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1.
Curr Probl Diagn Radiol ; 51(3): 340-343, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34334225

RESUMO

OBJECTIVE: Chest and sinus CT imaging among cancer patients undergoing chemotherapy and bone marrow transplant in the setting of neutropenic fever is not uncommon, yet the utility of routine imaging surveillance remains unclear. We aim to compare the rates of acute infection detected on CT chest and CT sinus exams performed in this clinical setting. METHODS: Reports of 1059 consecutive CT chest and sinus examinations for the clinical indication of neutropenic fever on 262 patients performed between January through June 2017 were retrospectively reviewed. Infection as reported was characterized as acute or worsening, improving, stable, indeterminate or negative. Results were tabulated and Pearson's chi-square test was used for comparison analysis. RESULTS: Absence of infection on CT sinus was significantly higher than CT chest (86.1% vs. 58.5%; P<0.001). Conversely, CT chest had significantly higher incidence of acute or worsening infection than CT sinus (28.7% vs. 11.6%; P<0.001). CT chest also showed significantly higher incidence of improving infection compared to CT sinus (6.2% vs. 1.1%; P<0.001). There was no significant difference between incidence of stable infection on CT chest and CT sinus (1.1% vs. 0.2%; P=0.059). Infection was indeterminate in 5.5% of CT chest vs. 1% on CT sinus (P<0.001). CONCLUSIONS: CT chest showed significantly higher diagnostic yield for acute infection than CT sinus, suggesting that sinusitis is less likely to be the source of fever than chest infections in febrile neutropenic patients. The majority of CT studies showed absence of infection, raising the question of the overall utility of routine surveillance CT imaging among this subset of patients.


Assuntos
Neutropenia Febril , Neoplasias , Neutropenia Febril/complicações , Neutropenia Febril/diagnóstico por imagem , Febre/diagnóstico por imagem , Febre/etiologia , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
2.
Sci Rep ; 11(1): 17647, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34480039

RESUMO

Post fever retinitis is a heterogenous entity that is seen 2-4 weeks after a systemic febrile illness in an immunocompetent individual. It may occur following bacterial, viruses, or protozoal infection. Optical coherence angiography (OCTA) is a newer non-invasive modality that is an alternative to fundus fluorescein angiography to image the retinal microvasculature. We hereby describe the vascular changes during the acute phase of post fever retinitis on OCTA. Imaging on OCTA was done for all patients with post fever retinitis at presentation with 3 × 3 mm and 8 × 8 mm scans centred on the macula and corresponding enface optical coherence tomography (OCT) scans obtained. A qualitative and quantitative analysis was done for all images. 46 eyes of 33 patients were included in the study. Salient features noted were changes in the superficial (SCP) and deep capillary plexus (DCP) with capillary rarefaction and irregularity of larger vessels in the SCP. The DCP had more capillary rarefaction when compared to the SCP. The foveal avascular zone (FAZ) was altered with an irregular perifoveal network. Our series of post fever retinitis describes the salient vascular features on OCTA. Although the presumed aetiology was different in all our patients, they developed similar changes on OCTA. While OCTA is not useful if there is gross macular oedema, the altered FAZ can be indicative of macular ischemia.


Assuntos
Febre/diagnóstico por imagem , Angiofluoresceinografia/métodos , Vasos Retinianos/diagnóstico por imagem , Retinite/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Febre/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retinite/etiologia , Adulto Jovem
4.
Jpn J Radiol ; 39(8): 802-810, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33932188

RESUMO

PURPOSE: To verify that physicians' presumptive diagnosis is the most significant factor for finding any signs related to the cause of fever on computed tomography (CT) images. MATERIALS AND METHODS: This single-center retrospective cohort study included patients (age ≥ 16 years) who underwent CT to investigate the cause of fever between January 1, 2014, and August 31, 2016. Patients who underwent surgical procedures were excluded. The primary outcome was the presence of suspicious CT findings related to the cause of fever. We performed univariate and multivariate logistic regression analyses, adjusted for CT contrast agent use, quick sequential organ failure assessment score > 1, and C-reactive protein level. RESULTS: We enrolled 171 patients, of which 57 had CT findings, and 114 did not. Multivariate logistic regression analyses demonstrated a significant difference for the presence of a presumptive diagnosis by the attending physician (odds ratio, 4.99; 95% confidence interval 2.31-10.76; p < 0.01), but not for other covariates, including C-reactive protein. CONCLUSIONS: In hospitalized patients with fever, an attending physicians' presumptive diagnosis is associated with the presence of fever-related CT findings. Improving the quality of the diagnostic assessment before the CT scan may lead to more appropriate CT imaging use.


