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Febbo J, Revels J, Ketai L. Viral Pneumonias. Infect Dis Clin North Am 2024; 38:163-182. [PMID: 38280762 DOI: 10.1016/j.idc.2023.12.009] [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] [Indexed: 01/29/2024]
Abstract
Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.
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Affiliation(s)
- Jennifer Febbo
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA.
| | - Jonathan Revels
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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2
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Liu XP, Mao CX, Wang GS, Zhang MZ. Metagenomic next-generation sequencing for pleural effusions induced by viral pleurisy: A case report. World J Clin Cases 2023; 11:844-851. [PMID: 36818630 PMCID: PMC9928708 DOI: 10.12998/wjcc.v11.i4.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/31/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Viral pleurisy is a viral infected disease with exudative pleural effusions. It is one of the causes for pleural effusions. Because of the difficult etiology diagnosis, clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion. Here, we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus. Viral infection was identified by metagenomic next-generation sequencing (mNGS).
CASE SUMMARY A 40-year-old male with a history of dermatomyositis, rheumatoid arthritis, and secondary interstitial pneumonia was administered with long-term oral prednisone. He presented with fever and chest pain after exposure to cold, accompanied by generalized sore and weakness, night sweat, occasional cough, and few sputums. The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed. The pleural fluids were found to be yellow and slightly turbid after pleural catheterization. Thoracoscopy showed fibrous adhesion and auto-pleurodesis. Combining the results in pleural fluid analysis and mNGS, the patient was diagnosed as viral pleuritis. After receiving Aciclovir, the symptoms and signs of the patient were relieved.
CONCLUSION Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination. mNGS is helpful for diagnosis.
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Affiliation(s)
- Xue-Ping Liu
- Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Chen-Xue Mao
- Department of Laboratory Diagnosis, Chongqing KingMed Center for Clinical Laboratory Co., Ltd, Chongqing 400050, China
| | - Guan-Song Wang
- Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ming-Zhou Zhang
- Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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Saura O, Chommeloux J, Levy D, Assouline B, Lefevre L, Luyt CE. Updates in the management of respiratory virus infections in ICU patients: revisiting the non-SARS-CoV-2 pathogens. Expert Rev Anti Infect Ther 2022; 20:1537-1550. [PMID: 36220790 DOI: 10.1080/14787210.2022.2134116] [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: 01/12/2023]
Abstract
INTRODUCTION Although viruses are an underestimated cause of community-acquired pneumonias (CAP) and hospital-acquired pneumonias (HAP)/ventilator-associated pneumonias (VAP) in intensive care unit (ICU) patients, they have an impact on morbidity and mortality. AREAS COVERED In this perspective article, we discuss the available data regarding the management of severe influenza CAP and herpesviridae HAP/VAP. We review diagnostic and therapeutic strategies in order to give clear messages and address unsolved questions. EXPERT OPINION Influenza CAP affects yearly thousands of people; however, robust data regarding antiviral treatment in the most critical forms are scarce. While efficacy of oseltamivir has been investigated in randomized controlled trials (RCT) in uncomplicated influenza, only observational data are available in ICU patients. Herpesviridae are an underestimated cause of HAP/VAP in ICU patients. Whilst incidence of herpesviridae identification in samples from lower respiratory tract of ICU patients is relatively high (from 20% to 50%), efforts should be made to differentiate local reactivation from true lung infection. Only few randomized controlled trials evaluated the efficacy of antiviral treatment in herpesviridae reactivation/infection in ICU patients and all were exploratory or negative. Further studies are needed to evaluate the impact of such treatment in specific populations.
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Affiliation(s)
- Ouriel Saura
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Juliette Chommeloux
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - David Levy
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Assouline
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Lefevre
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
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Febbo J, Revels J, Ketai L. Viral Pneumonias. Radiol Clin North Am 2022; 60:383-397. [DOI: 10.1016/j.rcl.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Role of Chest Imaging in Viral Lung Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126434. [PMID: 34198575 PMCID: PMC8296238 DOI: 10.3390/ijerph18126434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Abstract
The infection caused by novel beta-coronavirus (SARS-CoV-2) was officially declared a pandemic by the World Health Organization in March 2020. However, in the last 20 years, this has not been the only viral infection to cause respiratory tract infections leading to hundreds of thousands of deaths worldwide, referring in particular to severe acute respiratory syndrome (SARS), influenza H1N1 and Middle East respiratory syndrome (MERS). Although in this pandemic period SARS-CoV-2 infection should be the first diagnosis to exclude, many other viruses can cause pulmonary manifestations and have to be recognized. Through the description of the main radiological patterns, radiologists can suggest the diagnosis of viral pneumonia, also combining information from clinical and laboratory data.
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Baba Y, Ishiguro T, Gochi M, Shimizu Y, Takayanagi N. A 72-Year-Old Woman With Respiratory Failure and Bilateral Ground-Glass Opacities. Chest 2020; 158:e41-e45. [PMID: 32654738 PMCID: PMC7330554 DOI: 10.1016/j.chest.2019.11.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/10/2019] [Accepted: 11/09/2019] [Indexed: 12/02/2022] Open
Abstract
A 72-year-old woman with diabetes mellitus was admitted to our hospital because of dyspnea on exertion. Sputum cytologic evaluation revealed intranuclear inclusion bodies in the cells; we therefore considered viral pneumonia and performed a bronchoscopy. The bronchial washing fluid was positive for immunoperoxidase staining of herpes simplex virus type 1 (HSV1) and HSV1 polymerase chain reaction. The patient was diagnosed as having pneumonia due to HSV1 and was successfully treated with acyclovir.
