Peculiarities of radiological and laboratory values in patients with community-acquired pneumonia during COVID-19 pandemic

Literature and personal data on community-acquired pneumonia during the epidemic of a new coronavirus infection COVID-19 are presented. It was found that men and patients with moderately to severe form were treated for community-acquired pneumonia more often. The most common localizations were as follows (in descending frequency): bilateral multisegmental, right-sided lower lobe, left-sided lower lobe. Men as compared to women more often had the following localization of pneumonia: right-sided lower lobe pneumonia at the age of 20–30, 51–60; right-sided multisegmental in all age groups; left-sided lower lobe pneumonia at the age of 51–60, left-sided upper lobe pneumonia at the age of 20–50; left-sided multisegmental pneumonia in all age groups; slightly more frequent bilateral lower lobe pneumonia in different age groups; bilateral multisegmental pneumonia at the age of 20–30 and over 60. Conversely, the most common localization in women was as follows: right-sided lower lobe pneumonia at the age 31–50, right-sided upper lobe pneumonia at the age 20–30, left-sided lower lobe pneumonia at the age 20–50 and over 60, left-sided upper lobe pneumonia at the age over 60, bilateral lower lobe pneumonia at the age 31–40, bilateral multisegmental pneumonia at the age 41–60. Right-sided lower lobe pneumonia was equally often registered irrespective of gender in persons older than 60 years old. Right-sided upper lobe pneumonia was not registered in patients aged 31–40 and 41–50 years, and over 60 years old. The most frequent localization of pneumonia in mild form was left-sided lower lobe (35.3 %), right-si­ded lower lobe (20.6 %), and bilateral lower lobe (14.7 %). The least frequent were upper lobe localization of pneumonia in the right, left, and both lungs (2.94 % each), and left multisegmental pneumonia was not observed at all. The most frequent localization of pneumonia in the moderate form was the lower lobes of the right lung (29.4 %), left lung (18.3 %), and multisegmental in both lungs (28.8 %). It was least frequently registered in the upper lobe of the right lung (2.6 %), left lung (3.9 %) but was not registered in the upper lobes of both lungs. The most frequent localization of pneumonia in severe form was bilateral multisegmental (37.5 %). Right-sided multisegmental, left-sided lower lung and bilateral lower lung were the least common — 12.5 % for each. Subfebrile fever was registered more frequently in almost all localizations. More often normal or subfebrile temperature was registered in all localizations, except for right-sided upper lobe pneumonia, in which higher (febrile, pyretic) temperature was registered more often. In all localizations within three days after hospitalization most patients had normal leukocyte count, leukopenia was slightly more frequent in left-sided lower lobe pneumonia, leukocytosis — in the bilateral upper lobe, bilateral lower lobe, and right-sided upper lobe. In general, leukocytosis in community-acquired pneumonia was registered in 38.8 % of patients. In the first three days after hospitalization, a normal amount of lymphocytes was registered in the majority of patients, lymphopenia was observed in one-third of patients with right-sided upper and left-sided lower lobe localization.

Standardised 3D-CT Lung Volumes for Patients with Idiopathic Pulmonary Fibrosis

Background: The assessment of lung physiology via pulmonary function tests (PFTs) is essential for patients with idiopathic pulmonary fibrosis (IPF). However, PFTs require active participation, which can be challenging for patients with severe respiratory failure, such as during acute exacerbations (AE) of IPF. Recently advances enabled to re-construct of 3-dimensional computed-tomography (3D-CT) images. Methods: This is a retrospective multi-center cohort study. This study established a standardisation method and quantitative analysis of lung volume (LV) based on anthropometry using three-dimensional computed tomography (3D-CT) images. The standardised 3D-CT LV in patients with IPF at diagnosis (n=140) and during AE (cohort1; n=61 and cohort2; n=50) and those of controls (n=53) were measured. Results: The standardised 3D-CT LVs at IPF diagnosis were less than those of control patients, especially in the lower lung lobes. The standardised 3D-CT LVs were correlated with forced vital capacity (FVC) and validated using the modified Gender-Age-Physiology (GAP) index. The standardised 3D-CT LVs at IPF diagnosis were independently associated with prognosis. During AE, PFTs were difficult to perform, 3D-CT analyses revealed reduced lung capacity in both the upper and lower lobes compared to those obtained at diagnosis. Lower standardised 3D-CT LVs during AE were independently associated with worse outcomes in independent two cohorts. Particularly, volume loss in the upper lobe at AE had prognostic values.Conclusion: A novel image quantification method for assessing pulmonary physiology using standardised 3D-CT-derived LVs was developed. This method successfully predicts mortality in patients with IPF and AE of IPF, and may be a useful alternative to PFTs when PFTs cannot be performed.

