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Objective:To explore the clinical and chest CT features of anti-interferon(IFN)-γ autoantibodies-positive talaromycosis marneffei (TSM) infection in human immune deficiency virus (HIV)-negative patients.Methods:Clinical data and chest CT findings including pulmonary manifestations, bronchial changes, pleural changes, and extrapulmonary manifestations in 54 HIV-negative patients with Talaromyces marneffei (TM) infection and positive anti-interferon-γ(IFN-γ) autoantibody in the First Affiliated Hospital of Guangxi Medical University from December 2012 to September 2019 were retrospectively analyzed. CT score was rated for the degree of lung involvement, and the difference of involvement at different regions of the lung were compared. Results:Of 54 patients, 46 cases had fever, 43 cases had cough and expectoration, 28 cases had cutaneous or subcutaneous lesion, and 19 cases had arthritis or arthralgia. Laboratory tests showed that the value of CD4/CD8 decreased in 29 cases and platelet count increased in 32 cases. Only one of 54 patients had no abnormal findings on chest CT. In the remaining patients, chest CT manifestations were diverse, mainly presenting as fibrous cord-like lesions (87.0%, 47/54), lymph node enlargement (75.9%, 41/54), sporadic nodules (74.1%, 40/54), patchy consolidation (72.2%, 39/54), pleural effusion (59.2%, 32/54), and consolidation lesions associated with air bronchogram (63.0%, 34/54). Most of the lesions showed bilateral distribution (77.8%, 46/54), and involved both peripheral and central regions in 38 cases (70.4%, 38/54). CT score showed that there was no significant difference in the degree of involvement at different regions of the lung.Conclusions:The clinical and imaging manifestations of anti-IFN-γ antibody-positive patients with TM infection are characteristic. Most TSM patients with positive anti-IFN-γ antibody have fever, cough and expectoration. The main features of chest CT are cord focus, nodules, consolidation and pleural effusion. Lymph node enlargement often coexists with the above signs, and most of the lesions are distributed bilaterally.
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PurposeTo evaluate the diagnostic value of chest CT in 2019 novel coronavirus disease (COVID-19), using the reverse transcription polymerase chain reaction (RT-PCR) as a reference standard. At the same time, the imaging features of CT in confirmed COVID-19 patients would be summarized. MethodsA comprehensive literature search of 5 electronic databases was performed. The pooled sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the random-effects model and the summary receiver operating characteristic (SROC) curve. We also conducted a meta-analysis to estimate the pooled incidence of the chest CT imaging findings and the 95% confidence interval (95%CI). Meta-regression analysis was used to explore the source of heterogeneity. ResultsOverall, 25 articles comprising 4,857 patients were included. The pooled sensitivity of CT was 93% (95% CI, 89-96%) and specificity was 44% (95% CI, 27-62%). The area under the SROC curve was 0.94 (95% CI, 0.91-0.96). For the RT-PCR assay, the pooled sensitivity of the initial test and the missed diagnosis rate after the second-round test were 76% (95% CI: 59-89%; I2=96%) and 26% (95% CI: 14-39%; I2=45%), respectively. According to the subgroup analysis, the diagnostic sensitivity of CT in Hubei was higher than that in other regions. Besides, the most common patterns on CT imaging finding was ground glass opacities (GGO) 58% (95% CI: 49-70%), followed by air bronchogram 51% (95% CI: 31-70%). Lesions were inclined to distribute in peripheral 64% (95% CI: 49-78%), and the incidence of bilateral lung involvement was 69% (95% CI: 58-79%). ConclusionsThere were still several cases of missed diagnosis after multiple RT-PCR examinations. In high-prevalence areas, CT could be recommended as an auxiliary screening method for RT-PCR. Key pointsO_LITaking RT-PCR as the reference standard, the pooled sensitivity of CT was 93% (95% CI, 89-96%) and the specificity was 44% (95% CI, 27-62%). The area under the SROC curve was 0.94 (95% CI, 0.91-0.96). C_LIO_LIFor the RT-PCR assay, the pooled sensitivity of the initial test and the missed diagnosis rate after the second-round test were 76% (95% CI: 59-89%) and 26% (95% CI: 14-39%), respectively. C_LIO_LIGGO was the key sign of the CT imaging, with an incidence of 58% (95% CI: 49-70%) in patients with SARS-CoV-2 infection. Pneumonia lesions were inclined to distribute in peripheral 64% (95% CI: 49-78%) and bilateral 69% (95% CI: 58-79%) lung lobes. C_LI
