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Beck KS, Yoon JH, Yoon SH. Radiologic Abnormalities in Prolonged SARS-CoV-2 Infection: A Systematic Review. Korean J Radiol 2024; 25:473-480. [PMID: 38685737 PMCID: PMC11058427 DOI: 10.3348/kjr.2023.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/06/2024] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
We systematically reviewed radiological abnormalities in patients with prolonged SARS-CoV-2 infection, defined as persistently positive polymerase chain reaction (PCR) results for SARS-CoV-2 for > 21 days, with either persistent or relapsed symptoms. We extracted data from 24 patients (median age, 54.5 [interquartile range, 44-64 years]) reported in the literature and analyzed their representative CT images based on the timing of the CT scan relative to the initial PCR positivity. Our analysis focused on the patterns and distribution of CT findings, severity scores of lung involvement on a scale of 0-4, and the presence of migration. All patients were immunocompromised, including 62.5% (15/24) with underlying lymphoma and 83.3% (20/24) who had received anti-CD20 therapy within one year. Median duration of infection was 90 days. Most patients exhibited typical CT appearance of coronavirus disease 19 (COVID-19), including ground-glass opacities with or without consolidation, throughout the follow-up period. Notably, CT severity scores were significantly lower during ≤ 21 days than during > 21 days (P < 0.001). Migration was observed on CT in 22.7% (5/22) of patients at ≤ 21 days and in 68.2% (15/22) to 87.5% (14/16) of patients at > 21 days, with rare instances of parenchymal bands in previously affected areas. Prolonged SARS-CoV-2 infection usually presents as migrating typical COVID-19 pneumonia in immunocompromised patients, especially those with impaired B-cell immunity.
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Affiliation(s)
- Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Hwa Yoon
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea.
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2
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Barnaba Durairaj MV, Caraway H, Buresh R, Sampath R, Waghchoure S. Rapidly Progressing Secondary Organizing Pneumonia Due to Underlying Immunosuppression With Rituximab in SARS-CoV-2 Patients. Cureus 2024; 16:e60328. [PMID: 38883063 PMCID: PMC11177329 DOI: 10.7759/cureus.60328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Secondary organizing pneumonia (SOP) as a sequela to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) usually has a prolonged benign course with a good response to corticosteroids. We present a case series of three patients who developed rapid progression to organizing pneumonia, after initial presentation with SARS-CoV-2. Imaging revealed rapid interval progression of bilateral subpleural ground glass opacities, and lung biopsy showed dense fibroblastic plugs within the alveoli. Two patients were steroid-responsive, and one patient succumbed to his illness despite maximal therapy. We postulate that B-cell depletion and immunosuppression may cause rapid progression to SOP, as all three patients were immunosuppressed and on chronic rituximab therapy.
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Affiliation(s)
| | - Hayden Caraway
- Internal Medicine, University of North Carolina (UNC) Health Blue Ridge, Morganton, USA
| | - Robert Buresh
- Pathology, University of North Carolina (UNC) Health Blue Ridge, Morganton, USA
| | - Rahul Sampath
- Infectious Disease, University of North Carolina (UNC) Health Blue Ridge, Morganton, USA
| | - Simon Waghchoure
- Intensive Care Unit, University of North Carolina (UNC) Health Blue Ridge, Morganton, USA
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3
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Yomota M, Tanaka M, Kobayashi T, Kitano M, Ikeda S, Kanemasa Y, Yanagawa N, Hosomi Y. Interstitial lung changes and persistent COVID-19 in a patient with follicular lymphoma: A case report. Respirol Case Rep 2024; 12:e01298. [PMID: 38379821 PMCID: PMC10878828 DOI: 10.1002/rcr2.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
We herein report a case of interstitial lung changes in a patient with prolonged coronavirus disease 2019 (COVID-19) with follicular lymphoma receiving rituximab and bendamustine who recovered after treatment with a combination therapy consisting of corticosteroids and immunosuppressive agents. There is currently no treatment strategy for prolonged pneumonitis following COVID-19, which can be life-threatening for immunocompromised patients. Thus, further investigation is warranted.
