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1.
BMJ Case Rep ; 14(10)2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1495131

ABSTRACT

Acute COVID-19 usually lasts 4 weeks from the onset of symptoms. We report two cases of COVID-19-associated organising pneumonia (OP) occurring beyond 4 weeks from the acute onset of symptoms. Both tested positive for SARS reverse transcription-PCR 2 months before presentation with a resolution of respiratory symptoms. The first case presented with residual fatigue and worsening exertional dyspnoea. Chest CT revealed an OP pattern. The second case presented with worsening cough and new-onset pleuritic chest pain with persistent radiological consolidation. A transbronchial lung biopsy confirmed OP. Both patients responded well to 12 weeks of steroid therapy. This case illustrates the rare presentation of OP as a late sequela of COVID-19 and the good response to steroid therapy.


Subject(s)
COVID-19 , Cryptogenic Organizing Pneumonia , Pneumonia , Cough/etiology , Cryptogenic Organizing Pneumonia/diagnostic imaging , Cryptogenic Organizing Pneumonia/drug therapy , Humans , Lung/diagnostic imaging , Pneumonia/diagnosis , Pneumonia/drug therapy , Pneumonia/etiology , SARS-CoV-2
2.
Clin Infect Dis ; 73(2): e513-e522, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1493765

ABSTRACT

BACKGROUND: For pediatric pneumonia, the meteorological and air pollution indicators have been frequently investigated for their association with viral circulation but not for their impact on disease severity. METHODS: We performed a 10-year prospective, observational study in 1 hospital in Chongqing, China, to recruit children with pneumonia. Eight commonly seen respiratory viruses were tested. Autoregressive distributed lag (ADL) and random forest (RF) models were used to fit monthly detection rates of each virus at the population level and to predict the possibility of severe pneumonia at the individual level, respectively. RESULTS: Between 2009 and 2018, 6611 pediatric pneumonia patients were included, and 4846 (73.3%) tested positive for at least 1 respiratory virus. The patient median age was 9 months (interquartile range, 4‒20). ADL models demonstrated a decent fitting of detection rates of R2 > 0.7 for respiratory syncytial virus, human rhinovirus, parainfluenza virus, and human metapneumovirus. Based on the RF models, the area under the curve for host-related factors alone was 0.88 (95% confidence interval [CI], .87‒.89) and 0.86 (95% CI, .85‒.88) for meteorological and air pollution indicators alone and 0.62 (95% CI, .60‒.63) for viral infections alone. The final model indicated that 9 weather and air pollution indicators were important determinants of severe pneumonia, with a relative contribution of 62.53%, which is significantly higher than respiratory viral infections (7.36%). CONCLUSIONS: Meteorological and air pollution predictors contributed more to severe pneumonia in children than did respiratory viruses. These meteorological data could help predict times when children would be at increased risk for severe pneumonia and when interventions, such as reducing outdoor activities, may be warranted.


Subject(s)
Air Pollution , Pneumonia , Respiratory Syncytial Virus, Human , Respiratory Tract Infections , Virus Diseases , Air Pollution/adverse effects , Air Pollution/analysis , Child , China/epidemiology , Humans , Infant , Pneumonia/epidemiology , Pneumonia/etiology , Prospective Studies , Weather
4.
Med Hypotheses ; 146: 110396, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1386308

ABSTRACT

We have reviewed a considerable amount of recent scientific papers relating inflammation caused by air pollution with chronic and severe medical conditions. Furthermore, there are evidences relating organ inflammation caused by not only outdoor long-term but also short-term inhaled radioisotopes contained in high polluted air or in household natural radioactive background aerosols, in addition to SARS-COV-2 attached to bioaerosols, which are related with a worst evolution of severe acute respiratory syndrome patients. Reactive oxygen species (ROS) production induced by the interaction with environmental ionizing radiation contained in pollution is pointed out as a critical mechanism that predispose mainly to elder population, but not excluding young subjects, presenting previous chronic conditions of lung inflammation or neuroinflammation, which can lead to the most serious consequences.