Assuntos
Tomografia Computadorizada por Raios X , Idoso , Meios de Contraste , Feminino , Febre/diagnóstico por imagem , Febre/etiologia , Infecções por HIV , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 100(13): e24053, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787568

RESUMO

RATIONALE: Neurogenic fever is a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury. We report on a stroke patient with neurogenic fever due to injury of hypothalamus, demonstrated by using diffusion tensor imaging (DTI). PATIENT CONCERNS: A 28-year-old male patient was admitted to the rehabilitation department of university hospital at 30 months after onset. Brain MRI showed leukomalactic lesions in hypothalamus, bilateral medial temporal lobe, and bilateral basal ganglia. He showed intermittent high body temperature (maximum:39.5°C, range:38.5-39.2°C), but did not show any infection signs upon physical examination or after assessing his white blood cell count and inflammatory enzyme levels such as erythrocyte sedimentation rate and C-reactive protein. In addition, 8 age-matched normal (control) subjects (4 male, mean age: 26.6 years, range: 21-29years) were enrolled in the study. DIAGNOSIS: Intraventricular hemorrhage and intracerebral hemorrhage in the left basal ganglia. INTERVENTIONS: He underwent extraventricular drainage and ventriculoperitoneal shunting for hydrocephalus. OUTCOMES: DTI was performed at 30 months after onset, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for hypothalamus. The FA and ADC values of patient were lower and higher, respectively, by more than two standard deviations from control values. Injury of hypothalamus was demonstrated in a stroke patient with neurogenic fever. LESSIONS: Our results suggest that evaluation of hypothalamus using DTI would be helpful in patients show unexplained fever following brain injury.


Assuntos
Hemorragia Cerebral/complicações , Febre/etiologia , Hipotálamo/lesões , Acidente Vascular Cerebral/complicações , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Imagem de Tensor de Difusão , Febre/diagnóstico por imagem , Humanos , Hipotálamo/diagnóstico por imagem , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem
7.
Artigo em Alemão | MEDLINE | ID: mdl-33588477

RESUMO

OBJECTIVE: As dairy herds increase in size, close monitoring of health becomes a necessity, but this is expensive and labour-intensive. Early detection of febrile diseases is essential for economical and welfare reasons and to prevent the spread of disease. The goal of this study was therefore to evaluate a mobile, non-invasive technique for measuring the body temperature of cows that precludes the need for restraint of the animals. MATERIALS AND METHODS: An infrared thermographic imaging camera installed on a smart phone was used to measure the surface temperature of cows. In experiment 1, a metal block heated to defined temperatures was used to obtain infrared thermographic measurements (THM). The accuracy of THM made at different distances from the block and at 2 different ambient temperatures was determined. In experiment 2, non-febrile cows underwent infrared thermographic imaging, and the body regions with the highest correlations between thermographic and rectal temperature were identified. In experiment 3, THM were made in febrile and neighbouring non-febrile cows. RESULTS: In experiment 1, the thermographic and true temperatures of the block had the strongest relationships at 0.5 and 1.0 m (r = 0.98). The ambient temperature had a significant effect on the THM, which had larger variations and greater deviations from the block temperature at 14.8 °C than at 23.8 °C. In experiment 2, the maximum temperature at the eye (r = 0.37), THM at the muzzle (r = 0.28) and the medial canthus (r = 0.27) showed the strongest relationships with the rectal temperature. After correcting the THM with the mean difference between thermographic and rectal temperatures of the non-febrile cows, sensitivities of 88, 90 and 82 %, respectively, were calculated for THM at the muzzle, eye and medial canthus in febrile cows in experiment 3. The corresponding specificities were 6, 23 and 32 %. CONCLUSION AND CLINICAL RELEVANCE: Based on the low specificities of the infrared THM, the thermographic imaging camera has limited usefulness for the mass screening of dairy cows for febrile conditions. Cattle falsely identified as febrile need to be separated, caught and re-examined, which causes unnecessary stress to the animal and increases labour input.


