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1.
PLoS One ; 17(2): e0263261, 2022.
Article in English | MEDLINE | ID: covidwho-1666769

ABSTRACT

PURPOSE: To evaluate the association between the coronavirus disease 2019 (COVID-19) and post-inflammatory emphysematous lung alterations on follow-up low-dose CT scans. METHODS: Consecutive patients with proven COVID-19 infection and a follow-up CT were retrospectively reviewed. The severity of pulmonary involvement was classified as mild, moderate and severe. Total lung volume, emphysema volume and the ratio of emphysema/-to-lung volume were quantified semi-automatically and compared inter-individually between initial and follow-up CT and to a control group of healthy, age- and sex-matched patients. Lung density was further assessed by drawing circular regions of interest (ROIs) into non-affected regions of the upper lobes. RESULTS: A total of 32 individuals (mean age: 64 ± 13 years, 12 females) with at least one follow-up CT (mean: 52 ± 66 days, range: 5-259) were included. In the overall cohort, total lung volume, emphysema volume and the ratio of lung-to-emphysema volume did not differ significantly between the initial and follow-up scans. In the subgroup of COVID-19 patients with > 30 days of follow-up, the emphysema volume was significantly larger as compared to the subgroup with a follow-up < 30 days (p = 0.045). Manually measured single ROIs generally yielded lower attenuation values prior to COVID-19 pneumonia, but the difference was not significant between groups (all p > 0.05). CONCLUSION: COVID-19 patients with a follow-up CT >30 days showed significant emphysematous lung alterations. These findings may help to explain the long-term effect of COVID-19 on pulmonary function and warrant validation by further studies.


Subject(s)
COVID-19/complications , Pulmonary Emphysema/complications , Pulmonary Emphysema/diagnostic imaging , Radiation Dosage , SARS-CoV-2/genetics , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , Female , Follow-Up Studies , Humans , Lung/physiopathology , Lung Volume Measurements , Male , Middle Aged , Pulmonary Emphysema/physiopathology , Retrospective Studies
2.
Front Immunol ; 12: 798276, 2021.
Article in English | MEDLINE | ID: covidwho-1606542

ABSTRACT

Effects of initiation of programmed-death-protein 1 (PD1) blockade during active SARS-CoV-2 infection on antiviral immunity, COVID-19 course, and underlying malignancy are unclear. We report on the management of a male in his early 40s presenting with highly symptomatic metastatic lung cancer and active COVID-19 pneumonia. After treatment initiation with pembrolizumab, carboplatin, and pemetrexed, the respiratory situation initially worsened and high-dose corticosteroids were initiated due to suspected pneumonitis. After improvement and SARS-CoV-2 clearance, anti-cancer treatment was resumed without pembrolizumab. Immunological analyses with comparison to otherwise healthy SARS-CoV-2-infected ambulatory patients revealed a strong humoral immune response with higher levels of SARS-CoV-2-reactive IgG and neutralizing serum activity. Additionally, sustained increase of Tfh as well as activated CD4+ and CD8+ T cells was observed. Sequential CT scans showed regression of tumor lesions and marked improvement of the pulmonary situation, with no signs of pneumonitis after pembrolizumab re-challenge as maintenance. At the latest follow-up, the patient is ambulatory and in ongoing partial remission on pembrolizumab. In conclusion, anti-PD1 initiation during active COVID-19 pneumonia was feasible and cellular and humoral immune responses to SARS-CoV-2 appeared enhanced in our hospitalized patient. However, distinguishing COVID-19-associated changes from anti-PD1-associated immune-related pneumonitis posed a considerable clinical, radiographic, and immunologic challenge.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/drug therapy , Carcinoma, Non-Small-Cell Lung/drug therapy , Immune Checkpoint Inhibitors/therapeutic use , Lung Neoplasms/drug therapy , SARS-CoV-2/drug effects , Adult , CD8-Positive T-Lymphocytes/drug effects , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/virology , COVID-19/complications , COVID-19/immunology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/immunology , Humans , Immunity, Humoral/drug effects , Immunity, Humoral/immunology , Lung Neoplasms/complications , Lung Neoplasms/immunology , Male , Neoplasm Metastasis , Pneumonia/immunology , Pneumonia/prevention & control , Pneumonia/virology , SARS-CoV-2/immunology
3.
PLoS One ; 16(7): e0255045, 2021.
Article in English | MEDLINE | ID: covidwho-1319524

