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Dumea E, Lazar M, Chitu-Tisu CE, Barbu EC, Ion DA. COVID-19 associated pulmonary embolism: clinical, biochemical and CT imaging findings. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:307-322. [PMID: 38641909 DOI: 10.2478/rjim-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represented a disruptive pathology that emerged in late 2019 with profound implications ranging from individual health to health systems and world economy. Our study aimed to evaluate clinical, biochemical and computerized tomography (CT) parameters values in determining the severity of pulmonary embolism (PE) associated with COVID-19. METHODS We performed an observational cohort study evaluating demographic, clinical, biochemical, coagulation markers, as well as CT imaging parameters. RESULTS In our study on 186 patients with COVID-19, we found that 31 patients (16,66%) had pulmonary embolism. Significant correlations for the patients with PE were detected in C-reactive protein, lactate dehydrogenase, serum ferritin, IL-6, serum myoglobin, NT-proBNP, D-dimers, serum proteins, transaminases as well as white cell blood counts. Patients with pulmonary embolism had a more severe lung involvement, with thrombi distribution mainly involving the lower lobes. CONCLUSION Early identification of PE is an important step for timely and efficient treatment in the intensive care management of COVID-19 patients. Our study showed that high plasmatic values of lactate dehydrogenase, ferritin, IL-6, white blood cells and D-dimers and low proteins serum levels are strongly linked with COVID-19-associated pulmonary embolism.
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Affiliation(s)
- Eduard Dumea
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
| | - Mihai Lazar
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
- 2"Prof. Dr. Matei Bals" National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, Sector 2, 021105 Bucharest, Romania
| | - Cristina Emilia Chitu-Tisu
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
| | - Ecaterina Constanta Barbu
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
| | - Daniela Adriana Ion
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
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2
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Sideratou CM, Papaneophytou C. Persisting Shadows: Unraveling the Impact of Long COVID-19 on Respiratory, Cardiovascular, and Nervous Systems. Infect Dis Rep 2023; 15:806-830. [PMID: 38131885 PMCID: PMC10742861 DOI: 10.3390/idr15060072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), instigated by the zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), rapidly transformed from an outbreak in Wuhan, China, into a widespread global pandemic. A significant post-infection condition, known as 'long- COVID-19' (or simply 'long- COVID'), emerges in a substantial subset of patients, manifesting with a constellation of over 200 reported symptoms that span multiple organ systems. This condition, also known as 'post-acute sequelae of SARS-CoV-2 infection' (PASC), presents a perplexing clinical picture with far-reaching implications, often persisting long after the acute phase. While initial research focused on the immediate pulmonary impact of the virus, the recognition of COVID-19 as a multiorgan disruptor has unveiled a gamut of protracted and severe health issues. This review summarizes the primary effects of long COVID on the respiratory, cardiovascular, and nervous systems. It also delves into the mechanisms underlying these impacts and underscores the critical need for a comprehensive understanding of long COVID's pathogenesis.
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Affiliation(s)
| | - Christos Papaneophytou
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, 2417 Nicosia, Cyprus;
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Kawata N, Iwao Y, Matsuura Y, Suzuki M, Ema R, Sekiguchi Y, Sato H, Nishiyama A, Nagayoshi M, Takiguchi Y, Suzuki T, Haneishi H. Prediction of oxygen supplementation by a deep-learning model integrating clinical parameters and chest CT images in COVID-19. Jpn J Radiol 2023; 41:1359-1372. [PMID: 37440160 PMCID: PMC10687147 DOI: 10.1007/s11604-023-01466-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE As of March 2023, the number of patients with COVID-19 worldwide is declining, but the early diagnosis of patients requiring inpatient treatment and the appropriate allocation of limited healthcare resources remain unresolved issues. In this study we constructed a deep-learning (DL) model to predict the need for oxygen supplementation using clinical information and chest CT images of patients with COVID-19. MATERIALS AND METHODS We retrospectively enrolled 738 patients with COVID-19 for whom clinical information (patient background, clinical symptoms, and blood test findings) was available and chest CT imaging was performed. The initial data set was divided into 591 training and 147 evaluation data. We developed a DL model that predicted oxygen supplementation by integrating clinical information and CT images. The model was validated at two other facilities (n = 191 and n = 230). In addition, the importance of clinical information for prediction was assessed. RESULTS The proposed DL model showed an area under the curve (AUC) of 89.9% for predicting oxygen supplementation. Validation from the two other facilities showed an AUC > 80%. With respect to interpretation of the model, the contribution of dyspnea and the lactate dehydrogenase level was higher in the model. CONCLUSIONS The DL model integrating clinical information and chest CT images had high predictive accuracy. DL-based prediction of disease severity might be helpful in the clinical management of patients with COVID-19.
