ABSTRACT
We present a case of a 57-year-old male patient with a history of prolonged intensive care unit (ICU) stay for coronavirus disease 2019 (COVID-19) who developed fungal spondylodiscitis, a rare complication. The patient initially presented complaining of respiratory symptoms and was subsequently treated with tocilizumab, remdesivir, enoxaparin, and dexamethasone. Following ICU discharge, he experienced recurrent infections, including extended-spectrum beta-lactamase Klebsiella urinary tract infection. Two months later, he developed back pain; magnetic resonance imaging (MRI) revealed inflammatory spondylodiscitis. Despite empirical antibiotic therapy, his condition did not improve, and a bone biopsy confirmed Candida albicans infection. Antifungal treatment with fluconazole and anidulafungin resulted in a significant clinical improvement. The patient achieved complete recovery after six months of therapy. This case highlights the rare occurrence of fungal spondylodiscitis in COVID-19 patients with a history of ICU stay and emphasizes the importance of early recognition and appropriate management to mitigate potential complications.
ABSTRACT
BACKGROUND: The duration of postinspiratory pause prior to forced expiration may significantly influence the peak expiratory flow (PEF) measured during maximal forceful expirations. In comparison with maneuvers without a postinspiratory pause, maneuvers with 4 to 6-s pause at total lung capacity (TLC) result in decreased PEF values. The extent to which brief pauses (< 2 s) similarly affect PEF values is unknown. METHODS: Thirty-six healthy volunteers (mean [+/-SD] age, 35 +/- 8 years; 18 men) performed a series of maximal forceful expirations with two different types of maneuvers. One maneuver (NP) included no inspiratory pause at TLC prior to forceful expiration, whereas the second (P) included a brief pause (< or = 2 s). The speed of inhalation to TLC was rapid and similar for both maneuvers. The highest PEF for each maneuver was used for analysis. RESULTS: The maximal PEF did not differ (p > 0.05) between the P and NP maneuvers (7.78 +/- 1.45 vs 7.83 +/- 1.45 L/s, respectively). Comparison of the intermaneuver differences showed a bias of 0.05 L/s and 95% confidence interval in the range of -0.9 to 1.0 L/s. CONCLUSIONS: Forceful expiratory maneuvers with or without postinspiratory pauses of < or = 2 s produce identical maximal PEF values and, therefore, can be used interchangeably for the spirometric measurement of PEF in healthy subjects.