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Affiliation(s)
- Yuri Baba
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan; Department of Respiratory Medicine, Jikei University Kashiwa Hospital, Kashiwa City, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
| | - Mina Gochi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan; Department of Respiratory Medicine, Jikei University Kashiwa Hospital, Kashiwa City, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
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Chest Computed Tomography Findings in COVID-19 and Influenza: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6928368. [PMID: 32596354 PMCID: PMC7275219 DOI: 10.1155/2020/6928368] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
Objective The COVID-19 pandemic and annual influenza epidemic are responsible for thousands of deaths globally. With a similarity in clinical as well as laboratory findings, there is a need to differentiate these two conditions on chest CT scan. This paper attempts to use existing literature to draw out differences in chest CT findings in COVID-19 and influenza. Methods A search was conducted using PubMed. 17 original studies on chest CT findings in COVID-19 and influenza were identified for full-text review and data analysis. Findings. COVID-19 and influenza share similar chest CT findings. The differences found show that COVID-19 ground-glass opacities are usually peripherally located with the lower lobes being commonly involved, while influenza has a central, peripheral, or random distribution usually affecting the five lobes. Vascular engorgement, pleural thickening, and subpleural lines were reported in COVID-19 patients. In contrast, pneumomediastinum and pneumothorax were reported only in studies on influenza. Conclusion and Relevance. COVID-19 and influenza have overlapping chest CT features with few differences which can assist in telling apart the two pathologies. Additional studies are needed to further define the differences and degree between COVID-19 and influenza.
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Lee HL, Kim L, Kim CW, Kim JS, Nam HS, Ryu JS. An unusual case of herpes simplex virus pneumonia with cavitary and necrotic changes. Respir Med Case Rep 2020; 30:101086. [PMID: 32489848 PMCID: PMC7262008 DOI: 10.1016/j.rmcr.2020.101086] [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: 02/08/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022] Open
Abstract
Ground glass opacities, consolidation, and pleural effusions are observed in herpes simplex virus (HSV) pneumonia. Neither necrosis nor cavitation has been reported in areas of parenchymal disease. We describe a case of HSV pneumonia with unusual multiple cavitary and necrotic changes in an immunocompetent person. To our knowledge, this is the first reported case of HSV pneumonia with multiple cavitary and necrotic changes in areas of consolidation and nodules.
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Affiliation(s)
- Hong Lyeol Lee
- Department of Internal Medicine, Inha University College of Medicine, South Korea
| | - Lucia Kim
- Department of Pathology, Inha University College of Medicine, South Korea
| | - Cheol Woo Kim
- Department of Internal Medicine, Inha University College of Medicine, South Korea
| | - Jung Soo Kim
- Department of Internal Medicine, Inha University College of Medicine, South Korea
| | - Hae Sung Nam
- Department of Internal Medicine, Inha University College of Medicine, South Korea
| | - Jeong Seon Ryu
- Department of Internal Medicine, Inha University College of Medicine, South Korea
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Abstract
Infectious diseases are one of the main causes of morbidity and mortality worldwide. With new pathogens continuously emerging, known infectious diseases reemerging, increasing microbial resistance to antimicrobial agents, global environmental change, ease of world travel, and an increasing immunosuppressed population, recognition of infectious diseases plays an ever-important role in surgical pathology. This becomes particularly significant in cases where infectious disease is not suspected clinically and the initial diagnostic workup fails to include samples for culture. As such, it is not uncommon that a lung biopsy becomes the only material available in the diagnostic process of an infectious disease. Once the infectious nature of the pathological process is established, careful search for the causative agent is advised. This can often be achieved by examination of the hematoxylin and eosin-stained sections alone as many organisms or their cytopathic effects are visible on routine staining. However, ancillary studies such as histochemical stains, immunohistochemistry, in situ hybridization, or molecular techniques may be needed to identify the organism in tissue sections or for further characterization, such as speciation.
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Affiliation(s)
- Annikka Weissferdt
- Associate Professor, Department of Pathology, Division of Pathology and Laboratory Medicinec, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT Features of Viral Pneumonia. Radiographics 2018; 38:719-739. [PMID: 29757717 DOI: 10.1148/rg.2018170048] [Citation(s) in RCA: 396] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Viruses are the most common causes of respiratory infection. The imaging findings of viral pneumonia are diverse and overlap with those of other nonviral infectious and inflammatory conditions. However, identification of the underlying viral pathogens may not always be easy. There are a number of indicators for identifying viral pathogens on the basis of imaging patterns, which are associated with the pathogenesis of viral infections. Viruses in the same viral family share a similar pathogenesis of pneumonia, and the imaging patterns have distinguishable characteristics. Although not all cases manifest with typical patterns, most typical imaging patterns of viral pneumonia can be classified according to viral families. Although a definite diagnosis cannot be achieved on the basis of imaging features alone, recognition of viral pneumonia patterns may aid in differentiating viral pathogens, thus reducing the use of antibiotics. Recently, new viruses associated with recent outbreaks including human metapneumovirus, severe acute respiratory syndrome coronavirus, and Middle East respiratory syndrome coronavirus have been discovered. The imaging findings of these emerging pathogens have been described in a few recent studies. This review focuses on the radiographic and computed tomographic patterns of viral pneumonia caused by different pathogens, including new pathogens. Clinical characteristics that could affect imaging, such as patient age and immune status, seasonal variation and community outbreaks, and pathogenesis, are also discussed. The first goal of this review is to indicate that there are imaging features that should raise the possibility of viral infections. Second, to help radiologists differentiate viral infections, viruses in the same viridae that have similar pathogenesis and can have similar imaging characteristics are shown. By considering both the clinical and radiologic characteristics, radiologists can suggest the diagnosis of viral pneumonia. ©RSNA, 2018.
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Affiliation(s)
- Hyun Jung Koo
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Soyeoun Lim
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Jooae Choe
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Sang-Ho Choi
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Heungsup Sung
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Kyung-Hyun Do
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
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Luzzati R, D'Agaro P, Busca A, Maurel C, Martellani F, Rosin C, Segat L, Gatti G, Mascarello M, Confalonieri M. Herpes simplex virus (HSV) pneumonia in the non-ventilated immunocompromised host: Burden and predictors. J Infect 2018; 78:127-133. [PMID: 30267802 DOI: 10.1016/j.jinf.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/31/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate burden and predictors of HSV pneumonia among immunocompromised patients not undergoing invasive mechanical ventilation according to a tailored diagnostic algorithm. METHODS This prospective, observational study included immunocompromised adults with pneumonia non-responding to empirical antibiotic therapy. Bronchoalveolar lavage (BAL) specimens were cultured for bacteria, mycobacteria and fungi. Real-time PCR for Herpesviruses and other microorganisms were performed on BAL and other specimens. Cytological examination of BAL samples was carried out for identification of intranuclear inclusion bodies and immunohistochemical staining for HSV. RESULTS We enrolled 45 patients (mean age 64.6 years) from January 2015 to June 2016. Nineteen (42.2%) cases tested positive for HSV-1 PCR on BAL. According to our definitions, 11 (24.4%) patients had HSV-1 pneumonia with viral loads ranging between 103 copies/mL and 107 copies/mL. HSV-1 positive throat swab (OR 85.2, 95% CI 5.83-1245.1, P < 0.001) and solid organ transplant (SOT) (OR 53.3, 95% CI 1.37-2072.8, P < 0.03) as underlying condition were found to be independently associated with HSV pneumonia by multivariable analysis. CONCLUSIONS HSV pneumonia turned out to be relatively common and should be investigated especially in individuals with HSV positive throat swab and SOT. Interventional studies are needed to assess the real clinical impact of HSV pneumonia in immunocompromised patients.