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Affiliation(s)
- Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan.
- Graduate School of Science and Engineering, Chiba University, Chiba, 263-8522, Japan.
- Medical Mycology Research Center (MMRC), Chiba University, Chiba, 260-8673, Japan.
| | - Yuma Iwao
- Center for Frontier Medical Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba-shi, Chiba, 263-8522, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan
| | - Yukiko Matsuura
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-cho, Chuo-ku, Chiba-shi, Chiba, 260-0852, Japan
| | - Masaki Suzuki
- Department of Respirology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa-shi, Chiba, 277-8551, Japan
| | - Ryogo Ema
- Department of Respirology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane-shi, Chiba, 283-8686, Japan
| | - Yuki Sekiguchi
- Graduate School of Science and Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Hirotaka Sato
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
- Department of Radiology, Soka Municipal Hospital, 2-21-1, Souka, Souka-shi, Saitama, 340-8560, Japan
| | - Akira Nishiyama
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Masaru Nagayoshi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-cho, Chuo-ku, Chiba-shi, Chiba, 260-0852, Japan
| | - Yasuo Takiguchi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-cho, Chuo-ku, Chiba-shi, Chiba, 260-0852, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba-shi, Chiba, 263-8522, Japan
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Udeh R, Utrero-Rico A, Dolja-Gore X, Rahmati M, McEVoy M, Kenna T. Lactate dehydrogenase contribution to symptom persistence in long COVID: A pooled analysis. Rev Med Virol 2023; 33:e2477. [PMID: 37706263 DOI: 10.1002/rmv.2477] [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: 04/24/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
There's critical need for risk predictors in long COVID. This meta-analysis evaluates the evidence for an association between plasma lactate dehydrogenase (LDH) and long COVID and explores the contribution of LDH to symptoms persistent across the distinct post-acute sequelae of COVID-19 (PASC) domains. PubMed, EMBASE, Web of Science, and Google Scholar were searched for articles published up to 20 March 2023 for studies that reported data on LDH levels in COVID-19 survivors with and without PASC. Random-effect meta-analysis was employed to estimate the standardized mean difference (SMD) with corresponding 95% confidence interval of each outcome. There were a total of 8289 study participants (3338 PASC vs. 4951 controls) from 46 studies. Our meta-analysis compared to the controls showed a significant association between LDH elevation and Resp-PASC [SMD = 1.07, 95%CI = 0.72, 1.41, p = 0.01] but not Cardio-PASC [SMD = 1.79, 95%CI = -0.02, 3.61, p = 0.05], Neuro-PASC [SMD = 0.19, 95%CI = -0.24, 0.61, p = 0.40], and Gastrointestinal-PASC [SMD = 0.45, 95%CI = -1.08, 1.98, p = 0.56]. This meta-analysis suggests elevated LDH can be used for predicting Resp-PASC, but not Cardio-PASC, Neuro-PASC or gastrointestinal-PASC. Thus, elevated plasma LDH following COVID infection may be considered as a disease biomarker.
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Affiliation(s)
- Raphael Udeh
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, New South Wales, Australia
| | | | - Xenia Dolja-Gore
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Mark McEVoy
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC, Australia
| | - Tony Kenna
- Centre for Immunology & Infection Control, Queensland University of Technology, Bendigo, Queensland, Australia
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5
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Mitrea A, Postolache P, Man MA, Motoc NS, Sárközi HK, Dumea E, Zamfir V, Dantes E. [The profile of serum inflammatory biomarkers in patients with SARS-CoV-2 infection: how well do they reflect the presence of pulmonary involvement?]. Orv Hetil 2023; 164:1607-1615. [PMID: 37987704 DOI: 10.1556/650.2023.32880] [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: 07/02/2023] [Accepted: 08/08/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with inflammatory and imaging alterations that vary depending on the disease severity. OBJECTIVE Monitoring changes in inflammatory biomarkers may offer insights into the extent of pulmonary alterations observed in chest-CT. This study aimed to evaluate the profile of different inflammatory biomarkers, widely available and routinely measured in COVID-19 patients, and to determine whether alterations in their activity at admission and discharge correlate with lung involvement assessed through CT scans. METHODS We conducted a retrospective observational study, wherein chest-CT scans were performed upon admission, and blood tests were conducted at admission and discharge. Treatment and monitoring adhered to national and international guidelines. RESULTS The profile of serum inflammatory markers (including values at admission and discharge, as well as their evolution during hospitalization) demonstrated a correlation with lung involvement as assessed by the total severity score. The high activity of serum inflammatory markers upon admission, accompanied by minimal changes during hospitalization, indicated a severe form of COVID-19 with notable lung involvement. While statistically significant differences were observed in C-reactive protein, fibrinogen, erythrocyte sedimentation rate, lactate dehydrogenase, and neutrophil-to-lymphocyte ratio, C-reactive protein emerged as the most reliable marker for assessing pulmonary involvement. CONCLUSION Changes in serum inflammatory markers during hospitalization exhibited a weak to moderate negative correlation with the severity of lung involvement. Orv Hetil. 2023; 164(41): 1607-1615.
