Functional alterations due to post-COVID-19 lung lesions - lessons from a multicenter V/Q SPECT/CT based registry.

Aim The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients during second wave of the pandemic in a tertiary care hospital in New Delhi, India. We also aim to compare the findings on the HRCT chest during the second wave of COVID-19 with the data form earlier outbreaks and to look for any features specific to the second wave and thus indirectly to the delta variant of SARS-CoV-2. We also assessed the severity of the pulmonary involvement based on HRCT findings. Methods We analysed HRCT chest findings in 237 patients with COVID-19 admitted at our institute from 1st April 2021 to 31st May 2021. Covid-19 infection was confirmed by reverse transcription polymerase chain reaction (rt-PCR) or rapid antigen test (RAT) in all these patients. Results The mean age in our study group was 51.3 ± 12.1 years (range 19–79 years) comprising of 136 males (57.4%) and 101 females (42.6%). The majority of the patients showed bilateral (95.3%) and peripheral (42.6%) distribution of the disease. Ground glass opacities were the most common finding, seen in 214 (90.3%) patients, followed by interlobular septal thickening in 202 (85.8%) and crazy paving in 194 (81.3%) patients. Majority (36.7%) of these patients had a CT severity score above 20 indicating severe disease. Conclusion A typical pattern of peripheral subpleural often bilateral distribution of ground glass opacities on HRCT chest usually points to the possibility of COVID-19 pneumonia. The higher incidence of abnormalities on HRCT chest in patients with infection mainly from the delta variant of SARS-Cov-2 was mainly because of the more severe disease in the population. More research is needed to further evaluate the role of HRCT chest in the diagnosis of COVID-19 caused by different strains of the virus.

Computed tomography (CT) was a widely used diagnostic technique for COVID-19 during the pandemic. High-Resolution Computed Tomography (HRCT), is a type of computed tomography that enhances image resolution through the utilization of advanced methods. Due to privacy concerns, publicly available COVID-19 CT image datasets are incredibly tough to come by, leading to it being challenging to research and create AI-powered COVID-19 diagnostic algorithms based on CT images. To address this issue, we created HRCTCov19, a new COVID-19 high-resolution chest CT scan image collection that includes not only COVID-19 cases of Ground Glass Opacity (GGO), Crazy Paving, and Air Space Consolidation but also CT images of cases with negative COVID-19. The HRCTCov19 dataset, which includes slice-level and patient-level labeling, has the potential to assist in COVID-19 research, in particular for diagnosis and a distinction using AI algorithms, machine learning, and deep learning methods. This dataset, which can be accessed through the web at http://databiox.com , includes 181,106 chest HRCT images from 395 patients labeled as GGO, Crazy Paving, Air Space Consolidation, and Negative.

Background/Aims COVID-19 has been linked to the formation of a number of autoantibodies. This case is an important reminder to clinicians interpreting autoantibody results in conjunction with clinical manifestations. A previously fit 51 year old gentleman, with no prior history of autoimmune disease required admission with respiratory symptoms in April 2020 consistent with COVID-19 infection. His acute respiratory illness was complicated by empyema and left-sided pneumothorax requiring left pleural decortication and adhesiolysis under (VATS). Persistent respiratory symptoms and fatigue lead to investigations for long COVID. Positive antibodies detected were dsDNA 166IU/ml, Proteinase 3 antibodies 20IU/ml, Myeloperoxidase antibodies 32IU/ml, IgG anticardiolipin antibodies 90IU/ml and Glomerular basement membrane antibodies 351 IU/ml. Negative autoantibodies included ANA, RF, aCCP, b2GPI, smooth muscle, AMA and myositis related antibodies. Methods There were no clinical signs or symptoms of inflammatory arthropathy, vasculitis, thrombosis or connective tissue disease. Other investigations included a CT thorax showing no new lung lesions, unremarkable urine dipstick, normal urine ACR, normal US abdomen, CT sinuses and MRI brain. Results Trial course of prednisolone was given therapeutically due to long COVID symptoms. There was no significant impact on symptoms/ autoantibody titres thus steroids were discontinued. The patient was followed closely by the rheumatology team for two years. During that time, the autoantibody levels gradually decreased, and he did not develop clinical signs of autoimmune disease. His long COVID symptoms persisted, and he remains under the long COVID clinical team. Conclusion COVID-19 infection is known to cause an immune response. There have been published cases of positive ANA, U1-snRNP anti-SS-B/La, ANCA, anti-phospholipid and anti-SRP antibody formation following COVID-19 infection. The link between the pathophysiology of COVID-19, autoantibody formation and the role of autoimmunity is still unclear. This man's case was unusual in the number and variety of autoantibodies formed post COVID, this has not been reported in the literature to date. Some of the autoantibodies detected are highly specific for certain conditions, for example anti-GBM antibodies have a high specificity for Goodpasture’s syndrome, thus this case also illustrates the need to interpret positive autoantibodies in the context of clinical findings and history. Disclosure S. Islam: None. N. Erb: None.

