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Donuru A, Torigian DA, Knollmann F. Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features. Tomography 2024; 10:574-608. [PMID: 38668402 PMCID: PMC11054070 DOI: 10.3390/tomography10040045] [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: 01/27/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
Interlobular septa thickening (ILST) is a common and easily recognized feature on computed tomography (CT) images in many lung disorders. ILST thickening can be smooth (most common), nodular, or irregular. Smooth ILST can be seen in pulmonary edema, pulmonary alveolar proteinosis, and lymphangitic spread of tumors. Nodular ILST can be seen in the lymphangitic spread of tumors, sarcoidosis, and silicosis. Irregular ILST is a finding suggestive of interstitial fibrosis, which is a common finding in fibrotic lung diseases, including sarcoidosis and usual interstitial pneumonia. Pulmonary edema and lymphangitic spread of tumors are the commonly encountered causes of ILST. It is important to narrow down the differential diagnosis as much as possible by assessing the appearance and distribution of ILST, as well as other pulmonary and extrapulmonary findings. This review will focus on the CT characterization of the secondary pulmonary lobule and ILST. Various uncommon causes of ILST will be discussed, including infections, interstitial pneumonia, depositional/infiltrative conditions, inhalational disorders, malignancies, congenital/inherited conditions, and iatrogenic causes. Awareness of the imaging appearance and various causes of ILST allows for a systematic approach, which is important for a timely diagnosis. This study highlights the importance of a structured approach to CT scan analysis that considers ILST characteristics, associated findings, and differential diagnostic considerations to facilitate accurate diagnoses.
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Affiliation(s)
- Achala Donuru
- Division of Cardiothoracic Imaging, Department of Radiology, Hospitals of University of Pennsylvania, Philadelphia, PA 19104, USA; (D.A.T.); (F.K.)
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Abuladze LR, Blokhin IA, Gonchar AP, Suchilova MM, Vladzymyrskyy AV, Gombolevskiy VA, Balanyuk EA, Ni OG, Troshchansky DV, Reshetnikov RV. CT imaging of HIV-associated pulmonary disorders in COVID-19 pandemic. Clin Imaging 2023; 95:97-106. [PMID: 36706642 PMCID: PMC9846904 DOI: 10.1016/j.clinimag.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/30/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Liya R. Abuladze
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation,The Vishnevsky Nаtionаl Mediсаl Reseаrсh Сenter of Surgery, 117997 Mosсow, Bol. Serpukhovskаyа str., 27, Russian Federation,Corresponding author at: Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Ivan A. Blokhin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Anna P. Gonchar
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Maria M. Suchilova
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Anton V. Vladzymyrskyy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation,I.M. Sechenov First Moscow State Medical University (Sechenov University), 8, Trubetskaya str. 2, 119991 Moscow, Russian Federation
| | - Victor A. Gombolevskiy
- Artificial Intelligence Research Institute (AIRI), 121170, Kutuzovsky pr. 32, 1, Moscow, Russian Federation
| | - Eleonora A. Balanyuk
- Clinic of Aesthetic Medicine “Olymp Clinic”, 129090, 7, Sadovaya-Sukharevskaya str.1, Moscow, Russian Federation
| | - Oksana G. Ni
- City Clinical Hospital №40, Moscow Health Care Department, 8 Sosensky stan, Kommunarka settlement, 129301 Moscow, Russian Federation
| | - Dmitry V. Troshchansky
- City Clinical Hospital №40, Moscow Health Care Department, 8 Sosensky stan, Kommunarka settlement, 129301 Moscow, Russian Federation
| | - Roman V. Reshetnikov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
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Zhang F, Qin S, Xia F, Mao C, Li L. Case report: Streptococcus pneumoniae pneumonia characterized by diffuse centrilobular nodules in both lungs. Front Med (Lausanne) 2023; 9:1007160. [PMID: 36703900 PMCID: PMC9871572 DOI: 10.3389/fmed.2022.1007160] [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: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Streptococcus pneumoniae (S. pneumoniae) is the most common pathogen in community-acquired pneumonia (CAP) and takes the form of lobar pneumonia as typical computed tomography (CT) findings. Various patterns of radiological manifestation have also been reported in patients with S. pneumoniae pneumonia; however, the appearance of diffuse centrilobular nodules in both lungs is rarely reported. Case presentation We report the case of a patient with a history of chronic lymphocytic leukemia (CLL) for 9 years who presented with new-onset fever, cough, excess sputum, and shortness of breath for 1 week. He was given intravenous antibacterial (cephalosporin) treatment for 4 days, but his condition did not improve and dyspnea became more serious. The chest CT indicated diffuse centrilobular nodules in both lungs at admission. Patient's bronchoalveolar (BAL) fluid was sent for metagenomic next-generation sequencing, which only supported a diagnosis of S. pneumoniae infection. His condition improved gradually after antimicrobial treatment (moxifloxacin) and a follow-up CT showed that the diffuse centrilobular nodules in both lungs were absorbed completely. Conclusion This case highlights a rare CT presentation of S. pneumoniae pneumonia that should alert clinicians, so as to avoid taking unnecessary treatment measures.
