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Nadeem O, Sharma A, Alaouie D, Bradley P, Ouellette D, Fadel R, Suleyman G. Outcomes in patients with sarcoidosis and COVID-19. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023055. [PMID: 38126507 DOI: 10.36141/svdld.v40i4.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIM The effect of COVID-19 in patients with sarcoidosis has not been fully explored. The aim was to conduct a retrospective cohort study investigating outcomes in patients with sarcoidosis who were hospitalized with COVID-19. METHODS We included patients who had diagnoses of sarcoidosis and COVID-19 between January 1, 2020, and February 28, 2021. Primary outcomes included development of critical COVID-19; need for supplemental oxygen, noninvasive ventilation, and invasive ventilation; and death. Association of comorbidities and immunosuppression therapy with outcomes were analyzed. Multiple logistic regression analysis was used to assess risk factors associated with critical COVID-19. RESULTS Of 1198 patients with COVID-19, 169 had sarcoidosis (14.1%) and 1029 (85.9%) did not (control group). Of the 169 patients with sarcoidosis and COVID-19, 84 (49.7%) were hospitalized (study group: mean age 62.4 years; 61.9% women; and 56.0% Black). The study group required supplemental oxygen (81% vs 62%; p = 0.001) and noninvasive ventilation (33.3% vs 6.4%; p < 0.001) more often and had lower mortality (15.5% vs. 30.4%; p = 0.004) than the control group. In patients hospitalized with COVID-19, sarcoidosis was not associated with critical COVID-19 (odds ratio, 0.77; 95% CI, 0.46-1.29; p = 0.317), but having sarcoidosis while taking immunosuppression therapy was associated with decreased risk of critical COVID-19 (odds ratio, 0.45; 95% CI, 0.31-0.65; p < 0.001). CONCLUSIONS Patients with sarcoidosis may not be at increased risk of critical illness or death from COVID-19, and immunosuppression therapy in these patients may reduce the risk of critical COVID-19.
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Dhooria S, Chopra A, Munavvar M. Editorial: Pulmonary sarcoidosis. Front Med (Lausanne) 2023; 10:1177797. [PMID: 37064026 PMCID: PMC10090693 DOI: 10.3389/fmed.2023.1177797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- *Correspondence: Sahajal Dhooria
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, United States
| | - Mohammed Munavvar
- Department of Respiratory Medicine, Lancashire Teaching Hospitals, Preston, United Kingdom
- Faculty of Health, University of Central Lancashire, Preston, United Kingdom
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Yee AMF. Treatment of sarcoidosis in US rheumatology practices: comment on the article by Hamman et al. Arthritis Care Res (Hoboken) 2022; 74:2119-2120. [PMID: 35695770 DOI: 10.1002/acr.24970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/07/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Arthur M F Yee
- Hospital for Special Surgery/Weill Cornell Medicine, New York, NY
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Sarcoidosis and COVID-19: At the Cross-Road between Immunopathology and Clinical Manifestation. Biomedicines 2022; 10:biomedicines10102525. [PMID: 36289785 PMCID: PMC9599235 DOI: 10.3390/biomedicines10102525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with dysregulation of the immune system featuring inappropriate immune responses, exacerbation of inflammatory responses, and multiple organ dysfunction syndrome in patients with severe disease. Sarcoidosis, also known as Besnier-Boeck-Schaumann disease, is an idiopathic granulomatous multisystem disease characterized by dense epithelioid non-necrotizing lesions with varying degrees of lymphocytic inflammation. These two diseases have similar clinical manifestations and may influence each other at multiple levels, eventually affecting their clinical courses and prognosis. Notably, sarcoidosis patients are at high risk of severe COVID-19 pneumonia because of the underlying lung disease and chronic immunosuppressive treatment. In this narrative review, we will discuss interactions between sarcoidosis and COVID-19 in terms of clinical manifestations, treatment, and pathogenesis, including the role of the dysregulated renin-angiotensin system, altered immune responses involving increased cytokine levels and immune system hyperactivation, and cellular death pathways.
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Mogal MR, Sompa SA, Junayed A, Mahmod MR, Abedin MZ, Sikder MA. Common genetic aspects between COVID-19 and sarcoidosis: A network-based approach using gene expression data. Biochem Biophys Rep 2022; 29:101219. [PMID: 35128085 PMCID: PMC8803645 DOI: 10.1016/j.bbrep.2022.101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/21/2022] Open
Abstract
The pandemic situation of novel coronavirus disease 2019 (COVID-19) is a global threat on our current planet, with its rapid spread and high mortality rate. Sarcoidosis patients are at high risk to COVID-19 severity for having lung injuries as well as treating with immunosuppressive agents. So, physicians are in dilemma whether they should use immunosuppressive agents or not for the patients with sarcoidosis history and COVID-19 infection. Therefore, common factors should be identified to provide effective treatment. For determining the common genes between COVID-19 and sarcoidosis, GSE164805 and GSE18781 were retrieved from the Gene Expression Omnibus (GEO) database. Common upregulated genes were identified by using R language to investigate their involved pathways and gene ontologies (GO). With the aid of the STRING Cytoscape plugin tool, protein-protein interactions (PPIs) network was constructed. From the PPIs network, Hub genes and essential modules were detected by using Cytohubba, and MCODE respectively. For hub genes, TFs, TFs-miRNA, and drug, interaction networks were built through the NetworkAnalyst web platform. A total of 34 common upregulated genes were identified and among them, five hub genes, including TET2, MUC5AC, VDR, NFE2L2, and BCL6 were determined. In addition, a cluster having VDR and NFE2L2 was detected from the PPIs network. Moreover, 32 transcription factors and 9 miRNA were recognized for hub genes. Furthermore, vitamin D and some of its analogous compounds were obtained from the drug interaction network. In conclusion, hub genes identified in this study might have potential roles in modulating COVID-19 infection and sarcoidosis. However, further studies are required to corroborate this study. Sarcoidosis patients are at high risk to COVID-19 severity. This study aimed to find out common genetic factors for COVID-19 and Sarcoidosis. 34 common upregulated genes were identified from GSE164805 and GSE18781 datasets. From common upregulated genes, five hub genes, VDR, NFE2L2, BCL6, TET2, and MUC5AC, were recognized. Hub genes associated with miRNA, TFs, and drug molecules were also identified.