Deposition of Inhaled Levofloxacin in Cystic Fibrosis Lungs Assessed by Functional Respiratory Imaging

Pulmonary infections caused by Pseudomonas aeruginosa (PA) represent the leading cause of pulmonary morbidity in adults with cystic fibrosis (CF). In addition to tobramycin, colistin, and aztreonam, levofloxacin has been approved in Europe to treat PA infections. Nevertheless, no lung deposition data on inhaled levofloxacin are yet available. We conducted a Functional Respiratory Imaging (FRI) study to predict the lung deposition of levofloxacin in the lungs of patients with CF. Three-dimensional airway models were digitally reconstructed from twenty high-resolution computed tomography scans obtained from historical patients’ records. Levofloxacin aerosols generated with the corresponding approved nebuliser were characterised according to pharmacopeia. The obtained data were used to inform a computational fluid dynamics simulation of levofloxacin lung deposition using breathing patterns averaged from actual CF patients’ spirometry data. Levofloxacin deposition in the lung periphery was significantly reduced by breathing patterns with low inspiratory times and high inspiratory flow rates. The intrathoracic levofloxacin deposition percentages for moderate and mild CF lungs were, respectively, 37.0% ± 13.6 and 39.5% ± 12.9 of the nominal dose. A significant albeit modest correlation was found between the central-to-peripheral deposition (C/P) ratio of levofloxacin and FEV1. FRI analysis also detected structural differences between mild and moderate CF airways. FRI revealed a significant intrathoracic deposition of levofloxacin aerosols, which distributed preferentially to the lower lung lobes, with an influence of the deterioration of FEV1 on the C/P ratio. The three-dimensional rendering of CF airways also detected structural differences between the airways of patients with mild and moderate CF.

Liquid based cytology and immunohistochemistry on cytosmears based diagnosis of letterer-siwe disease in a 40 year male

: Histiocytes with coffee bean like nucleus are the diagnostic hallmark of Langerhans cell histiocytosis (LCH) supported with immunohistochemical (IHC) demonstration of fascin, CD1a and S-100. We report a case of Letterer-Siwe disease in a 40year male diagnosed on cytology and IHC on cytosmears along with cytomorphology in Liquid based cytology (LBC) smears. Forty year male presented with complains of low grade fever and reduced appetite from two years with a cervical swelling and discomfort from five months. Fine needle aspiration(FNA) from cervical lymph node showed sheets of histiocytes in background of mixed inflammatory cells. LBC smears highlighted fine chromatin, delicate nuclear outline with coffee bean like morphology. On IHC tumor cells were positive for S-100 and CD1a. CT thorax revealed consolidation in left lower lung, bone lesions were found on skeletal survey. Hence diagnosis of Letterer-Siwe disease was given. Patient responded well to systemic chemotherapy.

Effects of Bolus Holding on Respiratory–Swallow Coordination in Parkinson's Disease

Purpose: The aim of this study was to examine the effects of bolus holding on respiratory–swallow coordination (RSC) in people with Parkinson's disease (PD). Method: People with PD were prospectively recruited to undergo RSC assessment using simultaneous respiratory inductive plethysmography and flexible laryngoscopy. During RSC assessment, participants swallowed 5-ml thin liquid boluses during held and nonheld swallowing tasks. Measures of RSC were analyzed for each swallow, which included respiratory pause duration, lung volume at swallow initiation, respiratory phase patterning, and the presence of paradoxical respiratory movements. Multilevel statistical modeling was used to determine if differences in RSC were present between the held and nonheld tasks. Results: Thirty-three participants were enrolled. When compared to the nonheld swallows, the held swallows exhibited shorter respiratory pauses ( p = .001, R 2 = .019), lower lung volumes at swallow initiation ( p < .001, R 2 = .116), more frequent exhale–swallow–exhale patterns ( p < .001, OR = 4.30), and less frequent paradoxical respiratory movements ( p = .001, OR = 0.43). Conclusions: Findings from this study revealed that bolus holding significantly influences RSC in people with PD. This demonstrates that bolus holding may be an efficacious strategy to immediately improve RSC in PD. However, clinicians and researchers should consider avoiding bolus holding during swallowing evaluations if attempting to assess RSC behaviors that are most typical for the examinee.

