these data is challenging. Method(s): We used a multivariate patient similarity network (PSN) approach to analyse ~85 immune (cellular and humoral) and ~70 clinical features in 250 prospectively recruited patients 4-8 weeks after a SARS-CoV-2 diagnostic PCR. Result(s): Our multivariate analysis identified a minimal immune signature (CD69+CD4+ T-lymphocytes, CTLA-4+ Tlymphocytes and immature B-lymphocytes) that was strongly associated with disease severity and manifested even 4-8 weeks after COVID-19. Visualisation of clinical and laboratory parameters in patient clusters detected by PSN showed that a history of severe COVID-19 was associated with less frequent anosmia/ageusia and higher levels of IgM and IgG 4-8 weeks after COVID-19 compared with mild disease. Conclusion(s): Ours study reveals the relationship between immune profiles and severity of COVID-19, showing that more severe COVID-19 is typical lower proportion on immature B cells and cytotoxic T- lymphocytes. Our study demonstrates the benefits of implementing multivariate data-mining approaches for interpreting complex datasets, not only relating to COVID-19.

[Pulmonary complications following COVID-19 infection]

In the relatively short period of time since December 2019, hundreds of millions of people globally have been infected with SARS-CoV-2, irrespective of their age, gender or ethnicity. Over that time, numerous mutations of various degrees of virulence and pathogenicity have occurred. The course of COVID-19 infection, an acute disease caused by the virus, is rather varied, ranging from asymptomatic or symptoms of common viral respiratory diseases to critical, with multiorgan failure and high mortality in high-risk patients. The overall mortality of the disease is 1-2 %. Unlike other viral respiratory diseases, this infection is often associated with frequent and rather diverse clinical manifestations developing after the acute phase of the infection, that is, more than 28 days after its onset. These complications are observed in both individuals with mild illness treated at home and inpatients with severe to critical illness. They develop both early after acute infection and some time after recovering from the disease. This rather heterogeneous group of pathologies may affect various organs and organ systems, with respiratory tract involvement being the most common and one of the most serious complications. Severe respiratory post-COVID-19 complications often include respiratory tract infections, in particular pneumonia.

Bilateral multiple pneumatocele as a rare late complication of COVID-19 pneumonia

Pneumatocele is a cavity, which may develop rarely as a complication of pneumonia. It is more common in patients requiring ventilation support. After COVID-19 pneumonia, there are only several case reports described. Our case report is about a male patient without any serious commorbities. The patient had bilateral multiple pneumatocele which have formed in postacute phase of moderate course of COVID-19. Other possible causes have been exluded by a complex examination. During the follow-up there was a clear gradual spontaneous resorption of the finding. The patient is still in very good clinical condition. © 2021, SOLEN s.r.o.. All rights reserved.

Antibiotic treatment issues in patients with COVID-19

The COVID-19 pandemic may increase the current threat of antimicrobial resistance and exacerbate another, rather silent, pandemic posed by the increasing frequency of multidrug-resistant bacterial pathogens and the associated potential for loss of effective antibiotics. Antibiotic treatment has often been used in patients hospitalized for COVID-19 due to concerns about possible bacterial co-infection, as confirmed by previous experience with viral respiratory infections such as H1N1 influenza, SARS and MERS. Concerns or unknowns related to the COVID-19 pandemic have also affected physicians‘ behavior, including the use of antibiotics. However, the high rate of antibiotic use in patients, especially those with mild to moderate COVID-19 disease, is inconsistent with the actual incidence of bacterial co-infections and/or secondary respiratory infections. Thus, it is clear that a careful assessment of the role of antibiotic treatment in patients hospitalized for COVID-19 is required. According to the current WHO recommendation, the application of antibiotics is especially suitable for patients with severe/critical de-gree of respiratory insufficiency requiring intensive oxygen therapy, artificial lung ventilation or support by extracorporeal membrane oxygenation.

Covid-19 related olfactory impairment – diagnostics, significance and treatment

Aim: Smell disorders are frequent symptoms of COVID-19 disease. This systematic review covers the pathophysiology, diagnostics, prognostic significance, and treatment of COVID-19 related smell disorders. Methods: The articles were selected in accordance with the PRISMA guidelines. The inclusion criteria were: 1. peer-reviewed publications;2. studies on human subjects;3. studies published in English or Czech;and 4. used filters: meta-analysis/systematic review/randomized controlled trial. The exclusion criteria were: 1. abstracts from conferences;2. commentaries;and 3. inclusion of subjects younger than 18 years. The databases PubMed and Web of Science were searched. Using the search term “anosmia OR smell loss OR smell disorders OR dysosmia OR parosmia AND COVID-19”, 157 papers were selected for analysis, with 109 being ruled out based on the exclusion criteria. The full texts and their references were obtained and studied, and the references meeting the inclusion criteria were also included in this review, leading to a total of 68 papers selected for the review. Results: Approximately 60% of patients with COVID-19 disease present with smell disorders. Most studies agree anosmia appears more frequently in the mild course of the disease. The inflammation and demyelination of the olfactory nerve fibres probably play a key role in the pathogenesis. Damage to the supporting cells of the olfactory epithelium may also play an important role. Olfactory disorder may persist over a varying period of time after the resolution of the acute phase of COVID-19. Olfactory training seems to be beneficial in the treatment. The data regarding the efficacy of topical corticosteroids are inconsistent. No other drugs have yet demonstrated a clinical effect. Conclusion: Loss of smell is a common accompanying symptom in mostly mild forms of COVID-19. Olfactory training seems to be effective in treating this dysfunction. Pharmacotherapy (including local and systemic corticosteroids) has not yet proven effective.