Vaccination against respiratory tract pathogens in primary immune deficiency patients receiving immunoglobulin replacement therapy

Introduction

Inborn errors of immunity (IEI) increase morbidity and mortality risks, particularly from respiratory tract infections. Hence, vaccination becomes pivotal for IEI patients. This study aims to examine the vaccination and respiratory tract infection rates in a diverse IEI patient cohort undergoing immunoglobulin replacement therapy (IGRT).

Materials and Methods

We retrospectively evaluated IEI patients on IGRT at a tertiary care center. Data on vaccinations and respiratory infections were extracted from medical records.

Result

: The study included 33 patients (mean age= 37.7 ± 11.4 years; 17 male). The most common clinical phenotype in our cohort was primary antibody deficiencies (90.9%). Only two patients had a genetic diagnosis, both of whom were brothers diagnosed with Wiskott-Aldrich syndrome (WAS). Almost half (48.5%) of our patients had bronchiectasis and 81.8% were on prophylactic antibiotics. All patients with IEI included in the study were regularly receiving IGRT. The vaccination rate of patients against respiratory tract infections was 42.4%, 57.6%, and 78.8% for influenza, pneumococcus, and COVID-19, respectively. Only one patient (7.1%) who received the influenza vaccine developed an upper respiratory tract infection. However, viral panel analysis could not be performed for this patient as they did not present to the hospital. The COVID-19 vaccination rate was notably higher than that of other vaccines, likely due to increased awareness during the pandemic, aided by public advisories and media influence.

Conclusions

We observed higher vaccination rates for the COVID-19 vaccine compared to other vaccines (influenza and pneumococcal vaccines). Although we observed the potential impact of social and governmental influence in increasing vaccination rates, it is crucial to acknowledge that vaccination decisions in IEI patients must be individualized.

Is Obesity a Potential Risk factor for Poor Prognosis of COVID-19?

Background

Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19.

Materials and Methods

In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes.

Results

There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P <0.05 in all). In a multivariate analysis, obesity was associated with ICU admission (adjusted odds ratio [aOR]: 2.99, 95% confidence interval [CI]: 1.26 - 7.04, P = 0.012). Moreover, IMV requirement was associated with obesity (aOR: 8.73, 95% CI: 2.44 - 31.20, P = 0.001). Mortality occurred in 16%, 9%, and 1% of the obese group, overweight group, and normal-weight group, respectively (Chi-square trend analysis, P = 0.002).

Conclusion

Obesity is a risk factor for adverse outcomes and caused increased mortality, hence requiring close follow-up.

Correlation between the Diagnostic Yield from the Bronchoalveolar Lavage Fluid Analysis and Clinicoradiological Findings in Sarcoidosis

OBJECTIVES

The diagnosis of sarcoidosis is frequently challenging, requiring a search for less invasive, more reliable diagnostic methods. The bronchoalveolar lavage fluid (BALF) analysis has been used in the differential diagnosis of sarcoidosis for many years with a wide sensitivity and specificity rates. The objective of the study is to investigate whether diagnostic performance of the BALF analysis is altered by clinicoradiological findings of patients with sarcoidosis.

MATERIALS AND METHODS

The present study is a retrospective, single-center, observational study, designed in a sarcoidosis outpatient clinic in a training hospital. Patients who had undergone the bronchoalveolar lavage BAL procedure at diagnosis were included in the study. Demographics, clinical and detailed chest X-ray, and high-resolution computed tomography (HRCT) findings at diagnosis were recorded. According to the diagnostic performance, the BALF results were grouped as "diagnostic" and "non-diagnostic," and recorded parameters were compared between the groups.

RESULTS

Considering the BALF analysis of all the 257 patients, the mean lymphocyte ratio was 41±17.5 (5-80), and the mean CD4/CD8 was 5.5±4.7 (0.1-24.7). The BALF analysis was diagnostic in 56% (n=145) of patients. Diagnostic performance of the procedure did not correlate with any of the demographic data, smoking status, spirometric findings, chest X-ray staging, HRCT findings, and tomography scoring. Extrapulmonary involvement was significantly more frequent in the diagnostic group (66% vs. 34%, p=0.006).

CONCLUSION

BALF results signal sarcoidosis in more than half of the patients. The diagnostic role of BALF is greater in patients with extrapulmonary involvement.

Pulmonary Rehabilitation Reduces Emergency Admission and Hospitalization Rates of Patients with Chronic Respiratory Diseases

OBJECTIVES

Chronic respiratory diseases exert a global health burden with high health care costs, morbidity, and mortality. The aim of the present study was to investigate the effect of pulmonary rehabilitation (PR) on emergency admission and hospitalization rates of patients with chronic respiratory disease.

