scholarly journals Cytomegalovirus associated severe pneumonia in three liver transplant recipients

2020 ◽  
Vol 14 (11) ◽  
pp. 1338-1343
Author(s):  
Adem Kose ◽  
Murat Yalcinsoy ◽  
Emine Turkmen Samdanci ◽  
Bora Barut ◽  
Baris Otlu ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Ct Scan ◽  
Clinical Symptoms ◽  
Clinical Sample ◽  
Quantitative Polymerase Chain Reaction ◽  
Case Series ◽  
Severe Pneumonia ◽  
Fold Increase ◽  
Lung Parenchyma ◽  
Bronchial Biopsy

Introduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.

scholarly journals An Evaluation of Thrombotic Tendency by Whole-Body Enhanced CT Scan for Critical COVID-19 Pneumonia: A Case Series Study

2021 ◽  
Author(s):  
Fumihiro Ogawa ◽  
Yasufumi Oi ◽  
Kento Nakajima ◽  
Reo Matsumura ◽  
Tomoki Nakagawa ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ct Scan ◽  
Clinical Symptoms ◽  
Degradation Products ◽  
Thrombus Formation ◽  
Case Series ◽  
Whole Body ◽  
Pathological Feature ◽  
Case Series Study ◽  
Enhanced Ct

Abstract Background: Coronavirus disease (COVID-19) pneumonitis associated with severe respiratory failure has a high mortality rate. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently observed. Coagulopathy has emerged as a significant contributor to thrombotic complications. Although recommendations have been made for anticoagulant use for COVID-19, no guidelines have been specified.Case presentation: We describe four cases of critical COVID-19 with thrombosis detected by enhanced CT scan. The CT findings of all cases demonstrated typical findings of COVID-19 and pulmonary embolism or deep venous thrombus without critical exacerbation. Two patients died of respiratory failure due to COVID-19.Discussion: Previous reports have suggested coagulopathy with thrombotic signs as the main pathological feature of COVID-19, but no previous reports have focused on coagulopathy evaluated by whole-body enhanced CT scan. Changes in hemostatic biomarkers, represented by an increase in D-dimer and fibrin/fibrinogen degradation products, indicated that the essence of coagulopathy was massive fibrin formation. Although there were no clinical symptoms related to their prognosis, critical COVID-19-induced systemic thrombus formation was observed. Conclusions: Therapeutic dose anticoagulants should be considered for critical COVID-19 because of induced coagulopathy, and aggressive follow-up by whole body enhanced CT scan for systemic venous thromboembolism (VTE) is necessary.

scholarly journals An evaluation of venous thromboembolism by whole-body enhanced CT scan for critical COVID-19 pneumonia with markedly rises of coagulopathy related factors: a case series study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Fumihiro Ogawa ◽  
Yasufumi Oi ◽  
Kento Nakajima ◽  
Reo Matsumura ◽  
Tomoki Nakagawa ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Respiratory Failure ◽  
Ct Scan ◽  
Clinical Symptoms ◽  
Thrombus Formation ◽  
Case Series ◽  
Whole Body ◽  
Pathological Feature ◽  
Case Series Study ◽  
Enhanced Ct

Abstract Background Coronavirus disease (COVID-19) pneumonitis associated with severe respiratory failure has a high mortality rate. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently observed. Coagulopathy has emerged as a significant contributor to thrombotic complications. Although recommendations have been made for anticoagulant use for COVID-19, no guidelines have been specified. Case summary We describe four cases of critical COVID-19 with thrombosis detected by enhanced CT scan. The CT findings of all cases demonstrated typical findings of COVID-19 and pulmonary embolism or deep venous thrombus without critical exacerbation. Two patients died of respiratory failure due to COVID-19. Discussion Previous reports have suggested coagulopathy with thrombotic signs as the main pathological feature of COVID-19, but no previous reports have focused on coagulopathy evaluated by whole-body enhanced CT scan. Changes in hemostatic biomarkers, represented by an increase in D-dimer and fibrin/fibrinogen degradation products, indicated that the essence of coagulopathy was massive fibrin formation. Although there were no clinical symptoms related to their prognosis, critical COVID-19-induced systemic thrombus formation was observed. Conclusions Therapeutic dose anticoagulants should be considered for critical COVID-19 because of induced coagulopathy, and aggressive follow-up by whole body enhanced CT scan for systemic venous thromboembolism (VTE) is necessary.

scholarly journals Variety of radiological findings in a family with COVID-19: a case report

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Farideh Gharekhanloo ◽  
Iraj Sedighi ◽  
Salman Khazaei
Keyword(s):  
Ct Scan ◽  
Clinical Symptoms ◽  
Close Contact ◽  
Pediatric Population ◽  
Case Series ◽  
Lower Lobe ◽  
Ground Glass Opacity ◽  
Imaging Features ◽  
Standard Regimen ◽  
Asymptomatic Children

