Follow-up chest radiographic findings in patients with MERS-CoV after recovery.
01 Jul 2017-Indian Journal of Radiology and Imaging (Indian J Radiol Imaging)-Vol. 27, Iss: 3, pp 342-349
TL;DR: Lung fibrosis may develop in a substantial number of patients who have recovered from Middle East respiratory syndrome coronavirus (MERS-CoV) who were discharged from the hospital following improved clinical symptoms.
Abstract: Purpose: To evaluate the follow-up chest radiographic findings in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) who were discharged from the hospital following improved clinical symptoms. Materials and Methods: Thirty-six consecutive patients (9 men, 27 women; age range 21–73 years, mean ± SD 42.5 ± 14.5 years) with confirmed MERS-CoV underwent follow-up chest radiographs after recovery from MERS-CoV. The 36 chest radiographs were obtained at 32 to 230 days with a median follow-up of 43 days. The reviewers systemically evaluated the follow-up chest radiographs from 36 patients for lung parenchymal, airway, pleural, hilar and mediastinal abnormalities. Lung parenchyma and airways were assessed for consolidation, ground-glass opacity (GGO), nodular opacity and reticular opacity (i.e., fibrosis). Follow-up chest radiographs were also evaluated for pleural thickening, pleural effusion, pneumothorax and lymphadenopathy. Patients were categorized into two groups: group 1 (no evidence of lung fibrosis) and group 2 (chest radiographic evidence of lung fibrosis) for comparative analysis. Patient demographics, length of ventilations days, number of intensive care unit (ICU) admission days, chest radiographic score, chest radiographic deterioration pattern (Types 1-4) and peak lactate dehydrogenase level were compared between the two groups using the student t-test, Mann-Whitney U test and Fisher's exact test. Results: Follow-up chest radiographs were normal in 23 out of 36 (64%) patients. Among the patients with abnormal chest radiographs (13/36, 36%), the following were found: lung fibrosis in 12 (33%) patients GGO in 2 (5.5%) patients, and pleural thickening in 2 (5.5%) patients. Patients with lung fibrosis had significantly greater number of ICU admission days (19 ± 8.7 days; P value = 0.001), older age (50.6 ± 12.6 years; P value = 0.02), higher chest radiographic scores [10 (0-15.3); P value = 0.04] and higher peak lactate dehydrogenase levels (315-370 U/L; P value = 0.001) when compared to patients without lung fibrosis. Conclusion: Lung fibrosis may develop in a substantial number of patients who have recovered from Middle East respiratory syndrome coronavirus (MERS-CoV). Significantly greater number of ICU admission days, older age, higher chest radiographic scores, chest radiographic deterioration patterns and peak lactate dehydrogenase levels were noted in the patients with lung fibrosis on follow-up chest radiographs after recovery from MERS-CoV.
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TL;DR: The patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward is referred to, which can be divided into those who may have serious sequelae and those with a non-specific clinical picture, often dominated by fatigue and breathlessness.
Abstract: ### What you need to know
Post-acute covid-19 (“long covid”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness.1 Clinical management requires a whole-patient perspective.2 This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward. Broadly, such patients can be divided into those who may have serious sequelae (such as thromboembolic complications) and those with a non-specific clinical picture, often dominated by fatigue and breathlessness. The specialist rehabilitation needs of a third group, covid-19 patients whose acute illness required intensive care, have been covered elsewhere.3
In the absence of agreed definitions, for the purposes of this article we define post-acute covid-19 as extending beyond three weeks from the onset of first symptoms and chronic covid-19 as extending beyond 12 weeks. Since many people were not tested, and false negative tests are common,4 we suggest that a positive test for covid-19 is not a prerequisite for diagnosis.
### How common is it?
Around 10% of patients who have tested positive for SARS-CoV-2 virus remain unwell beyond three weeks, and a smaller proportion for months (see box 1).7 This is based on the UK COVID Symptom Study, in which people enter their ongoing symptoms on a smartphone app. This percentage is lower than that cited in many published observational …
1,045 citations
TL;DR: Data from previous coronavirus infections such as severe acute respiratory syndrome and Middle East respiratory syndrome, as well as emerging data from the COVID-19 pandemic, suggest there could be substantial fibrotic consequences following SARS-CoV-2 infection.