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Affiliation(s)
- Roberto Luzzati
- Infectious Diseases Unit, University Hospital of Trieste, Piazza dell'Ospitale 1, 34125 Trieste, Italy.
| | - Pierlanfranco D'Agaro
- Laboratory for Hygiene and Public Health, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Annalisa Busca
- Pulmonology Unit, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Cristina Maurel
- Infectious Diseases Unit, University Hospital of Trieste, Piazza dell'Ospitale 1, 34125 Trieste, Italy
| | - Fulvia Martellani
- Anatomy and Histopathology Unit, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Chiara Rosin
- Infectious Diseases Unit, University Hospital of Trieste, Piazza dell'Ospitale 1, 34125 Trieste, Italy
| | - Ludovica Segat
- Laboratory for Hygiene and Public Health, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Giuseppe Gatti
- Cardiosurgery Unit, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Marta Mascarello
- Infectious Diseases Unit, University Hospital of Trieste, Piazza dell'Ospitale 1, 34125 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, University Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
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Human Herpesvirus Alpha Subfamily (Herpes Simplex and Varicella Zoster) Viral Pneumonias: CT Findings. J Thorac Imaging 2018; 33:384-389. [PMID: 30188334 DOI: 10.1097/rti.0000000000000364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate CT features of pneumonias caused by the alpha Herpesviruses, herpes simplex virus (HSV), and varicella-zoster virus (VZV). MATERIALS AND METHODS By searching the electronic medical record from 2005 to 2017, we identified 12 patients with HSV and 15 with VZV pneumonia. Four patients with coinfection were excluded from imaging analysis. Two radiologists reviewed computed tomography scans (CTs) for findings including ground glass and nodules. CTs were assigned to a predominant pattern of crazy paving, nodular, or other. RESULTS The most common risk factor was hematologic malignancy, present in 58% of HSV and 47% of VZV patients. Crazy paving was seen in 50% of HSV and 31% of VZV cases; a nodular pattern was present in 20% of HSV and 69% of VZV patients (P=0.03). CONCLUSIONS Most patients with alpha Herpesvirus pneumonias demonstrated either a crazy paving or nodular pattern on CT. The nodular pattern was significantly more common in VZV than in HSV. Radiologists should consider these rare infections when evaluating immunocompromised patients with these imaging patterns.
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13
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Yoshimi M, Satou Y, Mori M. A case of herpes simplex virus pneumonia detected by sputum cytodiagnosis. Clin Case Rep 2017; 6:165-169. [PMID: 29375858 PMCID: PMC5771873 DOI: 10.1002/ccr3.1309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/03/2017] [Accepted: 11/05/2017] [Indexed: 12/02/2022] Open
Abstract
A sputum test is noninvasive and simple. It contributed to correct diagnosis of a patient with severe acute respiratory failure. We again point out the usefulness of sputum cytodiagnosis for differentiating severe pneumonia.
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Affiliation(s)
- Mayumi Yoshimi
- Department of Hematology & Blood Transfusion Mitsui Memorial Hospital Tokyo Japan
| | - Yu Satou
- Department of Internal medicine Mitsui Memorial Hospital Tokyo Japan
| | - Masaya Mori
- Department of Pathology Mitsui Memorial Hospital Tokyo Japan
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Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Infection. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7120007 DOI: 10.1007/174_2016_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community-Acquired Pneumonia (CAP) is the first leading cause of death due to infection worldwide.Many gram-positive, gram-negative bacteria, funguses and viruses can cause the infectious pulmonary disease, and the severity of pneumonia depends on the balance between the microorganism charge, the body immunity defenses and the quality of the underlying pulmonary tissue. The microorganisms may reach the lower respiratory tract from inhaled air or from infected oropharyngeal secretions. The same organism may produce several different patterns that depend on the balance between the microorganism charge and the body immunity defenses.CAP is classified into three main groups: lobar pneumonia, bronchopneumonia and interstitial pneumonia.Lobar pneumonia is characterized by the filling of alveolar spaces by edema full of white and inflammatory cells. Necrotizing pneumonia consists of a fulminant process associated with focal areas of necrosis that results in abscesses. Bronchopneumonia or lobular pneumonia, is characterized by a peribronchiolar inflammation with thickening of peripheral bronchial wall, the diffusion of inflammation to the centrilobular alveolar spaces and development of nodules.The interstitial pneumonia represents with the destruction and esfoliation of the respiratory ciliated and mucous cells. The interstitial septa, the bronchial and bronchiolar walls become thickened for the inflammation process and lymphocytes interstitial infiltrates.Chest radiography represents an important initial examination in all patients suspected of having pulmonary infection and for monitoring response to therapy.Its role is to identify the pulmonary opacities, their internal characteristics and distribution, pleural effusion and presence of other complications as abscesses and pneumothorax.High spatial CT resolution allows accurate assessment of air space inflammation.The CT findings include nodules, interlobular septal thickening, intralobular reticular opacities, ground-glass opacities, tree-in-bud pattern, lobar-segmental consolidation, lobular consolidation, abscesses, pneumatocele, pleural effusion, pericardial effusion, mediastinal and hilar lymphoadenopaties, airway dilatation and emphysema.
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Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
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Goodman P, Prosch H, Herold CJ. Imaging of Pulmonary Infections. DISEASES OF THE CHEST AND HEART 2015–2018 2015. [PMCID: PMC7121828 DOI: 10.1007/978-88-470-5752-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary infection is one of the most frequent causes of morbidity and mortality throughout the world. Many infections occur in individuals with concomitant intrapulmonary or extrathoracic diseases; however, they commonly develop in otherwise healthy people. In the non-immunocompromised population, pneumonia is the most prevalent community-acquired infection and the second most common nosocomial infectious disorder. In immunocompromised patients, in children, and in the elderly, pneumonia, as well as other pulmonary infections, may develop into a life-threatening condition.