Assuntos
Doenças dos Bovinos/diagnóstico por imagem , Febre/veterinária , Termografia/veterinária , Animais , Bovinos , Feminino , Febre/diagnóstico por imagem , Raios Infravermelhos , Smartphone , Termografia/instrumentação
8.
J Neurovirol ; 27(1): 26-34, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33492608

RESUMO

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degrees of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes, and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably parainfectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case. Finally, we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.


Assuntos
Ataxia/fisiopatologia , COVID-19/fisiopatologia , Tosse/fisiopatologia , Febre/fisiopatologia , Mialgia/fisiopatologia , Síndrome de Opsoclonia-Mioclonia/fisiopatologia , SARS-CoV-2/patogenicidade , Adulto , Anticonvulsivantes/uso terapêutico , Ataxia/diagnóstico por imagem , Ataxia/tratamento farmacológico , Ataxia/etiologia , Azitromicina/uso terapêutico , COVID-19/complicações , COVID-19/diagnóstico por imagem , Clonazepam/uso terapêutico , Tosse/diagnóstico por imagem , Tosse/tratamento farmacológico , Tosse/etiologia , Dispneia/diagnóstico por imagem , Dispneia/tratamento farmacológico , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Febre/diagnóstico por imagem , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Hidroxicloroquina/uso terapêutico , Levetiracetam/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mialgia/diagnóstico por imagem , Mialgia/tratamento farmacológico , Mialgia/etiologia , Síndrome de Opsoclonia-Mioclonia/diagnóstico por imagem , Síndrome de Opsoclonia-Mioclonia/tratamento farmacológico , Síndrome de Opsoclonia-Mioclonia/etiologia , Oseltamivir/uso terapêutico , SARS-CoV-2/efeitos dos fármacos , Ácido Valproico/uso terapêutico , Tratamento Farmacológico da COVID-19
9.
J Neurovirol ; 27(1): 12-25, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33367960

RESUMO

With the growing number of COVID-19 cases in recent times. significant set of patients with extra pulmonary symptoms has been reported worldwide. Here we venture out to summarize the clinical profile, investigations, and radiological findings among patients with SARS-CoV-2-associated meningoencephalitis in the form of a systemic review. This review was carried out based on the existing PRISMA (Preferred Report for Systematic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase, and Cochrane library and Preprint servers up till 30 June 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2," "COVID-19," and "meningoencephalitis." All peer reviewed, case-control, case report, pre print articles satisfying our inclusion criteria were involved in the study. Quantitative data was expressed in mean ± SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p < 0.05 considered to be statistically significant. A total of 61 cases were included from 25 studies after screening from databases and preprint servers, out of which 54 of them had completed investigation profile and were included in the final analysis. Clinical, laboratory findings, neuroimaging abnormalities, and EEG findings were analyzed in detail. This present review summarizes the available evidences related to the occurrence of meningoencephalitis in COVID-19.


Assuntos
COVID-19/fisiopatologia , Tosse/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Meningoencefalite/fisiopatologia , SARS-CoV-2/patogenicidade , Adulto , Idoso , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , COVID-19/diagnóstico por imagem , COVID-19/virologia , Confusão/diagnóstico por imagem , Confusão/tratamento farmacológico , Confusão/fisiopatologia , Confusão/virologia , Tosse/diagnóstico por imagem , Tosse/tratamento farmacológico , Tosse/virologia , Dispneia/diagnóstico por imagem , Dispneia/tratamento farmacológico , Dispneia/fisiopatologia , Dispneia/virologia , Eletroencefalografia , Fadiga/diagnóstico por imagem , Fadiga/tratamento farmacológico , Fadiga/virologia , Feminino , Febre/diagnóstico por imagem , Febre/tratamento farmacológico , Febre/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/tratamento farmacológico , Meningoencefalite/virologia , Pessoa de Meia-Idade , Neuroimagem , SARS-CoV-2/efeitos dos fármacos , Tratamento Farmacológico da COVID-19
10.
Infection ; 49(1): 57-61, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32725596