<h3>Abstract</h3> <h3>Background</h3> Long Covid remains a relatively new phenomenon with emerging understanding. Estimated UK prevalence of Long Covid with three or more symptoms lasting for 12 weeks or more was...

1. William T. Scouten, MD* 2. Jeanette White, MD† 1. *National Capital Consortium Pediatric Residency Program, National Naval Medical Center/Walter Reed Army Medical Center, Washington, DC 2. †Pediatric Critical Care, Children’s National Medical Center, Washington, DC A previously healthy 17-year-old girl complains of a “dry and intermittent” cough for the past 1.5 months. The cough worsens when she is recumbent and does not respond to over-the-counter cough medications. The cough is not associated with fever, chills, nausea, vomiting, night sweats, or weight loss. She reports several episodes of posttussive chest pain. Recently prescribed treatments of albuterol and fexofenadine do not alleviate her symptoms, despite her clinical diagnoses of exercise-induced bronchospasm and allergic rhinitis. She is an accomplished basketball player; her cough does not diminish her athletic performance. The patient’s past medical history is remarkable for a cardiac murmur noted at birth that resolved by 2 years of age and for three episodes of pneumonia by 6 months of age. She has no drug or environmental allergies, her immunizations are up-to-date, and her growth and development are normal. She denies drug, alcohol, or tobacco use. Further review of a psychosocial history reveals minimal adolescent risk characteristics. For the past 6 years, she has lived in the southwest United States and spent the prior summer in northern California. She denies exposure to others who had chronic cough, tuberculosis, or lung diseases. She admits to watching bats on one occasion during vacation in the past year. On physical examination, the patient appears healthy and is in no apparent distress. Vital signs are: temperature, 36.8°C (98.2°F); respiratory rate, 22 breaths/min; pulse, 88 beats/min; blood pressure, 117/73 mm Hg; and pulse oximetry, 100% hemoglobin-oxygen saturation while breathing room air. The patient’s respirations are unlabored, and she has adequate air movement. Auscultation of the chest reveals decreased breath sounds over the left base and fine, end-inspiratory crackles within the midposterior left chest. There is no appreciable egophony. The remainder of the physical findings are normal. A complete blood count reveals a white …