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Acute herpes simplex virus 1 pneumonitis in a patient with systemic lupus erythematosus. J Clin Rheumatol 2014; 20:42-4. [PMID: 24356475 DOI: 10.1097/rhu.0000000000000060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A woman with severe and longstanding systemic lupus erythematosus presented with a 1-week history of fever up to 38°C and pain in her right flank. Computed tomography scan of the chest revealed interstitial infiltrates and multiple nodules. Bronchoalveolar lavage did not show any inflammatory cells. Gram stain and cultures for aerobic and anaerobic bacteria, fungi, and Nocardia; acid-fast staining; polymerase chain reaction for tuberculosis, cytomegalovirus, herpesvirus 6, and parvovirus B19; and IF staining for pneumocystic and Legionella antigen were all negative. Transbronchial biopsy was nondiagnostic. Open lung biopsy with polymerase chain reaction and immunohistochemistry analyses revealed herpes simplex virus 1 infection. Acyclovir therapy was initiated and was followed by significant improvement. Herpes simplex virus 1 infection (although unusual) should be considered in patients with systemic lupus erythematosus with an atypical clinical presentation.
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Boundy KE, Fraire AE, Oliveira PJ. A patient with progressive dyspnea and multiple foci of airspace consolidation. Chest 2014; 145:167-172. [PMID: 24394829 DOI: 10.1378/chest.13-0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Keith E Boundy
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Armando E Fraire
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA
| | - Paulo J Oliveira
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
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Nestor J, Huggins T, Kummerfeldt C, DiVietro M, Walters K, Sahn S. Viral diseases affecting the pleura. J Clin Virol 2013; 58:367-73. [PMID: 23916378 DOI: 10.1016/j.jcv.2013.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/01/2013] [Accepted: 06/07/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Viruses affect the human body in multiple ways producing various disease states. The infections of the pulmonary parenchyma have been well described. However, there has been no current review of the literature pertaining to the pleura. AIM To review the available literature pertaining to diseases of the pleura that are caused by viral infections. METHODS A Medline search was performed and available research and review articles relating to viral infections that resulted in pleural effusions, pleural masses, pleural thickening, and pleural nodularity were reviewed. CONCLUSION There are numerous viruses that cause diseases of the pleura. Pleural effusions and lesions within the pleura are the most common presentation of the disease state. Polymerase chain reaction has the potential to further diagnose viral infections and expand our knowledge base in this field.
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Affiliation(s)
- Jennings Nestor
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, 96 Jonathan Lucas Street, Suite 812 - CSB, MSC 630, Charleston, SC 29425, United States.
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Pedrozo Pupo JC. Pulmonary Interstitium. LEARNING CHEST IMAGING 2013. [PMCID: PMC7120621 DOI: 10.1007/978-3-642-34147-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The first step in the radiographic evaluation of interstitial lung disease begins with a fundamental knowledge of the anatomy of the pulmonary interstitium and the different patterns of disruption. The anatomy of the pulmonary interstitium as demonstrated on CT of the chest with high resolution cuts is largely essential to establish the various radiological patterns that define interstitial lung disease such as the tree-in-bud, ground-glass opacity, crazy -paving, etc.
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Affiliation(s)
- John C. Pedrozo Pupo
- , Institute for Respiratory Care, University of Magdalena, Cra 21 Nr. 18-27, Santa Marta, 470004 MAGDALENA Colombia
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Brodoefel H, Vogel M, Spira D, Faul C, Beck R, Claussen C, Horger M. Herpes-Simplex-Virus 1 pneumonia in the immunocompromised host: High-resolution CT patterns in correlation to outcome and follow-up. Eur J Radiol 2012; 81:e415-20. [DOI: 10.1016/j.ejrad.2011.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/02/2011] [Indexed: 01/15/2023]
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Shah JN, Chemaly RF. Herpes Simplex Virus Pneumonia in Patients with Hematologic Malignancies. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7124034 DOI: 10.1007/978-3-642-15742-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Herpes simplex virus (HSV) pneumonia is rare and is usually seen in immunocompromised patients. Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) are at risk. Most of the cases of HSV pneumonia are caused by HSV-1; however, cases caused by HSV-2 have also been reported. Mucocutaneous disease often precedes the development of pneumonia, with nonspecific symptoms that include fever, cough, and dyspnea. Worsening oxygenation and failure to wean off mechanical ventilation despite broad-spectrum antimicrobial coverage is also a common presentation. Diagnosis requires a high degree of suspicion and is based on isolation of the virus from respiratory secretions and demonstration of cytopathic effects on histopathology. Acyclovir is the most widely used drug for treatment and prophylaxis. With increasing evidence of resistance to acyclovir and its analogs, newer agents such as foscarnet and cidofovir are being recommended as treatment options. Prophylaxis in patients with seropositive HSV undergoing chemotherapy or in the immediate post-HSCT period has been shown to reduce HSV disease rates and mortality rates. This chapter will focus on incidence and transmission, pathogenesis, risk factors, clinical features, diagnosis, and management of HSV pneumonia in patients with hematologic malignancies and HSCT, as well as outcome and prognosis.
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Chong S, Kim TS, Cho EY. Herpes simplex virus pneumonia: high-resolution CT findings. Br J Radiol 2010; 83:585-9. [PMID: 20442279 DOI: 10.1259/bjr/51409455] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to evaluate the high-resolution computed tomographic (HRCT) findings of five adult patients (either immunocompromised or immunocompetent) with herpes simplex virus (HSV) pneumonia. We retrospectively assessed HRCT images of 5 patients (all male patients, age range 39-70 years; mean 62 years) with HSV pneumonia. The specific pathological findings that allowed for a definite diagnosis of HSV pneumonia included the presence of intranuclear inclusion bodies on haematoxylin and eosin staining, or positive immunohistochemical staining. High-resolution CT scans (HiSpeed Advantage or LightSpeed QX/i, GE Healthcare) using 1- or 1.25-mm collimation at 10-mm intervals without intravenous contrast medium injection were assessed, in particular for the presence and distribution of parenchymal abnormalities including ground-glass attenuation, airspace consolidation, nodules and interlobular septal thickening. In two patients, pathological specimens were obtained from open lung biopsy or bronchoscopic biopsy, and were correlated with HRCT findings. Three HRCT patterns of pulmonary abnormalities were identified in our series of HSV pneumonia: predominant areas of diffuse or multifocal ground-glass attenuation, predominant areas of multifocal peribronchial consolidations, and a mixed pattern of both. Histopathologically, areas of ground-glass attenuation seen on HRCT corresponded to diffuse alveolar damage in one patient who underwent open lung biopsy. No specific differences in HRCT findings were seen between the immunocompromised and the immunocompetent patients. In patients suspected of having an acute lower respiratory infection, whether immunocompromised or immunocompetent, a possibility of HSV pneumonia can be included in differential diagnoses when diffuse or multifocal areas of ground-glass attenuation and/or consolidations are seen on HRCT.