RESUMO

BACKGROUND: The viral persistence in patients with Coronavirus Disease 2019 (COVID-19) remains to be investigated. METHODS: We investigated the viral loads, therapies, clinical features, and immune responses in a 70-year patient tested positive for SARS-CoV-2 for 3 months. FINDINGS: The patient exhibited the highest prevalence of abnormal indices of clinical features and immune responses at the first admission, including fever (38.3 â„ƒ), decreased lymphocytes (0.83 × 109/L) and serum potassium (3.1 mmol/L), as well as elevated serum creatinine (115 µmol/L), urea (8.6 mmol/L), and C-reactive protein (80 mg/L). By contrast, at the second and the third admission, these indices were all normal. Through three admissions, IL-2 increased from 0.14 pg/mL, 0.69 pg/mL, to 0.91 pg/mL, while IL-6 decreased from 11.78 pg/mL, 1.52 pg/mL, to 0.69 pg/mL, so did IL-10 from 5.13 pg/mL, 1.85 pg/mL, to 1.75 pg/mL. The steady declining trend was also found in TNF-α (1.49, 1.15, and 0.85 pg/mL) and IFN-γ (0.64, 0.42, and 0.27 pg/mL). The threshold cycle values of RT-PCR were 26.1, 30.5, and 23.5 for ORFlab gene, and 26.2, 30.6, and 22.7 for N gene, showing the patient had higher viral loads at the first and the third admission than during the middle term of the disease. The patient also showed substantially improved acute exudative lesions on the chest CT scanning images. CONCLUSIONS: The patient displayed declining immune responses in spite of the viral shedding for 3 months. We inferred the declining immune responses might result from the segregation of the virus from the immune system.


Assuntos
COVID-19/imunologia , Febre/imunologia , Linfopenia/imunologia , SARS-CoV-2/patogenicidade , Eliminação de Partículas Virais/imunologia , Idoso , Antivirais/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/imunologia , Proteína C-Reativa/metabolismo , COVID-19/diagnóstico por imagem , COVID-19/patologia , COVID-19/virologia , Teste para COVID-19/métodos , Creatinina/sangue , Creatinina/imunologia , Febre/diagnóstico por imagem , Febre/patologia , Febre/virologia , Hospitalização , Humanos , Imunidade , Interferon gama/sangue , Interferon gama/imunologia , Interleucina-10/sangue , Interleucina-10/imunologia , Interleucina-2/sangue , Interleucina-2/imunologia , Interleucina-6/sangue , Interleucina-6/imunologia , Linfopenia/diagnóstico por imagem , Linfopenia/patologia , Linfopenia/virologia , Masculino , Recidiva , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2/genética , SARS-CoV-2/imunologia , Tomografia Computadorizada por Raios X , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/imunologia , Carga Viral/efeitos dos fármacos
11.
Pediatrics ; 147(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32788269

RESUMO

A 16-year-old white boy with a history of chronic lung disease of prematurity, cough-variant asthma, and incidental lung nodules presented to the emergency center in spring 2020 with acute onset dry cough, shortness of breath, and fever. An initial history, gathered from his mother because of the patient's respiratory distress, revealed no recent travel. However, his mother is a health care worker at a hospital, and sick contacts included ongoing contact with a friend with cold-like symptoms. He had a variety of animals at home, including a dog, cats, fish, rodents, and reptiles. He had a history of vaping tobacco products >6 months ago. Fever and respiratory symptoms were associated with fatigue, chest tightness, abdominal pain, and myalgias. On examination, he was ill appearing and had tachycardia, tachypnea, borderline hypoxia with an oxygen saturation of 91% on room air, diminished breath sounds at the lung bases, and unremarkable abdominal examination results. A chest radiograph was consistent with the lung examination, revealing bilateral lower lobe hazy infiltrates. He showed initial improvement for 48 hours with antibiotics, intravenous fluid resuscitation, oxygen via nasal cannula, albuterol, and prednisone. Subsequently, he worsened with persistent high fever, increasing respiratory distress with pulmonary findings, and severe persistent epigastric pain, which added a layer of diagnostic complexity. As this patient's clinical course evolved and further history became available, pulmonary medicine and infectious diseases services were consulted to guide diagnostic evaluation and treatment of this patient early in the era of coronavirus disease 2019.


