Pulmonary tuberculosis presenting as acute respiratory distress syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. e237664
Author(s):  
Neha Chopra ◽  
Sujay Halkur Shankar ◽  
Sagnik Biswas ◽  
Animesh Ray
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Pulmonary Tuberculosis ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
The Other ◽  
Pulmonary Tb ◽  
Parenchymal Disease

Pulmonary tuberculosis (TB) may present in the form of parenchymal disease or extraparenchymal disease. Patients with TB as a primary cause of respiratory failure requiring mechanical ventilation have been reported to have mortality rates ranging between 47% and 80%. However, acute respiratory distress syndrome (ARDS) as a presentation of TB is rarely reported. We describe two cases of immunocompetent women presenting with ARDS. They were initially worked up for viral aetiologies in view of the ongoing COVID-19 pandemic but were later diagnosed to have microbiologically proven parenchymal pulmonary TB. One of our patients succumbed to nosocomial pneumonia, while the other was discharged to follow-up.

Unexpected High Mortality Rate Due to Acute Respiratory Distress Syndrome Among Infants with AML Enrolled on JPLSG AML-05 Trial

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2146-2146 ◽  
Author(s):  
Daisuke Tomizawa ◽  
Akiko Moriya Saito ◽  
Takashi Taga ◽  
Souichi Adachi ◽  
Hideki Nakayama ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
De Novo ◽  
Conflicts Of Interest ◽  
Tumor Lysis Syndrome ◽  
Age Groups ◽  
The Other ◽  
Cell Transplant

Abstract Abstract 2146 Background: Infants (age <1 year) with AML are naturally vulnerable to intensive cytotoxic therapy, however, usually treated with the same protocol as older children with or without dose modification. We report here the unexpected high treatment-related mortality (TRM) mainly due to acute respiratory distress syndrome (ARDS) observed among this age subgroup in the JPLSG AML-05 study. Patients & Methods: AML-05 study, registered at http://www.umin.ac.jp/ctr/ as UMIN000000511, opened on 11/1/2006 for children (age ≤18 years) with de novo AML excluding acute promyelocytic leukemia and myeloid leukemia associated with Down syndrome. The study stratifies patients by the specific cytogenetic characters and treatment response into 3 risk groups. All patients receive two common induction courses; the first induction course (Ind-1), “ECM,” is based on the predecessor trial AML99, consisted of etoposide (150 mg/m2 i.v. on days 1 to 5), Ara-C (200 mg/m2 for 12-hour i.v. on days 6 to 12), mitoxantrone (5 mg/m2 i.v. on days 6 to 10), and a single dose of triple IT on day 6. For patients <2 years old, drug dosages are reduced by calculating on body weight basis. TRM among infants in AML99 was as low as 7.4% (2/27). Nine early deaths (= deaths of any cause before initiating the second induction course) were reported among the first 275 patients enrolled on AML-05, and mortality was exceptionally high in infants (7/32, 21.8%). This prompted suspension of the protocol accrual for this age subgroup on 4/2/2009 and comprehensive review of induction adverse events (AEs) were carried out. Results: Among the 7 early deaths in infants, 4 deaths occurred during Ind-1 phase, and the other 3 after being off protocol therapy due to severe Ind-1 AEs. The causes of deaths were as follows; one of resistant disease, 4 of ARDS, one of interstitial pneumonia, and one of bacterial sepsis after receiving haploidentical stem cell transplant because of prolonged pancytopenia. Among the 4 ARDS cases, two had preceding RS virus infection, and the other 2 developed ARDS during marrow recovery with G-CSF use. We also evaluated grade 3 and 4 AEs in all age groups, of which 248/275 cases were evaluable. When comparing the infant group (N=27) and the older age group (≥ 1 year, N=221), there were no difference in hematological toxicities, however, non-hematological toxicities, such as renal, cardiac, pulmonary, neurological complications, and tumor lysis syndrome were significantly more common in the infant group. Conclusions: Early death rate among infants in AML-05 study was unacceptably high, and we decided to make the following changes to the AML-05: 1) additional dose reduction by 33% in Ind-1 for infants; 2) enhancing supportive care guidelines regarding infection prevention; 3) close prospective monitoring of induction toxic death. The enrollment of infants was re-opened on 8/11/2009, and no fatal cases are observed since then. Disclosures: No relevant conflicts of interest to declare.

Acute Respiratory Distress Syndrome: CT Abnormalities at Long-term Follow-up

Radiology ◽  
1999 ◽  
Vol 210 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Sujal R. Desai ◽  
Athol U. Wells ◽  
Michael B. Rubens ◽  
Timothy W. Evans ◽  
David M. Hansell
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Long Term Follow Up

scholarly journals Does Prone Positioning Decrease Mortality Rate in ARDS? A Systematic Review

2018 ◽  
Author(s):  
Joseph Sarkis
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Respiratory Distress Syndrome ◽  
Supportive Care ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Prone Positioning ◽  
Reduce Mortality Rate