Abstract Introduction In December 2019, a case series of pneumonia associated with seafood and wet animal market was reported as coronavirus disease 2019 (COVID-19) in Wuhan, Hubei, China. The COVID-19 less frequently affects the pediatric group, and asymptomatic children are commonly reported. This feature is important due to the potential transmissibility of COVID-19 through these cases. There is a variety of atypical clinical symptoms and imaging manifestations among children infected with COVID-19. Case presentation We report two sisters with COVID-19 pneumonia who had close contact with their 77-year-old grandmother. Their grandmother expired with a confirmed diagnosis of COVID-19. The older sister (15 years old) firstly presented with severe cough, fever, dyspnea, diarrhea, and lymphopenia. A chest computed tomography (CT) scan showed atypical lobar pneumonic infiltration only in the left lower lobe. The younger sister (6 years old) was affected the following day with milder symptoms (i.e., fever and cough). Her chest CT scan demonstrated typical mild generalized patchy ground-glass opacity with interlobular septal thickening scattered in both lungs. The CT presentation of their grandmother showed typical bilateral white lungs with crazy paving appearance. The standard regimen for both sisters was administrated, and the patients’ respiratory conditions improved after 5 days of treatment. Both cases were discharged with good general conditions. Conclusion Children are considered potentially important causes of COVID-19 transmission. The symptoms in children are milder, and clinicians should be aware of taking a definite history of infected family members. Atypical clinical symptoms and imaging features are more common in children than adults; therefore, it is necessary to identify the typical and atypical imaging patterns of COVID-19 pneumonia in the pediatric population.

scholarly journals Clinical and CT scan findings in patients with COVID-19 pneumonia: A comparison based on disease severity

2021 ◽  
Author(s):  
Sonia Hesam-Shariati ◽  
Susan Mohammadi ◽  
Morteza Abouzaripour ◽  
Behzad Mohsenpour ◽  
Bushra Zareie ◽  
...  
Keyword(s):  
Ct Scan ◽  
Disease Severity ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
White Blood Cells ◽  
Severe Pneumonia ◽  
Duration Of Hospitalization ◽  
The Mean ◽  
Severity Of The Disease ◽  
Interlobular Septal Thickening

Abstract Background The SARS-CoV-2 can cause severe pneumonia and highly impact general health. We aimed to investigate different clinical features and CT scan findings of patients with COVID-19 based on disease severity to have a better understanding of this disease. Methods 90 patients with coronavirus were divided into three categories based on the severity of the disease: mild/moderate, severe, and very severe. Clinical, laboratory and CT scan findings of the patients were examined retrospectively. Any association between these features and disease severity were assessed. Results The mean age and duration of hospitalization of patients increased with increasing the severity of disease. The most common clinical symptoms were shortness of breath, cough, and fever. As the severity of the disease increased from mild/moderate to very severe, there was an increase in neutrophile counts and a decrease in lymphocytes and white blood cells (WBC) showing excessive inflammation associated with severe forms of COVID-19. Subpleural changes (81%) and ground-glass opacification/opacity (GGO) lesions (73%) of the lung were the most common features among CT images of COVID-19 patients, and interlobular septal thickening (10%) was the lowest CT feature among patients. Regarding the affected parts of the lung in COVID-19 patients, bilaterial, peripheral and multiple lesions had the highest prevalence. Conclusions It has been shown that clinical, laboratory and CT scan findings varied in COVID-19 patients based on disease severity, which need to be considered carefully in timely diagnosis and treatment of this illness.

scholarly journals Case series of Pulmonary Alveolar Microlithiasis from India

2019 ◽  
Vol 12 (3) ◽  
pp. e227406 ◽  
Author(s):  
Manu Chopra ◽  
Manjit Sharad Tendolkar ◽  
Vasu Vardhan
Keyword(s):  
Rare Disease ◽  
Clinical Symptoms ◽  
Case Series ◽  
Lung Parenchyma ◽  
Response To Treatment ◽  
Definitive Treatment ◽  
Alveolar Type ◽  
Pulmonary Alveolar Microlithiasis ◽  
Alveolar Microlithiasis ◽  
Calcific Deposits

Pulmonary alveolar microlithiasis (PAM) is a rare disease characterised by calcific deposits in lung parenchyma. PAM being a progressive disease with dissociation between severity of clinical symptoms and radiological picture, it is often detected incidentally. Mutations in the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells are considered to be involved in the pathogenesis of PAM. The majority of the patients are diagnosed usually between the ages of 20 and 40 years, although paediatric PAM has also been reported. Diagnosis is confirmed by combination of radiological features, bronchial lavage and histopathological testing. At present, lung transplant is the only definitive treatment available. Though rare, the prevalence of PAM is worldwide. Till June 2018, 86 cases have been reported from India and 1042 cases have been reported worldwide. We report three cases from India, including a student, cement factory worker and a tailor, which will highlight the varied clinical and radiological presentations of this rare disease along with the response to treatment.