Pulmonary involvement is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA) and represents a serious complication, being the second cause of death after infection. High-resolution computed tomography (HRCT), owing to its increased sensitivity and diagnostic accuracy respect to the conventional chest radiograph (CXR), allows to detect pulmonary abnormalities in RA patients more frequently than CXR. The aim of this study was to assess pulmonary involvement by HRCT in lifelong non-smoking RA patients without symptoms and clinical signs of pulmonary disease. Seventy-two patients (54 women and 18 men) with a mean age of 56.8+/-10.4 years (range, 40-77 years) and mean duration of disease of 6.9+/-4.7 years (range, 2-12 years) entered the study. 52/72 (72%) were positive for rheumatoid factor (> 20 UI/ml). Standard CXR and HRCT were carried out in each patient. CXR showed a mild interstitial fibrosis in 7 patients (9.7%), whereas HRCT demonstrated pulmonary abnormalities in an higher number of them (22/72 = 30.5%). The most frequent abnormal findings on HRCT were irregular pleural margins (13.8%) and septal/subpleural lines (18%), both compatible with pulmonary fibrosis. Ground-glass opacities were found in 8.3% of the patients. Pulmonary nodules (diameter, range 0,5-2 cm) predominantly located in the subpleural portions of the lung, were demonstrated in the same percentage (8.3%) of patients. Small airway involvement, represented by bronchiectasis/bronchioloectasis, was shown in 15.2% of patients. Subpleural cysts were present in two cases (2.8%). No patient had evidence of honeycombing on HRCT. In conclusion, HRCT is an accurate, non-invasive and safe method of diagnosing lung abnormalities in RA patients without signs and clinical symptoms of pulmonary disease.

Pepsin plays a role in gastroesophageal reflux (GER). Aims of this study were to verify if pepsin could be the cause of frequent bronchial exacerbations and to check if the persistence of chronic respiratory symptoms were correlated with pre-existing respiratory diseases. From January to May 2016, 42 patients underwent a diagnostic bronchoscopy. All patients had a history of at least one bronchial exacerbation during the previous year. Bronchial lavage fluid specimens were obtained. A semiquantitative assessment of pepsin in the samples was carried out based on the intensity of the test sample. Pepsin was present in 37 patients (88%), but in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD), the finding of pepsin in the bronchoalveolar fluid was 100%. There was a strong positive statistical correlation between pepsin detection and radiological signs of GER (ρ=0.662), and between pepsin detection and diagnosis (ρ=0.682). No correlation was found between the bacteriology and the presence of pepsin in the airways (ρ=0.006). The presence of pepsin in the airways shows the occurrence of reflux. The persistence of respiratory symptoms by at least 2 months suggest an endoscopic bronchial examination. This straightforward test confirms the cause possible irritation of the airways and may prevent further diagnostic tests, such as an EGD or pH monitoring esophageal.

Long COVID: which symptoms can be attributed to SARS-CoV-2 infection?

COVID-19 pandemic has challenged healthcare systems worldwide. The aim of this study was to assess the results of a Respiratory Telerehabilitation Program implemented to patients post-COVID-19 in postacute phase of mild to critical course of COVID-19 who had persistent respiratory symptoms and had not received any vaccination. The intervention was performed during confinement. A quasi-experimental nonrandomized study was conducted in Spain during confinement. Respiratory Telerehabilitation Program was guided by a specialized physical therapist through a web platform (Zoom by Zoom Video Communications, San Jose, CA, USA). Participants were recruited through social webs. Outcome measures included respiratory rate, heart rate, percutaneous oxygen saturation, Mahler's Dyspnea Index, anxiety status, and quality of life [EuroQol 5 Dimension 5 (EQ-5D)]. A total number of 148 participants were recruited, with a final number of 100 participants completing the protocol (50 experimental group (EG)/50 control group (CG)). A total of 500 telerehabilitation sessions were performed for this study. In the EG, pre-post intervention comparative analysis showed significative changes in Mahler's functional dyspnea (p < 0.001), the State-Trait Anxiety Inventory (p < 0.001), oxygen saturation (p < 0.001), heart rate (p < 0.001), quality-of-life questionnaire (p < 0.001), and respiratory rate (p < 0.001). Participants in the CG showed an improvement in all the variables, but the differences were not statistically significant except in Mahler's functional dyspnea (p = 0.001) and in the quality-of-life questionnaire (p = 0.043). Percentage changes in pre-post intervention were calculated and compared between EG and CG. There were statistically significative differences in all the outcomes in favor of the EG. The implementation of a pulmonary telerehabilitation program for COVID-19 not vaccinated survivors in postacute phase with mild to critical course of COVID-19 with respiratory sequelae has proven its benefits in cardiorespiratory variables and dyspnea-related anxiety.