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Lommatzsch M, Rabe KF, Taube C, Joest M, Kreuter M, Wirtz H, Blum TG, Kolditz M, Geerdes-Fenge H, Otto-Knapp R, Häcker B, Schaberg T, Ringshausen FC, Vogelmeier CF, Reinmuth N, Reck M, Gottlieb J, Konstantinides S, Meyer J, Worth H, Windisch W, Welte T, Bauer T. Risk Assessment for Patients with Chronic Respiratory Conditions in the Context of the SARS-CoV-2 Pandemic Statement of the German Respiratory Society with the Support of the German Association of Chest Physicians. Respiration 2022; 101:307-320. [PMID: 35231915 PMCID: PMC8985038 DOI: 10.1159/000518896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/23/2022] Open
Abstract
Assessing the risk for specific patient groups to suffer from severe courses of COVID-19 is of major importance in the current SARS-CoV-2 pandemic. This review focusses on the risk for specific patient groups with chronic respiratory conditions, such as patients with asthma, chronic obstructive pulmonary disease, cystic fibrosis (CF), sarcoidosis, interstitial lung diseases, lung cancer, sleep apnea, tuberculosis, neuromuscular diseases, a history of pulmonary embolism, and patients with lung transplants. Evidence and recommendations are detailed in exemplary cases. While some patient groups with chronic respiratory conditions have an increased risk for severe courses of COVID-19, an increasing number of studies confirm that asthma is not a risk factor for severe COVID-19. However, other risk factors such as higher age, obesity, male gender, diabetes, cardiovascular diseases, chronic kidney or liver disease, cerebrovascular and neurological disease, and various immunodeficiencies or treatments with immunosuppressants need to be taken into account when assessing the risk for severe COVID-19 in patients with chronic respiratory diseases.
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Affiliation(s)
- Marek Lommatzsch
- Department of Pneumology, University of Rostock, Rostock, Germany
| | | | - Christian Taube
- Klinik für Pneumologie, University of Essen, Duisburg, Germany
| | | | | | - Hubert Wirtz
- Department of Pneumology, University of Leipzig, Leipzig, Germany
| | | | - Martin Kolditz
- Department of Pneumology, University of Dresden, Dresden, Germany
| | | | - Ralf Otto-Knapp
- German Central Committee against Tuberculosis, DZK, Berlin, Germany
| | - Brit Häcker
- German Central Committee against Tuberculosis, DZK, Berlin, Germany
| | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany
| | | | - Martin Reck
- LungenClinic Großhansdorf, Großhansdorf, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, University of Hannover, Hanover, Germany
| | | | - Joachim Meyer
- Lung Center Bogenhausen and Harlaching, Hospital Munich, Munich, Germany
| | | | | | - Tobias Welte
- Department of Respiratory Medicine, University of Hannover, Hanover, Germany
| | - Torsten Bauer
- Lung Hospital Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
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8
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Chang CWD, McCoul ED, Briggs SE, Guardiani EA, Durand ML, Hadlock TA, Hillel AT, Kattar N, Openshaw PJM, Osazuwa-Peters N, Poetker DM, Shin JJ, Chandrasekhar SS, Bradford CR, Brenner MJ. Corticosteroid Use in Otolaryngology: Current Considerations During the COVID-19 Era. Otolaryngol Head Neck Surg 2021; 167:803-820. [PMID: 34874793 DOI: 10.1177/01945998211064275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. DATA SOURCES PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. REVIEW METHODS Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19-specific findings. CONCLUSIONS Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. IMPLICATIONS FOR PRACTICE SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.
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Affiliation(s)
- C W David Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Marlene L Durand
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nrusheel Kattar
- Department of Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | | | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Rademacher JG, Tampe B, Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines (Basel) 2021; 9:vaccines9111313. [PMID: 34835244 PMCID: PMC8619392 DOI: 10.3390/vaccines9111313] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
Sarcoidosis can present as an acute form or take a chronic course. One of the acute presentations is Löfgren’s syndrome (LS), consisting of the symptom triad of bilateral hilar lymphadenopathy, erythema nodosum, and ankle periarthritis. In addition, there are occasional reports of sarcoid-like reactions following drug exposures. Nevertheless, reports of sarcoidosis or LS after vaccination have not been published. Here, we report two cases of de novo LS in a temporal association with different vaccines against the new coronavirus SARS-CoV-2. One patient developed the first symptoms three days after the second vaccination (first vaccination ChadOx-1, Astra Zeneca; second vaccination CX-024414, Moderna); in the second patient, symptoms started 28 days after the first vaccination (ChadOx-1, Astra Zeneca). Both patients eventually required treatment with glucocorticoids. Both patients achieved clinical improvement with treatment. In conclusion, we report the first two cases of LS shortly after SARS-CoV-2 vaccination.