Subject(s)
Air Pollution, Radioactive/adverse effects , COVID-19/etiology , Climate Change , Inflammation/etiology , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , SARS-CoV-2/pathogenicity , Aerosols , Air Microbiology , COVID-19/mortality , Causality , Humans , Inflammasomes/metabolism , Inflammasomes/radiation effects , Models, Biological , Nervous System Diseases/etiology , Pandemics , Particle Size , Particulate Matter/adverse effects , Pneumonia/etiology
5.
Lupus ; 30(11): 1856-1862, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1374060

ABSTRACT

Acute lupus pneumonitis (ALP) is a rare first-presenting manifestation of systemic lupus erythematosus (SLE). The characteristic symptoms are rapid onset of fever, cough (sometimes with hemoptysis), and dyspnea. ALP may progress to acute respiratory distress syndrome (ARDS), and it is a potentially fatal disease unless treated. Coronavirus disease 19 (COVID-19) has overlaps with ALP in terms of clinical presentation, and laboratory and radiological findings. This report describes a case of a young female patient presenting with ARDS during the pandemic of COVID-19. She had pancytopenia, elevated CRP, ferritin, and liver indices resembling macrophage activation syndrome. She also had hepatosplenomegaly, a small spleen infarct, adenopathy, minimal pleural, and pericardial effusion. After excluding COVID-19 by PCR and antibody tests, and other infections by cultures, with the help of antinuclear antibody and anti-double-stranded DNA, SLE and ALP were diagnosed, and she was treated with high-dose steroid and intravenous immunoglobulin. In conclusion, if patients presenting with pneumonia or ARDS have one or more of the findings of arthritis, serositis, rash, oral/nasopharyngeal ulcerations, cytopenias, and renal or neurologic disorder, SLE and ALP should be considered in differential diagnoses. Because of the high mortality rate of ALP reaching up to 50%, early diagnosis and immunosuppressive therapy are of vital importance.


Subject(s)
Lupus Erythematosus, Systemic/complications , Pneumonia/etiology , Respiratory Distress Syndrome/etiology , COVID-19/diagnosis , COVID-19/epidemiology , Cough/etiology , Diagnosis, Differential , Dyspnea/etiology , Female , Fever/etiology , Humans , Lupus Erythematosus, Systemic/diagnosis , Pandemics , Pneumonia/diagnosis , Respiratory Distress Syndrome/diagnosis , SARS-CoV-2 , Young Adult
6.
Respir Care ; 66(11): 1657-1664, 2021 11.
Article in English | MEDLINE | ID: covidwho-1372107

ABSTRACT

BACKGROUND: Survivors of coronavirus disease 2019 (COVID-19) associated pneumonia may show exercise-induced desaturation. We wondered whether these individuals show physiologic and symptom characteristics similar to individuals with chronic respiratory diseases with exercise-induced desaturation, namely COPD or interstitial lung diseases (ILD). We evaluated lung function, exercise capacity, and symptoms in these individuals compared with individuals with COPD or ILD and exercise-induced desaturation. METHODS: Survivors of COVID-19 associated pneumonia (study individuals), normoxemic at rest with exercise-induced desaturation, underwent assessment of dyspnea, dynamic lung volumes, carbon monoxide diffusion capacity, and the 6-min walk test. Data of individuals with COPD or with ILD and exercise-induced desaturation were also retrospectively analyzed. RESULTS: FVC was lower in individuals with COVID-19 or ILD than in those with COPD. Individuals who had COVID-19 walked < 70% of predicted and, as a whole, had a 6-min walk test performance similar to individuals with ILD but walked significantly less, showed more severe leg fatigue and dyspnea during exercise, and more exercise-induced desaturation than individuals with COPD. CONCLUSIONS: Survivors of COVID-19 associated pneumonia, who were normoxemic at rest with exercise-induced desaturation, had alterations in lung function, exercise capacity, and symptoms similar to individuals with ILD but more severe than individuals with COPD and exercise-induced desaturation.