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Capasso R, Pinto A, Serra N, Atripaldi U, Corcione A, Bocchini G, Guarino S, Lieto R, Rea G, Sica G, Valente T. Alert Germ Infections: Chest X-ray and CT Findings in Hospitalized Patients Affected by Multidrug-Resistant Acinetobacter baumannii Pneumonia. Tomography 2022; 8:1534-1543. [PMID: 35736874 PMCID: PMC9228714 DOI: 10.3390/tomography8030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
Acinetobacter baumannii (Ab) is an opportunistic Gram-negative pathogen intrinsically resistant to many antimicrobials. The aim of this retrospective study was to describe the imaging features on chest X-ray (CXR) and computed tomography (CT) scans in hospitalized patients with multidrug-resistant (MDR) Ab pneumonia. CXR and CT findings were graded on a three-point scale: 1 represents normal attenuation, 2 represents ground-glass attenuation, and 3 represents consolidation. For each lung zone, with a total of six lung zones in each patient, the extent of disease was graded using a five-point scale: 0, no involvement; 1, involving 25% of the zone; 2, 25−50%; 3, 50−75%; and 4, involving >75% of the zone. Points from all zones were added for a final total cumulative score ranging from 0 to 72. Among 94 patients who tested positive for MDR Ab and underwent CXR (males 52.9%, females 47.1%; mean age 64.2 years; range 1−90 years), 68 patients underwent both CXR and chest CT examinations. The percentage of patients with a positive CT score was significantly higher than that obtained on CXR (67.65% > 35.94%, p-value = 0.00258). CT score (21.88 ± 15.77) was significantly (p-value = 0.0014) higher than CXR score (15.06 ± 18.29). CXR and CT revealed prevalent bilateral abnormal findings mainly located in the inferior and middle zones of the lungs. They primarily consisted of peripheral ground-glass opacities and consolidations which predominated on CXR and CT, respectively.
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Affiliation(s)
- Raffaella Capasso
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-081-706-2629
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, 80138 Napoli, Italy;
| | - Umberto Atripaldi
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Section of Pediatrics, University Federico II of Naples, 80138 Napoli, Italy;
| | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Salvatore Guarino
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
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Debray MP, Carette MF, Loubet P, Pasquet B, Houhou Fidouh N, Benjoar M, Varon E, Brun AL, Claessens YE, Duval X, Khalil A. CT features of community-acquired pneumonia at the emergency department. Respir Med Res 2022; 81:100892. [PMID: 35489109 DOI: 10.1016/j.resmer.2022.100892] [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: 12/04/2021] [Revised: 01/26/2022] [Accepted: 02/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chest computed tomography (CT) was reported to improve the diagnosis of community-acquired pneumonia (CAP) as compared to chest X-ray (CXR). The aim of this study is to describe the CT-patterns of CAP in a large population visiting the emergency department and to see if some of them are more frequently missed on CXR. MATERIALS AND METHODS This is an ancillary analysis of the prospective multicenter ESCAPED study including 319 patients. We selected the 163 definite or probable CAP based on adjudication committee classification; 147 available chest CT scans were reinterpreted by 3 chest radiologists to identify CAP patterns. These CT-patterns were correlated to epidemiological, biological and microbiological data, and compared between false negative and true positive CXR CAP. RESULTS Six patterns were identified: lobar pneumonia (51/147, 35%), including 35 with plurifocal involvement; lobular pneumonia (43/147, 29%); unilobar infra-segmental consolidation (24/147, 16%); bronchiolitis (16/147, 11%), including 4 unilobar bronchiolitis; atelectasis and bronchial abnormalities (8/147, 5.5%); interstitial pneumonia (5/147, 3.5%). Bacteria were isolated in 41% of patients with lobar pneumonia-pattern (mostly Streptococcus pneumoniae and Mycoplasma pneumonia) versus 19% in other patients (p = 0.01). Respiratory viruses were equally distributed within all patterns. CXR was falsely negative in 46/147 (31%) patients. Lobar pneumonia was significantly less missed on CXR than other patterns (p = 0.003), especially lobular pneumonia and unilobar infra-segmental consolidation, missed in 35% and 58% of cases, respectively. CONCLUSION Lobar and lobular pneumonias are the most frequent CT-patterns. Lobar pneumonia is appropriately detected on CXR and mainly due to Streptococcus pneumoniae or Mycoplasma pneumoniae. Chest CT is very useful to identify CAP in other CT-patterns. Prior the COVID pandemic, CAP was rarely responsible for interstitial opacities on CT.
