Pneumonia Pattern Research Articles

Primary pulmonary lymphoma: a surgical series.

Primary pulmonary lymphoma (PPL) is a rare entity often underdiagnosed due to its non-specific clinical presentation. Our aim is to share our experience in the management of these lesions, which should be considered in the differential diagnosis of nodules affecting the lung parenchyma. We retrospectively studied a total of 14 patients who had undergone surgery between 2013 and 2021. We recorded pre- and post-operative information and conducted survival analyses. Of the 14 patients, seven were males. The mean age was 61.5. Most patients were asymptomatic. PPL presented predominantly as nodules or solid masses (71.4%), followed by consolidations with a pneumonia pattern and ground-glass nodule, with a median uptake on peak standardised uptake value (SUV) positron emission computed tomography of 5.7 mg/m2. There were nine cases (64.3%) of mucosa-associated lymphoid tissue lymphoma (MALT), four cases of diffuse large B cell lymphoma (28.6%) and one case of follicular B cell lymphoma. Fifty percent received adjuvant chemotherapy. Only one patient had disease progression. After a median follow-up of 38.6 months, 11 patients (78.6%) were still alive and disease-free. The overall 5-year survival was 92.9%. In conclusion, the most frequent PPL is the MALT type. Surgery seems to play a key role in diagnosis and treatment.

Prediction of Toddlers Acute Respiratory Infection (ARI) to Become Pneumonia in Martapura Catchment Area, Banjar District, Indonesia.

Introduction. The pneumonia pattern in young children may vary across different catchment areas. Therefore, this study aims to analyze the predictive factors for toddlers with an Acute Respiratory Infection (ARI) developing into pneumonia in the catchment area of Banjar Regency, Indonesia. Methods. A case-control design, with 300 respondents, consisting of 106 cases and 194 controls. A questionnaire of interviews with mothers/caregivers of toddlers. Forty-one indicators data were analyzed using multiple logistic regression with backward stepwise regression to arrive at the final model. Results. The predictive factors for toddlers with pneumonia were the child's age (P-value .070), child development (P-value .007), breastfeeding (P-value .051), family income (P-value .026), and location of houses along the river (P-value .025). Conclusion. A prediction index for toddler pneumonia has been compiled, which can be applied to improve the health of lower middle-class toddlers requiring more government attention.

Clinical features of severe Mycoplasma pneumoniae pneumonia with pulmonary complications in childhood: A retrospective study.

Incidence of severe M. pneumoniae pneumonia (SMPP) reported in China has been increasing over the last decade. We aimed to evaluate the clinical features of pediatric SMPP with pulmonary complications, according to laboratory tests and chest radiographic resolution patterns. We retrospectively reviewed 93 SMPP patients between January 2016 and February 2019, and grouped them by pneumonia pattern: pulmonary complications (63 patients) and extensive lung lesions without pulmonary complications (30 patients). SMPP patients with pleural effusion (medium or large) and necrotizing pneumonia showed longer duration of fever, high serum value of lactate dehydrogenase (LDH), d-dimer, and LDH to albumin ratio (LAR). LAR and d-dimer were associated with moderate or massive pleural effusion, and d-dimer was associated with lung necrosis. The average time of radiographic resolution in the pulmonary complication group was 12 weeks, while those with elevated d-dimer were significantly more likely to have longer time for radiographic clearance. We conclude that M. pneumoniae pneumonia in patients with pleural effusion (medium or large) or lung necrosis was more severe than those without pulmonary complications. LAR and d-dimer might be used as parameters to identify children susceptible to pleural effusion (medium or large) or lung necrosis, and longer time for radiographic clearance among pediatric patients of SMPP.

