ABSTRACT
Case report Introduction: PM is a rare, but potentially life-threatening complication during COVID 19 pandemic, being reported in patients affected by COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. Case details: We reported the clinical data of 4 cases affected by COVID-19 pneumonia complicated with PM. Chest CT scan showed multiple confluent areas of ground-glass opacities, crazy paving pattern, PM, cervical subcutaneous emphysema, and pneumothorax in one case. Management included pharmacological treatment, oxygen supplementation and no acute intervention recommended by cardiothoracic surgery. Case 1: 50-year- old male without past medical history, non-smoker, hypoxic on the day of admission. During the hospital stay, he continued to require increasing levels of oxygen and was subsequently flown to a tertiary care center for higher level of care. Case 2: 38-year- old male admitted with a 7-day history of fever, dyspnea and cought. He continues to be symptomatic with neurological manifestations (COVID19 Encephalopathy). Finally whose dyspnea regressed during hospitalization, he was discharged at his own request to come for control. Case 3: 73-year- old male with a history of hypertension, non-smoker, presented with complaints of shortness of breath for 1 week. He did not receive non invasive positive pressure ventilation. The pneumothorax and PM were managed conservatively. Case 4: 53-year- old lady with no significant past medical history, presented with fever and cough for 10 days and worsening shortness of breath for two days. Progressive deterioration of respiratory function transferred her to the intensive care unit. In view of worsening hypoxia and increased work of breathing, she was intubated on the same day and was started on volume control ventilator support. Despite the support measures she developed multiple organ failure and passed 35 days after the symptoms initiated. Conclusion(s): PM is usually self-limiting and is managed conservatively. Treatment of the underlying causes and least damaging ventilator settings possible to achieve adequate oxygenation are the mainstays in managing PM. COVID-19 patients with PM seem to have a more complicated clinical course and poor outcome.
ABSTRACT
Since the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there have been challenges recognizing the clinical features of SARS‑CoV‑2 and identifying therapeutic options. This has been compounded by viral mutations that affect clinical response and primary epidemiological indicators. Multiple variants of SARS‑CoV‑2 have been identified and classified on the basis of nomenclature implemented by scientific organizations and the World Health Organisation (WHO). A total of five variants of concern (VOCs) have been identified to date. The present study aimed to analyse clinical and epidemiological features of each variant. Based on these characteristics, predictions were made about potential future evolution. Considering the time and location of SARS-CoV-2 VOC emergence, it was hypothesised that mutations were not due to pressure caused by the vaccines introduced in December 2020 but were dependent on natural characteristics of the virus. In the process of adapting to the human body, SARS-CoV-2 is expected to undergo evolution to become more contagious but less deadly. SARS-CoV-2 was hypothesized to continue spread through isolated epidemic outbreaks due to the unimmunized population, mostly unvaccinated children and adults, and for coronaviruses to continue to present a public health problem.
ABSTRACT
Mycobacterium kansasii is a nontuberculous mycobacterium which leads to a chronic pulmonary infection that resembles pulmonary tuberculosis. Symptoms of pulmonary infection with M kansasii may include cough, sputum production, weight loss, breathlessness, chest pain, hemoptysis and fever or sweats.The paper presents the case of a 30-year-old woman, confirmed with moderate SARS-COV2 infection at a county hospital and transferred to "Marius Nasta" Institute for Pneumology for specialty treatment. At admission, the CT exam reveals multiple "tree in bud" lesions and cavity lesions located at the RUL level. Bacteriological examinations for the genus mycobacterium were initially negative, but from the bronchial aspirate, the bacteriological examination was BAAR positive. Genetic testing confirmed mycobacterium infection. Resistance to H, R was not detected. According to the national protocol, antibiotic treatment is initiated with Isoniazid, Rifampicin, Ethambutol and Pyrazinamide. The patient tolerated the treatment well throughout the hospitalization period, as there were no interactions between the treatment for SARS-COV2 and the antibiotic one. Due to the favorable evolution, the patient is discharged one month after starting treatment. As recommendations, the patient must present herself at the territorial TB clinic, in order to continue the antibiotic treatment for up to 6 months.At two months, the culture shows infection with mycobacterium kansassi, thus the treatment is modified by administering Rifampicin, Etambutol and Azithromycin. Following the administration of the new treatment, the lung lesions show regression. In the case of mycobacterium kansassi infections, the treatment will be continued for up to 12 months. The evolution of M. kansassi infection may be influenced by various factors, but in this case the moderate SARS-COV2 infection, cured in 3 weeks, did not influence the favourable evolution. Also, the absence of shortness of breath, as well as the compliance and absence of treatment resistance were keen factors in the evolution under treatment.In conclusion, the patient was initially admitted to the hospital for a moderate COVID-19 infection. The routine CT exam was also suggestive for a possible other pathology, and follow-up tests and examinations led to the discovery of an infection with M. kansassi. The SARS-COV-2 infection had favourable evolution under treatment and was cured in 3 weeks, but the treatment for M. kansassi is long-term and may have effects on the patients' psychology, as well as by the presence of adverse reactions, not following the treatment can be fatal with death occurring in 50% of cases.