Acute Respiratory Distress Syndrome (ARDS) is a clinical condition in which the lungs suffer severe irreversible, large-scale damage causing a grievous form of hypoxemic respiratory failure. Acute respiratory distress syndrome is one of the most evasive diagnosis confronted in the Intensive care unit (ICU) as the name, definition and diagnostic standards have adapted over the past four decades. An ARDS diagnosis is established by physiological criteria and continues to be a diagnosis of exclusion, which makes it crucial that medical professionals expand their knowledge base to effectively diagnose ARDS. Patients admitted with ARDS have high mortality rates ranging from 40 to 60 percent. High-level quality supportive care continues to be the sole option for ARDS treatment. Even with improved supportive care, however, ARDS prognosis is still poor. Extended prone positioning (PP) has been shown to increase alveolar recruitment end expiratory lung volume, thereby improving oxygenation and survival. Unfortunately, few studies have examined the association of mortality and prone positioning in ARDS. A systematic review was conducted to examine the following research question: Does prone positioning compared to supine positioning in patients with ARDS decrease mortality rates? This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP). A literature review was performed and data were collected from each study. A cross study analysis was performed and PP was found to reduce mortality rate in patients who were severely hypoxic. The reviewed studies demonstrated that incorporating early and longer periods of PP may improve mortality in ARDS patients, but further research is needed.

scholarly journals Intestinal Collinsella may mitigate infection and exacerbation of COVID-19 by producing ursodeoxycholate

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260451
Author(s):  
Masaaki Hirayama ◽  
Hiroshi Nishiwaki ◽  
Tomonari Hamaguchi ◽  
Mikako Ito ◽  
Jun Ueyama ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Gut Microbiota ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Sequencing Data ◽  
Angiotensin Converting Enzyme 2 ◽  
Underlying Mechanisms ◽  
Apoptotic Effects

The mortality rates of COVID-19 vary widely across countries, but the underlying mechanisms remain unelucidated. We aimed at the elucidation of relationship between gut microbiota and the mortality rates of COVID-19 across countries. Raw sequencing data of 16S rRNA V3-V5 regions of gut microbiota in 953 healthy subjects in ten countries were obtained from the public database. We made a generalized linear model (GLM) to predict the COVID-19 mortality rates using gut microbiota. GLM revealed that low genus Collinsella predicted high COVID-19 mortality rates with a markedly low p-value. Unsupervised clustering of gut microbiota in 953 subjects yielded five enterotypes. The mortality rates were increased from enterotypes 1 to 5, whereas the abundances of Collinsella were decreased from enterotypes 1 to 5 except for enterotype 2. Collinsella produces ursodeoxycholate. Ursodeoxycholate was previously reported to inhibit binding of SARS-CoV-2 to angiotensin-converting enzyme 2; suppress pro-inflammatory cytokines like TNF-α, IL-1β, IL-2, IL-4, and IL-6; have antioxidant and anti-apoptotic effects; and increase alveolar fluid clearance in acute respiratory distress syndrome. Ursodeoxycholate produced by Collinsella may prevent COVID-19 infection and ameliorate acute respiratory distress syndrome in COVID-19 by suppressing cytokine storm syndrome.

scholarly journals Recovery from COVID-19 and acute respiratory distress syndrome: the potential role of an intensive care unit recovery clinic: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Kirby P. Mayer ◽  
Jamie L. Sturgill ◽  
Anna G. Kalema ◽  
Melissa K. Soper ◽  
Sherif M. Seif ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Case Report ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Polymerase Chain

Abstract Background In this case report, we describe the trajectory of recovery of a young, healthy patient diagnosed with coronavirus disease 2019 who developed acute respiratory distress syndrome. The purpose of this case report is to highlight the potential role of intensive care unit recovery or follow-up clinics for patients surviving acute hospitalization for coronavirus disease 2019. Case presentation Our patient was a 27-year-old Caucasian woman with a past medical history of asthma transferred from a community hospital to our medical intensive care unit for acute hypoxic respiratory failure due to bilateral pneumonia requiring mechanical ventilation (ratio of arterial oxygen partial pressure to fraction of inspired oxygen, 180). On day 2 of her intensive care unit admission, reverse transcription–polymerase chain reaction confirmed coronavirus disease 2019. Her clinical status gradually improved, and she was extubated on intensive care unit day 5. She had a negative test result for coronavirus disease 2019 twice with repeated reverse transcription–polymerase chain reaction before being discharged to home after 10 days in the intensive care unit. Two weeks after intensive care unit discharge, the patient returned to our outpatient intensive care unit recovery clinic. At follow-up, the patient endorsed significant fatigue and exhaustion with difficulty walking, minor issues with sleep disruption, and periods of memory loss. She scored 10/12 on the short performance physical battery, indicating good physical function. She did not have signs of anxiety, depression, or post-traumatic stress disorder through self-report questionnaires. Clinically, she was considered at low risk of developing post–intensive care syndrome, but she required follow-up services to assist in navigating the healthcare system, addressing remaining symptoms, and promoting return to her pre–coronavirus disease 2019 societal role. Conclusion We present this case report to suggest that patients surviving coronavirus disease 2019 with subsequent development of acute respiratory distress syndrome will require more intense intensive care unit recovery follow-up. Patients with a higher degree of acute illness who also have pre-existing comorbidities and those of older age who survive mechanical ventilation for coronavirus disease 2019 will require substantial post–intensive care unit care to mitigate and treat post–intensive care syndrome, promote reintegration into the community, and improve quality of life.

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