Detection of Omicron Caused Pneumonia from Radiology Images Using Convolution Neural Network (CNN)

COVID-19 disease caused by the SARS-CoV-2 virus has created social and economic disruption across the world. The ability of the COVID-19 virus to quickly mutate and transfer has created serious concerns across the world. It is essential to detect COVID-19 infection caused by different variants to take preventive measures accordingly. The existing method of detection of infections caused by COVID-19 and its variants is costly and time-consuming. The impacts of the COVID-19 pandemic in developing countries are very drastic due to the unavailability of medical facilities and infrastructure to handle the pandemic. Pneumonia is the major symptom of COVID-19 infection. The radiology of the lungs in varies in the case of bacterial pneumonia as compared to COVID-19-caused pneumonia. The pattern of pneumonia in lungs in radiology images can also be used to identify the cause associated with pneumonia. In this paper, we propose the methodology of identifying the cause (either due to COVID-19 or other types of infections) of pneumonia from radiology images. Furthermore, because different variants of COVID-19 lead to different patterns of pneumonia, the proposed methodology identifies pneumonia, the COVID-19 caused pneumonia, and Omicron caused pneumonia from the radiology images. To fulfill the above-mentioned tasks, we have used three Convolution Neural Networks (CNNs) at each stage of the proposed methodology. The results unveil that the proposed step-by-step solution enhances the accuracy of pneumonia detection along with finding its cause, despite having a limited dataset.

Incidence and Patterns of Interstitial Lung Disease and Their Clinical Impact on Mortality in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Korean Single-Centre Observational Study.

Objectives This study investigated the frequency and patterns of interstitial lung disease (ILD) and their clinical effect on all-cause mortality during the follow-up period in patients with antineutrophil cytoplasmic antibody- (ANCA-) associated vasculitis (AAV) in Korea. Methods The medical records of 255 AAV patients with ILD were retrospectively reviewed. ILD and its patterns, the usual interstitial pneumonia (UIP) and non-UIP patterns, were confirmed using high-resolution computed tomography both at AAV diagnosis and during follow-up. Forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) were also obtained. Results The median age was 65.0 years, and 34.9% were male. ILD occurred in 53 patients, among whom 49.1% developed ILD after AAV diagnosis. Among AAV subtypes, the frequencies of ILD were significantly higher in both patients with microscopic polyangiitis (MPA) and those with AAV having myeloperoxidase (MPO)-ANCA (or P-ANCA) compared to other subtypes. However, there was no statistical significance in AAV subtypes or FVC/DLCO ratio between patients with the UIP and non-UIP patterns. In particular, the cumulative patients' survival rate was lower in patients with AAV and ILD than in those without ILD. Conclusions ILD occurred in one-fifth of Korean patients with AAV in this study and was associated with MPA and MPO-ANCA (or P-ANCA). In addition, ILD significantly increased the rate of all-cause mortality in these patients with AAV. Therefore, we suggest the need for more attention and more frequent regular visit for patients with AAV and ILD regardless of the time of ILD occurrence.

BACTERIOLOGY AND ANTIBIOTIC SENSITIVITY PATTERNS IN VENTILATOR-ASSOCIATED PNEUMONIA

Background: Ventilator-Associated Pneumonia is the most common cause of hospital-acquired infections among patients admitted in Intensive Care Unit with mechanical ventilation. Identification of bacteria and their susceptibility to commonly used antibiotics is very essential for the treatment of the patients. The aim of this study was to determine the bacteriological profile and antibiotic sensitivity patterns in the Endotracheal Aspirate cultures that were sent in Microbiology laboratory. Methods: A hospital-based 3-year retrospective analysis on culture of Endotracheal Aspirate was done. Data from Intensive Care Unit was collected from January 2018 to January 2021, and the laboratory reports were used to determine Ventilator-Associated Pneumonia, pathogen profile and antimicrobial sensitivity patterns. Data entry and analysis was done using Statistical Package for Social Sciences version 16. Results: Out of 147 ventilated patients in Intensive Care Unit, 115 samples were sent to microbiology laboratory with suspected Ventilator-Associated Pneumonia among which 95 (82.60 %) were positive cultures. The most common etiological agent causing Ventilator-Associated Pneumonia was found to be Klebsiella pneumoniae with 24 isolates (25.26%) and multidrug resistance was also mainly found with Klebsiella pneumoniae in 17 samples (70.83%). All of the gram-negative isolates were sensitive to colistin and resistant to ampicillin. All gram-positive isolates were sensitive of linezolid and vancomycin and most were resistant to penicillin. Conclusions: Klebsiella pneumoniae is one of the most common organisms that is associated with nosocomial infection like Ventilator-Associated Pneumonia. The emergence of multidrug resistance is still a great threat and hindrance for the treatment of Ventilator-Associated Pneumonia.