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Goto K, Uehara M, Okamoto K, Takeda N, Morita H, Hatano M, Komuro I. The therapeutic dilemma of immunosuppressive drugs for refractory cardiac sarcoidosis in COVID-19 infection. ESC Heart Fail 2021; 8:5577-5582. [PMID: 34697891 PMCID: PMC8653200 DOI: 10.1002/ehf2.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/13/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with refractory cardiac sarcoidosis (CS) take a high dose of corticosteroid and immunosuppressive agents. During the pandemic outbreak of severe acute respiratory syndrome coronavirus 2, appropriate treatment of corticosteroids or immunosuppressive agents in CS patients with coronavirus disease 2019 (COVID‐19) is unknown. Here, the woman with refractory CS receiving maintenance therapy with 15 mg of prednisolone daily and 10 mg of methotrexate weekly was emergently admitted to our hospital because of COVID‐19. This case was successfully treated by the intravenous administration of dexamethasone 6 mg/day instead of prednisolone and interruption of methotrexate without resulting in recurrent life‐threatening ventricular lethal arrhythmias or obvious sarcoidosis flare‐ups. She started taking prednisolone and methotrexate at the maintenance dose immediately and at 2 weeks after discharge, respectively. Although the optimal regimen of immunosuppressive agents during COVID‐19 is under intense debate, this report might provide an effective treatment strategy for CS patients with COVID‐19.
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Affiliation(s)
- Kohsaku Goto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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George LJ, Philip AM, John KJ, George AA, Nayar J, Mishra AK, Lal A. A review of the presentation and outcome of sarcoidosis in coronavirus disease 2019. J Clin Transl Res 2021; 7:657-665. [PMID: 34778596 PMCID: PMC8580525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the setting of the current pandemic, concerns have arisen regarding the multisystemic involvement of sarcoidosis and the possible exacerbations in response to the exposure to severe acute respiratory syndrome coronavirus 2. AIM This study aims to compare the differences in clinical presentation, management, and outcome of coronavirus disease 2019 (COVID-19) between patients with sarcoidosis and those in the general population. METHODS A literature search was conducted by reviewing original research articles such as case reports, case series, observational studies, and questionnaire-based surveys published in PubMed/Medline, Web of Science, and Google scholar. Data from individual patients in case series and case reports have been pooled to create a data set that was compared with larger such cohorts obtained from several other observational studies. RESULTS Twenty-seven patients were identified from 14 original articles. No significant differences were found in the clinical manifestations of patients with sarcoidosis presenting with COVID-19 as compared to the general population. The rate of hospitalization in our study was found to be 48.1%. The overall mortality in our study was 7.4%, which is higher than the global average of 2.1%. CONCLUSION Our observations have reinforced the hypothesis that the presence of additional medical comorbidities is associated with a higher risk of intensive care unit admission. Furthermore, the presence of moderate to a severe limitation in pulmonary functions is an additional risk factor associated with increased hospital admissions and mortality in sarcoidosis. However, neither the diagnosis of sarcoidosis nor ongoing treatment with steroids, methotrexate, or other immunosuppressants was associated with a poorer prognosis in patients with sarcoidosis. RELEVANCE FOR PATIENTS Patients with sarcoidosis must take added precautions to mitigate the risk of acquiring COVID-19 infection in view of the COVID-19-related mortality rate in this group of patients. Specifically, immunocompromised patients (on immunomodulator drugs and high dose steroids) have been found to have an increased risk of contracting COVID-19. Overall impact on prognostication and outcome in cases requiring hospitalization remains yet to be determined.
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Affiliation(s)
- Lina James George
- Department of Pulmonary Medicine, DR KM Cherian Institute of Medical Sciences, Kallissery, Kerala, India
| | - Anil Mathew Philip
- Department of Medicine, St. Thomas Mission Hospital, Kattanam, Kerala, India
| | - Kevin John John
- Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Anu Anna George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States
| | - Jemimah Nayar
- Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Purohit D, Ahirwar AK, Sakarde A, Asia P, Gopal N. COVID-19 and lung pathologies. Horm Mol Biol Clin Investig 2021; 42:435-443. [PMID: 34333882 DOI: 10.1515/hmbci-2020-0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/06/2021] [Indexed: 12/18/2022]
Abstract
COVID-19 is a global emergency with over 10 million cases and over 500, 000 deaths worldwide. The SARS CoV-2 is a RNA virus belonging to the family coronaviridae. It has high infectivity. The manifestations of the disease range from asymptomatic or mild symptoms to severe pneumonia and ARDS. The CT scan of lung shows consolidation and "Ground Glass Opacities". The persons with other comorbidities are considered to be at a higher rate of acquiring the infection. Asthma and other allergies have not been identified as major risk factors for COVID-19 as the number of asthmatic patients having COVID-19 is not high enough for it to be considered so. The occurrence of COVID-19 in COPD patients can be related with smoking. The ACE-2 expression in such patients was considerably high. The relation between COVID-19 and Tuberculosis can also be reflected in terms of the stigma associated with diagnosis and treatment of such diseases in some communities, eventually increasing the chances of people's reluctance to seek medical help. Cancer patients are usually more susceptible to infections. Lung cancer is no different. Additionally, lung cancer also has strong association with smoking further increasing the risk. The risk of getting infection and its severity is high for autoimmune disorders as well as fungal infections. Currently there is no definite treatment of COVID-19. However, some of the currently used modalities are hydroxychloroquine and antiviral drugs.