Persistent Post COVID-19 Symptoms and Functional Status after 12-14 weeks of recovery, Tamil Nadu, India, 2021

Fatigue, sleep disturbance, and neurological symptoms during and after COVID-19 are common and might be associated with inflammation-induced changes in tryptophan (Trp) and phenylalanine (Phe) metabolism. This pilot study investigated interferon gamma inducible biochemical pathways (namely Trp catabolism, neopterin, tyrosine [Tyr], and nitrite formation) during acute COVID-19 and reconvalescence. Thirty one patients with moderate to severe COVID-19 admitted to the University Hospital of Innsbruck in early 2020 (March-May) were followed up. Neurotransmitter precursors Trp, Phe, Tyr as well as kynurenine (Kyn), neopterin, nitrite, and routine laboratory parameters were analyzed during acute infection and at a follow-up (FU) 60 days thereafter. Clinical symptoms of patients (neurological symptoms, fatigue, sleep disturbance) were recorded and associations with concentrations of laboratory parameters investigated. Almost half of the patients suffered from neurological symptoms (48.4%), the majority of patients experienced sleep difficulties (56.7%) during acute COVID-19. Fatigue was present in nearly all patients. C-reactive protein (CRP), interleukin-6 (IL-6), neopterin, Kyn, Phe concentrations were significantly increased, and Trp levels depleted during acute COVID-19. Patients with sleep impairment and neurological symptoms during acute illness presented with increased CRP and IL-6 concentrations, Trp levels were lower in patients with sleep disturbance. In general, inflammatory markers declined during reconvalescence. A high percentage of patients suffered from persistent symptoms at FU (neurological symptoms: 17.2%, fatigue: 51.7%, sleeping disturbance: 34.5%) and had higher CRP concentrations. Nitrite and Phe levels were lower in patients with sleeping difficulties at FU and Kyn/Trp ratio, as indicator of IDO activity, was significantly lower in patients with neurological symptoms compared to patients without them at FU. In summary, inflammation induced alterations of amino acid metabolism might be related to acute and persisting symptoms of COVID-19.

Changes in pulmonary microvascular perfusion after SARS-CoV-2 infection remains poorly characterized due to limitations in longitudinal imaging. To provide a longitudinal evaluation of lung perfusion, we used quantitative dynamic contrast enhanced MRI (DCE-MRI) on a 0.55T MRI system in patients following COVID-19. In this prospective study, we performed quantitative DCE-MRI to generate perfusion maps on patients with a history of COVID-19 between June 2020 and June 2023. Imaging studies were divided into acute, recovery, convalescent, and extended study phases, collected over 3 years. Median lung perfusion, perfusion heterogeneity, perfusion defect percent, pulmonary transit time, arterial transit time, and transit time defect percent were measured. Perfusion metrics were correlated with pulmonary function tests (PFT), disease severity, cardiorespiratory symptoms, vaccine status, viral variant, and chest CT findings. We included 84 post-COVID-19 patients and 156 separate DCE-MRI exams for analysis, and 10 healthy volunteers. Statistical significance between patients with COVID-19 and healthy volunteers was observed for perfusion defect percent in all study phases (p < 0.01). Five patients had visible perfusion defects. Lower median perfusion was found in patients with low diffusing capacity for carbon monoxide (DLCO) in the recovery phase (p = 0.02), and patients with heterogeneous perfusion maps in the acute phase were more likely to have low DLCO at their final PFT measurements (p = 0.01). During the convalescent phase, patients with residual symptoms had lower median perfusion (p = 0.01), unvaccinated patients had higher transit time defect percent (p = 0.0047), and ground glass opacities on CT were associated with lower median perfusion (p = 0.004). Pulmonary microvascular perfusion abnormalities are found months after COVID-19, with correlative findings in patients with persistence of pulmonary symptoms and impaired pulmonary function. Our findings further support the utilization of DCE-MRI in a broad range of pulmonary vascular disorders. clinicaltrials.gov NCT04401449 (registered 2020-05-22) and NCT03331380 (registered 2017-11-02).