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Affiliation(s)
- Makiko Yomota
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Masaru Tanaka
- Department of Infectious DiseasesTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Takayuki Kobayashi
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Masatake Kitano
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Saori Ikeda
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Yusuke Kanemasa
- Department of OncologyTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Noriyo Yanagawa
- Department of RadiologyTokyo Metropolitan Komagome HospitalTokyoJapan
| | - Yukio Hosomi
- Department of Respiratory MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
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4
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Tonon CR, Tanni SE, Rocha J, Godoy I, Polegato BF, Pereira FWL, Martins D, Prudente RA, Franco ET, Brizola F, Baldi BG, Okoshi MP. Organizing pneumonia and COVID-19. Am J Med Sci 2023; 366:458-463. [PMID: 37778722 DOI: 10.1016/j.amjms.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Organizing pneumonia (OP) is an interstitial lung disease, and can be cryptogenic, if no cause is identified, or secondary to several conditions. COVID-19-induced persistent inflammation can be associated with interstitial lung disease. We present a review of literature of OP and COVID-19-induced OP with an illustrative case. A 38-year-old man was admitted with COVID-19 that required mechanical ventilation for 56 days. Initial chest computed tomography (CT) revealed diffuse bilateral ground-glass opacities in the lungs with consolidation areas involving 75 % of the parenchyma. After weaning from MV, the patient still required oxygen supplementation. A new chest CT scan also showed extensive diffuse areas of consolidation and ground-glass opacity. OP was hypothesized and 40 mg/day prednisone initiated and continued for six months with resolution of lung functional and image abnormalities. Organizing pneumonia should be included in the differential diagnosis of COVID-19 patients with respiratory symptoms after partial pulmonary recovery.
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Affiliation(s)
- Carolina Rodrigues Tonon
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Suzana Erico Tanni
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Juliana Rocha
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Irma Godoy
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Bertha Furlan Polegato
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Filipe Welson Leal Pereira
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Danilo Martins
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Robson Aparecido Prudente
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Estefania Thome Franco
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Fernando Brizola
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Bruno Guedes Baldi
- Pneumology Division, Heart Institute (InCor), Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marina Politi Okoshi
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil.
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5
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Fukuda Y, Mochizuki K, Ijichi M, Homma T, Tanaka A, Sagara H. Efficacy of Additional Corticosteroids After Dexamethasone Treatment for Moderate to Severe COVID-19: An Observational Study. Cureus 2023; 15:e43179. [PMID: 37692586 PMCID: PMC10487281 DOI: 10.7759/cureus.43179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background Previous studies have demonstrated dexamethasone (DEX)'s efficacy for coronavirus disease 2019 (COVID-19). In contrast, patients with residual lung field shading and symptoms after DEX treatment have been observed, and the efficacy of additional corticosteroids (AC) is unknown. Objectives We aimed to investigate the efficacy of AC in patients with COVID-19 with residual respiratory symptoms or who required oxygen therapy or invasive mechanical ventilation after DEX treatment. Methods This was a single-center, retrospective observational study including 261 patients with community-onset COVID-19, aged ≥ 18 years, admitted to our hospital between March 1, 2020, and May 31, 2021. Finally, 34 patients were included in the study who met all four of the following criteria: (1) required oxygen therapy or invasive ventilation, (2) were treated with DEX, (3) had residual shading on chest imaging after DEX treatment, or (4) had unimproved respiratory symptoms or oxygen saturation < 90%. We reviewed the medical records and clinical courses of 14 patients who received AC therapy (AC group) and 20 patients who did not (non-additional corticosteroids or NC group). Results The 90-day mortality rate was 35.7% in the AC group and 25.0% in the NC group. There was no statistically significant difference between the two groups (p = 0.797). In addition, there was no difference between groups in the proportion of patients who required oxygen therapy at discharge (64% vs. 35%, p = 0.162). The time from the end of DEX therapy to discharge was significantly longer in the AC group (median 7.5 vs. 33 days, p = 0.019). Regarding serious adverse events, infection was statistically more common in the AC group than in the NC group (p = 0.005). Conclusions AC after DEX treatment does not improve clinical outcomes and may prolong hospital stay.
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Affiliation(s)
- Yosuke Fukuda
- Department of Medicine, Division of Respiratory Medicine and Allergology, Yamanashi Red Cross Hospital, Fujikawaguchiko-machi, JPN
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Kaoru Mochizuki
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Miharu Ijichi
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
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6
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Trottier CA, Wong B, Kohli R, Boomsma C, Magro F, Kher S, Anderlind C, Golan Y. Dual Antiviral Therapy for Persistent Coronavirus Disease 2019 and Associated Organizing Pneumonia in an Immunocompromised Host. Clin Infect Dis 2023; 76:923-925. [PMID: 36281907 PMCID: PMC9620374 DOI: 10.1093/cid/ciac847] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
The management of patients with prolonged viral shedding and coronavirus disease 2019 symptoms remains unclear. Combining antivirals, as practiced in other infections, is theoretically advantageous. We present a case of persistent, symptomatic severe acute respiratory syndrome coronavirus 2 infection and associated organizing pneumonia that was successfully treated with an extended course of combination antiviral therapy.