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Affiliation(s)
- Darshana Purohit
- All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ashok Kumar Ahirwar
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Apurva Sakarde
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Priyanka Asia
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Niranjan Gopal
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
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Kondle S, Hou T, Manansala M, Ascoli C, Novak RM, Sweiss N. Treatment of COVID-19 in Patients With Sarcoidosis. Front Med (Lausanne) 2021; 8:689539. [PMID: 34336892 PMCID: PMC8322657 DOI: 10.3389/fmed.2021.689539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/17/2021] [Indexed: 01/16/2023] Open
Abstract
Recent case reports and studies on treating COVID-19 in patients with chronic sarcoidosis describe different treatment modalities ranging from glucocorticoids to biologic medications. This review article summarizes seven case series and reports totaling 46 patients. While one case report suggested that sarcoidosis medications such as glucocorticoids may lengthen the COVID-19 disease course, another study with a larger registry suggests they do not. More studies are needed to elucidate an improvement in outcomes. It is possible that addition of TNF-alpha inhibitors at COVID-19 diagnosis decreases hospitalization rate. Overall, it is difficult to make firm conclusions regarding treatment given the heterogeneity of treatment modalities in the current literature. Our summarized findings are outlined with the opinions of sarcoidosis, pulmonary, and infectious disease experts in a flow chart that provides clinicians with our proposed management algorithm for sarcoidosis patients who develop COVID-19. We emphasize a need for exchange of information regarding management of COVID-19 in the setting of sarcoidosis to further improve treatment in this vulnerable population of patients.
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Affiliation(s)
- Shreya Kondle
- Department of Medicine, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Titus Hou
- Department of Medicine, University of Illinois College of Medicine at Rockford, Rockford, IL, United States
| | - Michael Manansala
- Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL, United States
| | - Christian Ascoli
- Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL, United States
| | - Richard M Novak
- Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL, United States
| | - Nadera Sweiss
- Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL, United States
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14
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Kahlmann V, Manansala M, Moor CC, Shahrara S, Wijsenbeek MS, Sweiss NJ. COVID-19 infection in patients with sarcoidosis: susceptibility and clinical outcomes. Curr Opin Pulm Med 2021; 27:463-471. [PMID: 34397613 DOI: 10.1097/mcp.0000000000000812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Patients with sarcoidosis may be at higher risk of coronavirus disease-19 (COVID-19) as over 90% of the patients have pulmonary involvement and many are treated with immunosuppressive agents. This review will summarize the current literature regarding sarcoidosis and COVID-19, with a particular focus on susceptibility, clinical outcomes, management, and approach to vaccination. RECENT FINDINGS Data about COVID-19 and sarcoidosis include a number of case series and reports, cohort studies, and registries. Literature is not conclusive whether patients with sarcoidosis have increased susceptibility to COVID-19. Patients with moderate to severe impaired pulmonary function may be at increased risk of adverse outcomes and mortality. Whether immunosuppressive medication increases risk of COVID-19 severity or affects vaccination response is not yet clear. Novel approaches, such as telemedicine and home monitoring programs, are promising to ensure continuity of care for patients with sarcoidosis during the COVID-19 pandemic. SUMMARY Current evidence about the risk and clinical outcomes of COVID-19 infection in patient with sarcoidosis, is mainly extrapolated from other immune-mediated diseases. Hence, further research that focuses on the sarcoidosis population is warranted.
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Affiliation(s)
- Vivienne Kahlmann
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Catharina C Moor
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Shiva Shahrara
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago.,Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Marlies S Wijsenbeek
- Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Nadera J Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago
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15
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Tana C, Schiavone C. The Chameleon Behavior of Sarcoidosis. J Clin Med 2021; 10:jcm10132780. [PMID: 34202837 PMCID: PMC8269299 DOI: 10.3390/jcm10132780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Claudio Tana
- COVID-19 Medicine Unit and Geriatrics Clinic, S.S. Annunziata Hospital of Chieti, 66100 Chieti, Italy
- Correspondence:
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy;
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16
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Delavari F, Varzaneh FN, Rezaei N. Neurologic Manifestations of COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:343-353. [PMID: 33973188 DOI: 10.1007/978-3-030-63761-3_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neurological manifestations of novel coronavirus disease (COVID-19) are reported to occur in as much as 37% of the affected patients. These manifestations range from headache and dizziness to altered mental status and consciousness, anosmia, ageusia, sensory disturbances, and stroke. The mechanisms by which the neurological symptoms arise are not yet determined but may either proceed as an indirect consequence of systemic hyperinflammation or result from the direct invasion of the virus to neural and glial cells. The neural invasion can explain both the retrograde pathway of encephalitis and the early manifestation of anosmia by invading the olfactory bulb. Moreover, in the case of attacking the brain stem, it may take part in the early apnea manifestation reported by patients. Additionally, neurotropism of the virus could be the cause of acute hemorrhagic encephalitis. Hyperinflammation can have acute and prolonged effects in the nervous system, such as acute demyelination and predisposition to multiple sclerosis. Moreover, the pro-inflammatory state contributes to hypercoagulation, which in turn could result in cerebrovascular injuries in COVID-19 patients. This chapter would discuss that the neurologic manifestations of the COVID-19 are to be looked at as a multifactorial entangled phenomenon.