scholarly journals 2695. Pneumocystis jirovecii Pneumonia in the Era of Effective Prophylaxis Following Hematopoietic Stem Cell Transplant

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S947-S948
Author(s):  
Alexander Christian Drelick ◽  
Priya Kodiyanplakkal ◽  
Markus Plate ◽  
Michael J Satlin ◽  
Rosemary Soave ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Clinical Symptoms ◽  
Quantitative Polymerase Chain Reaction ◽  
Case Series ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct

Abstract Background Pneumocystis jirovecii pneumonia is an uncommon and life-threatening disease that can occur following hematopoietic stem cell transplantation (HSCT). Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis greatly reduces the incidence of PJP. We aim to determine what factors contribute to the development of PJP following HSCT where TMP-SMX prophylaxis is widely used. Methods We performed a single-center, retrospective case series of HSCT recipients from January 1, 2012 to December 31, 2018. Subjects had clinical symptoms and radiographic evidence for PJP along with at least one positive Pneumocystis test obtained from bronchoalveolar lavage (BAL) including direct fluorescence antibody (DFA), quantitative polymerase chain reaction (qPCR), cytology, and pathology. Results 1111 subjects underwent HSCT; of whom, 25 (2.2%) met inclusion criteria and were treated for PJP. 6 were autologous and 19 were allogeneic HSCT recipients (1.23% and 3.05% of total autologous and allogeneic HSCT, respectively). All allogeneic HSCT recipients received in-vivo T-cell depletion. Median duration from autologous and allogeneic HSCT to PJP diagnosis were 138 days (range 20 to 348) and 346 days (range 41 to 771), respectively. PJP qPCR was positive in all samples tested (n = 20, range < 84 to 14900). DFA was positive in 6 (28%). Death from pneumonia occurred in 2 subjects; 11 (44%) required ICU stay, and 7 (27%) required intubation. At diagnosis, 3 subjects had relapse of underlying disease and 10 were on immunosuppression. 12 were on PJP prophylaxis (autologous HSCT n = 3), the most common of which was atovaquone (n = 5); only 2 subjects were on TMP-SMX. Cytomegalovirus (CMV) viremia was detected in 9 subjects (36%) prior to PJP diagnosis; 4 had pulmonary CMV coinfection. In total, 17 subjects (68%) had one of the above risk factors for PJP. Median total lymphocyte count and % lymphocytes were 5.1 × 103 cells/μL (range 1.4 to 38.5 × 103 cells/μL) and 9.6% (range 1.1 to 29.5%), respectively. Conclusion PJP is an uncommon (2.2% of the study population) complication of HSCT while receiving PJP prophylaxis and in the absence of disease relapse, CMV reactivation, or ongoing immunosuppression. Presentation is often delayed in this population; a high degree of clinical suspicion should prompt diagnostic evaluation using a combination of laboratory tests on BAL fluid. Disclosures All authors: No reported disclosures.

Slowly or Nonresolving Legionnaires’ Disease: Case Series and Literature Review

2019 ◽  
Vol 70 (9) ◽  
pp. 1933-1940 ◽  
Author(s):  
Cécile Pouderoux ◽  
Christophe Ginevra ◽  
Ghislaine Descours ◽  
Anne-Gaëlle Ranc ◽  
Laetitia Beraud ◽  
...  
Keyword(s):  
Ct Scan ◽  
Clinical Symptoms ◽  
Case Series ◽  
Lung Abscess ◽  
Attributable Mortality ◽  
Duration Of Treatment ◽  
Threshold Detection ◽  
Persistent Symptoms ◽  
Disease Case ◽  
Legionnaires Disease

Abstract Background Rarely, Legionnaires’ disease (LD) can progress into a slowly or nonresolving form. Methods A nationwide retrospective study was conducted by the French National Reference Center for Legionella (2013–2017) including cases of slowly or nonresolving LD defined as persistent clinical symptoms, computed tomography (CT) scan abnormalities, and Legionella detection in lower respiratory tract specimens by culture and/or real-time (RT) polymerase chain reaction (PCR) &gt;30 days after symptom onset. Results Twelve cases of community-acquired slowly or nonresolving LD were identified among 1686 cases of culture-positive LD. Median (interquartile range [IQR]) age was 63 (29–82) years. Ten (83.3%) patients had ≥1 immunosuppressive factor. Clinically, 9 patients transiently recovered before further deterioration (median [IQR] symptom-free interval, 30 [18–55] days), 3 patients had uniformly persistent symptoms (median [IQR] time, 48 [41.5–54] days). Two patients had &gt;2 recurrences. CT scan imagery found lung abscess in 5 (41.6%) cases. Slowly or nonresolving LD was diagnosed on positive Legionella cultures (n = 10, 83.3%) at 49.5 (IQR, 33.7–79) days. Two cases were documented through positive Legionella RT PCR at 52 and 53 days (cycle threshold detection of 21.5 and 33.7, respectively). No genomic microevolution and no Legionella resistance to antibiotics were detected. The median (IQR) duration of treatment was 46.5 (21–92.5) days. Two empyema cases required thoracic surgery. At a median (IQR) follow-up of 26 (14–41.5) months, LD-attributable mortality was 16.6% (n = 2). Conclusions Slowly or nonresolving LD may occur in immunocompromised patients, possibly leading to lung abscess and empyema.