Assuntos
Lesão Pulmonar Aguda/diagnóstico por imagem , COVID-19 , Tosse/diagnóstico por imagem , Febre/diagnóstico por imagem , Vaping/efeitos adversos , Lesão Pulmonar Aguda/etiologia , Adolescente , COVID-19/diagnóstico por imagem , COVID-19/genética , Tosse/etiologia , Diagnóstico Diferencial , Febre/etiologia , Humanos , Masculino , Reação em Cadeia da Polimerase em Tempo Real/métodos , Vaping/patologia
12.
Trop Doct ; 51(2): 233-235, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33283680

RESUMO

Kawasaki disease is a common childhood vasculitis. Fever and lymphadenopathy, at times, are the only clinical presentation of Kawasaki disease, which mimics infectious lymphadenitis, especially, when other features are yet to evolve. In such a scenario, ultrasonography of cervical lymph nodes can help to differentiate Kawasaki disease lymphadenitis from infectious lymphadenitis. We present one such patient who was initially diagnosed as having bacterial lymphadenitis; however, ultrasonography of the neck lymph nodes showed typical imaging features described with Kawasaki disease lymphadenitis.


Assuntos
Febre/diagnóstico por imagem , Linfadenite/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Pré-Escolar , Diagnóstico Diferencial , Febre/patologia , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenite/patologia , Masculino , Síndrome de Linfonodos Mucocutâneos/patologia , Pescoço , Ultrassonografia
13.
Mediators Inflamm ; 2020: 3203241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061825

RESUMO

INTRODUCTION: Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Monitoring GCA activity during tocilizumab (TCZ) treatment is an unmet need, since low serum levels of C-reactive protein (CRP) during treatment may underestimate disease activity. To date, few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. We report herein a cohort of GCA patients treated with TCZ and followed up with multimodal imaging. Patients and Methods. We collected clinical, laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. Disease activity was assessed at baseline and within 12 months from the start of treatment using different imaging techniques such as color Doppler ultrasonography (CDUS), magnetic resonance imaging/angiography (MRI/MRA), computed tomography angiography (CTA), and/or positron emission tomography (PET). RESULTS: Four patients were affected by cranial and 7 by LV-GCA. All patients were treated with oral glucocorticoids (GCs) (mean dose 55.68 mg ± 8.19 of prednisone or equivalent) in combination with TCZ. Treatment was preceded in 5 cases by 3 intravenous boluses of 1000 mg methylprednisolone. A significant decrease of the mean dose of oral GCs was observed between baseline and the last follow-up visit (4.65 ± 3.69 mg) (p = 0.003). TCZ treatment significantly decreased erythrocyte sedimentation rate (p < 0.01) and CRP levels (p < 0.01). At follow-up (mean 8.18 ± 3.63 months), all patients were in clinical and serological remission. Moreover, PET, CDUS, MRI/MRA, and CTA did not show any LVV finding. CONCLUSIONS: Our study highlights TCZ efficacy in inducing GCA remission and its steroid-sparing effect. We highlighted a reliability of imaging procedures in the evaluation of disease activity and treatment response. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/tratamento farmacológico , Imagem Multimodal/métodos , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Angiografia por Tomografia Computadorizada , Fadiga/diagnóstico por imagem , Fadiga/tratamento farmacológico , Fadiga/metabolismo , Feminino , Febre/diagnóstico por imagem , Febre/tratamento farmacológico , Febre/metabolismo , Arterite de Células Gigantes/metabolismo , Cefaleia/diagnóstico por imagem , Cefaleia/tratamento farmacológico , Cefaleia/metabolismo , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler
14.
Am J Trop Med Hyg ; 103(4): 1350-1351, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783797
16.
Eur J Radiol ; 129: 109092, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32485335