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Affiliation(s)
- Caitlin A Trottier
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts, USA
| | - Beverly Wong
- Department of Medicine, Division of Pulmonary and Critical Care, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rakhi Kohli
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Cassidy Boomsma
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Francis Magro
- Department of Medicine, Division of Infectious Diseases, Lowell General Hospital, Lowell, Massachusetts, USA
| | - Sucharita Kher
- Department of Medicine, Division of Pulmonary and Critical Care, Tufts Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christina Anderlind
- Department of Medicine, Division of Pulmonary and Critical Care, Tufts Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yoav Golan
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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7
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Ketchersid K. A review of organizing pneumonia. JAAPA 2023; 36:16-19. [PMID: 36749158 DOI: 10.1097/01.jaa.0000918776.59717.eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
ABSTRACT Organizing pneumonia is a clinical and pathological syndrome that describes a lung injury caused by an inflammatory reaction in the alveolar connective tissue. Classified as an interstitial lung disease, it can be secondary to infection, drug toxicity, connective tissue disorders, inhalation injuries (cocaine), organ transplant, or radiotherapy, and also can be idiopathic. Although organizing pneumonia is not a new phenomenon, it has been noted to be a complication of COVID-19, and should be considered in patients who have had COVID-19 and have atypical chest imaging, because treatment includes corticosteroids instead of antimicrobials.
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Affiliation(s)
- Kimberlee Ketchersid
- Kimberlee Ketchersid practices in hospital medicine at VCU Health System in Richmond, Va., and is the manager of the APP Transition to Practice Program. The author has disclosed no potential conflicts of interest, financial or otherwise
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8
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Heubner L, Trautmann-Grill K, Tiebel O, Mirus M, Güldner A, Rand A, Spieth PM. Treatment of Acquired von Willebrand Disease due to Extracorporeal Membrane Oxygenation in a Pediatric COVID-19 Patient with Vonicog Alfa: A Case Report and Literature Review. TH OPEN 2023; 7:e76-e81. [PMID: 36846831 PMCID: PMC9949976 DOI: 10.1055/a-2008-4367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
Acquired von Willebrand disease (aVWD) is frequently observed in patients with the need for extracorporeal membrane oxygenation (ECMO). aVWD can be treated by plasma-derived concentrates containing factor VIII (FVIII) and/or von Willebrand factor (VWF) and recombinant VWF concentrate as well as adjuvant therapies such as tranexamic acid and desmopressin. However, all of these therapeutic options possibly cause thromboembolism. Therefore, the optimal treatment remains uncertain. This report presents a case of a 16-year-old patient suffering from severe acute respiratory distress syndrome due to coronavirus disease 2019 with the need of ECMO support. Our patient developed aVWD under ECMO therapy characterized by loss of high-molecular-weight multimers (HMWM) and severe bleeding symptoms following endoscopic papillotomy due to sclerosing cholangitis. At the same time standard laboratory parameters showed hypercoagulability with increased fibrinogen level and platelet count. The patient was successfully treated with recombinant VWF concentrate (rVWF; vonicog alfa; Veyvondi) combined with topic tranexamic acid application and cortisone therapy. rVWF concentrate vonicog alfa is characterized by ultra-large multimers and absence of FVIII. Patient could be successfully weaned from ECMO support after 72 days. Multimer analysis 1 week after ECMO decannulation showed an adequate reappearance of HMWM.
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Affiliation(s)
- Lars Heubner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany,Address for correspondence Lars Heubner, MD Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus DresdenDresdenGermany
| | - Karolin Trautmann-Grill
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden. Germany
| | - Oliver Tiebel
- Institute of Clinical Chemistry, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden. Germany
| | - Martin Mirus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Andreas Güldner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Axel Rand
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
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9
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Wismans LV, Lopuhaä B, de Koning W, Moeniralam H, van Oosterhout M, Ambarus C, Hofman FN, Kuiken T, Endeman H, Mustafa DAM, von der Thüsen JH. Increase of mast cells in COVID-19 pneumonia may contribute to pulmonary fibrosis and thrombosis. Histopathology 2023; 82:407-419. [PMID: 36366933 PMCID: PMC9877713 DOI: 10.1111/his.14838] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/10/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
AIMS Lung tissue from COVID-19 patients shares similar histomorphological features with chronic lung allograft disease, also suggesting activation of autoimmune-related pathways in COVID-19. To more clearly understand the underlying spectrum of pathophysiology in COVID-19 pneumonia, we analysed mRNA expression of autoimmune-related genes in post-mortem lung tissue from COVID-19 patients. METHODS AND RESULTS Formalin-fixed, paraffin-embedded lung tissue samples of 18 COVID-19 patients and eight influenza patients were used for targeted gene expression profiling using NanoString technology. Multiplex immunofluorescence for tryptase and chymase was applied for validation. Genes related to mast cells were significantly increased in COVID-19. This finding was strengthened by multiplex immunofluorescence also showing a significant increase of tryptase- and chymase-positive cells in COVID-19. Furthermore, receptors for advanced glycation end-products (RAGE) and pro-platelet basic protein (PPBP) were up-regulated in COVID-19 compared to influenza. Genes associated with Type I interferon signalling showed a significant correlation to detected SARS-CoV2 pathway-related genes. The comparison of lung tissue samples from both groups based on the presence of histomorphological features indicative of acute respiratory distress syndrome did not result in finding any specific gene or pathways. CONCLUSION Two separate means of measuring show a significant increase of mast cells in SARS-CoV-2-infected lung tissue compared to influenza. Additionally, several genes involved in fibrosis and thrombosis, among which are RAGE and PPBP, are up-regulated in COVID-19. As mast cells are able to induce thrombosis and fibrosis, they may play an important role in the pathogenesis of COVID-19.