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Affiliation(s)
- Adriana Mitrea
- 1 Konstancai "Ovidius" Egyetem, Általános Orvostudományi Kar, "Sf. Apostol Andrei" Konstanca Megyei Sürgősségi Kórház, Tüdőgyógyászati Osztály Konstanca Románia
| | | | - Milena Adina Man
- 3 Kolozsvári "Iuliu Hațieganu" Orvosi és Gyógyszerészeti Egyetem, Általános Orvosi Kar, Tüdőgyógyászati Tanszék, "Leon Daniello" Pneumophtysiologiai Klinikai Kórház Kolozsvár Románia
| | - Nicoleta Stefania Motoc
- 3 Kolozsvári "Iuliu Hațieganu" Orvosi és Gyógyszerészeti Egyetem, Általános Orvosi Kar, Tüdőgyógyászati Tanszék, "Leon Daniello" Pneumophtysiologiai Klinikai Kórház Kolozsvár Románia
| | - Hédi-Katalin Sárközi
- 4 Marosvásárhelyi "George Emil Palade" Orvosi, Gyógyszerészeti, Tudomány- és Technológiai Egyetem, Tüdőgyógyászati Tanszék Marosvásárhely Románia
| | - Elena Dumea
- 5 Konstancai "Ovidius" Egyetem, Általános Orvostudományi Kar, Fertőző Betegségek Klinikai Kórháza Konstanca Románia
| | - Viorica Zamfir
- 6 Konstancai "Ovidius" Egyetem, Általános Orvostudományi Kar, Pneumophtisiologiai Klinikai Kórház Konstanca Románia
| | - Elena Dantes
- 6 Konstancai "Ovidius" Egyetem, Általános Orvostudományi Kar, Pneumophtisiologiai Klinikai Kórház Konstanca Románia
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Manole C, Baroiu L, Nechita A, Voinescu DC, Ciubara A, Debita M, Tatu AL, Ciubara AB, Stefanopol IA, Anghel L, Nechifor A, Firescu D. Comparative Evaluation of the Clinical Severity of COVID-19 of Vaccinated and Unvaccinated Patients in Southeastern Romania in the First 6 Months of 2022, during the Omicron Wave. Healthcare (Basel) 2023; 11:2184. [PMID: 37570424 PMCID: PMC10418776 DOI: 10.3390/healthcare11152184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The pandemic wave produced by SARS-CoV-2 Omicron was characterized by milder clinical forms and high contagiousness. The vaccination rate against COVID-19 in Romania was approximately 42%. (2) Objectives: Comparison of the clinical severity in vaccinated patients compared to unvaccinated ones. (3) Methods: A retrospective cohort study was conducted on a group of 699 adult patients confirmed with COVID-19 who presented in the "Sf. Cuvioasa Parascheva" Infectious Diseases Clinical Hospital of Galati, Romania, between 1 January 2022 and 30 June 2022. The study compared the need for hospitalization, reinfections, demographic and comorbidity data, clinical and paraclinical parameters from the initial evaluation, and the ratio of unfavorable developments on subgroups chosen according to the vaccination status. (4) Results and Conclusions: Our study reveals that unvaccinated patients required hospitalization in 54.68% of cases, while fully vaccinated patients had a hospitalization rate of 40.72%, which was significantly lower than that of the unvaccinated group (p = 0.01); patients who received a booster dose had a hospitalization rate of 27.84% (p < 0.01, significantly lower than unvaccinated individuals; p = 0.01, significantly lower than fully vaccinated individuals); and among the four patients who received four doses, none required hospitalization. From the analysis of the two subgroups of hospitalized patients, we observed a significantly higher prevalence of radiological lesions, such as pulmonary opacities in the group of unvaccinated patients and a higher average duration of hospitalization, and serum values of D-dimers and blood-sugar at admission were significantly higher in unvaccinated patients. The higher presence of these parameters, which are indicators of severe progression in clinical studies, in the group of unvaccinated patients suggests the need to include them in the initial evaluation of the unvaccinated patients with COVID-19.The cumulative share of deaths and transfers in the ICU was higher in the group of unvaccinated patients, but the difference between the groups had no statistical significance. This study draws attention to the possibility of severe clinical forms among both vaccinated and unvaccinated populations, especially in the elderly and in patients with multiple comorbidities.
