The differential diagnosis of pneumonia in two patients infected by atypical pathogens

The current study presents two patients who lived in a rural family with close contact and suffered from rapidly progressive pneumonia. Chest computed tomography images and lymphocytopenia indicated the possibility of COVID-19 infection, but antibody and nucleic acid tests excluded this possibility. Negative results were obtained from corresponding tests for pneumococcal, adenovirus, fungal and legionella infection. Metagenomics analysis and subsequent antibody tests confirmed mycoplasma pneumonia. After treating with moxifloxacin, both patients recovered well and left the hospital. In terms of complicated infectious disease, consideration of atypical pathogens and medical and epidemiological history were important for differential diagnosis of COVID-19; metagenomics analysis was useful to provide direct references for diagnosis.

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Preoperative chest computed tomography in emergency surgery during COVID-19 pandemic

Journal of Perioperative Practice ◽

10.1177/17504589211024405 ◽

2021 ◽

pp. 175045892110244

Author(s):

Vasiliki Chatzaraki ◽

Rahel A Kubik-Huch ◽

Anna Potempa ◽

Andi Gashi ◽

Andrée Friedl ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Surgery ◽

Clinical Symptoms ◽

Preoperative Assessment ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Negative Results ◽

Computed Tomography Images ◽

Preoperative Chest

Background The COVID-19 pandemic challenges the recommendations for patients’ preoperative assessment for preventing severe acute respiratory syndrome coronavirus type 2 transmission and COVID-19-associated postoperative complications and morbidities. Purpose To evaluate the contribution of chest computed tomography for preoperatively assessing patients who are not suspected of being infected with COVID-19 at the time of referral. Methods Candidates for emergency surgery screened via chest computed tomography from 8 to 27 April 2020 were retrospectively evaluated. Computed tomography images were analysed for the presence of COVID-19-associated intrapulmonary changes. When applicable, laboratory and recorded clinical symptoms were extracted. Results Eighty-eight patients underwent preoperative chest computed tomography; 24% were rated as moderately suspicious and 11% as highly suspicious on computed tomography. Subsequent reverse transcription polymerase chain reaction (RT-PCR) was performed for seven patients, all of whom tested negative for COVID-19. Seven patients showed COVID-19-associated clinical symptoms, and most were classified as being mildly to moderately severe as per the clinical classification grading system. Only one case was severe. Four cases underwent RT-PCR with negative results. Conclusion In a cohort without clinical suspicion of COVID-19 infection upon referral, preoperative computed tomography during the COVID-19 pandemic can yield a high suspicion of infection, even if the patient lacks clinical symptoms and is RT-PCR-negative. No recommendations can be made based on our results but contribute to the debate.

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COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽

10.2174/2666796701999201209142919 ◽

2020 ◽

Vol 01 ◽

Author(s):

Maria Silvia De Feo ◽

Viviana Frantellizzi ◽

Giuseppe De Vincentis

Keyword(s):

Infectious Disease ◽

Differential Diagnosis ◽

Ct Scan ◽

Imaging Technique ◽

False Negative ◽

Clinical Signs ◽

Negative Results ◽

Infectious Disease Department ◽

False Negative Results ◽

99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

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Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

International Journal of Surgical Pathology ◽

10.1177/1066896917724888 ◽

2017 ◽

Vol 26 (1) ◽

pp. 89-92 ◽

Cited By ~ 1

Author(s):

Anisha M. Fernandes ◽

Maheshkumar M. Lakhe ◽

Sanjay A. Pai

Keyword(s):

Differential Diagnosis ◽

Acute Appendicitis ◽

Muscularis Propria ◽

Immunocompromised Patients ◽

Lymphoid Follicles ◽

Negative Results ◽

Immunosuppressed Patients ◽

Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

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Anti COVID-19 immunity developed as assessed in a community-based oncological center

Archives of Cancer Science and Therapy ◽

10.29328/journal.acst.1001021 ◽

2020 ◽

Vol 4 (1) ◽

pp. 038-041

Author(s):

Guix Teresa ◽

Panichi Marco ◽

Guix Ines ◽

García Iván ◽

Llebaría Carles ◽

...