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Affiliation(s)
- Farnaz Delavari
- University of Geneva, Geneva, Switzerland.
- Interactive Research Education and Training Association (IRETA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Farnaz Najmi Varzaneh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Baltimore, MD, USA
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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17
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Manansala M, Baughman R, Novak R, Judson M, Sweiss N. Management of immunosuppressants in the era of coronavirus disease-2019. Curr Opin Pulm Med 2021; 27:176-183. [PMID: 33779588 DOI: 10.1097/mcp.0000000000000770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Patients on chronic immunosuppressive treatments at baseline are at increased risk of opportunistic infections. These patients are at especially increased risk of morbidity and mortality during the coronavirus-19 (COVID-19) pandemic. This review will focus on patients with diseases in which immunosuppression is a vital part of the treatment regimen, including those with solid organ transplants, rheumatologic disorders, sarcoidosis, and inflammatory bowel disease (IBD). We will summarize the current knowledge of immunosuppression in these diseases and the risk of contracting COVID-19. Furthermore, we will discuss if immunosuppression increases severity of COVID-19 presentation. RECENT FINDINGS Since the start of the COVID-19 pandemic, a large number patients receiving chronic immunosuppression have been infected with SARS-CoV-2. Moreover, our understanding of the immunology of SARS-CoV-2 is advancing at a rapid pace. Currently, a number of clinical trials are underway to investigate the role of immunosuppressive treatments in the management of this disease. SUMMARY Currently, there is no conclusive evidence to suggest that solid organ transplant recipients on chronic immunosuppression are at increased risk of contracting COVID-19. Solid organ transplant recipients may be at increased risk for worse COVID-19 outcomes but the data are not consistent. There is evidence to suggest that patients with rheumatologic disorders or IBDs are not at increased risk of contracting COVID-19 and do not necessarily experience worse clinical outcomes. Patients with sarcoidosis are not necessarily at increased risk of COVID-19, although there is limited data available to determine if immunosuppression worsens outcomes in this population.
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Affiliation(s)
- Michael Manansala
- Department of Medicine, Academic Internal Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Robert Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Richard Novak
- Division of Infectious Disease, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Marc Judson
- Department of Medicine, Albany Medical College, Albany, New York
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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18
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Manansala M, Chopra A, Baughman RP, Novak R, Lower EE, Culver DA, Korsten P, Drake WP, Judson MA, Sweiss N. COVID-19 and Sarcoidosis, Readiness for Vaccination: Challenges and Opportunities. Front Med (Lausanne) 2021; 8:672028. [PMID: 33996868 PMCID: PMC8119656 DOI: 10.3389/fmed.2021.672028] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is an immune mediated chronic inflammatory disorder that is best characterized by non-caseating granulomas found in one or more affected organs. The COVID-19 pandemic poses a challenge for clinicians caring for sarcoidosis patients who may be at increased risk of infection compared to the general population. With the recent availability of COVID-19 vaccines, it is expected that clinicians raise questions regarding efficacy and safety in sarcoidosis. However, studies examining safety and efficacy of vaccines in sarcoidosis are lacking. In this review, we examine the current literature regarding vaccination in immunocompromised populations and apply them to sarcoidosis patients. The available literature suggests that vaccines are safe and effective in patients with autoimmune disorders and in those taking immunosuppressive medications. We strongly recommend the administration of COVID-19 vaccines in patients with sarcoidosis. We also present a clinical decision algorithm to provide guidance on vaccination of sarcoidosis patients against COVID-19.
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Affiliation(s)
- Michael Manansala
- Department of Medicine, Academic Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, NY, United States
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Richard Novak
- Division of Infectious Disease, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Daniel A Culver
- Cleveland Clinic, Department of Pulmonary Medicine, Cleveland, OH, United States
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Wonder P Drake
- Division of Infectious Disease, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, NY, United States
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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19
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Tana C, Schiavone C, Cipollone F, Giamberardino MA. Management Issues of Sarcoidosis in the Time of Coronavirus Disease 2019. Chest 2021; 159:1306-1307. [PMID: 33678261 PMCID: PMC7930726 DOI: 10.1016/j.chest.2020.09.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Cosima Schiavone
- SS. Annunziata Hospital; Internistic Ultrasound Unit, Chieti, Italy
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20
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Sweiss NJ, Korsten P, Baughman RP, Culver DA, Judson MA. Response. Chest 2021; 159:1307-1308. [PMID: 33678263 PMCID: PMC7930724 DOI: 10.1016/j.chest.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Peter Korsten
- University of Illinois at Chicago, Department of Nephrology and Rheumatology, Göttingen, Germany
| | - Robert P Baughman
- University Medical Center Göttingen, Department of Medicine, Cincinnati, OH
| | - Daniel A Culver
- University of Cincinnati Medical Center, Pulmonary and Critical Care Medicine, Cleveland, OH
| | - Marc A Judson
- Cleveland Clinic, Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY
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21
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Lui JK, Mesfin N, Tugal D, Klings ES, Govender P, Berman JS. Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis. J Intensive Care Med 2021; 37:441-458. [PMID: 33611981 DOI: 10.1177/0885066621993041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.