Lymphoid Interstitial Pneumonitis In Rheumatoid Arthritis

Lymphoid Interstitial Pneumonitis (LIP) is a rare interstitial lung disease in rheumatoid arthritis (RA). LIP occurs in a patient with high titers of rheumatoid factor (RF), absence of inflammatory pain and limited joint damage, despite long-standing RA. In these patients, extra-articular manifestations occur even if joint disease activity is low. RA is an autoimmune disease which affects mostly the diarthrodial joints but can also have extra-articular manifestations such as lung disease. Interstitial lung disease (ILD) is frequently encountered in patients with RA. Patterns of usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), lymphoid interstitial pneumonitis (LIP) and organizing pneumonia (OP) have been described on surgical lung biopsies in RA patients [1].

Rates of Pneumocystis Jirovecii Pneumonia and Prophylaxis Prescribing Patterns in a Large Electronic Health Record Cohort of Patients with Systemic Lupus Erythematosus

Rates of Pneumocystis Jirovecii Pneumonia and Prophylaxis Prescribing Patterns in a Large Electronic Health Record Cohort of Patients with Systemic Lupus Erythematosus

Distinct Clinical and Laboratory Patterns of Pneumocystis jirovecii Pneumonia in Renal Transplant Recipients.

Late post-transplant Pneumocystis jirovecii pneumonia (PcP) has been reported in many renal transplant recipients (RTRs) centers using universal prophylaxis. Specific features of PcP compared to other respiratory infections in the same population are not well reported. We analyzed clinical, laboratory, administrative and radiological data of all confirmed PcP cases between January 2009 and December 2014. To identify factors specifically associated with PcP, we compared clinical and laboratory data of RTRs with non-PcP. Over the study period, 36 cases of PcP were identified. Respiratory distress was more frequent in PcP compared to non-PcP (tachypnea: 59%, 20/34 vs. 25%, 13/53, p = 0.0014; dyspnea: 70%, 23/33 vs. 44%, 24/55, p = 0.0181). In contrast, fever was less frequent in PcP compared to non-PcP pneumonia (35%, 11/31 vs. 76%, 42/55, p = 0.0002). In both cohorts, total lymphocyte count and serum sodium decreased, whereas lactate dehydrogenase (LDH) increased at diagnosis. Serum calcium increased in PcP and decreased in non-PcP. In most PcP cases (58%, 21/36), no formal indication for restart of PcP prophylaxis could be identified. Potential transmission encounters, suggestive of interhuman transmission, were found in 14/36, 39% of patients. Interhuman transmission seems to contribute importantly to PcP among RTRs. Hypercalcemia, but not elevated LDH, was associated with PcP when compared to non-PcP.