746 citations
TL;DR: Radiological and physiological abnormalities were still found in a considerable proportion of COVID-19 survivors without critical cases 3 months after discharge, and higher level of D-dimer levels on admission could effectively predict impaired DLCO after 3 months discharge.
604 citations
Cites background from "Follow-up chest radiographic findin..."
...Clinically, patients with abnormal HRCT scans were generally older than those with normal chest HRCT score, which implied that higher chest radiological scores was mostly obtained in elder patients [35]....
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TL;DR: A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 patients who succumbed to and who recovered from 2019 novel coronavirus disease and to compare them with recovered patients.
Abstract: Background The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan, Hubei Province of China since December 2019. This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease (COVID-19). Methods Clinical data were collected from two tertiary hospitals in Wuhan. A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 (death group) and we compare them with recovered patients (recovered group). Continuous variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed by χ test or Fisher exact test as appropriate. Results Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients. The median age of the death group was older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, Z = 9.738, P Conclusions Compared to the recovered group, more patients in the death group exhibited characteristics of advanced age, pre-existing comorbidities, dyspnea, oxygen saturation decrease, increased WBC count, decreased lymphocytes, and elevated CRP levels. More patients in the death group had complications such as ARDS, acute cardiac injury, acute kidney injury, shock, and DIC.
566 citations
Cites background from "Follow-up chest radiographic findin..."
...[28] Another study found lung fibrosis in 33% of patients who have recovered from MERS-CoV....
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...Another study found lung fibrosis in 33% of patients who have recovered from MERS-CoV.([29]) It is possible that pulmonary fibrosis will become one of the serious complications in patients with 2019-nCoV infection....
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TL;DR: In this paper, a review of the literature on long COVID-19 syndrome is presented, which is driven by long-term tissue damage (e.g. lung, brain, and heart) and pathological inflammation (i.e. from viral persistence, immune dysregulation, and autoimmunity).
Abstract: Long COVID or post-COVID-19 syndrome first gained widespread recognition among social support groups and later in scientific and medical communities. This illness is poorly understood as it affects COVID-19 survivors at all levels of disease severity, even younger adults, children, and those not hospitalized. While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID-19. Other persistent symptoms may include cognitive and mental impairments, chest and joint pains, palpitations, myalgia, smell and taste dysfunctions, cough, headache, and gastrointestinal and cardiac issues. Presently, there is limited literature discussing the possible pathophysiology, risk factors, and treatments in long COVID, which the current review aims to address. In brief, long COVID may be driven by long-term tissue damage (e.g. lung, brain, and heart) and pathological inflammation (e.g. from viral persistence, immune dysregulation, and autoimmunity). The associated risk factors may include female sex, more than five early symptoms, early dyspnoea, prior psychiatric disorders, and specific biomarkers (e.g. D-dimer, CRP, and lymphocyte count), although more research is required to substantiate such risk factors. While preliminary evidence suggests that personalized rehabilitation training may help certain long COVID cases, therapeutic drugs repurposed from other similar conditions, such as myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, and mast cell activation syndrome, also hold potential. In sum, this review hopes to provide the current understanding of what is known about long COVID.
563 citations
References
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TL;DR: The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
Abstract: A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
4,809 citations
"Follow-up chest radiographic findin..." refers background in this paper
...Outbreaks of infection of the Middle East respiratory syndrome coronavirus (MERS‐CoV) are an emerging global health crisis.[1] Until recently, most cases (1,223 with 520 deaths) have occurred in Saudi Arabia and exhibit a case fatality of approximately 43%....
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TL;DR: Members of the Fleischner Society compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984 and 1996 for Thoracic radiography and computed tomography, respectively.
Abstract: Members of the Fleischner Society compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984 and 1996 for thoracic radiography and computed tomography (CT), respectively. The need to update the previous versions came from the recognition that new words have emerged, others have become obsolete, and the meaning of some terms has changed. Brief descriptions of some diseases are included, and pictorial examples (chest radiographs and CT scans) are provided for the majority of terms.
3,299 citations
"Follow-up chest radiographic findin..." refers background or methods in this paper
...[14] GGO was defined as an area of increased lung opacity within which margins of pulmonary vessels may be indistinct.[14] A diagnosis of nodular opacity was considered when an opacity was focal and round in shape....