Subject(s)
COVID-19 , Pneumonia , Exercise Test , Humans , Pneumonia/etiology , Retrospective Studies , SARS-CoV-2 , Survivors
7.
Medicine (Baltimore) ; 100(31): e26692, 2021 Aug 06.
Article in English | MEDLINE | ID: covidwho-1354336

ABSTRACT

ABSTRACT: To investigate computed tomography (CT) diagnostic reference levels for coronavirus disease 2019 (COVID-19) pneumonia by collecting radiation exposure parameters of the most performed chest CT examinations and emphasize the necessity of low-dose CT in COVID-19 and its significance in radioprotection.The survey collected RIS data from 2119 chest CT examinations for 550 COVID-19 patients performed in 92 hospitals from January 23, 2020 to May 1, 2020. Dose data such as volume computed tomography dose index, dose-length product, and effective dose (ED) were recorded and analyzed. The radiation dose levels in different hospitals have been compared, and average ED and cumulative ED have been studied.The median dose-length product, volume computed tomography dose index, and ED measurements were 325.2 mGy cm with a range of 6.79 to 1098 mGy cm, 9.68 mGy with a range of 0.62 to 33.80 mGy, and 4.55 mSv with a range of 0.11 to 15.37 mSv for COVID-19 CT scanning protocols in Chongqing, China. The distribution of all observed EDs of radiation received by per patient undergoing CT protocols during hospitalization yielded a median cumulative ED of 17.34 mSv (range, 2.05-53.39 mSv) in the detection and management of COVID-19 patients. The average number of CT scan times for each patient was 4.0 ±â€Š2.0, and the average time interval between 2 CT scans was 7.0 ±â€Š5.0 days. The average cumulative ED of chest CT examinations for COVID-19 patients in Chongqing, China greatly exceeded public limit and the annual dose limit of occupational exposure in a short period.For patients with known or suspected COVID-19, a chest CT should be performed on the principle of rapid-scan, low-dose, single-phase protocol instead of routine chest CT protocol to minimize radiation doses and motion artifacts.


Subject(s)
COVID-19/diagnostic imaging , Pneumonia/diagnostic imaging , Radiation Dosage , Tomography, X-Ray Computed/classification , Adult , COVID-19/complications , China , Female , Humans , Male , Middle Aged , Pneumonia/etiology , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/statistics & numerical data
8.
Curr Opin Crit Care ; 27(5): 468-473, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1331613

ABSTRACT

PURPOSE OF REVIEW: The aim of this review is to provide an overview of the current evidence of secondary pneumonias in COVID-19 patients, its incidence, risk factors and impact outcomes. RECENT FINDINGS: Early studies reported low incidence of hospital-acquired infections in COVID-19 patients. More recent large studies clearly showed that the incidence of secondary pneumonias was markedly high in patients under mechanical ventilation. Duration of mechanical ventilation, acute respiratory distress syndrome, prone position and male sex were identified as risk factors. The adjunctive therapy with steroids and immunomodulators were associated with a higher risk of pneumonia and invasive pulmonary Aspergillosis. Although secondary pneumonias seemed to be associated with poor outcomes, namely mortality, in comparison with influenza, no difference was found in heterogeneity of outcomes. Immunosuppressive therapy has been studied in several observational and randomized trials with conflicting results and the true impact on superinfections, namely secondary pneumonias, has not been properly assessed. SUMMARY: According to the current evidence, COVID-19 patients are at an increased risk of secondary pneumonias. The impact of immunosuppressive therapies on superinfections is yet to be determined. Further studies are needed to assess the true risk of secondary infections associated with immunosuppressive therapies and to identify preventive strategies.


Subject(s)
COVID-19 , Pneumonia , Critical Illness , Humans , Male , Pneumonia/epidemiology , Pneumonia/etiology , Respiration, Artificial/adverse effects , Risk Factors , SARS-CoV-2
9.
J Res Health Sci ; 21(2): e00512, 2021 May 26.
Article in English | MEDLINE | ID: covidwho-1326174

ABSTRACT

BACKGROUND: This study aimed to analyze the demographic and epidemiological features of identified COVID-19 cases in Kazakhstan. STUDY DESIGN: A cross-sectional study. METHODS: This cross-sectional study aimed to analyze COVID-19 cases (n=5116) collected from March 13 to June 6, 2020, in Kazakhstan. The data were obtained from a state official medical electronic database. The study investigated the geographic and demographic data of patients as well as the association of COVID-19 cases with gender and age. The prevalence of symptoms, the presence of comorbidities, complications, and COVID-19 mortality were determined for all patients. RESULTS: The mean±SD age of the patients in this study was 34.8±17.6 years, and the majority (55.7%) of COVID-19 cases were male and residents of cities (79.6%). In total, 80% of the cases had the asymptomatic/mild form of the disease. Cough (20.8 %) and sore throat (17.1%) were the most common symptoms among patients, and pneumonia was diagnosed in 1 out of 5 cases. Acute respiratory distress syndrome (ARDS) was recorded in 1.2% of the patients. The fatality rate was 1% in the study population and lethality was 2.6 times higher in males compared to females.  Each additional year in age increased the probability of COVID-19 infection by 1.06 times. The presence of cardiovascular, diabetes, respiratory, and kidney diseases affected the rate of mortality (P<0.05). CONCLUSION: The results demonstrated a high proportion (40%) of the asymptomatic type of coronavirus infection in the Kazakhstan population. The severity of COVID-19 symptoms and lethality were directly related to the age of patients and the presence of comorbidities.