MATERIALS AND METHODS

In this retrospective cohort study, hospitalization rates and emergency admissions of patients before (December 2014-December 2015) and after PR (January 2015-December 2016) were investigated. Patients with chronic respiratory diseases were included. Chronic obstructive pulmonary disease (COPD) patients were classified based on the Global Initiative Chronic Obstructive Pulmonary Disease assessment scheme. PR was applied by three physiotherapists over 8 weeks (2 days/week). Data on patient demographics, clinical and anthropometric data, spirometry, exercise capacity, and quality of life before and after PR were acquired.

RESULTS

This study evaluated 51 patients, of whom 76% were men. A total of 37 (73%) COPD patients and 14 (27%) non-COPD patients (7 bronchiectasis, 4 interstitial lung disease, and 3 kyphoscoliosis) were included. The patients exhibited significantly improved incremental shuttle walk test (ISWT) and endurance test scores (p<0.05) after PR. Similar to exercise capacity, the patients exhibited significantly improved Modified Medical Research Council (mMRC) score, St. George's Respiratory Questionnaire (SGRQ), anxiety and depression scores (p<0.05) after PR. In COPD patients, differences in pre- and post-PR ISWT, COPD assessment test, mMRC, and SGRQ scores were statistically significant (p=0.001). The number of emergency admissions and hospitalizations significantly decreased after PR (p=0.001; p=0.001). The post-PR FEV₁% of COPD significantly increased (p=0.029).

CONCLUSION

Pulmonary rehabilitation leads to an increase in exercise capacity as well as improved quality of life, resulting in a decrease in emergency admissions and hospitalization rates. Considering the cost of hospitalization, it is important to add PR to the management of patients with chronic respiratory diseases, in addition to medical therapy.

Look closer to welders' lung

Introduction

Welding produces miscellaneous gases and particles that has various impact on respiratory system and long term exposure may result "welders'lung". The aim of this study is to describe the radiological findings of welders' and make an awereness for welders radilogical findings.

Materials and Methods

The clinical and radiological findings of welders' who had hospital applications with respiratory symptoms between January 2010-January 2017 were evaluated retrospectively.

Result

A total of 16 male welders with mean age 37 ± 8 years had the mean duration of welding occupation 12 ± 7 years. The most common symptoms were coughing (87%), sputum production (63%) and dyspnoea (63%).Thirteen welders were working in shipyards and 3 in construction business and other workplaces. Three (19%) patients had rhonchi on physical examination and these patients had decreased FEV1/FVC values below 70% on spirometry. Poorly-defined centrilobular micronodules that were not clearly visible on chest radiographs observed on thorax high resolution computed tomography. Bronchoscopy was performed to 7 patients. Iron-positive pigment granules and ferruginous bodies were revealed in 3 patients' bronchoalveolar lavage.

Conclusions

Welders' chest X-ray deserve a closer look. In pulmonary radiology, there may be radiographical findings ranging from small ill defined nodules to groundglass opacites. Physcians should look more careful to welders' chest X-ray and incase of suspicious findings best can be detected on high HRCT. An awareness for the radiological findings will also reduce interventional procedures in these patients hereby, occupational history must be included in daily practice of physicians.

Granulomatous polyangitis (Wegener granulomatosis): Clinical findings and results of long-term follow-up

INTRODUCTION

To evaluate long-term outcome of patients with granulomatous polyangitis (GPA) followed up in a tertiary university hospital.

PATIENTS AND METHODS

We reviewed medical records of 22 patients with GPA diagnosis confirmed by tissue biopsies between 2004 and 2014.

RESULT

The mean time from the onset of symptoms to diagnosis was 7.8 ± 12.3 months [interquartile range (IR)= 4.0]. The most commonly involved organs were the upper respiratory tract (URT) (72.7%), lower respiratory tract (81.8%) and kidneys (72.7%). URT involvement indicated good prognosis (p= 0.046). Survival in the patients with and without URT involvement was 124.6 ± 6.9 months and 59.7 ± 22.9 months, respectively. End-stage renal failure (ESRF) requiring dilaysis and cardiac involvement were associated with mortality (p= 0.022 and p= 0.026, respectively). Of the 12 dialysis-dependent patients at diagnosis, 11 survived > 3 months and seven regained renal function permanently. Dialysis dependency was significantly lower in patients who received plasmapheresis (p= 0.047). Overall mortality rate was 18% (4/22). Mean survival was 55.9 ± 42.8 months (IR= 84.0).

CONCLUSIONS

Diagnosis of GPA may be delayed by the nonspecific nature of its symptoms. URT involvement was associated with good prognosis, whereas cardiac involvement and ESRF requiring dialysis were associated with poor outcome. Plasmapheresis may increase the rate of renal recovery in the patients with ESRF requiring dialysis.