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Affiliation(s)
- Marie Pierre Debray
- AP-HP, Hôpital Bichat, Service de radiologie, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris Cité; INSERM UMR 1152, Paris, France.
| | - Marie France Carette
- Sorbonne Université, UPMC, Paris VI, Paris, France ; AP-HP, Hôpital Tenon, Service de radiologie, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Paul Loubet
- VBMID, Inserm U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Place du Pr R. Debré, Univ Montpellier, 30029 Nîmes Cedex 9, France
| | - Blandine Pasquet
- AP-HP, Unité de Recherche Clinique, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Nadhira Houhou Fidouh
- AP-HP, Hôpital Bichat, Service de virologie, 46 rue Henri Huchard, 75018 Paris, France
| | - Mikhael Benjoar
- AP-HP, Hôpital Tenon, Service de radiologie, 4 rue de la Chine, 75970, Paris Cedex 20, France
| | - Emmanuelle Varon
- National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Anne Laure Brun
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de radiologie, 83 Boulevard de l'Hôpital, 75013 Paris, France; Foch Hospital, Service de radiologie, 40 rue Worth, 92150 Suresnes, France
| | - Yann Erick Claessens
- Department of Emergency Medicine, Princess Grace Hospital Center, Avenue Pasteur MC-98002 Monaco, Monaco
| | - Xavier Duval
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, F-75018 Paris, France ; Université de Paris, IAME, INSERM, F-75018 Paris
| | - Antoine Khalil
- AP-HP, Hôpital Bichat, Service de radiologie, 46 rue Henri Huchard; Université de Paris Cité - Faculté de Médecine Bichat, 75018 Paris, France; INSERM UMR 1152, Paris, France
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Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review. Nutrients 2021; 13:nu13041339. [PMID: 33920639 PMCID: PMC8073922 DOI: 10.3390/nu13041339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. METHODS A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. RESULTS In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). CONCLUSION This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.
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Zhou J, Liao X, Cao J, Ling G, Ding X, Long Q. Differential diagnosis between the coronavirus disease 2019 and Streptococcus pneumoniae pneumonia by thin-slice CT features. Clin Imaging 2021; 69:318-323. [PMID: 33045476 PMCID: PMC7536592 DOI: 10.1016/j.clinimag.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The chest computed tomography (CT) features of coronavirus disease 2019 (COVID-19) and Streptococcus pneumoniae pneumonia (S. pneumoniae pneumonia) were compared to provide further evidence for the differential imaging diagnosis of patients with these two types of pneumonia. METHODS Clinical information and chest CT data of 149 COVID-19 patients between January 9, 2020 and March 15, 2020 and 97 patients with S. pneumoniae pneumonia between January 23, 2011 and March 18, 2020 in Zhongnan Hospital of Wuhan University were retrospectively analyzed. In addition, CT features were comparatively analyzed. RESULTS According to the chest CT images, the probability of lung segmental and lobar pneumonia in S. pneumoniae pneumonia was higher than that in COVID-19(P<0.001); the probabilities of ground-glass opacity (GGO), the "crazy paving" sign, and abnormally thickened interlobular septa in COVID-19 were higher than those in S. pneumoniae pneumonia(P = 0.005, P<0.001, P<0.001, respectively); and the probabilities of consolidation lesions, bronchial wall thickening, centrilobular nodules, and pleural effusion in S. pneumoniae pneumonia were higher than those in COVID-19 (P<0.001, P = 0.001, P = 0.003, P = 0.001, respectively). CONCLUSION The findings of GGO, the crazy paving sign, and abnormally thickened interlobular septa on chest CT were significantly higher in COVID-19 than S. pneumoniae pneumonia. The most important differential points on chest CT signs between COVID-19 and S. pneumoniae pneumonia were whether disease lesions were distributed in entire lung lobes and segments and whether the crazy paving sign, interlobular septal thickening, and consolidation lesions were found.