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Affiliation(s)
- S Chong
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul 156-755, South Korea
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Reyes CV, Bolden JR. Herpes simplex virus type-1 pneumonitis in immunocompetent young woman. Heart Lung 2009; 38:526-9. [PMID: 19944877 DOI: 10.1016/j.hrtlng.2009.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 03/12/2009] [Accepted: 05/29/2009] [Indexed: 11/29/2022]
Abstract
A healthy young woman presented with an overwhelming hyperacute herpes simplex virus-1 pneumonia that dramatically responded to intravenous acyclovir. It is postulated that the infection was a reactivation of latent virus in the vagal ganglia, in the absence of retrograde extension of herpes labialis/gingivostomatitis, or hematogenous spread from extragenital and other sources of infection. It is also postulated that the patient's amazing improvement overnight was a real-time coincidence of spontaneous recovery from the viral infection and prompt initiation of acyclovir treatment.
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Affiliation(s)
- Cesar V Reyes
- Department of Clinical Laboratories, Morris Hospital, Morris, Illinois, USA
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25
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Witt MN, Braun GS, Ihrler S, Schmid H. Occurrence of HSV-1-induced pneumonitis in patients under standard immunosuppressive therapy for rheumatic, vasculitic, and connective tissue disease. BMC Pulm Med 2009; 9:22. [PMID: 19450259 PMCID: PMC2705343 DOI: 10.1186/1471-2466-9-22] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 05/18/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus type-1 (HSV-1) has been described to cause respiratory tract infections in critically ill patients or in individuals that are immunocompromised. It is a continuing matter of debate under which circumstances HSV-1 is a relevant pathogen for pneumonitis. While its role during critical illness has been investigated by prospective interventional studies, comparatively little systematic data is available on the role of HSV-1 for pneumonitis in outpatients with autoimmune disease under a maintenance regimen of immunosuppression. METHODS We retrospectively reviewed the charts of approximately 1400 patients with rheumatoid arthritis, vasculitis, and systemic lupus erythematosus (SLE) that were followed at the outpatient clinic of a German University hospital during the years 2000-2007. Episodes of admission to a ward resulting in the diagnosis of pneumonia/pneumonitis were identified, and the type of pneumonia and clinical features retrospectively studied. RESULTS 63 patients with rheumatoid arthritis, vasculitis, or SLE were admitted to a ward and diagnosed to have pneumonia/pneumonitis. Using bronchoscopy a total of 6 cases of pulmonary infection associated with HSV-1 in the lower respiratory tract were identified. Among those, 2 cases suggested a causative role of HSV-1 as the sole agent causing pneumonitis that proved clinically responsive to antiviral treatment. In the remaining 4 cases HSV-1 appeared as a bystander of bacterial infection. Maintenance therapy with leflunomide, which inhibits HSV-1 assembly in vitro, was associated with a milder course of pneumonitis in one patient. Detection of HSV-1 was associated with stronger immunosuppressive regimens and vasculitic disease. CONCLUSION The present study analyzed the frequency and hallmarks of cases of HSV-1 associated pneumonitis that occurred in a comparatively large cohort of patients with rheumatologic autoimmune diseases. In an area of controversy, this study provides further evidence that HSV-1 causes isolated pneumonitis in the immunocompromised. The study may provide an estimate on the frequency of relevant HSV-1 infection and bacterial agents in outpatients with autoimmune disease.
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Affiliation(s)
- Matthias N Witt
- Department of Nephrology, Medical Policlinic, University of Munich, Munich, Germany.
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Aisenberg G, Torres H, Tarrand J, Safdar A, Bodey G, Chemaly RF. Herpes simplex virus lower respiratory tract infection in patients with solid tumors. Cancer 2008; 115:199-206. [DOI: 10.1002/cncr.24011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Maounis N, Blana A, Ellina E, Chorti M, Lekkakou A, Mermigkis D, Spanakis N, Emmanouilidou A. Simultaneous cytological diagnosis of herpes simplex virus infection and primary lung cancer: Report of two cases. Diagn Cytopathol 2008; 36:818-22. [DOI: 10.1002/dc.20921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cunha BA, Eisenstein LE, Dillard T, Krol V. Herpes simplex virus (HSV) pneumonia in a heart transplant: Diagnosis and therapy. Heart Lung 2007; 36:72-8. [PMID: 17234480 DOI: 10.1016/j.hrtlng.2006.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 07/18/2006] [Indexed: 10/23/2022]
Abstract
Organ transplants are frequently complicated by viral infections. The period of maximum immunosuppression, 1 to 6 months posttransplantation, predisposes one to intracellular pathogens. The most common intracellular viral pathogens in transplant recipients include cytomegalovirus (CMV), herpes simplex virus (HSV), and respiratory syncytial virus (RSV). Cytomegalovirus and HSV are common viral pathogens in the early transplant period (0-1 month posttransplant). Although respiratory syncytial virus commonly presents in the late posttransplant period (> or =6 months posttransplant), HSV pneumonia may be acquired in organ transplants by endogenous reactivation caused by immunosuppression or may be introduced from colonized oropharyngeal secretions into the lower respiratory tract during intubation in patients on ventilators. In ventilated patients without severe preexisting lung disease, HSV pneumonia presents with otherwise unexplained profound/prolonged hypoxemia or "failure to wean." As other viral pneumonias, HSV pneumonia is characterized by profound hypoxemia requiring a high FIo(2), and a highly increased A-a gradient (> or =30). These findings are indicative of an oxygen diffusion defect typical of noninfectious (eg, sarcoidosis) or infectious disorders (eg, HSV, cytomegalovirus, respiratory syncytial virus, Pneumocystis (carinii) jiroveci pneumonia) primarily affecting the interstitium of the lung. We present a case of HSV pneumonia in a heart transplant recipient and include a review of the clinical presentation, diagnostic findings, and therapy of HSV pneumonia.