Subject(s)
COVID-19 , Carrier State/virology , Cough/etiology , Pandemics , Pharyngitis/etiology , Adolescent , Adult , Age Factors , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/mortality , COVID-19/virology , Carrier State/epidemiology , Child , Comorbidity , Cough/epidemiology , Cross-Sectional Studies , Female , Humans , Kazakhstan/epidemiology , Male , Middle Aged , Pharyngitis/epidemiology , Pneumonia/epidemiology , Pneumonia/etiology , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/etiology , Retrospective Studies , SARS-CoV-2 , Sex Factors , Young Adult
10.
Mikrobiyol Bul ; 55(3): 342-356, 2021 Jul.
Article in Turkish | MEDLINE | ID: covidwho-1325951

ABSTRACT

Limited data exists to date on the predictors for the development of pneumonia in patients with mild and moderate coronavirus (COVID-19). In this study, it was aimed to evaluate the demographic characteristics and clinical findings of mild and moderate COVID-19 and to determine the risk factors for the development of COVID-19 pneumonia in patients admitted to the pandemic outpatient clinic of a university hospital. A total of 414 patients with laboratory confirmed COVID-19 were included. Of these, 220 (53.1%) were male, the mean age was 38.3 ± 12.7. Median duration of hospital admission from the onset of symptoms was three days (0-11). Of the confirmed COVID-19 cases, 154 (37.2%) had a history of family contact and the most common symptoms were weakness (68.4%), myalgia (61.8%), headache (56.5%), loss of smell (45.2%), loss of taste (43.2%) and anorexia (42.8%). Among females, weakness (p= 0.016), headache (p= 0.008), sore throat (p= 0.032), nausea (p= 0.003), anorexia (p= 0.045), loss of taste (p= 0.005) and loss of smell (p<0.001) were more common. Loss of taste (47.6% vs. 25%, p<0.001) and loss of smell (50% vs. 26.3%, p<0.001) were more common in patients with under the age of 50 and cough (43.4% vs. 29.3%, p= 0.003) was more common in patients with above the age of 40. Among 46 (11.1%) patients with asymptomatic COVID-19, there was no significant difference (p= 0.500) between the genders. Pneumonia was detected in 150 (43.8%) of 339 patients who underwent thorax computed tomography. In the univariate analysis; advanced age (p<0.001, odds ratio (OR)= 1.44), obesity (p<0.001 OR= 2.5), not being actively smoking (p<0.001, OR= 6.19), fever at first admission (p= 0.002, OR= 2.02), cough (p<0.001, OR= 3.26), shortness of breath (p<0.001, OR= 23.37), weakness (p= 0.042, OR= 1.63), anorexia (p= 0.009, OR= 1.79) and elevation of D-dimer (p= 0.014, OR= 1.92) were associated with the development of pneumonia. In multivariate analysis, obesity (p= 0.005, OR= 2.69), not being actively smoking (p<0.001, OR= 5.43), cough at first admission p= 0.017, OR= 2.16) and shortness of breath (p= 0.008, OR= 16.22) was determined as an independent risk factor for the development of pneumonia. CRP (p<0.001), D-dimer (p<0.001), ferritin (p<0.001) values among 108 (26.1%) patients with a body-mass index(BMI) >30 were high, and 60.9% of the patients had pneumonia (p<0.001) . CRP (p<0.001), D-dimer (p= 0.010) values were low, lymphocyte count (p= 0.001) was high among 106 (25.6%) active smokers, and 15.6% of the patients had pneumonia (p<0.001). Of the patients reported with persistent symptoms, 25.9% had loss of smell, 25% had weakness, and 23.1% had loss of taste on the seventh day; 21.1% had loss of smell, 21.1% had myalgia, and 19.7% had loss of taste on the 14th day. During their follow-up, the COVID-19 polymerase chain reaction (PCR) test was studied in 286 patients for control purposes. The median time of being negative for COVID-19 PCR test was eight days (3-56). In conclusion, symptoms may last longer than 14 days in 20- 30% of patients presenting with mild-moderate clinical findings. In addition, obesity should be considered as an important risk factor for COVID-19 pneumonia.