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Affiliation(s)
- Jun Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Xingnan Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Jia Cao
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Gonghao Ling
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Xun Ding
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - QingYun Long
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
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Cucchiari D, Pericàs JM, Riera J, Gumucio R, Md EC, Nicolás D. Pneumococcal superinfection in COVID-19 patients: A series of 5 cases. Med Clin (Barc) 2020; 155:502-505. [PMID: 32591180 PMCID: PMC7274636 DOI: 10.1016/j.medcli.2020.05.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In the context of the COVID-19 pandemic the risk of misdiagnosis of other causes of respiratory infection is likely. In this work we aim to describe the clinical characteristics, treatment and outcome of pneumococcal infection in COVID-19 patients. PATIENTS AND METHODS Every COVID-19 patient presenting with concomitant pneumococcal pneumonia during March 2020 in a tertiary teaching Hospital In Barcelona, Spain. RESULTS Five patients with PCR confirmed COVID19 or clinical and radiological suspicion were diagnosed of pneumococcal infection. In all cases chest X-ray were abnormal, with unilateral or bilateral infiltrates. Procalcitonin showed to be not sensitive enough to detect pneumococcal infection. Antibiotherapy was promptly started in all five cases with subsequent satisfactory evolution. CONCLUSION International guidelines do not include the universal screening for bacterial co-infection. Radiological pattern of COVID-19 can be indistinguishable from that of pneumococcus pneumonia and frequency of co-infection is not well stablished, therefore clinicians should be aware of the possible SARS-CoV-2-pneumococcus association to avoid misdiagnosis and delay antibiotic therapy.
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Affiliation(s)
- David Cucchiari
- Renal Transplantation Unit, Nephrology Service, Hospital Clinic Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Service, Hospital Clínic Barcelona, Spain; Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic Barcelona, Spain
| | | | - Emmanuel Coloma Md
- Hospital at Home Unit, Medical and Nurse Direction, Internal Medicine Service, Hospital Clinic Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Medical and Nurse Direction, Internal Medicine Service, Hospital Clinic Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Cucchiari D, Pericàs JM, Riera J, Gumucio R, Md EC, Nicolás D. Pneumococcal superinfection in COVID-19 patients: A series of 5 cases. MEDICINA CLINICA (ENGLISH ED.) 2020; 155:502-505. [PMID: 33521301 PMCID: PMC7834874 DOI: 10.1016/j.medcle.2020.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In the context of the COVID-19 pandemic the risk of misdiagnosis of other causes of respiratory infection is likely. In this work we aim to describe the clinical characteristics, treatment and outcome of pneumococcal infection in COVID-19 patients. PATIENTS AND METHODS Every COVID-19 patient presenting with concomitant pneumococcal pneumonia during March 2020 in a tertiary teaching Hospital In Barcelona, Spain. RESULTS Five patients with PCR confirmed COVID19 or clinical and radiological suspicion were diagnosed of pneumococcal infection. In all cases chest X-ray were abnormal, with unilateral or bilateral infiltrates. Procalcitonin showed to be not sensitive enough to detect pneumococcal infection. Antibiotherapy was promptly started in all five cases with subsequent satisfactory evolution. CONCLUSION International guidelines do not include the universal screening for bacterial co-infection. Radiological pattern of COVID-19 can be indistinguishable from that of pneumococcus pneumonia and frequency of co-infection is not well stablished, therefore clinicians should be aware of the possible SARS-CoV-2-pneumococcus association to avoid misdiagnosis and delay antibiotic therapy.