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Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA
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Simoons-Smit AM, Kraan EM, Beishuizen A, Strack van Schijndel RJ, Vandenbroucke-Grauls CM. Herpes simplex virus type 1 and respiratory disease in critically-ill patients: real pathogen or innocent bystander? Clin Microbiol Infect 2006; 12:1050-9. [PMID: 17002604 DOI: 10.1111/j.1469-0691.2006.01475.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) has been associated with pulmonary disease, mostly in severely immunocompromised patients. After reactivation and shedding in the oropharynx, the virus may reach the lower respiratory tract by aspiration or by contiguous spread. HSV-1 can be detected in clinical specimens by virus culture or quantitatively by nucleic acid amplification techniques. With these techniques, HSV-1 is often detected in the respiratory secretions of critically-ill patients. However, a clear diagnosis of HSV-1 pneumonia is difficult to establish because clinical criteria, radiological features and laboratory findings all lack specificity. Lower respiratory tract HSV-1 infections have not been associated with specific risk-factors. There is also an absence of consistent data concerning the effect of antiviral treatment on the outcome of critically-ill patients. Further studies are needed to better define the pathogenic role of HSV-1 in the lower respiratory tract of these patients, to improve the diagnosis, and, especially, to assess the need for antiviral treatment in the individual patient.
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Affiliation(s)
- A M Simoons-Smit
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
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Franquet T, Rodriguez S, Martino R, Giménez A, Salinas T, Hidalgo A. Thin-Section CT Findings in Hematopoietic Stem Cell Transplantation Recipients with Respiratory Virus Pneumonia. AJR Am J Roentgenol 2006; 187:1085-90. [PMID: 16985161 DOI: 10.2214/ajr.05.0439] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to use serial thin-section CT scans to assess the incidence of respiratory viral infection and lung abnormalities in a large patient population at high risk of pulmonary complications. MATERIALS AND METHODS The study population consisted of 26 recipients of hematopoietic stem cell transplants who had proven respiratory viral pneumonia. In all cases, thin-section CT scans were obtained before fiberoptic bronchoscopy and bronchoalveolar lavage. The study included only patients in whom bronchoalveolar lavage fluid showed no evidence of organisms other than respiratory viruses. The CT scans were assessed for the presence, extent, and anatomic distribution of ground-glass attenuation, air-space consolidation, nodules, centrilobular branching structures (tree-in-bud), thickening of the bronchovascular bundles, and pleural effusion. RESULTS Areas of ground-glass attenuation were identified in 24 (92%) of 26 patients and were the only finding in eight patients. Multiple nodules, seen in 17 (65%) of 26 patients, measured 3-10 mm in diameter or were larger than 10 mm. The nodules had a centrilobular or random distribution. A tree-in-bud appearance was seen in six of the patients with centrilobular nodules. This pattern had a bilateral distribution and involved mainly the lower lung zones. CT revealed thickening of the bronchovascular bundles in 16 (61%) of the patients. Thickening was bilateral in 14 and unilateral in two patients. Bronchial wall thickening involved the lower lobes in six patients and had a patchy random distribution in the remaining nine patients. Air-space consolidation was present in nine (35%) of the cases. It had a lobular or subsegmental distribution in eight of the patients and a segmental distribution in one patient. Areas of consolidation were randomly distributed throughout the lungs in all cases. Less common findings included bilateral pleural effusion and bronchial dilatation. CONCLUSION Respiratory viral infection is common among adult recipients of hematopoietic stem cell transplants, occurring over a wide time span after transplantation. The presence of respiratory viral infection must be considered in any patient with new respiratory symptoms, fever, or findings at CT such as extensive or patchy areas of ground-glass opacities or a mixture of patterns, most commonly ground-glass attenuation, thickening of the bronchial walls, and multiple small nodules.
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Affiliation(s)
- Tomas Franquet
- Department of Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Avda Sant Antoni Ma Claret 167, 08025 Barcelona, Spain
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Ferrari A, Luppi M, Potenza L, Riva G, Morselli M, Imovilli A, Volzone F, Rossi G, Codeluppi M, Guaraldi G, Torelli G. Herpes simplex virus pneumonia during standard induction chemotherapy for acute leukemia: case report and review of literature. Leukemia 2005; 19:2019-21. [PMID: 16049511 DOI: 10.1038/sj.leu.2403893] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gasparetto EL, Escuissato DL, Inoue C, Marchiori E, Müller NL. Herpes Simplex Virus Type 2 Pneumonia After Bone Marrow Transplantation. J Thorac Imaging 2005; 20:71-3. [PMID: 15818204 DOI: 10.1097/01.rti.0000154072.39497.61] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Bone marrow transplant recipients have increased prevalence of viral infections, including Herpes simplex pneumonia. The majority of infections are due to HSV type 1. We report the high-resolution CT findings in 3 bone marrow transplant patients with herpes simplex type 2 pneumonia. The most common CT features were focal areas of consolidation seen in 3 patients, and small centrilobular nodules and areas of ground-glass attenuation seen in 2 patients.