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Affiliation(s)
- Leonoor V Wismans
- Present address:
Department of SurgeryErasmus Medical CenterRotterdamthe Netherlands,The Tumor Immuno‐Pathology Laboratory, Department of PathologyJosephine Nefkens Institute, Erasmus Medical CenterRotterdamthe Netherlands
| | - Boaz Lopuhaä
- Present address:
Department of SurgeryErasmus Medical CenterRotterdamthe Netherlands,Department of PathologyJosephine Nefkens Institute, Erasmus Medical CenterRotterdamthe Netherlands
| | - Willem de Koning
- The Tumor Immuno‐Pathology Laboratory, Department of PathologyJosephine Nefkens Institute, Erasmus Medical CenterRotterdamthe Netherlands,Clinical Bioinformatics Unit, Department of PathologyErasmus Medical CenterRotterdamthe Netherlands
| | - Hazra Moeniralam
- Department of Internal Medicine and Intensive CareSt. Antonius HospitalNieuwegeinthe Netherlands
| | | | - Carmen Ambarus
- Department of Pathology DNASt. Antonius HospitalNieuwegeinthe Netherlands
| | - Frederik N Hofman
- Department of Cardiothoracic SurgerySt. Antonius HospitalNieuwegeinthe Netherlands
| | - Thijs Kuiken
- Department of ViroscienceErasmus Medical CenterRotterdamthe Netherlands
| | - Henrik Endeman
- Department of Adult Intensive CareErasmus Medical CenterRotterdamthe Netherlands
| | - Dana A M Mustafa
- The Tumor Immuno‐Pathology Laboratory, Department of PathologyJosephine Nefkens Institute, Erasmus Medical CenterRotterdamthe Netherlands,Department of PathologyJosephine Nefkens Institute, Erasmus Medical CenterRotterdamthe Netherlands
| | - Jan H von der Thüsen
- Department of PathologyJosephine Nefkens Institute, Erasmus Medical CenterRotterdamthe Netherlands
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10
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Muacevic A, Adler JR, Davila-Chapa C, Krishnan P. Glucocorticoid Therapy in COVID-19-Induced Organizing Pneumonia: A Rare Occurrence. Cureus 2023; 15:e33991. [PMID: 36824563 PMCID: PMC9941028 DOI: 10.7759/cureus.33991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Background Although the incidence of post-COVID-19 organizing pneumonia (OP) is low, the mortality and morbidity in select patients appear to be high. Anticipating specific populations who may be at higher risk and initiating treatment earlier could reduce mortality. Research question Does treatment with high dose, standard dose, or no glucocorticoids for COVID-19 infection impact the incidence and clinical outcome in COVID-19-induced OP? Study design and methods This was a single-center, retrospective, observational cohort study conducted from 03/01/2020 to 06/30/2021 in hospitalized patients over the age of 18 with confirmed COVID-19 infection and computed tomography (CT) scan evidence of OP. Institutional review board (IRB) approval was obtained from the institution (STUDY00002241). Patients' demographics and oxygen requirements at the time of diagnosis, at the time of discharge, and at one, three, six, 10, and 12 months post-discharge were obtained. The dose, duration, and choice of glucocorticoid therapy were recorded for each subject, as well as oxygen requirements during hospitalization. Despite radiological evidence of OP, patients on minimal supplemental oxygen requirements did not receive high-dose or long-duration glucocorticoid therapy. Results A total of 881 patients were admitted with COVID-19, of which 42 met the study criteria. Three patients underwent a lung biopsy to confirm the diagnosis of organizing pneumonia. All other patients were diagnosed based on CT imaging and clinical presentation. Of the patients, 17% did not receive any steroid treatment, while 36% received dexamethasone and 43% received prednisone. The most common oxygen requirement at the time of discharge for steroid-treated patients was nasal cannula (55%) and room air (29%). The incidence of OP in this patient population was 0.05 with a mortality rate of 14%. Interpretation and relevance The incidence of post-COVID-19 OP appears to be lower than anticipated. Steroids for patients on lower supplemental oxygen requirements were discontinued although they had radiological evidence of OP. Patients who were on higher supplemental oxygen requirements at 10 days were continued on steroids regardless of imaging. The decision to continue steroids should be based on individual patient characteristics such as oxygen requirements. In the future, larger multicenter cohort studies would help understand further treatment of post-COVID-19-associated OP. Anticipating specific populations who may be at higher risk and starting treatment earlier could help reduce mortality.
