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1.
Indian Journal of Respiratory Care ; 11(1):52-58, 2022.
Article in English | Web of Science | ID: covidwho-1810701

ABSTRACT

Background: Atypical category of COVID-19 could not be differentiated from tuberculosis (TB) in high-resolution computed tomography (HRCT) of the chest because of similar imaging features. This study aims to distinguish between the HRCT features of TB and atypical COVID-19. Methodology: Interferon-gamma release assay (IGRA) was performed in all the 54 COVID-positive patients, showing atypical COVID features that are suspicious of TB on the HRCT chest. Atypical imaging features such as a tree in bud nodules, patchy consolidations, cavitation with surrounding consolidation, discrete nodules, mediastinal lymphadenopathy, and pleural effusion were analyzed in 50 IGRA-negative patients. Results: We found trees in bud nodules (93%) and consolidations (56%) involving predominantly lower lobes, i.e., superior and posterobasal segments. Discrete nodules and cavitation with surrounding consolidation were seen involving predominantly upper lobes (78 and 57% cases, respectively), i.e., apicoposterior and lingular segments of the left upper lobe. The maximum number (67%) of right paratracheal enlarged nodes and bilateral pleural effusions (71%) were found in IGRA-negative COVID-19 patients. Conclusions: It is not always possible to differentiate features of atypical COVID-19 from TB based on HRCT chest alone because of similar appearances and distribution of tree in bud nodules, consolidation, cavitation, and lymphadenopathy in HRCT chest. Since both bilateral and unilateral pleural effusions may be seen in TB, it is impossible to differentiate COVID-19 from TB based on pleural effusion. Therefore, exclusion of TB will need supportive, relevant laboratory investigations (Sputum acid fast bacilli, cartridge-based nucleic acid amplification test, and IGRA) for appropriate diagnosis and management.

2.
Indian Journal of Respiratory Care ; 11(1):67-70, 2022.
Article in English | Web of Science | ID: covidwho-1810698

ABSTRACT

Barotrauma has many different presentations, including pneumothorax, subcutaneous emphysema, pneumoperitoneum, and pneumomediastinum. We have presented and analyzed some interesting cases of barotrauma in this case series. Case 1 in our series developed a thin-walled new cavity due to barotrauma, mimicking pneumatocele and fungal cavity. Case 2 presented with coexistence of pneumothorax and cavity with fungal infestation. Severity of barotrauma due to positive pressure ventilation has been shown in case 3. An interesting case of barotrauma in a 36-week primigravida, post cesarean section, causing dehiscence of scar, presented as case 4 in our series. Early and rapid imaging diagnosis of barotrauma should be pursued. In patients with mechanical ventilation, identifying small changes in imaging characteristics of cavitary lesions, such as fungal, bacterial, or transient cavities, would aid physicians in offering a correct treatment plan.

3.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1799083

ABSTRACT

Background: The occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India. Several reports related to rhino-nasal-sinus mucormycosis in COVID patients have been published in recent times;however, very less has been reported about invasive pulmonary fungal infections caused mainly by mucor, aspergillus or invasive candida species. We aimed to present 6 sputum culture proved cases of invasive pulmonary fungal infection (four mucormycosis and two invasive candidiasis) in COVID patients, the clues for the diagnosis of fungal invasion as well as difficulties in diagnosing it due to superimposed COVID imaging features. Case presentation: The HRCT imaging features of the all 6 patients showed signs of fungal invasion in the form of cavities formation in the pre-existing reverse halo lesions or development of new irregular margined soft tissue attenuating growth within the pre-existing or in newly formed cavities. Five out of six patients were diabetics. Cavities in cases 1, 2, 3 and 4 of mucormycosis were aggressive and relatively larger and showed relatively faster progression into cavities in comparison with cases 5 and 6 of invasive candidiasis. Conclusion: In poorly managed diabetics or with other immunosuppressed conditions, invasive fungal infection (mucormycosis, invasive aspergillosis and invasive candidiasis) should be considered in the differential diagnosis of cavitary lung lesions.

4.
Egyptian Journal of Radiology and Nuclear Medicine ; 52(1), 2021.
Article in English | EMBASE | ID: covidwho-1511768

ABSTRACT

Background: There has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM. Case presentation: Rhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed. Conclusion: Uncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.