357. A Comparison of Chest CT Findings in Cancer and Non-Cancer Patients with COVID-19

BackgroundThe purpose of this study was to compare chest computed tomography (CT) scan findings in cancer versus non-cancer patients with COVID-19 infection. We sought to assess the correlation between radiologic patterns of COVID-19 pneumonia, clinical course, and outcomes. MethodsWe performed a retrospective study of COVID-19 positive cancer and non-cancer pts who had chest CT scans at the time of diagnosis, at our hospital and 16 other centers in Asia, Australia, Europe, North America and South America, between March, 2020 and November, 2020. Patients’ age, underlying diseases, symptoms, laboratory studies, and radiologic findings consisting of bilateral ground-glass opacities (GGOs), multifocal organizing pneumonia (MOP) were collected in association with clinical outcomes. ResultsWe identified 426 pts with cancer and 622 non-cancer pts. Thereafter, cancer pts were analyzed into 3 distinct groups and similar to non-cancer pts: GGOs group (n=224, 54%), GGOs+MOP group (n=61, 14.6%), and a third group of neither GGOs or MOP (n=131, 31.4%) in cancer pts, and in non-cancer pts: GGOs group (n=387, 62.8%), GGOs +MOP group (n=100, 16.2%), and a third group of neither GGOs or MOP (n=129, 21%). The median patients’ age was 54 in non-cancer pts vs 62 in cancer pts (p< 0.001) and there were more males in the non-cancer group 57% vs 47% (p=0.001). Cough was more prevalent in non-cancer pts, 71% vs 59% (p< 0.001) and similar to fever (73% vs 57%, p< 0.001). Neutropenia < 0.5 k/µL and lymphocytopenia < 1 k/µL were more frequent in cancer pts (p< 0.001). In cancer pts, there was no statistically significance difference between the 3 groups (hospital admission, mechanical ventilation, readmission within 30 days, and mortality), except pts who required non-invasive (NI) ventilation were more frequent in the GGOs group, 55% (p=0.005). In non-cancer, pts with GGOs +MOP have higher hospital admission, ICU transfer, NI- and mechanical ventilation compared to the 2 other groups (p< 0.001). While readmission to hospital or mortality rate within 30 days were similar between the 3 groups. ConclusionThis study reveals that non-cancer pts tended to have more radiologic findings on chest CT scan compared to cancer pts at the time of COVID-19 diagnosis and were associated with more worrisome COVID-19-related clinical outcomes. Disclosures All Authors: No reported disclosures

Prognostic value of radiological findings indeterminate for UIP pattern and anterior upper lobe honeycomb-like lesion in chronic fibrosing interstitial lung disease associated with MPO-ANCA

BackgroundMyeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) is often positive in patients with interstitial lung disease (ILD), which is also often present in patients with microscopic polyangiitis (MPA). A possible association between MPO-ANCA, MPA, and idiopathic ILD remains unclear. The objective of this study was to determine whether high-resolution computed tomography (HRCT) classification based on recent idiopathic pulmonary fibrosis guideline and specific CT findings can obtain new knowledge of prognostic factors in all MPO-ANCA-positive patients with ILD including both idiopathic ILD and MPA-ILD.MethodsWe analyzed 101 consecutive MPO-ANCA-positive patients with respiratory disease. We assessed the diagnostic accuracy of CT findings, HRCT pattern, and specific radiological signs. Prognostic predictors were determined using Cox regression models.ResultsSubjects with chronic ILD included 22 patients with MPA-ILD and 39 patients with ILD but without MPA. A quarter of the patients were radiological indeterminate for usual interstitial pneumonia (UIP) pattern, which resulted in a better prognosis than that for UIP pattern. “Increased attenuation around honeycomb and traction bronchiectasis” and “anterior upper lobe honeycomb-like lesion” were found to be highly frequent radiological findings (39% and 30%, respectively). In addition, the latter finding was a significant negative prognostic factor.ConclusionsRadiological indeterminate for UIP was a useful HRCT classification in MPO-ANCA-positive patients with ILD. In addition, anterior upper lobe honeycomb-like lesion was found to be specific radiological finding that was a significant prognostic factor. The present results might aid in the assessment of appropriate strategies of diagnosis in these patients.