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Affiliation(s)
- Justin K Lui
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nathan Mesfin
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Derin Tugal
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth S Klings
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Praveen Govender
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey S Berman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
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22
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Ramdani H, Benelhosni K, Moatassim Billah N, Nassar I. COVID-19 pneumonia in a patient with sarcoidosis: A case report. Clin Case Rep 2021; 9:910-913. [PMID: 33598270 PMCID: PMC7869356 DOI: 10.1002/ccr3.3684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023] Open
Abstract
Key prognostic elements to consider in sarcoidosis patients who contract COVID-19 pneumonia are pulmonary involvement, the underlying immune system dysfunction, immunosuppressive therapies' use, and the increased risk for hypercoagulability.
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Affiliation(s)
- Hanae Ramdani
- Radiology DepartmentIbn Sina University Hospital CenterRabatMorocco
| | | | | | - Ittimade Nassar
- Radiology DepartmentIbn Sina University Hospital CenterRabatMorocco
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23
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Baughman RP, Lower EE, Buchanan M, Rottoli P, Drent M, Sellares J, Terwiel M, Elfferich M, Francesqui J, Barriuso Cabrerizo MR, Sweiss N, Martone F, Al-Hakim T, Judson MA. Risk and outcome of COVID-19 infection in sarcoidosis patients: results of a self-reporting questionnaire. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:e2020009. [PMID: 33597796 PMCID: PMC7883514 DOI: 10.36141/svdld.v37i4.10726] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/29/2020] [Indexed: 01/02/2023]
Abstract
Background: It has been suggested that sarcoidosis patients, especially those on immunosuppressive medications, are at increased risk for COVID-19 infection and more severe disease. Methods: A questionnaire was developed in four languages (English, Dutch, Italian, and Spanish). The questionnaire queried whether patients had been infected with COVID-19 and outcome of the infection. Risk factors for COVID-19 infection were collected. Results: A total of 5200 sarcoidosis patients completed the questionnaire with 116 (2.23%) reporting infection and 18 (15.8%) required hospitalization. Increased hazard ratio (HR) for COVID-19 infection were seen for those with a COVID-19 infected roommate (HR=27.44, p<0.0001), health care provider (HR=2.4, p=0.0001), pulmonary sarcoidosis (HR=2.48, p=0.001), neurosarcoidosis (HR=2.02, p<0.01), or rituximab treatment (HR=5.40, p<0.0001). A higher rate of hospitalization was found for those with underlying heart disease (HR=3.19 (1.297-7.855), p<0.02). No other feature including race, other immunosuppressive agent, age, or underlying condition was associated with a significant increased risk for infection or more severe disease. Conclusion: The overall rate of COVID-19 was 2.23%, suggesting an increased rate of COVID-19 infection. However, when an analysis of the questionnaires of sarcoidosis and non-sarcoidosis patients was performed in one localized area over this time period, the rate of COVID-19 infection was similar in both groups. Sarcoidosis patients who cohabitated with COVID-19 infected individuals, worked in health care, had pulmonary or neurologic sarcoidosis, or were treated with rituximab had an increased risk for COVID-19 infection. No significant increased risk for hospitalization could be identified based on age, race, gender or any specific immunosuppressive treatment. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020009)
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Affiliation(s)
- Robert P Baughman
- University of Cincinnati Medical Center, Department of Medicine, Cincinnati, OH, USA
| | - Elyse E Lower
- University of Cincinnati Medical Center, Department of Medicine, Cincinnati, OH, USA
| | | | - Paola Rottoli
- Specialization School of Respiratory Diseases, Dept of Medical, Surgical and Neurological Sciences, Siena University, Italy
| | - Marjolein Drent
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands.,Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Maastricht, the Netherlands.,ild care foundation research team, Ede, the Netherlands
| | - Jacobo Sellares
- Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomedica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.,Interstitial Lung Diseases Core member, European Reference Network for Rare Diseases of the Respiratory System (ERN-LUNG), Spain
| | - Michelle Terwiel
- ILD Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marjon Elfferich
- ild care foundation research team, Ede, the Netherlands.,Hospital Gelderse Vallei, Ede, the Netherlands
| | - Joel Francesqui
- Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Nadera Sweiss
- Division of Rheumatology and Medical Director of the Arthritis Clinic and Bernie Mac Sarcoidosis Translational Advanced Research Center (STAR), University of Illinois Chicago, Chicago IL, USA
| | | | | | - Marc A Judson
- Department of Medicine, Albany Medical College, Albany NY, USA
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24