Fatigue, Blurry Vision, and Swollen Optic Nerves

A 71-year-old woman had development of generalized fatigue over 1 week, along with low-grade fever. The fever resolved, but the fatigue persisted. Subsequently, retro-orbital and head discomfort developed. One month later, she had blurred vision. An ophthalmic examination revealed mild dyschromatopsia, bilateral visual field constriction, bilateral marked optic disc edema, and vitreous cells graded as vitreous haze score 2.0. Magnetic resonance imaging of the brain showed confluent abnormal areas of T2 hyperintensity without mass effect or enhancement involving the subcortical and periventricular white matter in the cerebral hemispheres bilaterally, basal ganglia, pons, and left thalamus. She had 2 lumbar punctures, which showed normal opening pressures. Cerebrospinal fluid analysis showed an increased white blood cell count cytologically consistent with reactive pleocytosis with a predominance of lymphocytes. The cerebrospinal fluid protein level was increased and cultures were negative for organisms. Immunostain confirmed polyclonal plasma cells and a possible T-cell proliferative disorder. The cerebrospinal fluid and serum were positive for collapsin-response mediator protein 5-immunoglobulin G and microtubule-associated protein 1B- immunoglobulin G antibodies at high titers. Computed tomography of the chest, abdomen, and pelvis showed an indeterminate pulmonary nodule in the upper lobe. Bronchoscopy identified thickened mucosa in the right lower lung consistent with small cell carcinoma. Positron emission tomography showed abnormal hypermetabolic areas of the ascending colon. Biopsy revealed tubulovillous adenoma of the ascending colon, and the patient underwent a right-sided colon resection and anastomosis. The patient was diagnosed with paraneoplastic optic neuropathy (collapsin-response mediator protein 5-immunoglobulin G–associated optic neuropathy and vitritis). Intravenous methylprednisolone was given for 5 days, followed by a prolonged course of oral prednisone, with slight visual improvement. The patient underwent a right-sided thoracotomy with biopsy of the right lower lobe, the results of which were consistent with small cell undifferentiated carcinoma. Paraneoplastic neurologic syndromes are a heterogeneous group of disorders associated with various systemic cancers and with other mechanisms believed to be immune mediated. Paraneoplastic visual syndromes can precede or follow a diagnosis of cancer.

Lung Function, Allergic Sensitization and Asthma in School-Aged Children After Viral-Coinfection Bronchiolitis

BACKGROUND. Our main objective was to compare the lung function, the rate of allergic sensitization and the prevalence of asthma at 7-9 years in children hospitalized for bronchiolitis with viral coinfection versus single viral infection.METHODS. Observational study in children with previous bronchiolitis and current age 7-9 years. Clinical data were collected. Fraction of exhaled nitric oxide (FeNO) determination, spirometry and skin prick test for common aeroallergens were performed.RESULTS. A total of 181 children hospitalized for bronchiolitis (40 coinfections and 141 single infections), with median age of 8.3 years (IQR:7.5-9.1) were included. Single-HRV-infections showed lower basal FEV1(%) than coinfections (p=0.04) and lower z-score FEV1 than single-RSV-infections(p=0.04) or coinfections(p=0.02). Also, single-HRV-infections had lower post-bronchodilator FEV1(%) and z-score FEV1 values than coinfections (p=0.03 and p=0.03). Single-HRV-bronchiolitis was an independent risk factor for FEV1<80%(p=0.007). FeNO value >25 ppb was detected in 21(12.5%) cases, without differences between viral groups(p=0.768). The prevalence of allergic sensitization was similar in coinfections (31.4%) versus single infections (38.7%), (p=0.428). The highest frequency of allergic rhinitis was observed in single-HRV patients(p=0.004).The respiratory morbidity at 7-9 years of coinfected patients was similar to the single-HRV ones. In contrast, the likelihood of current asthma was up to 5 times higher in RSV/HRV coinfections than in the single-RSV-infections ones (p=0.012).CONCLUSIONS. The respiratory morbidity at 7-9 years of age after severe bronchiolitis is significantly higher in single-HRV or viral coinfection patients that in single-RSV ones. Single-HRV-bronchiolitis is independently associated with lower lung function at school-age.

Desquamation Interstitial Pneumonia Presenting as a Solid Mass in the Lung: a Case Report.

Background: Desquamation interstitial pneumonia (DIP) is a rare type of idiopathic interstitial pneumonia. High resolution computed tomography (HRCT) shows ground glass opacities without the peripheral reticular opacities characteristic of usual interstitial pneumonia (UIP). Here we report a case of DIP presenting as a solid mass in the lung, which is rarely described in the literature.Case presentation: A 77-year-old man presented with dry cough and dyspnea on exertion for one month was admitted to our hospital. The lung CT scan showed there was a pulmonary mass in right lower lung and the patient was scheduled for surgery. He was a sculpture artist, non-smoker and the previous medical history included only mandatory spondylitis without other connective tissue diseases. Nine days post-last CT, the FDG PET/CT demonstrated the mass in the right lower lung was significantly hypermetabolic (SUV value=8.9) but inflammatory exudate could be observed around the mass. We gave antibiotics and performed CT-guided percutaneous lung biopsy. The result showed that there were a large number of macrophages in the alveolar cavity, alveolar epithelial type II cells hyperplasia in some areas and chronic inflammation was noted in the interstitium. Then the desquamative interstitial pneumonia was diagnosed. We gave the patient glucocorticoid therapy, then the patient's symptoms disappeared gradually and the lung CT showed that the pulmonary mass was disappeared.Conclusions: Our report illustrates the rare presentation of DIP. Furthermore, for the pulmonary mass, even if appeared hypermetabolic on PET/CT, it is still necessary to make a definite pathological diagnosis before operation, so as to reduce the damage to patients.