Evolution of CT patterns in novel coronavirus (2019-nCoV) pneumonia in relation to clinical and laboratory data

Introduction. The CT patterns of coronavirus pneumonia are clear and represent certain pathomorphosis at the period of coronavirus pandemic. However, there are a lot of questions about influence of CT-patterns and their dynamic change on a disease’s severity. The aim of the study. To evaluate the dynamics of pulmonary CT changes of novel coronavirus (2019-nCoV) pneumonia in relation to clinical and laboratory data. Materials and methods. CT studies in dynamics of 108 patients with a of novel coronavirus (2019-nCoV) pneumonia were analyzed. The first CT study was performed on admission (6,7±4,1 days of the disease), the first control CT on 11,1±4,9 days of the disease, and the second CT control was performed on 16,7±5,6 days of the disease. Results. The volume of the lesion and the predominant CT symptom at admission did not affect the prognosis. However, changes in the repeated CT study had a high prognostic value. Thus, the occurrence of a pattern of organizing pneumonia during repeated study is associated with a good prognosis, while an increase in the zones of «crazy paving» and a larger volume of damage are unfavorable prognostic signs. An increase in the volume of changes in the type of ground glass and «crazy paving» correlated with increased levels of C-reactive protein, lactate dehydrogenase, and lymphopenia. Conclusion. Data from CT studies in dynamics for novel coronavirus (2019-nCoV) pneumonia have a prognostic value and, in combination with clinical and laboratory data, can influence decision-making on patient management.

Radiological and Physiological Predictors of IPF Mortality.

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) has a variable clinical course, which ranges from being asymptomatic to progressive respiratory failure. The purpose of this study was to evaluate the novel clinical parameters of IPF patients who receive an anti-fibrotic agent. Materials and Methods: From January 2011 to January 2021, we identified 39 IPF patients at Okinawa Chubu Hospital. Clinical information was obtained, such as laboratory data, pulmonary function test (PFT) results, and chest images, including of soft tissue thickness and the high-resolution computed tomography (HRCT) pattern at diagnosis. Results: The mean age was 72.9 ± 7.0 (53–85); 27 patients were men and 12 were women. The mean body mass index was 25.1 ± 3.9 (17.3–35). Twenty-four were active smokers and the median number of packs per year was 20. Regarding laboratory findings, mean white blood cell (WBC), lactate dehydrogenase (LDH), and Krebs Von den Lungen-6 (KL-6) values were 7816 ± 1859, 248 ± 47, and 1615 ± 1503, respectively. In PFT, the mean percent predicted FVC, percent predicted total lung capacity, percent predicted functional residual capacity (FRC), and percent predicted diffusion capacity of the lung for carbon monoxide (DLco) were 66.8 ± 14.9%, 71.8 ± 13.7%, 65 ± 39.6%, and 64.6 ± 27.9%, respectively. In chest radiological findings, soft tissue thickness at the right 9th rib was 26.4 ± 8.8 mm. Regarding chest HRCT patterns, 15 showed the definite usual interstitial pneumonia (UIP) pattern, 16 showed the probable UIP pattern, and eight showed the indeterminate for UIP pattern. In the treatment, 24 patients received pirfenidone and 15 patients took nintedanib. The mean observation period was 38.6 ± 30.6 months and 24 patients died. The median survival time was 32.4 months (0.9–142.5). Multivariate analysis adjusted for age showed that both soft tissue thickness [Hazard ratio (HR): 0.912, 95% confidence interval (CI): 0.859–0.979, p-value: 0.009] and percent FRC [HR: 0.980, 95% CI: 0.967–0.992, p-value: 0.002] were robust predictors of IPF mortality. Conclusions: In IPF patients treated with anti-fibrotic agents, both soft tissue thickness at the right 9th rib shown on the chest radiograph and %FRC can be novel predictors of IPF mortality.

Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis

Pneumonia is one of the top 10 diseases by morbidity in Bhutan. This study aimed to investigate the spatial and temporal trends and risk factors of childhood pneumonia in Bhutan. A multivariable Zero-inflated Poisson regression model using a Bayesian Markov chain Monte Carlo simulation was undertaken to quantify associations of age, sex, altitude, rainfall, maximum temperature and relative humidity with monthly pneumonia incidence and to identify the underlying spatial structure of the data. Overall childhood pneumonia incidence was 143.57 and 10.01 per 1000 persons over 108 months of observation in children aged < 5 years and 5–14 years, respectively. Children < 5 years or male sex were more likely to develop pneumonia than those 5–14 years and females. Each 1 °C increase in maximum temperature was associated with a 1.3% (95% (credible interval [CrI] 1.27%, 1.4%) increase in pneumonia cases. Each 10% increase in relative humidity was associated with a 1.2% (95% CrI 1.1%, 1.4%) reduction in the incidence of pneumonia. Pneumonia decreased by 0.3% (CrI 0.26%, 0.34%) every month. There was no statistical spatial clustering after accounting for the covariates. Seasonality and spatial heterogeneity can partly be explained by the association of pneumonia risk to climatic factors including maximum temperature and relative humidity.