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Lommatzsch M, Rabe KF, Taube C, Joest M, Kreuter M, Wirtz H, Blum TG, Kolditz M, Geerdes-Fenge H, Otto-Knapp R, Häcker B, Schaberg T, Ringshausen FC, Vogelmeier CF, Reinmuth N, Reck M, Gottlieb J, Konstantinides S, Meyer FJ, Worth H, Windisch W, Welte T, Bauer T. [Risk Assessment for Patients with Chronic Respiratory and Pulmonary Conditions in the Context of the SARS-CoV-2 Pandemic - Statement of the German Respiratory Society (DGP) with the Support of the German Association of Respiratory Physicians (BdP)]. Pneumologie 2020; 75:19-30. [PMID: 33242887 DOI: 10.1055/a-1321-3400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- M Lommatzsch
- Zentrum für Innere Medizin, Abteilung Pneumologie, Universitätsmedizin Rostock, Rostock
| | - K F Rabe
- LungenClinic Großhansdorf, Großhansdorf.,Deutsches Zentrum für Lungenforschung
| | - C Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik, Westdeutsches Lungenzentrum, Essen
| | - M Joest
- Lungen- und Allergiezentrum Bonn, Bonn
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg.,Deutsches Zentrum für Lungenforschung
| | - H Wirtz
- Abt. Pneumologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - T G Blum
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - M Kolditz
- Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - H Geerdes-Fenge
- Universitätsmedizin Rostock, Zentrum für Innere Medizin, Abteilung für Infektionskrankheiten und Tropenmedizin, Rostock
| | - R Otto-Knapp
- Dtsch. Zentralkomitee zur Bekämpfung der Tuberkulose, DZK, Berlin
| | - B Häcker
- Dtsch. Zentralkomitee zur Bekämpfung der Tuberkulose, DZK, Berlin
| | | | - F C Ringshausen
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - C F Vogelmeier
- Klinik für Pneumologie, Universitätsklinikum Marburg, Marburg.,Deutsches Zentrum für Lungenforschung
| | - N Reinmuth
- Asklepios Fachkliniken München-Gauting, Thorakale Onkologie, Gauting.,Deutsches Zentrum für Lungenforschung
| | - M Reck
- LungenClinic Großhansdorf, Großhansdorf.,Deutsches Zentrum für Lungenforschung
| | - J Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - S Konstantinides
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik, München
| | | | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln GmbH, Lehrstuhl für Pneumologie der Universität Witten-Herdecke
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - T Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
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25
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Manansala M, Ascoli C, Alburquerque AG, Perkins D, Mirsaedi M, Finn P, Sweiss NJ. Case Series: COVID-19 in African American Patients With Sarcoidosis. Front Med (Lausanne) 2020; 7:588527. [PMID: 33251236 PMCID: PMC7672207 DOI: 10.3389/fmed.2020.588527] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022] Open
Abstract
Data on the clinical presentation and outcomes of sarcoidosis patients with coronavirus disease 19 (COVID-19) are scarce. In this case series, we identified 5 out of 238 sarcoidosis patients who are enrolled in an ongoing longitudinal observational study who developed COVID-19 during the study period and follow their clinical course. Four patients recovered completely, whereas one patient expired during hospital admission. Our preliminary experience suggests that African American patients with chronic sarcoidosis treated with disease-modifying anti-rheumatic drugs (DMARDs) or anti-tumor necrosis factor (TNF) therapy do not seem to be at increased risk of respiratory or life-threatening complications from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with the general population, although at the present time, we advocate for maintaining a high level of vigilance and strict follow-up in this patient population.
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Affiliation(s)
- Michael Manansala
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Christian Ascoli
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Ana Goico Alburquerque
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - David Perkins
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Mehdi Mirsaedi
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Patricia Finn
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Nadera J Sweiss
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, United States
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26
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Kayser MZ, Valtin C, Greer M, Karow B, Fuge J, Gottlieb J. Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients. Telemed J E Health 2020; 27:807-815. [PMID: 33054671 DOI: 10.1089/tmj.2020.0170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. This is due to both to the reallocation of resources toward COVID-19 patients as well as concern for the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant (LTx) recipients. Introduction: New methods such as telemedicine are needed to bridge the gap in follow-up care caused by the pandemic. Materials and Methods: A retrospective analysis of video consultations (VCs) in comparison with on-site visits (OSVs) was performed during a 6-week period in an LTx center in Germany. VC included a structured work-up questionnaire and vital sign documentation. Results: During the 6-week study period, 75 VCs were performed for 53 patients and 75 OSVs by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred through VC. Physician-patient consultations were reduced by 47% compared with the equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. Discussion: Implementation of VC helped to reduce the need for OSV and thus the risk of SARS-CoV-2 exposure in our patient cohort. This technology can be adopted to provide care for a wide range of chronic illnesses. Conclusions: VC can preserve access to specialist care while reducing SARS-CoV-2 exposure for patients with chronic illnesses during the pandemic.