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11
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Palones E, Curto E, Pelegrí A, Arilla M, Solanes I, Crespo-Lessmann A. Iatrogenic Adrenal Insufficiency Following Post COVID-19 Organizing Pneumonia. Arch Bronconeumol 2023; 59:63-65. [PMID: 35970652 PMCID: PMC9329133 DOI: 10.1016/j.arbres.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Esther Palones
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elena Curto
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Anna Pelegrí
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marina Arilla
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ingrid Solanes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Astrid Crespo-Lessmann
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
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12
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Oda T, Hagiwara E, Yamaya T, Ogura T. Timeline of Oxygen Demand in Patients with COVID-19 Pneumonia. Intern Med 2022; 61:3651-3658. [PMID: 36198590 PMCID: PMC9841100 DOI: 10.2169/internalmedicine.0190-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective In patients with coronavirus disease 2019 (COVID-19), understanding the timeline of oxygen demand and severe respiratory failure, such as intensive care unit (ICU) admission, may clarify the therapeutic window when home-care treatment is possible and help determine the timing of treatment in hospitalized patients to improve the respiratory status. We examined the timeline of respiratory status in hospitalized patients with moderate-to-severe COVID-19 in terms of oxygen demand and ICU admission. Methods We retrospectively assessed all patients with COVID-19 who were admitted to our hospital between February 2020 and February 2021 and required supplemental oxygen. This study included 66 patients who were transferred to the ICU (ICU patients) and 144 patients who were not transferred to the ICU (non-ICU patients). Results In the total cohort, the median duration from symptom onset to the need for supplemental oxygen was 8 [interquartile range (IQR) 6-10] days. This duration was significantly shorter in ICU patients than in non-ICU patients [8 (IQR 6-9) vs. 9 (IQR 6-10) days, p=0.02]. The median duration from symptom onset to ICU admission was 9 (IQR 8-11) days in severely ill patients. The median duration from the initiation of supplemental oxygen to ICU admission was 1.0 (IQR 1-2.75) days. Only 2 of 66 patients (3.0%) were admitted to the ICU six days or later after the initiation of supplemental oxygen. Conclusion Physicians should carefully monitor each patient's condition after eight days from symptom onset. New therapies and their early administration are needed to reduce the frequency of respiratory failure in COVID-19 patients.
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Affiliation(s)
- Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takafumi Yamaya
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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13
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Wong CK, Sia LC, Ooi NZM, Chan WY, Pang YK. Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia. PLoS One 2022; 17:e0276848. [PMCID: PMC9671325 DOI: 10.1371/journal.pone.0276848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Management of severe COVID-19 patients with persistent respiratory failure after acute phase treatment is not only challenging, but evidence for treatment is scarce, despite some authors reporting favourable clinical responses to corticosteroid therapy in histologically proven secondary organising pneumonia (OP). This study aimed to report the course of the disease, radiological pattern and clinical outcomes of severe COVID-19 patients with persistent respiratory failure. Methods This was a retrospective cohort study of severe COVID-19 patients who were admitted to a single tertiary centre from 1 January 2021 to 30 June 2021. The clinical data of the patients during admission and clinic follow-up, including radiological images, were traced using electronic medical records. Results In our cohort, the mortality rate for those with severe COVID-19 was 23.1% (173/749). Among the survivors, 46.2% (266/576) had persistent respiratory failure (PRF) after 14 days of illness. Of them, 70.3% (187/266) were followed up, and 68% (128/187) received oral corticosteroid (prednisolone) maintenance treatment. OP pattern made up the majority (81%) of the radiological pattern with a mean severity CT score of 10 (SD±3). The mean prednisolone dose was 0.68mg/kg/day with a mean treatment duration of 47 days (SD±18). About one-third of patients (67/187) had respiratory symptoms at 4 weeks (SD±3). Among 78.1% (146/187) who had a repeated CXR during follow-up, only 12 patients (8.2%, SD±3) had radiological improvement of less than 50% at 6 weeks (SD±3), with 2 of them later diagnosed as pulmonary tuberculosis. Functional assessments, such as the 6-minute walk test and the spirometry, were only performed in 52.4% and 15.5% of the patients, respectively. Conclusion Almost half of the patients with severe COVID-19 had PRF, with a predominant radiological OP pattern. More than two-thirds of the PRF patients required prolonged oral corticosteroid treatment. Familiarising clinicians with the disease course, radiological patterns, and potential outcomes of this group of patients may better equip them to manage their patients.