Acute Limb Ischemia in One Dose Vaccination of COVID-19

Introduction: The extraordinary thrombotic manifestations of Corona virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in several literatures, but in this report, we presented a special case of acute limb ischemia in a patient that has been vaccinated by COVID-19 vaccine. Acute limb ischemia (ALI) is defined as decreasing in arterial perfusion of a limb with a threat to viability of the limb and mortality. COVID-19 has been declared as a global pandemic by the WHO. Patients with COVID-19 have abnormalities in blood coagulation parameters and are prone to thromboembolic events. This hypercoagulable state caused by COVID-19 mainly manifests as venous thromboembolism while peripheral arterial involvement is less frequent. Case: A 54-year diabetic and smoker male has already got one dose COVID-19 vaccination came to our emergency unit with severe acute respiratory syndrome and pain, pale and paresthesia of his left leg. There was pneumonia pattern according to chest X-ray and a ground glass opacity in chest CT-scan, he was confirmed infected by COVID-19 according to RT-PCR test. From CT-Angiography we found multiple thrombosis in the distal aorta, superficial femoral artery (SFA), anterior tibial artery (ATA), and posterior tibial artery (PTA) of left lower extremity. Initial treatment we started with unfractionated heparin, oxygenation, intravenous fluid and analgesia. We managed the patient in isolation ward special for COVID-19. We did thrombectomy to save the limb, nevertheless in few days after we performed amputation at the level of talonavicular joint to the distal part of left foot caused by gangrene. Conclusion: Vaccination can protect from COVID-19 if we vaccinated with full dose and our immune system able to create antibody. The condition will be different in immunocompromised condition and we get not full dose vaccination. Covid-19 Patient with Diabetes and smoker could have higher risk to develop acute limb ischemia because of hypercoagulable state. Management of a COVID-19 patient with cute limb ischemia is more complicated and challenging. Although we have already vaccinated life style modification like wearing a mask, social distancing and using hand sanitizer can give us more protection from Covid 19. Keywords: acute limb ischemia, COVID-19 vaccination, heparinization, thrombectomy

COVID-19 early detection for imbalanced or low number of data using a regularized cost-sensitive CapsNet

With the presence of novel coronavirus disease at the end of 2019, several approaches were proposed to help physicians detect the disease, such as using deep learning to recognize lung involvement based on the pattern of pneumonia. These approaches rely on analyzing the CT images and exploring the COVID-19 pathologies in the lung. Most of the successful methods are based on the deep learning technique, which is state-of-the-art. Nevertheless, the big drawback of the deep approaches is their need for many samples, which is not always possible. This work proposes a combined deep architecture that benefits both employed architectures of DenseNet and CapsNet. To more generalize the deep model, we propose a regularization term with much fewer parameters. The network convergence significantly improved, especially when the number of training data is small. We also propose a novel Cost-sensitive loss function for imbalanced data that makes our model feasible for the condition with a limited number of positive data. Our novelties make our approach more intelligent and potent in real-world situations with imbalanced data, popular in hospitals. We analyzed our approach on two publicly available datasets, HUST and COVID-CT, with different protocols. In the first protocol of HUST, we followed the original paper setup and outperformed it. With the second protocol of HUST, we show our approach superiority concerning imbalanced data. Finally, with three different validations of the COVID-CT, we provide evaluations in the presence of a low number of data along with a comparison with state-of-the-art.