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MESH Headings
- Acute Disease
- Adult
- Bone Marrow Transplantation/adverse effects
- Bronchoalveolar Lavage Fluid/virology
- Child
- Female
- Herpes Simplex/complications
- Herpes Simplex/diagnosis
- Herpes Simplex/virology
- Herpesvirus 2, Human/isolation & purification
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myeloid/complications
- Lung/diagnostic imaging
- Lung/virology
- Male
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/virology
- Postoperative Complications/diagnosis
- Postoperative Complications/virology
- Radiography, Thoracic/methods
- Tomography, X-Ray Computed/methods
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Franquet T, Rodríguez S, Martino R, Salinas T, Giménez A, Hidalgo A. Human Metapneumovirus Infection in Hematopoietic Stem Cell Transplant Recipients. J Comput Assist Tomogr 2005; 29:223-7. [PMID: 15772541 DOI: 10.1097/01.rct.0000157087.14838.4c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the high-resolution computed tomography (CT) findings in hematopoietic stem cell transplant (HCT) recipients who had proven human metapneumovirus (HMPV) pneumonia. MATERIALS AND METHODS The study included 5 HCT recipients who had proven HMPV pneumonia. The patients included 4 men and 1 woman ranging in age from 23 to 58 years (mean age = 42 years). The CT scans were assessed for the presence, appearance, size, and distribution of parenchymal abnormalities. RESULTS Human metapneumovirus was isolated in all 5 patients in this series. None of these patients had any other infectious organism identified in cultures or bronchoalveolar lavage. The predominant CT findings were bilateral abnormalities in all patients, consisting primarily of a mixture of patterns, including, most commonly, ground-glass attenuation and nodular opacities. Areas of ground-glass opacification had no zonal predominance and were bilateral, asymmetric, and patchily distributed. Multiple nodules were identified in 4 (80%) of 5 patients. Nodules were multiple; less than 5 nodules were identified in 1 case, and 5 to 10 nodules were identified in 3 cases. All nodules in all cases were less than 10 mm in diameter. Areas of air-space consolidation were identified in 2 (40%) patients. All patients were available for follow-up; lesions improved in 4 patients. CONCLUSION The thin-section CT manifestations of HMPV pneumonia usually consist of a mixture of patterns, including, most commonly, ground-glass attenuation and nodular opacities.
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Affiliation(s)
- Tomás Franquet
- Department of Radiology, Hospital de Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
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Miller WT, Shah RM. Isolated Diffuse Ground-Glass Opacity in Thoracic CT: Causes and Clinical Presentations. AJR Am J Roentgenol 2005; 184:613-22. [PMID: 15671387 DOI: 10.2214/ajr.184.2.01840613] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Wallace T Miller
- Department of Radiology, University of Pennsylvania School of Medicine, 3400 Spruce St., Silverstein 1, Philadelphia, PA 19104, USA.
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Verheij J, Groeneveld ABJ, Beishuizen A, Lingen AV, Simoons-Smit AM, van Schijndel RJMS. Herpes simplex virus type 1 and normal protein permeability in the lungs of critically ill patients: a case for low pathogenicity? Crit Care 2004; 8:R139. [PMID: 15153242 PMCID: PMC468896 DOI: 10.1186/cc2850] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 02/03/2003] [Accepted: 03/12/2004] [Indexed: 11/16/2022] Open
Abstract
Introduction The pathogenicity of late respiratory infections with herpes simplex virus type 1 (HSV-1) in the critically ill is unclear. Methods In four critically ill patients with persistent pulmonary infiltrates of unknown origin and isolation of HSV-1 from tracheal aspirate or bronchoalveolar lavage fluid, at 7 (1–11) days after start of mechanical ventilatory support, a pulmonary leak index (PLI) for 67Gallium (67Ga)-transferrin (upper limit of normal 14.1 × 10-3/min) was measured. Results The PLI ranged between 7.5 and 14.0 × 10-3/min in the study patients. Two patients received a course of acyclovir and all survived. Conclusions The normal capillary permeability observed in the lungs argues against pathogenicity of HSV-1 in the critically ill, and favors that isolation of the virus reflects reactivation in the course of serious illness and immunodepresssion, rather than primary or superimposed infection in the lungs.
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Affiliation(s)
- Joanne Verheij
- From the Department of Intensive Care, Nuclear Medicine
- the Institute for Cardiovascular Research
- Department of Medical Microbiology and Infection Control
| | - AB Johan Groeneveld
- From the Department of Intensive Care, Nuclear Medicine
- Department of Medical Microbiology and Infection Control
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Abstract
Pneumonia is one of the leading causes of morbidity, hospitalization, and mortality in both industrialized and developing countries. In particular, pulmonary infections acquired in the community, and pneumonias arising in the hospital setting, represent a major medical and economic problem and thus a continuous challenge to health care. For the radiologist, it is important to understand that community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) share a number of characteristics, but should, in many respects be regarded as separate entities. CAP and NP arise in different populations, host different spectra of causative pathogens, and pose different challenges to both the clinician and the radiologist. CAP is generally seen in outpatients, is most frequently caused by Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, and Chlamydia, and its radiologic diagnosis is relatively straightforward. NP, in contrast, develops in the hospital setting, is commonly caused by gram-negative bacteria, and may generate substantial problems for the radiologist. Overall, both for CAP and NP, imaging is an integral component of the diagnosis, important for classification and differential diagnosis, and helpful for follow-up.
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Affiliation(s)
- Christian J Herold
- Department of Radiology, University of Vienna, Vienna General Hospital, Austria.
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Abstract
Les pneumonies infectieuses aiguës constituent un problème de santé publique important, car elles sont une cause majeure de morbidité et de mortalité chez l’adulte. Si les données cliniques et radiographiques permettent le plus souvent de faire le diagnostic de pneumonie infectieuse, le diagnostic étiologique est plus difficile. En effet, de nombreux agents pathogènes peuvent être responsables de pneumonie et la réaction du parenchyme pulmonaire est peu variée, d’où la faible spécificité des lésions radiologiques observées en dehors de quelques cas particuliers. C’est pourquoi la compréhension des mécanismes physiopathologiques permet d’expliquer certains aspects radiologiques. De même, la connaissance des bases anatomocliniques et radiologiques autorise la reconnaissance de trois aspects radiographiques principaux. Quant à l’appréciation des contextes épidémiologique et immunitaire, ils peuvent permettre également d’approcher le germe en cause.