Subject(s)
COVID-19 , Pneumonia , Adult , Female , Hospitalization , Humans , Male , Middle Aged , Pneumonia/epidemiology , Pneumonia/etiology , Risk Factors , SARS-CoV-2
13.
JBJS Case Connect ; 11(2)2021 06 08.
Article in English | MEDLINE | ID: covidwho-1261314

ABSTRACT

CASE: A 57-year-old woman with a history of COVID-19 pneumonia, myelodysplastic syndrome, type II diabetes mellitus, and nonalcoholic steatohepatitis underwent elective total hip arthroplasty 3 months after her COVID-19 infection had clinically resolved. Her postoperative course was complicated by COVID-19-negative pneumonia within 24 hours postoperatively requiring ICU admission. CONCLUSION: Patients who have previously recovered from COVID-19 infection may have long-lasting cardiopulmonary effects that may be asymptomatic. Further assessment of postoperative risk and guidance on preoperative evaluation of COVID-19 "survivors" is needed.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , COVID-19/complications , Pneumonia/etiology , Postoperative Complications/etiology , Female , Humans , Middle Aged
14.
J Clin Pharmacol ; 61(11): 1406-1414, 2021 11.
Article in English | MEDLINE | ID: covidwho-1241509

ABSTRACT

Glucocorticoids are frequently prescribed in inflammatory diseases and have recently experienced a boom in the treatment of COVID-19. Small studies have shown an effect of glucocorticoids on inflammatory marker levels, but definitive proof is lacking. We investigated the influence of prednisone on inflammatory biomarkers in a previous multicenter, randomized, placebo-controlled trial that compared a 7-day treatment course of 50-mg prednisone to placebo in patients hospitalized with community-acquired pneumonia. We compared levels of C-reactive protein (CRP), procalcitonin (PCT), leukocyte and neutrophil count between patients with and without glucocorticoid treatment at baseline and on days 3, 5, and 7 and at discharge by Wilcoxon tests and analysis of variance. A total of 356 patient data sets in the prednisone group and 355 in the placebo group were available for analysis. Compared to placebo, use of prednisone was associated with reductions in levels of CRP on days 3, 5, and 7 (mean difference of 46%, P < .001 for each time point). For PCT, no such difference was observed. Leukocyte and neutrophil count were higher in the prednisone group at all time points (mean difference of 27% for leukocytes and 33% for neutrophils, P <.001 for all time points). We conclude that after administration of glucocorticoids in community-acquired pneumonia, patients had lower CRP levels and increased leukocyte and neutrophil count as compared to the placebo group. PCT levels were not different between treatment groups. PCT levels thus may more appropriately mirror the resolution of infection compared to more traditional inflammatory markers.


Subject(s)
C-Reactive Protein/analysis , COVID-19 , Community-Acquired Infections , Leukocyte Count/methods , Pneumonia , Prednisone/administration & dosage , Procalcitonin/blood , Aged, 80 and over , Analysis of Variance , Biomarkers, Pharmacological/blood , COVID-19/drug therapy , COVID-19/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Drug Monitoring/methods , Female , Glucocorticoids/administration & dosage , Humans , Male , Pneumonia/blood , Pneumonia/drug therapy , Pneumonia/epidemiology , Pneumonia/etiology , SARS-CoV-2 , Statistics, Nonparametric
15.
Eur Rev Med Pharmacol Sci ; 25(9): 3610-3613, 2021 May.
Article in English | MEDLINE | ID: covidwho-1232733

ABSTRACT

OBJECTIVE: The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS: The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS: Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS: This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies.