5.
Journal of Clinical and Diagnostic Research ; 15(3):TC01-TC05, 2021.
Article in English | EMBASE | ID: covidwho-1160406

ABSTRACT

Introduction: An early diagnosis of Coronavirus Disease (COVID-19) is of utmost importance, so that patients can be isolated and treated in time, eventually preventing spread of the disease, improving the prognosis and reducing the mortality. High Resolution Computed Tomography (HRCT) chest imaging and Artificial Intelligence (AI) driven analysis of HRCT chest images can play a vital role in management of COVID-19 patients. Aim: To explore the various HRCT chest findings in different phases of COVID-19 pneumonia and to assess the potential role of AI in quantitative assessment of lung parenchymal involvement in COVID-19 pneumonia. Materials and Methods: The present retrospective observational study which was conducted between 1st May 2020 to 13th August 2020. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) positive 2169 COVID-19 patients who underwent HRCT chest were included in the study. Presence and distribution of lesions like: Ground Glass Opacity (GGO), consolidation and any specific patterns like septal thickening, reverse halo, sign, etc., were noted in the HRCT images. HRCT chest findings in different phases of disease (Early: <5 days, Intermediate: 6-10 days and Late phase: >10 days) were assessed. CT Severity Score (CTSS) was calculated based on the extent of lung involvement on HRCT, which was then correlated with the clinical severity of the disease. Artificial Intelligence powered "CT Pneumonia analysis" algorithm was used to quantify the extent of involvement of lungs by calculating Percentage of Opacity (PO) and Percentage of High Opacity (PHO) in lungs. Tests of statistical significance, like Chi-square, Analysis of Variance (ANOVA) and Post-hoc tests were applied depending on the type of variables, wherever applicable. Results: Radiological findings were seen in HRCT chest of 1438 patients. Typical pattern of COVID-19 pneumonia, i.e., bilateral, peripherally located GGO with or without consolidation was seen in 846 patients. About 294 asymptomatic patients were found to be radiologically positive. HRCT chest in the early phase of disease mostly showed GGO. Features like increased reticulation, predominance of consolidation, presence of fibrous stripes indicated late phase. About 91.3% of cases having CTSS ≤7 were asymptomatic or clinically mild whereas, 81.2% cases having score ≥15 were clinically severe. The mean PO and PHO (30.1±28.0 and 8.4±10.4, respectively) were remarkably higher in clinically severe category. Conclusion: Progression of COVID-19 pneumonia is rapid, so radiologists and clinicians need to get familiarised with the typical CT chest findings, hence patients can be treated on time, eventually improving the prognosis and reducing the mortality. Artificial Intelligence has the potential to be a valuable tool in management of COVID-19 patients.

6.
Journal of Clinical and Diagnostic Research ; 15(2):4, 2021.
Article in English | Web of Science | ID: covidwho-1129836

ABSTRACT

Introduction: Novel Coronavirus-2019 (nCoV-2019) is capable of human-to-human transmission and can lead to acute respiratory distress syndrome similar to Middle East Respiratory Syndrome (MERS) due to lung parenchyma destruction. Some patients with COVID-19 consistently demonstrated no hypoxaemia, however, some patients develop sense of difficulty in breathing due to increased airway resistance. Aim: To assess the potential of High Resolution Computed Tomography (HRCT) thorax as an early predictor of hypoxaemia in COVID-19 patients. Materials and Methods: A prospective longitudinal cohort study of 1000 Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 and HRCT thorax positive patients, who were monitored simultaneously for SpO(2) levels, were undertaken. HRCT findings were graded into Computerised Tomography Severity Index (CTSI) and correlated with patient's SpO(2) levels, at the time of scan on admission. Patients, who had normal SpO(2) levels (>= 95%) at the time of initial scan, were monitored upto five days. Pearson's correlation test was used to find correlation between CTSI and SpO(2) levels. Results: In present study group there was male predominance (4:1). Fever was the most common clinical presentation followed by cough. HRCT thorax features were categorised as Typical 769 (76.9%), Indeterminate 176 (17.6%) and atypical 55 (5.5%). 371 (82.8%) patients with SpO(2) >95% were having CTSI between 0-7, similarly 189 (54.4%) patients with SpO(2) 90-94% were having CTSI between 8-15 and 133 (64.8%) patients with SpO(2) <90% were having CTSI between 16-25. So, the present study categorised the patients into three groups-Category 1 (CTSI 0-7), Category 2 (CTSI 8-15) and Category 3 (CTSI 16-25) for better and prompt identification of clinical severity and their management. Majority of patients in CTSI category 1, 2 and 3 were having SpO(2) levels >= 95%, 90-94% and <90%, respectively. Statistical correlation between CTSI and SpO(2) levels at the time of initial scan was significant (Pearson's correlation coefficient (r)=-0.261 and p-value <0.01). Number of patients who developed hypoxaemia (SpO(2) <95%) on follow-up in CTSI Category 1, 2 and 3 were 42 (11.32%), 10 15.87%) and 2 (14.28%), respectively. The association between CTSI and development of hypoxaemia based on follow-up SpO(2) levels was statistically found to be insignificant (chi-square value=1.21, degree of freedom (d.f.) 2 and p-value=0.570). Conclusion: In present study group, a negative correlation was established between CTSI and SpO(2) levels. The association between CTSI and development of hypoxaemia on follow-up SpO(2) monitoring was found to be non-significant statistically. So, HRCT thorax cannot be relied upon as an early predictor of hypoxaemia in COVID-19 patients.

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