Diagnosis of myositis-associated interstitial lung disease: Utility of the myositis autoantibody line immunoassay

ObjectivesThe detection of myositis autoantibodies (MA) in patients with interstitial lung disease (ILD) has major implications for diagnosis and management, especially amyopathic and forme frustes of idiopathic inflammatory myositis-associated ILD (IIM-ILD). Use of the MA line immunoblot assay (MA-LIA) in non-rheumatological cohorts remains unvalidated. We assessed the diagnostic performance of the MA-LIA and explored combined models with clinical variables to improve identification of patients with IIM-ILD. MethodsConsecutive patients referred to a specialist ILD clinic, with ILD-diagnosis confirmed at multidisciplinary meeting, and MA-LIA performed within six months of baseline were included. Pre-specified MA-LIA thresholds were evaluated for IIM-ILD diagnosis. ResultsA total 247 ILD patients were included (IIM-ILD n = 12, non-IIM connective tissue disease-associated ILD [CTD-ILD] n = 52, idiopathic interstitial pneumonia [IIP] n = 115, other-ILD n = 68). Mean age was 64.8 years, with 45.3% female, mean FVC 75.5% and DLCO 59.2% predicted. MA were present in 13.8% overall and 83.3% of IIM-ILD patients. The most common MA in IIM-ILD and non-IIM ILD patients were anti-Jo-1 (prevalence 40%) and anti-PMScl (29.2%) autoantibodies respectively. The pre-specified low-positive threshold (>10 signal intensity) had the highest discriminative capacity for IIM-ILD (AUC 0.86). Combining MA-LIA with age, gender, clinical CTD-manifestations and an overlap non-specific interstitial pneumonia/organising pneumonia pattern on HRCT improved discrimination for IIM-ILD (AUC 0.96). ConclusionThe MA-LIA is useful to support a diagnosis of IIM-ILD as a complement to multi-disciplinary ILD assessment. Clinical interpretation is optimised by consideration of the strength of the MA-LIA result together with clinical and radiological features of IIM-ILD.

The Bacterial Pneumonia Characteristics based on Climate and Meteorological Parameters in Indonesia, the Tropical Country: A Preliminary Study

Introduction: As a tropical country, Indonesia has the potential to influence the characteristics of infectious diseases. The purpose of this study was to see how the pattern of pneumonia on various weather components such as rainfall, humidity, and temperature.Methods: This study was carried by retrospective screening in the infectious ward in one of the tertiary referral hospitals.Results: A total of 876 cases of pneumonia from eight treatment rooms were included in the study. The highest pneumonia cases occurred in February with 239 (27.2%) cases followed in April and May with 169 (19.2%) and 159 (18.2%) cases respectively. After microbiological examination, bacterial growth was found in 191 cases. The highest number of bacteria was found in February with 62 (32%), followed by May with 33 (17.2%) and April with 31 (16.2%) samples. Most of the bacterial grown were gram-negative (94.3%), dominated by Klebsiella pneumoniae (35%), followed by Acinetobacter baumanii 17.2% and Pseudomonas aeruginosa 12%. On the examination of antibiotic sensitivity, it was found that amikacin has a consistently high sensitivity (90%) for pneumonia caused by most bacterial causes (Acinetobacter baumanii, Klebsiella pneumoniae, and Escherichia coli).Conclusion: The study did not show any remarkable bacterial patterns based on weather components such as rainfall, humidity, and temperature during the rainy season. However, increasing the surveillance period will provide a better insight into the bacterial pattern and can compare it in the rainy and dry seasons.