Subject(s)
COVID-19/diagnosis , COVID-19/mortality , Death Certificates , COVID-19/complications , Cause of Death/trends , Diabetes Mellitus/diagnosis , Diabetes Mellitus/mortality , Epidemics , Humans , Italy/epidemiology , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/mortality
16.
PLoS Pathog ; 17(4): e1009531, 2021 04.
Article in English | MEDLINE | ID: covidwho-1231265

ABSTRACT

Most individuals who consume foods contaminated with the bacterial pathogen Listeria monocytogenes (Lm) develop mild symptoms, while others are susceptible to life-threatening systemic infections (listeriosis). Although it is known that the risk of severe disease is increased in certain human populations, including the elderly, it remains unclear why others who consume contaminated food develop listeriosis. Here, we used a murine model to discover that pulmonary coinfections can impair the host's ability to adequately control and eradicate systemic Lm that cross from the intestines to the bloodstream. We found that the resistance of mice to oral Lm infection was dramatically reduced by coinfection with Streptococcus pneumoniae (Spn), a bacterium that colonizes the respiratory tract and can also cause severe infections in the elderly. Exposure to Spn or microbial products, including a recombinant Lm protein (L1S) and lipopolysaccharide (LPS), rendered otherwise resistant hosts susceptible to severe systemic Lm infection. In addition, we show that this increase in susceptibility was dependent on an increase in the production of interleukin-10 (IL-10) from Ncr1+ cells, including natural killer (NK) cells. Lastly, the ability of Ncr1+ cell derived IL-10 to increase disease susceptibility correlated with a dampening of both myeloid cell accumulation and myeloid cell phagocytic capacity in infected tissues. These data suggest that efforts to minimize inflammation in response to an insult at the respiratory mucosa render the host more susceptible to infections by Lm and possibly other pathogens that access the oral mucosa.


Subject(s)
Listeria monocytogenes/immunology , Listeriosis/immunology , Pneumonia/immunology , Animals , Disease Progression , Disease Susceptibility , Female , Interleukin-10/metabolism , Killer Cells, Natural/metabolism , Killer Cells, Natural/physiology , Lipopolysaccharides , Listeria monocytogenes/pathogenicity , Listeriosis/complications , Listeriosis/pathology , Male , Mice , Mice, Inbred C57BL , Mice, Transgenic , Mouth Diseases/complications , Mouth Diseases/immunology , Mouth Diseases/microbiology , Mouth Diseases/pathology , Pneumonia/complications , Pneumonia/etiology , Pneumonia/pathology
17.
J Clin Neurosci ; 88: 108-112, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1174389

ABSTRACT

The novel human coronavirus disease (COVID-19) has been associated with vascular and thrombotic complications, some of which may result from endothelial dysfunction, including the posterior reversible encephalopathy syndrome (PRES). We report a case series of 8 patients with COVID-19 and PRES diagnosed at two academic medical centers between March and July of 2020. The clinical, laboratory and radiographic data, treatment, and short-term outcomes were retrospectively analyzed. The mean age was 57.9 ± 12 years, and 50% were women. Four patients had previous vascular comorbidities. All the patients suffered from severe pneumonia, requiring intensive care unit admission. Five patients were not hypertensive at presentation (all SBP < 127 mmHg). Neurologic symptoms included seizures in 7 patients; impaired consciousness in 5 patients; focal neurological signs in 3 patients; and visual disturbances in 1 patient. All patients underwent brain magnetic resonance imaging which indicated asymmetric T2 prolongation or diffusion changes (50%), extensive fronto-parieto-occipital involvement (25%), vascular irregularities (12.5%) and intracranial hemorrhage (25%). Four patients were treated with tocilizumab. Three patients were discharged without neurologic disability, 2 patients had persistent focal neurologic deficits and 2 expired. One patient's prognosis remains guarded. Together, these data support the relationship between PRES and endothelial dysfunction associated with severe COVID-19. In patients with severe COVID-19, PRES can be triggered by uncontrolled hypertension, or occur independently in the setting of systemic illness and certain medications. Like other infectious processes, critically ill patients with COVID-19 may be at greater risk of PRES because of impaired vasoreactivity or the use of novel agents like Tocilizumab.