<b>Background:</b> Clinical outcome and parenchymal lung abnormalities (PLA) data from hospitalized patients with COVID 19 pneumonia are limited. <b>Objectives:</b> (1) Understand and compare the patterns of PLA on high resolution computed tomographic (HRCT) at admission, 4-8 weeks post-admission in all patients and 10-12 weeks post-admission in a subgroup of patients (2) follow up their general health status on phone 6 months post admissionMethods: Prospective, observational study of consecutive adult patients hospitalized with RT-PCR confirmed COVID-19 pneumonia in a tertiary centre, India. Clinical data and HRCT image patterns and distribution of PLA at admission, 4-8 weeks in all patients and at 10-12 weeks in a subgroup of patients were analysed using a novel, composite radiological score (CRS). Surviving patients were followed up telephonically 6 months later. Findings: Of 179 patients, HRCT features were ground glass opacity (144, 80.4%), consolidation (23, 12.8%) and reticulation (7, 4%) at admission. 74% demonstrated resolving PLA with 14% showing complete resolution at 4-8 weeks. Fine reticulations were seen in 12% at 8 weeks and 20% in a subgroup of 44 patients who had persisting symptoms at 10-12 weeks. CRS correlated well with clinical severity and recovery (p=0.003). At 6 months, 144 responded to the phone follow up, reported no functional impairment and had returned to their pre-COVID health status. Conclusion: PLA resolved in 88% at 8 weeks and all the 144 patients who were followed up at 6 months reported return to pre-COVID 19 health status. This is quite reassuring amidst concerns of ‘long COVID’

Babesiosis is a tick-borne illness caused by the protozoan Babesia microti. Most patients are asymptomatic but the infection may produce a spectrum of symptoms in immunocomprimised patients, especially asplenic patients. These range from mild fever, sweats, fatigue, and myalgias to severe multiorgan failure, including acute respiratory distress syndrome and death. Radiographic appearances include bilateral patchy air space and interstitial opacities. We report the radiographic, high-resolution computed tomography (HRCT), and hematologic appearances in a 63-year-old man presenting with acute babesisois. HRCT images revealed smooth septal thickening and intralobular lines superimposed on ground glass opacities in both upper lobes. Follow-up HRCT after 2 weeks of therapy demonstrated resolution of the pulmonary parenchymal abnormalities.

Objective Pneumocystis pneumonia (PCP) is a serious fungal infection that can be life threatening in immunocompromised hosts. We evaluated the association between the radiological patterns of PCP on high-resolution computed tomography (HRCT) and clinical characteristics and the prognosis of patients with connective tissue disease (CTD). Methods All CTD patients who developed PCP from January 1999 to April 2017 were retrospectively evaluated. Patients were divided into three groups based on their chest HRCT findings: Ground glass opacity (GGO) sharply demarcated from the adjacent normal lung by interlobular septa (demarcated GGO), diffuse GGO without obvious demarcation (diffuse GGO), and GGO with mixed consolidation (mixed GGO). We compared the clinical characteristics at the onset of PCP and the outcomes among the groups. Results A total of 35 cases were identified: demarcated GGO (n=8, 23%), diffuse GGO (n=19, 54%), and mixed GGO (n=8, 23%). The mixed GGO group showed a higher serum C-reactive protein level (p<0.0001), lower lymphocyte count (p=0.07), lower serum albumin (p<0.001), and lower partial pressure of arterial oxygen/fraction of inspiratory oxygen ratios (p<0.001) in comparison to the demarcated and diffuse GGO groups. The mixed GGO group showed significantly higher mortality in comparison to the demarcated and diffuse GGO groups (88% vs. 7%, p<0.0001). Conclusion GGO with mixed consolidation on chest HRCT was associated with a poor outcome of PCP in patients with CTD.