Long-term clinical course and outcome in patients with primary Sj\xf6gren syndrome-associated interstitial lung disease

Interstitial lung disease (ILD) is the most common lung manifestation in patients with Sjögren syndrome (SJS) and is associated with poor outcomes. This study aimed to investigate the long-term clinical course and prognostic factors in patients with SJS-ILD. Clinical data and high-resolution computed tomography (HRCT) images of 62 patients with primary SJS-ILD were retrospectively analyzed (biopsy-proven cases, n = 16). The mean patient age was 59.8 years; 83.9% of the patients were females, and 38.7% showed a usual interstitial pneumonia (UIP) pattern on HRCT. The median follow-up period was 61.5 months. During follow-up, 15 patients (24.2%) died, 7 (11.3%) experienced acute exacerbation (AE), and 27 (43.5%) progressed. The 1-, 3- and 5-year survival rates were 93.5%, 85.8%, and 81.1%, respectively. Age (hazard ratio [HR]: 1.158, P = 0.003), C-reactive protein (CRP) level (HR: 1.212, P = 0.045), FVC (HR: 0.902, P = 0.005), and a UIP pattern on HRCT (HR: 4.580, P = 0.029) were significant prognostic factors in multivariable Cox analysis. In conclusion, death, AE, and ILD progression occurred in 25%, 10%, and 50% of the patients with SJS-ILD, respectively. Older age, higher CRP level, lower FVC, and a UIP pattern on HRCT indicated poor prognosis.

Chronic immune checkpoint inhibitor (ICI) pneumonitis in patients (pts) with non-small cell lung cancer (NSCLC).

9103 Background: ICI pneumonitis is an immune-related adverse event (irAE) of the lung and often requires discontinuation of ICI. While some pneumonitis cases resolve within the recommended 4-6-week period of corticosteroid therapy, others either fail to improve or have multiple flares necessitating longer or repeated courses of steroids. We investigated the clinical features and courses of pts with chronic pneumonitis. Methods: We analyzed 869 pts with NSCLC initiated on ICIs at our institution between 2011 and 2019 for development of ICI pneumonitis. Chronic pneumonitis was defined as any pneumonitis requiring a total of ≥12 weeks of steroids, given either continuously or over multiple courses of treatment. Cases of chronic pneumonitis in which the initial course of steroids lasted ≥12 weeks without interruption were termed “primary refractory pneumonitis”. Subsequent episodes of pneumonitis were categorized as either “recurrent pneumonitis” from ICI rechallenge or “pneumonitis flare” after steroid taper without ICI rechallenge. Chest CT scans were analyzed to classify the imaging patterns. Results: Of the 869 pts analyzed, 44 developed ICI pneumonitis (5.1%) and 22 of the 44 (50%) experienced chronic pneumonitis (Grade 2 in 11, Grade 3 in 9, and Grade 4 in 2). A cryptogenic organizing pneumonia (COP) pattern was the most common CT pattern among all pneumonitis cases (30/44) and in chronic pneumonitis cases (14/22). Among chronic pneumonitis cases, the median number of total weeks on corticosteroid therapy was 25.9 (range: 12.4 – 114.4 weeks). Four pts required additional immunosuppressive agents including mycophenolate or infliximab. Fourteen of 22 pts with chronic pneumonitis had primary refractory pneumonitis, while the remaining 8 pts were weaned off of steroids within 12 weeks but later developed additional episode(s) of pneumonitis, ultimately resulting in a total steroid duration of ≥12 weeks. The 14 pts with primary refractory pneumonitis had significantly shorter time to pneumonitis onset compared to the other 8 pts (median time to onset: 1.8 vs. 5.5 months, Wilcoxon ranksum p = 0.04). Seventeen of 22 patients had their ICI permanently discontinued; of these, 9 pts subsequently experienced pneumonitis flare after steroid taper, necessitating additional course(s) of steroid therapy. 5 of the 22 patients were rechallenged with ICI, and 4 of them had recurrent pneumonitis with ICI rechallenge. Conclusions: Half of the pts diagnosed with pneumonitis developed chronic pneumonitis requiring at least 12 weeks in aggregate of glucocorticoid therapy. Some patients had an initial prolonged steroid course while others initially improved and then flared, even after ICI discontinuation. Recognition of chronic pneumonitis as a distinct and common clinical entity is important in management of pts with ICI pneumonitis.