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Terzano C, Petroianni A, Ricci A. Herpes simplex pneumonia: Combination therapy with oral acyclovir and aerosolized ribavirin in an immunocompetent patient. CURRENT THERAPEUTIC RESEARCH 2004; 65:90-6. [PMID: 24936107 PMCID: PMC4052960 DOI: 10.1016/s0011-393x(04)90008-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2003] [Indexed: 11/24/2022]
Abstract
BACKGROUND Herpes simplex viruses (HSVs) are known to cause respiratory tract infections in immunocompromised hosts and, in rare instances, in immunocompetent hosts. Numerous in vitro and in vivo studies have shown that aerosolized administration of ribavirin can potently and selectively inhibit viral replication in pulmonary disease, thereby increasing the effectiveness of acyclovir in HSV. OBJECTIVE In this case study, we reported on a 46-year-old immunocompetent woman with HSV type 1 pneumonia with bilateral pulmonary infiltrates but without mucocutaneous lesions. METHODS The diagnosis was confirmed using cytology, viral culture, and serology. Because of the persistence of fever and dyspnea, we chose an antiviral therapy. The patient received oral acyclovir and aerosolized ribavirin to improve the antiviral effectiveness of the acyclovir and to reduce the symptoms and the time to resolution of the pulmonary disease. RESULTS After 3 days of therapy, dyspnea and fever decreased and hypoxemia improved. After 2 weeks, computed tomography showed complete resolution of pulmonary abnormalities. The patient did not report any adverse effects. CONCLUSIONS In our case study, we demonstrated that therapy with a combination of aerosolized ribavirin and oral acyclovir may be useful to reduce the severity of viral infection, the adverse effects, and the days of hospitalization. To our knowledge, this is the first report in the literature of the synergistic effects of the combination of aerosolized ribavirin and oral acyclovir in the treatment of an immunocompetent patient with HSV pneumonia.
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Affiliation(s)
- Claudio Terzano
- Respiratory Diseases Unit, Department of Cardiovascular and Respiratory Sciences, Fondazione E. Lorillard Spencer Cenci, University “La Sapienza,” Rome, Italy
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Franquet T, Müller NL, Giménez A, Martínez S, Madrid M, Domingo P. Infectious pulmonary nodules in immunocompromised patients: usefulness of computed tomography in predicting their etiology. J Comput Assist Tomogr 2003; 27:461-8. [PMID: 12886125 DOI: 10.1097/00004728-200307000-00001] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the high-resolution computed tomography (CT) findings in immunocompromised patients who had nodular opacities and a proven diagnosis to determine whether the various infectious pulmonary nodules have distinguishing features on CT. MATERIALS AND METHODS The high-resolution CT scans obtained in 78 immunocompromised patients with solitary or multiple nodular opacities of proven infectious etiology were reviewed retrospectively by 2 independent thoracic radiologists. Patients whose predominant abnormality consisted of branching linear or nodular opacities (tree-in-bud pattern) characteristic of infectious bronchiolitis and endobronchial spread of tuberculosis were excluded. The CT scans were assessed for the presence, appearance, size, and distribution of parenchymal nodules. Relations between findings at CT and the different infectious etiologies of nodules were assessed with regression analysis. Agreement between the 2 observers was assessed using the kappa statistic. RESULTS The infectious causes included mycobacteria (n = 24), fungi (n = 22), bacteria (n = 20), and viruses (n = 12). Multivariate analysis demonstrated that a diameter <10 mm was the only independent predictor of etiology (P < 0.0001) and that patients whose nodules all measured less than 10 mm in diameter were most likely to have a viral infection. Nodules limited in size to less than 10 mm in diameter were seen in 83% of viral infections compared with 5% of bacterial infections (odds ratio [OR] = 95.0; 95% confidence interval (CI): 6.08-4,321.5, P < 0.0001), 0% of mycobacterial infections (OR = 91.7; 95% CI: 7.21-4,090.22, P < 0.0001), and 14% of fungal infections (OR = 31.67; 95% CI: 3.56-375.09, P = 0.0003). CONCLUSION Although some overlap exists, nodule size is helpful in the differential diagnosis of infectious causes of nodules in immunocompromised patients. Patients whose nodules are all less than 10 mm in diameter are most likely to have a viral infection.
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Affiliation(s)
- Tomás Franquet
- Department of Radiology, Hospital de Sant Pau, Universitat Autonoma de Barcelona, Avda. Sant Antoni Ma. Claret 167, 08025 Barcelona, Spain.
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Tuengerthal S. Pneumonien. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS, Suh GY, Kwon OJ, Han J. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 2002; 22 Spec No:S137-49. [PMID: 12376607 DOI: 10.1148/radiographics.22.suppl_1.g02oc15s137] [Citation(s) in RCA: 210] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Numerous viruses, including influenza virus, measles virus, Hantavirus, adenovirus, herpesviruses, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Influenza virus types A and B cause most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus, herpesviruses, measles virus, and adenovirus. The radiographic findings, which consist mainly of patchy or diffuse ground-glass opacity with or without consolidation and reticular areas of increased opacity, are variable and overlapping. Computed tomographic findings, which are also overlapping, consist of poorly defined centrilobular nodules, ground-glass attenuation with a lobular distribution, segmental consolidation, or diffuse ground-glass attenuation with thickened interlobular septa. The radiologic findings reflect the variable extents of the histopathologic features: diffuse alveolar damage (intraalveolar edema, fibrin, and variable cellular infiltrates with a hyaline membrane), intraalveolar hemorrhage, and interstitial (intrapulmonary or airway) inflammatory cell infiltration. Clinical information such as patient age, immune status, community outbreaks, symptom onset and duration, and presence of a rash remain important aids in diagnosis of viral causes.
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Affiliation(s)
- Eun A Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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Ko JP, Shepard JA, Sproule MW, Trotman-Dickenson B, Drucker EA, Ginns LC, Wain JC, McLoud TC. CT manifestations of respiratory syncytial virus infection in lung transplant recipients. J Comput Assist Tomogr 2000; 24:235-41. [PMID: 10752884 DOI: 10.1097/00004728-200003000-00009] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of our study was to evaluate CT findings during respiratory syncytial virus (RSV) infection in lung transplant recipients and to identify sequelae. METHOD Thirty-nine CT scans prior to, during, and following acute infection in 10 lung transplant recipients were reviewed. Abnormalities that were new from baseline observations and occurred within 4 weeks of diagnosis were defined as acute. Chronic findings were defined as those present >4 weeks after diagnosis. RESULTS Findings in nine patients were ground-glass (seven), air-space (five), and tree-in-bud (four) opacities and acute bronchial dilatation (four) and wall thickening (four). Patients lacked pleural effusions or lymph node enlargement. Five of seven patients with follow-up exams had new air trapping (three), persistent bronchial dilatation (three), and thickening (two). Three and 2 of the 10 patients developed bronchiolitis obliterans syndrome and obliterative bronchiolitis, respectively. CONCLUSION During acute infection, patients commonly had ground-glass opacities but lacked pleural effusions and lymph node enlargement. There can be chronic sequelae after infection.
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Affiliation(s)
- J P Ko
- Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
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