ABSTRACT

PURPOSE: Cardiovascular comorbidity anticipates severe progression of COVID-19 and becomes evident by coronary artery calcification (CAC) on low-dose chest computed tomography (LDCT). The purpose of this study was to predict a patient's obligation of intensive care treatment by evaluating the coronary calcium burden on the initial diagnostic LDCT. METHODS: Eighty-nine consecutive patients with parallel LDCT and positive RT-PCR for SARS-CoV-2 were included from three centers. The primary endpoint was admission to ICU, tracheal intubation, or death in the 22-day follow-up period. CAC burden was represented by the Agatston score. Multivariate logistic regression was modeled for prediction of the primary endpoint by the independent variables "Agatston score > 0", as well as the CT lung involvement score, patient sex, age, clinical predictors of severe COVID-19 progression (history of hypertension, diabetes, prior cardiovascular event, active smoking, or hyperlipidemia), and laboratory parameters (creatinine, C-reactive protein, leucocyte, as well as thrombocyte counts, relative lymphocyte count, d-dimer, and lactate dehydrogenase levels). RESULTS: After excluding multicollinearity, "Agatston score >0" was an independent regressor within multivariate analysis for prediction of the primary endpoint (p<0.01). Further independent regressors were creatinine (p = 0.02) and leucocyte count (p = 0.04). The Agatston score was significantly higher for COVID-19 cases which completed the primary endpoint (64.2 [interquartile range 1.7-409.4] vs. 0 [interquartile range 0-0]). CONCLUSION: CAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.


Subject(s)
COVID-19/complications , Calcinosis/complications , Calcinosis/diagnostic imaging , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Disease Progression , Radiography, Thoracic , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Pandemics , Prognosis , Radiation Dosage
4.
NPJ Digit Med ; 4(1): 69, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1180281

ABSTRACT

The COVID-19 pandemic has worldwide individual and socioeconomic consequences. Chest computed tomography has been found to support diagnostics and disease monitoring. A standardized approach to generate, collect, analyze, and share clinical and imaging information in the highest quality possible is urgently needed. We developed systematic, computer-assisted and context-guided electronic data capture on the FDA-approved mint LesionTM software platform to enable cloud-based data collection and real-time analysis. The acquisition and annotation include radiological findings and radiomics performed directly on primary imaging data together with information from the patient history and clinical data. As proof of concept, anonymized data of 283 patients with either suspected or confirmed SARS-CoV-2 infection from eight European medical centers were aggregated in data analysis dashboards. Aggregated data were compared to key findings of landmark research literature. This concept has been chosen for use in the national COVID-19 response of the radiological departments of all university hospitals in Germany.

5.
PLoS One ; 15(12): e0244267, 2020.
Article in English | MEDLINE | ID: covidwho-999837

ABSTRACT

BACKGROUND: Cardiovascular comorbidity anticipates poor prognosis of SARS-CoV-2 disease (COVID-19) and correlates with the systemic atherosclerotic transformation of the arterial vessels. The amount of aortic wall calcification (AWC) can be estimated on low-dose chest CT. We suggest quantification of AWC on the low-dose chest CT, which is initially performed for the diagnosis of COVID-19, to screen for patients at risk of severe COVID-19. METHODS: Seventy consecutive patients (46 in center 1, 24 in center 2) with parallel low-dose chest CT and positive RT-PCR for SARS-CoV-2 were included in our multi-center, multi-vendor study. The outcome was rated moderate (no hospitalization, hospitalization) and severe (ICU, tracheal intubation, death), the latter implying a requirement for intensive care treatment. The amount of AWC was quantified with the CT vendor's software. RESULTS: Of 70 included patients, 38 developed a moderate, and 32 a severe COVID-19. The average volume of AWC was significantly higher throughout the subgroup with severe COVID-19, when compared to moderate cases (771.7 mm3 (Q1 = 49.8 mm3, Q3 = 3065.5 mm3) vs. 0 mm3 (Q1 = 0 mm3, Q3 = 57.3 mm3)). Within multivariate regression analysis, including AWC, patient age and sex, as well as a cardiovascular comorbidity score, the volume of AWC was the only significant regressor for severe COVID-19 (p = 0.004). For AWC > 3000 mm3, the logistic regression predicts risk for a severe progression of 0.78. If there are no visually detectable AWC risk for severe progression is 0.13, only. CONCLUSION: AWC seems to be an independent biomarker for the prediction of severe progression and intensive care treatment of COVID-19 already at the time of patient admission to the hospital; verification in a larger multi-center, multi-vendor study is desired.


Subject(s)
COVID-19/diagnostic imaging , Radiation Dosage , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/pathology , Aorta, Thoracic/radiation effects , Aorta, Thoracic/virology , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , Critical Care , Female , Hospitalization , Humans , Intubation, Intratracheal/methods , Lung/diagnostic imaging , Lung/pathology , Lung/radiation effects , Lung/virology , Male , Middle Aged , Patient Admission , SARS-CoV-2/pathogenicity , SARS-CoV-2/radiation effects , Thorax/pathology , Thorax/radiation effects , Thorax/virology
6.
Lancet Infect Dis ; 21(6): e149-e162, 2021 06.
Article in English | MEDLINE | ID: covidwho-974782

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.