RESUMO

PURPOSE: To evaluate the diagnostic accuracy and the imaging features of routine admission chest X-ray in patients suspected for novel Coronavirus 2019 (SARS-CoV-2) infection. METHOD: We retrospectively evaluated clinical and X-ray features in all patients referred to the emergency department for suspected SARS-CoV-2 infection between March 1st and March 13th. A single radiologist with more than 15 years of experience in chest-imaging evaluated the presence and extent of alveolar opacities, reticulations, and/or pleural effusion. The percentage of lung involvement (range <25 % to 75-100 %) was also calculated. We stratified patients in groups according to the time interval between symptoms onset and X-ray imaging (≤ 5 and > 5 days) and according to age (≤ 50 and > 50 years old). RESULTS: A total of 518 patients were enrolled. Overall 314 patients had negative and 204 had positive RT-PCR results. Lung lesions in patients with SARS-Cov2 pneumonia primarily manifested as alveolar and interstitial opacities and were mainly bilateral (60.8 %). Lung abnormalities were more frequent and more severe by symptom duration and by increasing age. The sensitivity and specificity of chest X-ray at admission in the overall cohort were 57 % (95 % CI = 47-67) and 89 % (83-94), respectively. Sensitivity was higher for patients with symptom onset > 5 days compared to ≤ 5 days (76 % [62-87] vs 37 % [24-52]) and in patients > 50 years old compared to ≤ 50 years (59 % [48-69] vs 47 % [23-72]), at the expense of a slightly lower specificity (68 % [45-86] and 82 % [73-89], respectively). CONCLUSIONS: Overall chest X-ray sensitivity for SARS-CoV-2 pneumonia was 57 %. Sensitivity was higher when symptoms had started more than 5 days before, at the expense of lesser specificity, while slightly higher in older patients in comparison to younger ones.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Dispneia/diagnóstico por imagem , Dispneia/virologia , Serviço Hospitalar de Emergência , Feminino , Febre/diagnóstico por imagem , Febre/virologia , Hospitalização , Humanos , Itália , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Admissão do Paciente/normas , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/virologia , Testes Imediatos/normas , Alvéolos Pulmonares/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , SARS-CoV-2 , Sensibilidade e Especificidade , Tempo para o Tratamento , Tomografia Computadorizada por Raios X , Raios X , Adulto Jovem
17.
Eur Radiol ; 30(10): 5588-5598, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32440781

RESUMO

OBJECTIVES: To compare CT findings of early (within 3 weeks post-onset)- and later (within 1 month before or after diagnostic criteria were satisfied, and later than 3 weeks post-onset) stage thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome. METHODS: Between 2014 and 2019, 13 patients with TAFRO syndrome (8 men and 5 women; mean age, 54.9 years) from nine hospitals were enrolled. The number of the following CT findings (CT factors) was recorded: the presence of anasarca, organomegaly, adrenal ischaemia, anterior mediastinal lesion, bony lesion, and lymphadenopathy. Records of adrenal disorders (adrenomegaly, ischaemia, and haemorrhage) throughout the disease course were also collected. Differences in CT factors at each stage were statistically compared between remission and deceased groups. RESULTS: Para-aortic oedema and mild lymphadenopathy were observed in all patients, whereas pleural effusion, ascites, and subcutaneous oedema were found in 5/13, 7/13, and 7/13 cases, respectively, at the early stage. CT factors at the early stage were significantly higher in the deceased than in the remission group (mean, 11 vs 6.5; p = 0.04), while they were nonsignificant at the later stage. Adrenal disorders were present in 7/13 cases throughout the course including 6 of adrenomegaly and 4 of ischaemia at the early stage. CONCLUSIONS: Para-aortic oedema and mild lymphadenopathy are most common at the early stage. Anasarca, organomegaly, lymphadenopathy, and adrenal disorders on early-stage CT are useful for unfavourable prognosis prediction. Moreover, adrenal disorders are frequent even at the early stage and are useful for early diagnosis of TAFRO syndrome. KEY POINTS: • CT findings facilitate early diagnosis and prognosis prediction in TAFRO syndrome. • Adrenal disorders are frequently observed in TAFRO syndrome. • Adrenal disorders are useful for differential diagnosis of TAFRO syndrome.


Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Edema/diagnóstico por imagem , Febre/diagnóstico por imagem , Trombocitopenia/diagnóstico por imagem , Doenças das Glândulas Suprarrenais , Adulto , Idoso , Ascite/complicações , Ascite/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/complicações , Diagnóstico Diferencial , Edema/complicações , Feminino , Febre/complicações , Fibrose/complicações , Fibrose/diagnóstico por imagem , Hemorragia/diagnóstico , Humanos , Japão/epidemiologia , Linfadenopatia/complicações , Linfadenopatia/diagnóstico por imagem , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Derrame Pleural/complicações , Prognóstico , Estudos Retrospectivos , Trombocitopenia/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
Infection ; 48(3): 445-452, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32301099

RESUMO

AIMS AND BACKGROUND: The COVID-19 outbreak spread in China and is a threat to the world. We reported on the epidemiological, clinical, laboratory, and radiological characteristics of children cases to help health workers better understand and provide timely diagnosis and treatment. METHODS: Retrospectively, two research centers' case series of 67 consecutive hospitalized cases including 53 adult and 14 children cases with COVID-19 between 23 Jan 2020 and 15 Feb 2020 from Jinan and Rizhao were enrolled in this study. Epidemiological, clinical, laboratory, and radiological characteristics of children and adults were analyzed and compared. RESULTS: Most cases in children were mild (21.4%) and conventional cases (78.6%), with mild clinical signs and symptoms, and all cases were of family clusters. Fever (35.7%) and dry cough (21.4%) were described as clinical manifestations in children cases. Dry cough and phlegm were not the most common symptoms in children compared with adults (p = 0.03). In the early stages of the disease, lymphocyte counts did not significantly decline but neutrophils count did in children compared with adults (p = 0.02). There was a lower level of CRP (p = 0.00) in children compared with adults. There were 8 (57.1%) asymptomatic cases and 6 (42.9%) symptomatic cases among the 14 children cases. The age of asymptomatic patients was younger than that of symptomatic patients (p = 0.03). Even among asymptomatic patients, 5 (62.5%) cases had lung injuries including 3 (60%) cases with bilateral involvement, which was not different compared with that of symptomatic cases (p = 0.58, p = 0.74). CONCLUSIONS: The clinical symptoms of children are mild, there is substantial lung injury even among children, but that there is less clinical disease, perhaps because of a less pronounced inflammatory response, and that the occurrence of this pattern appears to inversely correlate with age.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Tosse/patologia , Febre/patologia , Pulmão/virologia , Pneumonia Viral/patologia , Adulto , Fatores Etários , Doenças Assintomáticas , Proteína C-Reativa/imunologia , Proteína C-Reativa/metabolismo , COVID-19 , Criança , China/epidemiologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Tosse/diagnóstico por imagem , Tosse/epidemiologia , Citocinas/imunologia , Citocinas/metabolismo , Febre/diagnóstico por imagem , Febre/epidemiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Pulmão/patologia , Linfócitos/imunologia , Linfócitos/virologia , Neutrófilos/imunologia , Neutrófilos/virologia , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Tomografia Computadorizada por Raios X
19.
Ned Tijdschr Geneeskd ; 1642020 03 12.
Artigo em Holandês | MEDLINE | ID: mdl-32267636

RESUMO

A 19-year-old woman presented with a productive cough, fever and chest pain. Clinical and chest X-ray findings prompted us to do a CT-scan, which revealed a mediastinal mass extending in the left thoracic cavity, suggestive of a teratoma with an obstructive pneumonia. The patient was successfully treated with intravenous antibiotics and surgical removal of the tumour.


Assuntos
Antibacterianos/administração & dosagem , Neoplasias do Mediastino/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Administração Intravenosa , Dor no Peito/diagnóstico por imagem , Tosse/diagnóstico por imagem , Dispneia/etiologia , Feminino , Febre/diagnóstico por imagem , Humanos , Neoplasias do Mediastino/cirurgia , Pneumonia/tratamento farmacológico , Pneumonia/cirurgia , Teratoma/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
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