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...[12‐18] A diagnosis of consolidation was made when there was an area of increased opacity present that obscured the vessel margin and airway walls, with or without an air bronchogram.[14] GGO was defined as an area of increased lung opacity within which margins of pulmonary vessels may be indistinct....
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TL;DR: SARS is a serious respiratory illness that led to significant morbidity and mortality in this cohort of 138 cases of suspected SARS during a hospital outbreak in Hong Kong.
Abstract: background There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong. methods From March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed. results There were 66 male patients and 72 female patients in this cohort, 69 of whom were health care workers. The most common symptoms included fever (in 100 percent of the patients); chills, rigors, or both (73.2 percent); and myalgia (60.9 percent). Cough and headache were also reported in more than 50 percent of the patients. Other common findings were lymphopenia (in 69.6 percent), thrombocytopenia (44.8 percent), and elevated lactate dehydrogenase and creatine kinase levels (71.0 percent and 32.1 percent, respectively). Peripheral air-space consolidation was commonly observed on thoracic computed tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the intensive care unit; 5 patients died, all of whom had coexisting conditions. In a multivariate analysis, the independent predictors of an adverse outcome were advanced age (odds ratio per decade of life, 1.80; 95 percent confidence interval, 1.16 to 2.81; P=0.009), a high peak lactate dehydrogenase level (odds ratio per 100 U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42; P=0.003), and an absolute neutrophil count that exceeded the upper limit of the normal range on presentation (odds ratio, 1.60; 95 percent confidence interval, 1.03 to 2.50; P=0.04). conclusions SARS is a serious respiratory illness that led to significant morbidity and mortality in our cohort.
2,256 citations
"Follow-up chest radiographic findin..." refers background or methods in this paper
...This finding of the higher peak of lactate dehydrogenase level has been seen in patients affected with SARS and shown to be a good independent predictor of a worse clinical outcome.[20,21] Future studies focusing on understanding the underlying pathophysiology of developing lung fibrosis in this patient population would be valuable to better elucidate the direct underlying risk factors and their consequences....
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...Comparison of chest radiograph findings and clinical parameters Patient demographics, length of ventilations days, number of ICU admission days, chest radiographic score, chest radiographic deterioration pattern (Types 1–4)[5‐7] and peak lactate dehydrogenase level[20,21] were compared between the cohort’s two study groups[5‐7] in order to evaluate the association with the presence of lung fibrosis seen on follow‐up chest radiographs....
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803 citations
TL;DR: Survivors of ARDS have a clinically significant reduction in HRQL that appears to be caused exclusively by ARDS and its sequelae.
Abstract: ContextHealth-related quality of life (HRQL) is reduced in
patients who survive acute respiratory distress (ARDS), but whether
this decline in HRQL is caused by ARDS or other aspects of the
patient's illness or injury is unknownObjectiveTo determine if there are differences in the HRQL of
ARDS survivors and comparably ill or injured controls without ARDSDesignProspective, matched, parallel cohort studySettingA 411-bed municipal medical and regional level I trauma
centerPatientsSeventy-three pairs of ARDS survivors and
severity-matched controls with the clinical risk factors for ARDS of
sepsis and trauma admitted between January 1, 1994, and July 30, 1996Main Outcome MeasuresThe HRQL of ARDS survivors and controls,
assessed by generic and pulmonary disease–specific HRQL instruments
(Medical Outcomes Study 36-Item Short Form Health Survey, Standard Form
[SF-36] and St George's Respiratory Questionnaire [SGRQ],
respectively)ResultsClinically meaningful and statistically significant
reductions in HRQL scores of ARDS survivors (n=73) were
seen in 7 of 8 SF-36 domains and 3 of 3 SGRQ domains compared with
matched controls (P<001 for all reductions) The largest
decrements in the HRQL were seen in physical function and pulmonary
symptoms and limitations Analysis of trauma-matched pairs
(n=46) revealed significant reductions in 7 of 8 SF-36
domains (P≤02) and 3 of 3 SGRQ domains (P≤003)
Analysis of sepsis-matched pairs (n=27) revealed
significant reductions in 6 of 8 SF-36 domains (P≤05) and 3
of 3 SGRQ domains (P≤002)ConclusionsSurvivors of ARDS have a clinically significant
reduction in HRQL that appears to be caused exclusively by ARDS and its
sequelae Reductions were primarily noted in physical functioning and
pulmonary disease–specific domains
412 citations