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Affiliation(s)
- Chee Kuan Wong
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Leng Cheng Sia
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- * E-mail:
| | | | - Wai Yee Chan
- Imaging Department—Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Yong-kek Pang
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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14
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Chong WH, Saha BK, Tan CK. Clinical Outcomes of Routine Awake Prone Positioning in COVID-19 Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Prague Med Rep 2022; 123:140-165. [PMID: 36107444 DOI: 10.14712/23362936.2022.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Before coronavirus disease 2019 (COVID-19) emerged, proning had been demonstrated to improve oxygenation in those with acute hypoxic respiratory failure and be performed in non-intensive care settings. This benefit was further exemplified by the COVID-19 pandemic, leading to awake prone positioning (APP). We assessed the efficacy of routine APP versus standard care in preventing death and invasive mechanical ventilation (IMV) in non-intubated hypoxic COVID-19 patients. PubMed, Cochrane Library, Scopus, and medRxiv databases were used from January 1st, 2020, to January 15th, 2022, to identify randomized controlled trials (RCTs). Routine APP group were encouraged to be self-prone, whereas the standard care group received care according to local clinical practice and allowed APP crossover as rescue therapy. We included eight COVID-19 RCTs assessing 809 APP vs. 822 standard care patients. APP group had less IMV requirement (26.5% vs. 30.9%; OR - odds ratio 0.77; P=0.03) than the standard care group, with subgroup analysis showing greater benefit (32.5% vs. 39.1%; OR 0.75; P=0.02) for those mainly requiring oxygen support of non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC). The time to IMV initiation was similar (mean 8.3 vs. 10.0 days; P=0.66) for patients requiring NIMV and HFNC. Patients mainly receiving supplemental oxygen and non-rebreather masks had improved oxygenation parameters, although not statistically significant. Other outcomes involving all-cause hospital mortality, hospital and ICU (intensive care unit) length of stay, and adverse events were comparable. APP appeared to be an important modality for reducing IMV requirements, especially in those requiring NIMV and HFNC.
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Affiliation(s)
- Woon Hean Chong
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, USA
| | - Chee Keat Tan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore
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15
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Tonietto TA, Lincho CS, Marques LDS, Elsing J, da Silveira F, Fendt LC, Montes THM, dos Passos MG, Vargas T, Marin LG, Nedel WL. Influence of radiologic pattern and the presence of Diffuse Parenchymal Lung Disease on outcome in ventilated patients with COVID 19 pneumonia: impact on prognosis. Intern Med J 2022; 53:492-496. [PMID: 36053990 PMCID: PMC9538882 DOI: 10.1111/imj.15912] [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: 03/30/2022] [Accepted: 07/04/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Suspected organising pneumonia (OP) is a common finding in patients with severe coronavirus disease 2019 (COVID-19), but the impact on outcomes of the radiological patterns of diffuse parenchymal lung disease on outcome of these patients is still uncertain. AIMS Investigate the presence of radiological images compatible with OP and its association with clinical outcomes in patients with COVID-19 submitted to invasive mechanical ventilation (IMV). METHODS Retrospective, unicentric cohort study composed of patients who required IMV and underwent chest computerized tomography to investigate secondary complications of COVID-19. We compared patients with radiological findings characteristic of suspected OP with those without this condition. The main outcome was hospital mortality. RESULTS Two hundred and ten patients were included, and 65 had signals compatible with OP. All patients with suspected OP were treated with corticosteroids. There was no difference in IVM-free days until day 28 between the groups (median, 0 days; interquartile range [IQR], 0-14.8) in the group with suspected OP vs 0 days (IQR, 0-11) in the group without suspected OP (P = 0.14). In univariate analysis, the presence of suspected OP was associated with lower hospital mortality; however, after correction for potential confounding variables, it was not associated with the outcome, even after matching by propensity score in patients without this condition. CONCLUSION OP radiologic pattern in patients with severe COVID-19 is not associated with worse outcomes.