Keyword(s):

Cancer Treatment ◽

General Public ◽

Healthcare Workers ◽

Close Contact ◽

Treatment Center ◽

Community Based ◽

Major Objective ◽

Health Authorities ◽

Oncological Center ◽

Antibody Tests

Introduction: Serology (antibody) tests for the SARS-CoV-2 have been proposed as an instrument to inform health authorities about immunization during the COVID-19 pandemic. As there is a significant part of the population that may have some degree of immunity, it is of great interest to communicate the immunization results obtained in the first 500 healthcare workers (HCW), patients and relatives tested in a community-based Oncological Center. Materials and methods: Between April 9th, 2020 and May 8th, 2020, a group of healthcare workers (HCW), their families, and general public who had had the COVID-19 or had been in close contact with confirmed cases of COVID-19 were screened for IgG SARS-CoV-2 antibodies. The tests were carried out in a rigorous manner, strictly following the guidelines approved by the Spanish Ministry of Health (Ministerio de Sanidad). Results: The major objective of this study was to determine the proportion of asymptomatic infected individuals and those who had already secreted IgG against SARS-CoV-2 in our cancer treatment center or in the community of Barcelona. Patients were tested with PCR, Rapid diagnostic test (RDT) or enzyme-linked immunoabsorbent assay (ELISA). A total of 521 participants were tested, 206 with RDT and 315 with ELISA, 59 (11,32%) resulted positive to SARS-CoV-2. Conclusion: RDT and ELISA proved to be effective and sensible enough to determine the extent of SARS-CoV-2 immunization in a community-based oncological center. The degree of immunization reached is nowadays far away from what can be considered desirable for a herd immunization.

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Clinical and Dynamic Computed Tomography Features of 24 Patients With Coronavirus Disease 2019

Canadian Association of Radiologists Journal ◽

10.1177/0846537120918834 ◽

2020 ◽

pp. 084653712091883 ◽

Cited By ~ 4

Author(s):

Bingkun Jie ◽

Xiaojin Liu ◽

Huaqian Suo ◽

Guoqing Qiao ◽

Qingshui Zheng ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Characteristics ◽

Close Contact ◽

Dynamic Computed Tomography ◽

Chest Tightness ◽

Wuhan City ◽

Travel History ◽

Chest Computed Tomography ◽

Regional Center ◽

Interlobular Septal Thickening

Purpose: To explore the clinical and dynamic computed tomography features of coronavirus disease 2019. Methods: We enrolled 24 patients with coronavirus disease 2019 treated at a regional center in Dezhou, China, from January 22 to February 5, 2020, and analyzed data retrospectively. Results: Nineteen cases had close contact with people with coronavirus disease 2019, and five patients denied a travel history in Wuhan City or contact with patients having coronavirus disease 2019. Symptoms were fever, cough, chest tightness, dyspnea, fatigue, and muscle pain. Chest computed tomography showed multiple ground-glass opacities distributed along peribronchial bundles and subpleural areas, often accompanied by bronchiectasis, vascular thickening, and interlobular septal thickening after coronavirus disease 2019 progression. Conclusions: Coronavirus disease 2019 has certain clinical characteristics and typical computed tomography features.

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Endotracheal Metastasis Causing Airway Obstruction

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.10.44964 ◽

2020 ◽

Vol 4 (1) ◽

pp. 96-98

Author(s):

Yudai Yano ◽

Takashi Fujiwara ◽

Masanobu Mizuta

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Emergency Department ◽

Differential Diagnosis ◽

Respiratory Symptoms ◽

Primary Lung Cancer ◽

Chest Computed Tomography ◽

Important Differential Diagnosis ◽

Emergency Tracheostomy ◽

Rare Lesion

Endotracheal metastasis, a critical complication of primary lung cancer, is an extremely rare lesion. A 73-year-old woman who had previously received treatment for lung cancer presented to our emergency department with dyspnea. A chest computed tomography and nasopharyngolaryngoscopy showed an endotracheal mass below the epiglottis, obstructing the trachea almost completely. The patient had an emergency tracheostomy, and then the mass was removed via median laryngotomy. This lesion was proven to be a recurrent metastasis of lung cancer. Clinicians should recognize endotracheal metastasis as an important differential diagnosis in cancer patients presenting with respiratory symptoms.

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