Subject(s)
COVID-19/complications , Posterior Leukoencephalopathy Syndrome/etiology , Adult , Aged , Brain/diagnostic imaging , Comorbidity , Consciousness Disorders/etiology , Critical Care/statistics & numerical data , Critical Illness , Cytokine Release Syndrome/epidemiology , Cytokine Release Syndrome/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Pneumonia/etiology , Pneumonia/therapy , Retrospective Studies , Seizures/etiology , Vision Disorders/etiology
18.
Biomarkers ; 26(2): 114-118, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1165038

ABSTRACT

INTRODUCTION: Coronavirus disease-2019 (COVID-19) with lung involvement frequently causes morbidity and mortality. Advanced age appears to be the most important risk factor. The receptor for advanced glycation end-product (RAGE) pathway is considered to play important roles in the physiological aging and pathogenesis of lung diseases. This study aimed to investigate the possible relationship between COVID-19 and RAGE pathway. MATERIALS AND METHODS: This study included 23 asymptomatic patients and 35 patients with lung involvement who were diagnosed with COVID-19 as well as 22 healthy volunteers. Lung involvement was determined using computed tomography. Serum soluble-RAGE (sRAGE) levels were determined using enzyme-linked immunosorbent assay. RESULTS: The sRAGE levels were significantly higher in the asymptomatic group than in the control group. Age, fibrinogen, C-reactive protein, and ferritin levels were higher and the sRAGE level was lower in the patients with lung involvement than in the asymptomatic patients. CONCLUSIONS: In this study, patients with high sRAGE levels were younger and had asymptomatic COVID-19. Patients with low sRAGE levels were elderly patients with lung involvement, which indicates that the RAGE pathway plays an important role in the aggravation of COVID-19.


Subject(s)
Antigens, Neoplasm/metabolism , COVID-19/physiopathology , Mitogen-Activated Protein Kinases/metabolism , Signal Transduction , Adult , Aged , Aging , COVID-19/complications , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pneumonia/diagnostic imaging , Pneumonia/etiology , Tomography, X-Ray Computed
19.
Curr Opin Infect Dis ; 34(2): 169-174, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1112129

ABSTRACT

PURPOSE OF REVIEW: This review aims to evaluate the evidence and recommendations for the prescription of corticosteroids as adjunctive therapy in patients with severe community-acquired pneumonia. RECENT FINDINGS: Corticosteroids have been prescribed with the objective to attenuate the marked and persistent activation of the immune system. However, some causes of community-acquired pneumonia, namely viral, are associated with unexpected low levels of cytokines and depressed cellular immunity. As a result, several recent randomized controlled trials and large prospective observational studies repeatedly showed that corticosteroids had no impact on survival, and in some types of pneumonia like influenza, its use was associated with potential harmful effects like invasive aspergillosis. Apart from this, adverse effects, namely hyperglycemia, superinfections and increased length-of-stay, were frequent findings in the corticosteroid-treated patients. SUMMARY: According to the current evidence, corticosteroids are recommended in Pneumocystis jiroveci pneumonia in HIV-infected patients and recommendations are against its use in influenza. In all other forms of severe community-acquired pneumonia, with the exclusion of SARS-CoV-2 pneumonia, the strength of the evidence does not support the safe and widespread use of corticosteroids as adjunctive therapy. Further studies are needed to identify subgroups of severe community-acquired pneumonia that can benefit or not from corticosteroids.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Pneumonia/drug therapy , Adrenal Cortex Hormones/adverse effects , Clinical Decision-Making , Combined Modality Therapy , Community-Acquired Infections , Humans , Pneumonia/etiology , Pneumonia/immunology , Pneumonia/pathology , Practice Guidelines as Topic , Safety
20.
Pediatr Infect Dis J ; 40(3): e111-e113, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1075647

ABSTRACT

Our study describes more than 100 children hospitalized with pneumonia during lockdown in the first pandemic wave with only 20% attributable to SARS-CoV-2. The serologic study during follow-up only helped to detect 4%. Other etiologies were common. Older age, presence of headache, vomiting, lymphopenia and thrombopenia were associated with COVID-19 pneumonia.


Subject(s)
COVID-19/complications , Pandemics , Pneumonia/etiology , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , Child , Child, Hospitalized , Child, Preschool , Female , Hospitals, University , Humans , Infant , Male , Pneumonia/epidemiology , Pneumonia/virology , SARS-CoV-2/genetics , Spain/epidemiology , Tertiary Care Centers
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