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Affiliation(s)
- David Cucchiari
- Renal Transplantation Unit, Nephrology Service, Hospital Clinic Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Service, Hospital Clínic Barcelona, Spain
- Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic Barcelona, Spain
| | | | - Emmanuel Coloma Md
- Hospital at Home Unit, Medical and Nurse Direction, Internal Medicine Service, Hospital Clinic Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Nicolás
- Hospital at Home Unit, Medical and Nurse Direction, Internal Medicine Service, Hospital Clinic Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Ishiwada N. Current situation and need for prevention of invasive pneumococcal disease and pneumococcal pneumonia in 6- to 64-year-olds in Japan. J Infect Chemother 2020; 27:7-18. [PMID: 33011068 DOI: 10.1016/j.jiac.2020.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 01/28/2023]
Abstract
We conducted a systematic review of the literature to evaluate the reported epidemiology and burden of invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) among children and adults aged 6-64 years in Japan. Studies published from Japan between September 2009 and September 2019 and indexed in the MEDLINE/PubMed or ICHUSHI databases were evaluated. A majority of the studies reported overlapping age ranges, including children aged <6 years and adults aged >64 years. According to the national surveillance data, 19% of the IPD cases were patients aged 5-59 years, and an increasing trend in IPD cases was reported from 2013 to 2017. Comorbidities were consistent with those reported by the Advisory Committee on Immunization Practices. Deaths from IPD appeared to increase nearly 3-fold between 2013 and 2017. Overall, both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) coverage was higher for IPD compared with PP. All the serotypes known to be prominent in Japan were also identified as common serotypes (3, 6A, 19A: PCV13 serotypes; 12F: outbreak serotype; 15A, 35B: drug-resistant serotypes). This systematic literature review suggests a substantial burden of IPD and PP in Japanese children and adults aged 6-64 years. The burden of comorbidities, hospitalizations, and mortality was particularly high among adults. Concerted pneumococcal vaccination strategies may help to reduce the incidence and burden of IPD and PP in this large proportion of the Japanese population.
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Affiliation(s)
- Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8673, Japan.
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Aberegg SK, Maddock SD, Blagev DP, Callahan SJ. Diagnosis of EVALI: General Approach and the Role of Bronchoscopy. Chest 2020; 158:820-827. [PMID: 32092322 DOI: 10.1016/j.chest.2020.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 01/08/2023] Open
Abstract
A 23-year-old man arrives at the ED with a 3-week history of dyspnea, dry cough, fevers, and night sweats. Two weeks previously, he was evaluated in an outpatient clinic and given a course of azithromycin for presumed infectious pneumonia. His symptoms did not improve, and he was seen 1 week later in an urgent care center and given a prescription for doxycycline, which he has been taking without improvement. He states that he feels miserable, has severe nausea and vomiting, and has not eaten in several days. His only medical history is childhood asthma. He reports no surgeries and takes no medications. He has no risk factors for HIV, does not smoke combustible cigarettes or use IV drugs, and has not recently traveled. Examination shows a room air saturation of 89%, a temperature of 38.3°C, and a respiratory rate of 22 breaths/min. Results of his examination are normal, and there are no rales or wheezing heard in the lungs. Chest radiograph shows bilateral, consolidative opacities. WBC count is 14,000, with left shift. Results of biochemistries are normal. Erythrocyte sedimentation rate is 104, and procalcitonin is 0.08. Urine toxicology screen is positive for tetrahydrocannabinol (THC). Asked specifically about vaping and e-cigarette use, he reports that he recently began using THC "carts" that his friend gets from an unknown supplier. What is the diagnosis and what additional steps are necessary to confirm it? Is bronchoscopy indicated?
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Affiliation(s)
| | | | - Denitza P Blagev
- University of Utah Health, Salt Lake City, UT; Intermountain Healthcare, Murray, UT
| | - Sean J Callahan
- University of Utah Health, Salt Lake City, UT; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT.