Subject(s)
Antifungal Agents/therapeutic use , COVID-19/complications , Coinfection/drug therapy , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/drug therapy , Amphotericin B , Azoles/pharmacology , Humans , Nitriles , Pyridines , SARS-CoV-2 , Triazoles , Voriconazole/therapeutic use
7.
Bone ; 144: 115790, 2021 03.
Article in English | MEDLINE | ID: covidwho-959609

ABSTRACT

BACKGROUND: Besides throat-nose swab polymerase chain reaction (PCR), unenhanced chest computed tomography (CT) is a recommended diagnostic tool for early detection and quantification of pulmonary changes in COVID-19 pneumonia caused by the novel corona virus. Demographic factors, especially age and comorbidities, are major determinants of the outcome in COVID-19 infection. This study examines the extra pulmonary parameter of bone mineral density (BMD) from an initial chest computed tomography as an associated variable of pre-existing comorbidities like chronic lung disease or demographic factors to determine the later patient's outcome, in particular whether treatment on an intensive care unit (ICU) was necessary in infected patients. METHODS: We analyzed 58 PCR-confirmed COVID-19 infections that received an unenhanced CT at admission at one of the included centers. In addition to the extent of pulmonary involvement, we performed a phantomless assessment of bone mineral density of thoracic vertebra 9-12. RESULTS: In a univariate regression analysis BMD was found to be a significant predictor of the necessity for intensive care unit treatment of COVID-19 patients. In the subgroup requiring intensive care treatment within the follow-up period a significantly lower BMD was found. In a multivariate logistic regression model considering gender, age and CT measurements of bone mineral density, BMD was eliminated from the regression analysis as a significant predictor. CONCLUSION: Phantomless assessed BMD provides prognostic information on the necessity for ICU treatment in course of COVID-19 pneumonia. We recommend using the measurement of BMD in an initial CT image to facilitate a potentially better prediction of severe patient outcomes within the 22 days after an initial CT scan. Consequently, in the present sample, additional bone density analysis did not result in a prognostic advantage over simply considering age. Significantly larger patient cohorts with a more homogenous patient age should be performed in the future to illustrate potential effects. CLINICAL RELEVANCE: While clinical capacities such as ICU beds and ventilators are more crucial than ever to help manage the current global corona pandemic, this work introduces an approach that can be used in a cost-effective way to help determine the amount of these rare clinical resources required in the near future.


Subject(s)
Bone Density , COVID-19/diagnostic imaging , COVID-19/physiopathology , Adult , Feasibility Studies , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Phantoms, Imaging , Prognosis , Radiography, Thoracic , Regression Analysis , Tomography, X-Ray Computed , Treatment Outcome
8.
Radiologe ; 60(10): 943-948, 2020 Oct.
Article in German | MEDLINE | ID: covidwho-856129

ABSTRACT

OBJECTIVE: In spring 2020 imaging findings of the lungs were found in several radiological practices and in outpatient clinic patients, which indicated acute or previous viral pneumonia. It was striking that many of the patients affected had only mild symptoms. In this case study it was investigated to what extent SARS-CoV­2 can cause lung involvement even with minor symptoms. MATERIAL AND METHODS: In this study five outpatient radiological centers and two inpatient hospitals in North Rhine-Westphalia and Baden-Württemberg in Germany were involved. The retrospective analysis included outpatients with radiologically detected viral pneumonia, who were examined in March or April 2020. The clinical symptoms were divided into severity levels 1-5 using a simplified clinical score. The lung images were evaluated with respect to features specific for COVID-19 . The presence of a SARS-CoV­2 infection was verified using PCR, antibody testing and/or typical computed tomography (CT) morphology. RESULTS: A total of 50 patients were included, all of whom had radiological signs of viral pneumonia. The majority had no or only few non-specific symptoms (26/50). This was followed by mild symptoms of a flu-like infection (17/50). Severe forms were rare in outpatients (7/50). Detection of COVID-19 was successful in 30/50 cases using PCR and in 4/50 cases using an antibody test. In 16/50 cases the diagnosis was based on typical CT criteria and on the typical COVID patient history. CONCLUSION: A SARS-CoV­2 infection leads to lung involvement more often than previously assumed, namely not only in severely ill hospitalized patients but also in cases with only mild or even non-specific symptoms.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Ambulatory Care , COVID-19 , Germany , Humans , Inflammation , Outpatients , Retrospective Studies , SARS-CoV-2
9.
Eur J Radiol ; 132: 109274, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-753628