scholarly journals Comparison of clinical findings and CT scan in patients with COVID-19 pneumonia based on disease severity

2021 ◽  
Author(s):  
Sonia Hesam-Shariati ◽  
Susan Mohammadi ◽  
Morteza Abouzaripour ◽  
Behzad Mohsenpour ◽  
Bushra Zareie ◽  
...  
Keyword(s):  
Ct Scan ◽  
Disease Severity ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
White Blood Cells ◽  
Severe Pneumonia ◽  
Clinical Findings ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease ◽  
Interlobular Septal Thickening

Abstract The SARS-CoV-2 can cause severe pneumonia and highly impact general health. We aimed to investigate different clinical features and CT scan findings of patients with COVID-19 based on disease severity to have a better understanding of this disease. For this purpose, 90 patients with coronavirus were examined retrospectively, which were divided into three categories based on the severity of the disease: mild/moderate, severe, and very severe. It has been shown that mean age and duration of hospitalization of patients increased with increasing the severity of disease. The most common clinical symptoms were shortness of breath, cough, and fever. As the severity of the disease increased from mild/moderate to very severe, there was an increase in neutrophile counts and a decrease in lymphocytes and white blood cells (WBC) showing excessive inflammation associated with severe forms of COVID-19. Subpleural changes (81%) and ground-glass opacification/opacity (GGO) lesions (73%) of the lung were the most common features among CT images of COVID-19 patients, and interlobular septal thickening (10%) was the lowest CT feature among patients. Regarding the affected parts of the lung in COVID-19 patients, bilaterial, peripheral and multiple lesions had the highest prevalence. Overall, it has been shown that clinical, laboratory and CT scan findings vary in COVID-19 patients based on disease severity, which need to be considered carefully in early diagnosis and treatment of this illness.

Estimation of premorbid intelligence and executive cognitive functions with lexical reading tasks

2020 ◽  
Author(s):  
Graham Pluck
Keyword(s):  
Cognitive Impairment ◽  
Lexical Decision ◽  
Cognitive Ability ◽  
Memory Span ◽  
Clinical Sample ◽  
Case Series ◽  
Stem Completion ◽  
Clinical Neuropsychology ◽  
Premorbid Intelligence ◽  
Highly Correlated

Introduction: Estimation of premorbid function is essential to accurate assessment of cognitive impairments in clinical neuropsychology and behavioral neurology, and has numerous research applications. However, current methods are rudimentary and imperfect. We explored how lexical tasks can be best used to accurately and precisely estimate intelligence and executive functions.Methods: We studied lexical word pronunciation, lexical decision, and stem-completion naming in the estimation of cognitive ability, in samples of healthy adults (n = 143), and patients with cognitive impairment due to neurological illness (n =15). Cognitive assessments included intelligence (WAIS-IV), episodic memory, and eight tests of executive functioning, including Theory of Mind.Results: When examined at the group level, single word pronunciation was particularly robust in the presence of cognitive impairment in patients with dementia. However, as a case series, patients showed idiosyncratic patterns of preservation of lexical skills including on tests of pronunciation, lexical decision and stem-completion naming. All of these tasks were highly correlated with IQ scores in a non-clinical sample, suggesting that they could be used as estimators of premorbid intelligence. Simulated impairments in non-clinical controls suggested that the median score from the three different tasks had the highest correlation with, and provided the most accurate and precise estimates of, intelligence, and was also the least sensitive to impairment. Finally, we show that these methods also predict executive functions, in particular, strong correlations were found for proverb interpretation, phonemic/semantic alternating verbal fluency, and working memory span performance. Conclusions: Several lexical tasks are potentially useful in predication of pre-illness cognitive ability in patients with neurological or psychiatric illness. However, due to the heterogeneity of impairments between patients, estimation of premorbid levels could be improved by the use of the median estimated values from multiple tests. This could potentially improve diagnostic accuracy and quantification of neuropsychological impairments.

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

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