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Affiliation(s)
- Tiago A. Tonietto
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
| | - Carla S. Lincho
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
| | - Leonardo da S. Marques
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
- Programa de Pós‐Graduação em Cardiologia ‐ Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Janaina Elsing
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
| | - Fernando da Silveira
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
- Programa de Pós‐Graduação em Pneumologia ‐ Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Lucia C.C. Fendt
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
| | | | | | - Taiani Vargas
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
| | - Luiz G. Marin
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
| | - Wagner L. Nedel
- Intensive Care Unit ‐ Grupo Hospitalar Conceição Porto Alegre Brazil
- Programa de Pós‐Graduação em Bioquímica ‐ Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
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16
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Pourshahid S, Khademolhosseini S, Giri B, Cossio M, Rubio E. A Case of Steroid-Responsive Severe Pneumonia Following a Recent COVID-19 Infection in a Patient With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection. Cureus 2022; 14:e26785. [PMID: 35967156 PMCID: PMC9370069 DOI: 10.7759/cureus.26785] [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] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
A twenty-two-year-old woman with a history of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) on rituximab presented with fever, abdominal pain, and worsening shortness of breath requiring supplemental oxygen via nasal cannula one month after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection from which she was minimally symptomatic and had recovered. Radiographic studies revealed bilateral patchy consolidations interspersed with ground-glass opacities (GGO). She was started on antibiotics for presumed community-acquired pneumonia with no improvement. Echocardiography revealed preserved biventricular function and a suspected intracardiac mass. A cardiac magnetic resonance imaging (CMRI) revealed myocarditis and no intracardiac mass. Fever persisted and oxygen requirements increased from FiO2 0.4 to 1.0. Repeat CXR showed subtotal left hemithorax opacification. Bronchoscopic samples showed a negative Gram stain and an unremarkable cell count differential. In view of this and given her lack of response to antibiotics with worsening respiratory status, high-dose steroids were started. She improved rapidly, and six days later she was off oxygen. Transbronchial biopsies showed benign parenchyma with some intra-alveolar fibrin deposition with no definitive evidence of viral cytopathic effect, vasculitis, or diffuse alveolar damage (DAD). Follow-up imaging in the pulmonary clinic revealed improvement of prior airspace disease with some new migratory opacities that completely resolved after 12 weeks. Pulmonary function tests and repeat CMRI were normal three months after discharge. Multisystem inflammatory syndrome in adults (MISA), post-covid organizing pneumonia (OP), and immune reconstitution inflammatory syndrome (IRIS) are rare and potentially steroid-responsive causes of pneumonia, which were in our differential diagnosis. It is imperative to consider the rare possibility of steroid-responsive pneumonia-like MISA, post-COVID-OP, and IRIS in patients with worsening respiratory symptoms following a recent SARS-CoV 2 infection.
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17
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Nakakubo S, Kamada K, Yamashita Y, Nakamura J, Matsumoto M, Horii H, Sato K, Morinaga D, Suzuki M, Okazaki N, Takakuwa E, Matsuno Y, Konno S. Delayed-onset Organizing Pneumonia Emerging after Recovery from Coronavirus Disease 2019: A Report of Three Cases Diagnosed Using Transbronchial Cryobiopsy and a Review of the Literature. Intern Med 2022; 61:1403-1410. [PMID: 35249922 PMCID: PMC9152860 DOI: 10.2169/internalmedicine.9016-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We present three cases with an atypical clinical course of organizing pneumonia (OP) secondary to coronavirus disease 2019 (COVID-19). Three patients were discharged with satisfactory improvement after standard steroid therapy for COVID-19. Shortly after the completion of treatment, the patients experienced a flare-up of symptoms. Imaging results showed new lesions in the lungs. Transbronchial lung cryobiopsy showed histological findings consistent with OP in all cases. Steroids were administered, and a good therapeutic response was observed. This report is the first to describe pathologically confirmed OP that developed after recovery from COVID-19. Careful follow-up is advisable for patients who have recovered from COVID-19.