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Affiliation(s)
- Moritz Z Kayser
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Bernd Karow
- Department for Hospital Innovation and Quality Management, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
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27
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Jeny F, Lhote R, Lorillon G, Belhomme N, Pugnet G, Borie R, Justet A, Jouneau S, Freymond N, Mekinian A, Dhote R, Tandjaoui-Lambiotte Y, Saindenberg N, Gazengel P, Hervier B, Haroche J, Mathian A, Hié M, Chazal T, Taieb D, Uzunhan Y, Le Pavec J, Annesi-Maesano I, Bergot E, Tazi A, Amoura Z, Valeyre D, Nunes H, Cohen-Aubart F. Correspondence on 'Glucocorticoid-induced relapse of COVID-19 in a patient with sarcoidosis'. Ann Rheum Dis 2020; 81:e241. [PMID: 33004334 DOI: 10.1136/annrheumdis-2020-218957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Florence Jeny
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Raphael Lhote
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Gwenael Lorillon
- Service de Pneurmologie, Assistance Publique Hôpitaux de Paris, Hopital Saint-Louis, Paris, France
| | - Nicolas Belhomme
- Département de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
| | - Grégory Pugnet
- UMR1027, Service de Médecine Interne, INSERM et CHU de Toulouse, Toulouse, France.,Service de Médecine Interne, CHU Toulouse, Toulouse, France
| | - Raphaël Borie
- Service de Pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Aurélien Justet
- Service de Pneumologie, CHU Caen, Caen, Basse-Normandie, France
| | | | | | - Arsène Mekinian
- Service de Médecine Interne, DHUi2B, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Robin Dhote
- Service de Médecine Interne, Assitance Publique Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | | | | | - Pierre Gazengel
- Service de Pneumologie, Centre chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Baptiste Hervier
- Service de Médecine Interne, Assitance Publique Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | - Julien Haroche
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alexis Mathian
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Miguel Hié
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Thibaud Chazal
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Dov Taieb
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Yurdagul Uzunhan
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Jérôme Le Pavec
- Service de Pneumologie, Centre chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | | | | | - Abdellatif Tazi
- Service de Pneurmologie, Assistance Publique Hôpitaux de Paris, Hopital Saint-Louis, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Dominique Valeyre
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Hilario Nunes
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, Service de Médecine Interne 2, maladies auto-immunes et systémiques, Assitance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
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28
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Govender P, Cozier YC. Sarcoidosis in a time of pandemic. Eur Respir J 2020; 56:56/3/2002376. [PMID: 32883761 DOI: 10.1183/13993003.02376-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Praveen Govender
- Dept of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA.,The Sarcoidosis Clinic at Boston Medical Center, Boston, MA, USA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston University School of Medicine, Boston, MA, USA .,Dept of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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29
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Antoniou KM, Raghu G, Tzilas V, Bouros D. Management of Patients with Interstitial Lung Disease in the Midst of the COVID-19 Pandemic. Respiration 2020; 99:625-627. [PMID: 32841954 PMCID: PMC7490496 DOI: 10.1159/000509523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University General Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Vasilios Tzilas
- Athens Medical Center and 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- Athens Medical Center and 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece,
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30
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Abstract
A sarcoidosis patient may be refractory to corticosteroid therapy. This may be because corticosteroids are ineffective in relieving the sarcoidosis patient's symptoms/dysfunction or because the clinician has determined that the risks of corticosteroids outweigh their benefits. Interestingly, when corticosteroids truly fail to improve a sarcoidosis patient's condition, it is very rarely because of failure of the drug as an anti-granulomatous agent; rather, it is usually because the patient's symptoms were unrelated to active sarcoid granulomas. In this manuscript, we review the causes of corticosteroid refractory sarcoidosis. The clinician should consider these causes when confronted with a sarcoidosis patient who is either not responding to corticosteroids, developing corticosteroid side-effects, or is at significant risk of developing such side-effects. We believe that determining the cause of corticosteroid refractory sarcoidosis may aid the clinicians in optimizing the care of sarcoidosis patients and clinical researchers in appropriately stratifying patients for clinical trials.
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31
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Yates PA, Newman SA, Oshry LJ, Glassman RH, Leone AM, Reichel E. Doxycycline treatment of high-risk COVID-19-positive patients with comorbid pulmonary disease. Ther Adv Respir Dis 2020; 14:1753466620951053. [PMID: 32873175 PMCID: PMC7476338 DOI: 10.1177/1753466620951053] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Infection with novel SARS-CoV-2 carries significant morbidity and mortality in patients with pulmonary compromise, such as lung cancer, autoimmune disease, and pneumonia. For early stages of mild to moderate disease, care is entirely supportive.Antiviral drugs such as remdesivir may be of some benefit but are reserved for severe cases given limited availability and potential toxicity. Repurposing of safer, established medications that may have antiviral activity is a possible approach for treatment of earlier-stage disease. Tetracycline and its derivatives (e.g. doxycycline and minocycline) are nontraditional antibiotics with a well-established safety profile, potential efficacy against viral pathogens such as dengue fever and chikungunya, and may regulate pathways important in initial infection, replication, and systemic response to SARS-CoV-2. We present a series of four high-risk, symptomatic, COVID-19+ patients, with known pulmonary disease, treated with doxycycline with subsequent rapid clinical improvement. No safety issues were noted with use of doxycycline.Doxycycline is an attractive candidate as a repurposed drug in the treatment of COVID-19 infection, with an established safety profile, strong preclinical rationale, and compelling initial clinical experience described here.The reviews of this paper are available via the supplemental material section.
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MESH Headings
- Adenocarcinoma of Lung/complications
- Adenocarcinoma of Lung/diagnosis
- Adenocarcinoma of Lung/therapy
- Adult
- Aged
- Aged, 80 and over
- COVID-19
- Comorbidity
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/drug therapy
- Doxycycline/administration & dosage
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Multimorbidity
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pulmonary Disease, Chronic Obstructive/complications
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/therapy
- Risk Assessment
- Sampling Studies
- Sarcoidosis, Pulmonary/complications
- Sarcoidosis, Pulmonary/diagnosis
- Sarcoidosis, Pulmonary/therapy
- Treatment Outcome
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Affiliation(s)
- Paul A. Yates
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Steven A. Newman
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lauren J. Oshry
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Ashton M. Leone
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Elias Reichel
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
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