ABSTRACT

PURPOSE: Low-dose computed tomography (LDCT) of the chest is a recommended diagnostic tool in early stage of COVID-19 pneumonia. High age, several comorbidities as well as poor physical fitness can negatively influence the outcome within COVID-19 infection. We investigated whether the ratio of fat to muscle area, measured in initial LDCT, can predict severe progression of COVID-19 in the follow-up period. METHOD: We analyzed 58 individuals with confirmed COVID-19 infection that underwent an initial LDCT in one of two included centers due to COVID-19 infection. Using the ratio of waist circumference per paravertebral muscle circumference (FMR), the body composition was estimated. Patient outcomes were rated on an ordinal scale with higher numbers representing more severe progression or disease associated complications (hospitalization/ intensive care unit (ICU)/ tracheal intubation/ death) within a follow-up period of 22 days after initial LDCT. RESULTS: In the initial LDCT a significantly higher FMR was found in patients requiring intensive care treatment within the follow-up period. In multivariate logistic regression analysis, FMR (p < .001) in addition to age (p < .01), was found to be a significant predictor of the necessity for ICU treatment of COVID-19 patients. CONCLUSION: FMR as potential surrogate of body composition and obesity can be easily determined in initial LDCT of COVID-19 patients. Within the multivariate analysis, in addition to patient age, low muscle area in proportion to high fat area represents an additional prognostic information for the patient outcome and the need of an ICU treatment during the follow-up period within the next 22 days. This multicentric pilot study presents a method using an initial LDCT to screen opportunistically for obese patients who have an increased risk for the need of ICU treatment. While clinical capacities, such as ICU beds and ventilators, are more crucial than ever to help manage the current global corona pandemic, this work introduces an approach that can be used for a cost-effective way to help determine the amount of these rare clinical resources required in the near future.


Subject(s)
Body Composition , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Obesity/complications , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Betacoronavirus , COVID-19 , Feasibility Studies , Female , Humans , Male , Middle Aged , Pandemics , Pilot Projects , Predictive Value of Tests , Prognosis , Radiation Dosage , Risk Factors , SARS-CoV-2
10.
Eur J Haematol ; 105(4): 508-511, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-612274

ABSTRACT

The number of people suffering from the new coronavirus SARS-CoV-2 continues to rise. In SARS-CoV-2, superinfection with bacteria or fungi seems to be associated with increased mortality. The role of co-infections with respiratory viral pathogens has not yet been clarified. Here, we report the course of COVID-19 in a CLL patient with secondary immunodeficiency and viral co-infection with parainfluenza.


Subject(s)
COVID-19/complications , Coinfection/complications , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Paramyxoviridae Infections/complications , Antibodies, Viral/blood , COVID-19/immunology , COVID-19/therapy , Humans , IgG Deficiency/complications , IgG Deficiency/immunology , IgG Deficiency/therapy , Immunoglobulins, Intravenous/therapeutic use , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Male , Middle Aged , Pandemics , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology
11.
Mycoses ; 63(6): 528-534, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-547397

ABSTRACT

OBJECTIVES: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Pulmonary Aspergillosis/complications , Respiratory Distress Syndrome/complications , Aged , Antifungal Agents/therapeutic use , Bronchoalveolar Lavage Fluid/chemistry , Bronchoalveolar Lavage Fluid/virology , COVID-19 , Coronavirus Infections/diagnostic imaging , Female , Galactose/analogs & derivatives , Germany , Hemorrhage/etiology , Hospitals, Teaching , Humans , Intensive Care Units , Lung Diseases/etiology , Male , Mannans/analysis , Metapneumovirus/isolation & purification , Middle Aged , Nitriles/therapeutic use , Pandemics , Paramyxoviridae Infections/etiology , Pneumonia, Viral/diagnostic imaging , Pulmonary Aspergillosis/diagnostic imaging , Pyridines/therapeutic use , Respiratory Distress Syndrome/diagnostic imaging , Retrospective Studies , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Triazoles/therapeutic use , Voriconazole/therapeutic use
12.
Rofo ; 192(7): 633-640, 2020 07.
Article in English, German | MEDLINE | ID: covidwho-401514

ABSTRACT

This information provided by the Thoracic Imaging Section of the German Radiological Society is intended to give physicians recommendations on the use of thoracic imaging procedures in the context of the current COVID-19 pandemic. It represents the consensus of the authors based on the previous scientific knowledge and is intended to provide guidance for unified, structured CT reporting if COVID-19 pneumonia is suspected. The recommendations presented correspond to state of knowledge at the time of print and will be updated according to the results of ongoing and future scientific studies. KEY POINTS:: · COVID-19. · chest imaging. · German Radiological Society. CITATION FORMAT: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P et al. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed , COVID-19 , Germany , Humans , Pandemics , Radiography, Thoracic/standards , Radiology/standards , Societies
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