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Affiliation(s)
- Sho Nakakubo
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Keisuke Kamada
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Yu Yamashita
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Munehiro Matsumoto
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Hiroshi Horii
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Kazuki Sato
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Daisuke Morinaga
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Nanase Okazaki
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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18
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(Takefumi Tsunemitsu) 恒健, (Takao Suzuki) 鈴崇, (Masaru Matsumoto) 松優. 重症COVID–19患者における侵襲的人工呼吸管理中のステロイドの投与終了と28日死亡率の関連の検討,後方視的コホート研究(Association between corticosteroid treatment termination during invasive mechanical ventilation and 28–day mortality in severe COVID–19 patients, a retrospective cohort study). NIHON KYUKYU IGAKUKAI ZASSHI: JOURNAL OF JAPANESE ASSOCIATION FOR ACUTE MEDICINE 2022. [PMCID: PMC9088569 DOI: 10.1002/jja2.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: To investigate the association between corticosteroid treatment termination during invasive mechanical ventilation and 28–day mortality in severe COVID–19 patients. Methods: The study was a single–center, retrospective cohort study of COVID–19 patients undergoing invasive mechanical ventilation on their scheduled corticosteroid termination day between March 1, 2020, and June 30, 2021. The scheduled corticosteroid termination day was scheduled 10 days after initiation of dexamethasone 6mg orally or 6.6mg intravenously. Patients who terminated corticosteroids during the ventilatory period and did not receive corticosteroids thereafter were defined as the termination group, whereas patients who continued to receive corticosteroids in some form after the scheduled corticosteroid termination day were defined as the continuation group. The primary endpoint was 28–day mortality, and the difference was evaluated using the log–rank test. Results: The 28–day mortality was found to be 61% (14 of 23 patients) in the termination group, which was significantly higher than the 28–day mortality of 22% (5 of 23 patients) in the continuation group (Hazard Ratio: 3.82, 95% CI: 1.37–10.68; p=0.005). Conclusions: In severe COVID–19 patients, corticosteroid termination during invasive ventilation is associated with an increased 28–day mortality.
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Affiliation(s)
- 恒光 健史 (Takefumi Tsunemitsu)
- 兵庫県立尼崎総合医療センター救急集中治療科(Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center)
| | - 鈴木 崇生 (Takao Suzuki)
- 兵庫県立尼崎総合医療センター救急集中治療科(Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center)
| | - 松本 優 (Masaru Matsumoto)
- 兵庫県立尼崎総合医療センター救急集中治療科(Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center)
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19
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Zhang M, Liang Y, Yu D, Du B, Cheng W, Li L, Yu Z, Luo S, Zhang Y, Wang H, Zhang X, Zhang W. A systematic review of Vaccine Breakthrough Infections by SARS-CoV-2 Delta Variant. Int J Biol Sci 2022; 18:889-900. [PMID: 35002532 PMCID: PMC8741840 DOI: 10.7150/ijbs.68973] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022] Open
Abstract
Vaccines are proving to be highly effective in controlling hospitalization and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as shown by clinical trials and real-world evidence. However, a deadly second wave of coronavirus disease 2019 (COVID-19), infected by SARS-CoV-2 variants, especially the Delta (B.1.617.2) variant, with an increased number of post-vaccination breakthrough infections were reported in the world recently. Actually, Delta variant not only resulted in a severe surge of vaccine breakthrough infections which was accompanied with high viral load and transmissibility, but also challenged the development of effective vaccines. Therefore, the biological characteristics and epidemiological profile of Delta variant, the current status of Delta variant vaccine breakthrough infections and the mechanism of vaccine breakthrough infections were discussed in this article. In addition, the significant role of the Delta variant spike (S) protein in the mechanism of immune escape of SARS-CoV-2 was highlighted in this article. In particular, we further discussed key points on the future SARS-CoV-2 vaccine research and development, hoping to make a contribution to the early, accurate and rapid control of the COVID-19 epidemic.
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Affiliation(s)
- Mengxin Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Ying Liang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Dongsheng Yu
- Department of Chinese Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Bang Du
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Weyland Cheng
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Lifeng Li
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Zhidan Yu
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Shuying Luo
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Yaodong Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Huanmin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Xianwei Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
| | - Wancun Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
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20
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Chen P, Cheng C, Li L, Yu C. Pneumonia rebound after stopping steroid in a patient with COVID-19: A case report. Respirol Case Rep 2021; 9:e0869. [PMID: 34721880 PMCID: PMC8543054 DOI: 10.1002/rcr2.869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with severe coronavirus disease 2019 (COVID-19) can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. The current treatment guideline recommends the use of corticosteroids in patients who require supplemental oxygen or are mechanically ventilated. This study reports a patient with severe COVID-19 pneumonia. Initially, the patient was treated with dexamethasone for 10 days and remdesivir for 5 days. There was clinical improvement following the treatments. However, on day 15, the patient experienced rebound pneumonia and clinical deterioration. His clinical condition improved until dexamethasone was re-administered. This case demonstrates the rebound phenomenon after the steroid was discontinued. The duration and timing of steroids are crucial to reduce the risk of prolonged systemic inflammation and rebound pneumonia.
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Affiliation(s)
- Po‐Hao Chen
- Division of Pulmonary, Critical Care, and Sleep MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Chun‐Yuan Cheng
- Division of Infectious DiseasesKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Li‐Fu Li
- Division of Pulmonary, Critical Care, and Sleep MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Chung‐Chieh Yu
- Division of Pulmonary, Critical Care, and Sleep MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan
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