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Affiliation(s)
- Corina Manole
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (A.B.C.); (D.F.)
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania;
| | - Aurel Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania;
| | - Doina Carina Voinescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (A.B.C.); (D.F.)
| | - Anamaria Ciubara
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Elisabeta Doamna’ Psychiatric Hospital, 800179 Galati, Romania
| | - Mihaela Debita
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania;
- Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
| | - Alin Laurențiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Cuv. Parascheva’ Clinical Hospital of Infectious Diseases, 800179 Galati, Romania;
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 800010 Galati, Romania
| | - Alexandru Bogdan Ciubara
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (A.B.C.); (D.F.)
- Clinical Surgical Department, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania
| | - Ioana Anca Stefanopol
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania;
- Clinical Surgical Department, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania
| | - Lucreția Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (A.B.C.); (D.F.)
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania; (C.M.); (A.N.); (D.C.V.); (A.C.); (A.L.T.); (L.A.); (A.N.)
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (A.B.C.); (D.F.)
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 800010 Galati, Romania
| | - Dorel Firescu
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (A.B.C.); (D.F.)
- Clinical Surgical Department, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania
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Sweis JJG, Sweis NWG, Alnaimat F, Jansz J, Liao TWE, Alsakaty A, Azam A, Elmergawy H, Hanson HA, Ascoli C, Rubinstein I, Sweiss N. Immune-mediated lung diseases: A narrative review. Front Med (Lausanne) 2023; 10:1160755. [PMID: 37089604 PMCID: PMC10117988 DOI: 10.3389/fmed.2023.1160755] [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: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
The role of immunity in the pathogenesis of various pulmonary diseases, particularly interstitial lung diseases (ILDs), is being increasingly appreciated as mechanistic discoveries advance our knowledge in the field. Immune-mediated lung diseases demonstrate clinical and immunological heterogeneity and can be etiologically categorized into connective tissue disease (CTD)-associated, exposure-related, idiopathic, and other miscellaneous lung diseases including sarcoidosis, and post-lung transplant ILD. The immunopathogenesis of many of these diseases remains poorly defined and possibly involves either immune dysregulation, abnormal healing, chronic inflammation, or a combination of these, often in a background of genetic susceptibility. The heterogeneity and complex immunopathogenesis of ILDs complicate management, and thus a collaborative treatment team should work toward an individualized approach to address the unique needs of each patient. Current management of immune-mediated lung diseases is challenging; the choice of therapy is etiology-driven and includes corticosteroids, immunomodulatory drugs such as methotrexate, cyclophosphamide and mycophenolate mofetil, rituximab, or other measures such as discontinuation or avoidance of the inciting agent in exposure-related ILDs. Antifibrotic therapy is approved for some of the ILDs (e.g., idiopathic pulmonary fibrosis) and is being investigated for many others and has shown promising preliminary results. A dire need for advances in the management of immune-mediated lung disease persists in the absence of standardized management guidelines.
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Affiliation(s)
| | | | - Fatima Alnaimat
- Division of Rheumatology, Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Jacqueline Jansz
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Ting-Wei Ernie Liao
- School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Alaa Alsakaty
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Abeera Azam
- Department of Internal Medicine, The University of Texas Health Science Center at Tyler, Tyler, TX, United States
| | - Hesham Elmergawy
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Hali A. Hanson
- UIC College of Pharmacy, University of Illinois Chicago, Chicago, IL, United States
| | - Christian Ascoli
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
- Research Service, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
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Murphy MC, Little BP. Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging Evaluation. Radiology 2023; 307:e222379. [PMID: 36692398 PMCID: PMC9888022 DOI: 10.1148/radiol.222379] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with severe COVID-19 pneumonia requiring ICU admission and prolonged hospital stay is presented. The infection resulted in long term morbidity, functional decline and abnormal chest CT findings. Mechanisms for long term lung injury post COVID-19 infection, imaging appearances and role of imaging in follow-up are discussed.
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Affiliation(s)
- Mark C. Murphy
- Fellow in Cardiothoracic Imaging and Intervention Massachusetts
General Hospital, Boston
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