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Seo H, Cha SI, Shin KM, Lim JK, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Relationship Between Clinical Features and Computed Tomographic Findings in Hospitalized Adult Patients With Community-Acquired Pneumonia. Am J Med Sci 2018; 356:30-38. [PMID: 30049328 PMCID: PMC7093861 DOI: 10.1016/j.amjms.2018.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/05/2023]
Abstract
Background Data on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images. Methods Patients with CAP who underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data. Results A total of 40 patients (2.4%) were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups. Conclusions The bronchiolitis group was characterized by a higher frequency of M. pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.
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Affiliation(s)
- Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
| | - Kyung-Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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13
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Abstract
RATIONALE The etiology and outcome of diffuse acute infectious bronchiolitis (DAIB) in adults is not well known. OBJECTIVES To retrospectively review adult patients with DAIB without pneumonia, document the etiologies and outcomes, and assess the relation between DAIB and postinfectious bronchiolitis obliterans. METHODS We retrospectively analyzed medical records of 1,664 patients with lower respiratory tract infections admitted to our institution in Saitama, Japan. DAIB was diagnosed when patients developed acute feverish lower respiratory tract infection and chest computed tomography demonstrated mainly multiple centrilobular nodules in four or more lobes. Pneumonia was diagnosed when patients developed acute feverish lower respiratory tract infection and chest computed tomography demonstrated consolidation and/or ground-glass opacities with or without centrilobular nodules. MEASUREMENTS AND MAIN RESULTS Of the 1,664 patients, 20 (1.2%) and 1,644 (98.8%) patients were diagnosed as having DAIB and pneumonia, respectively. Of the 20 patients with DAIB, the etiology was determined in 16 (80%): 13 (65.0%) had a single pathogen and 3 (15.0%) had two pathogens. Detected organisms included Mycoplasma pneumoniae in eight (40.0%) patients, influenza virus in two (10.0%), influenza virus and Streptococcus pneumoniae in two (10.0%), Haemophilus influenzae in three (15.0%), and respiratory syncytial virus and rhinovirus in one (5.0%) patient. All patients improved and none developed postinfectious bronchiolitis obliterans. CONCLUSIONS The three most common etiologies of DAIB in the studied adults were M. pneumoniae, influenza virus, and H. influenzae. None of the patients with DAIB developed postinfectious bronchiolitis obliterans.
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Nie Y, Li C, Zhang J, Wang H, Han P, Lv X, Xu X, Guo M. Clinical Application of High-Resolution Computed Tomographic Imaging Features of Community-Acquired Pneumonia. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016; 22:1053-61. [PMID: 27031210 PMCID: PMC4819687 DOI: 10.12659/msm.895638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background This article discusses the value of high-resolution computed tomography (HRCT) in the diagnosis and treatment of pulmonary infections. Lung infection caused by pathogens is an important cause of death. Traditional methods to treat lung infection involved empirical antibiotic therapy. Thin-slice CT scanning is widely used in the clinical setting, and HRCT scan can very clearly show alveolar and bronchiolar involvement of infection. Material/Methods In total, 178 patients with community-acquired pneumonia (CAP) were enrolled. All the patients underwent CT scan, qualified sputum, and blood samples for culture or immunological biochemical tests. CT imaging features, pathogenic bacteria, and treatment results were used for statistical analysis. Results In 77 patients with lobar consolidation, the rate of detection was 43.26% (77/178), and in 101 patients with lobular pneumonia it was 56.74% (101/178). In 51 patients, pathogenic bacteria were detected (28.65%, 51/178). Sixteen of 33 patients detected with bacteria had cavities (48.5%, 16/33) and 35 of 145 patients detected with bacteria had no cavities (24.1%, 35/145). The difference between the 2 groups was statistically significant (χ2=7.795, P=0.005). According to the pathogenic bacteria, 38 patients were cured (74.51%, 38/51), and according to the CT imaging features 81 patients were cured (71.05%, 81/114). No statistically significant difference was found between them (χ2=0.209, P=0.647). Conclusions Treatment effect of CAP based on HRCT findings is not inferior to treatment effect guided by microbial characterization.
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Affiliation(s)
- Yunqiang Nie
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Cuiyun Li
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Jingling Zhang
- Department of Eendocrinology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Hui Wang
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Ping Han
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Xin Lv
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Xinyi Xu
- Department of Respiratory Medicine, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Miao Guo
- Department of Geriatrics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
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Tamayose M, Fujita J, Parrott G, Miyagi K, Maeshiro T, Hirata T, Higa F, Tateyama M, Watanabe A, Aoki N, Niki Y, Kadota JI, Yanagihara K, Kaku M, Hori S, Kohno S. Correlations between extent of X-ray infiltration and levels of serum C-reactive protein in adult non-severe community-acquired pneumonia. J Infect Chemother 2015; 21:456-63. [PMID: 25817351 DOI: 10.1016/j.jiac.2015.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/06/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
Pneumonia cases can vary in both severity and chest X-ray findings. Elevated C-reactive protein (CRP) levels may be an indicator of disease severity. We retrospectively evaluated factors correlated with the extent of chest X-ray infiltration both in community-acquired pneumonia (CAP) and a subgroup of cases with pneumococcal pneumonia. In a clinical study that evaluated the efficacy of sitafloxacin, 137 patients with CAP had been previously enrolled. In our study, 75 patients with pneumococcal pneumonia were identified among these 137 CAP patients. The extent of chest X-ray infiltration was scored and correlations with age, sex, body temperature, white blood cell (WBC) count, and CRP levels were analyzed using multivariate analysis with logistic regression. Significant correlations were observed between the extent of chest X-ray infiltration and CRP levels in both CAP and pneumococcal pneumonia. Our data indicates that CRP is a valuable and informative resource that could reflect the severity of pneumonia in cases of both CAP and pneumococcal pneumonia.
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Affiliation(s)
- Maki Tamayose
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan.
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Gretchen Parrott
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Kazuya Miyagi
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Tatsuji Maeshiro
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Tetsuo Hirata
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Futoshi Higa
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Masao Tateyama
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Japan
| | - Akira Watanabe
- Research Division for the Development of Anti-Infective Agents, Institute of Development, Aging and Cancer, Tohoku University, Japan
| | - Nobuki Aoki
- Department of Internal Medicine, Shinrakuen Hospital, Japan
| | - Yoshihito Niki
- Department of Clinical Infectious Diseases, School of Medicine, Showa University, Japan
| | - Jun-ichi Kadota
- Department of Internal Medicine 2, Oita University Faculty of Medicine, Japan
| | | | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Seiji Hori
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan
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Garg D, Johnson LB, Szpunar S, Fishbain JT. Clinical value of chest computerized tomography scans in patients admitted with pneumonia. J Hosp Med 2014; 9:447-50. [PMID: 24677753 DOI: 10.1002/jhm.2190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 11/11/2022]
Abstract
Patients admitted with pneumonia often receive a chest computed tomography (CT) scan for a variety of reasons. We conducted this study to evaluate our overall utilization and the clinical impact of CT scans in patients admitted to our institution with pneumonia. Patients admitted to our facility from January 2008 through November 2011 with a confirmed diagnosis of pneumonia were eligible for evaluation. Information related to patient demographics, performance of a CT scan, pneumonia-related procedures, severity of illness, and outcomes was collected. One hundred ninety-five patients met inclusion criteria. Sixty-nine patients had CT scans performed. CT scans were performed more often in younger patients (58.1 ± 19.0 vs 66.8 ± 18.6, P = 0.002), individuals with lower CURB 65 (Confusion, Urea, Respiratory rate, Blood pressure, Age > 65) scores (1.7 ± 1.4 vs 2.2 ± 1.4, P = 0.037), and those with no infiltrates or consolidation on plain radiographs (26.9% vs 7.1%, P < 0.0001). Patients who had a procedure performed had longer average length of stays (15.3 ± 11.9 vs 6.8 ± 4.1 days, P = 0.016). Pneumonia-related procedures were more likely performed in patients who had a CT scan. Specific guidelines and objective rules need to be developed to prospectively guide the use of advanced imaging techniques in pneumonia patients.
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Affiliation(s)
- Deepak Garg
- Department of Infectious Diseases, Western Michigan School of Medicine, Kalamazoo, Michigan
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