Viral Pneumonitis Research Articles (Page 1)

Abstract Introduction Anti-Melanoma Differentiation-Associated gene 5 dermatomyositis (anti-MDA5 DM) is a distinct subtype of idiopathic inflammatory myopathy, often associated with clinically amyopathic features and rapidly progressive interstitial lung disease (RP-ILD). Early symptoms may resemble seronegative rheumatoid arthritis, complicating early diagnosis. COVID-19 infection adds another layer of complexity, both as a potential trigger for autoimmune phenomena and as a source of overlapping pulmonary pathology. This overlap can result in delayed recognition and treatment of potentially life-threatening autoimmune pathology. We present a case of anti-MDA5 DM with ILD in which an initial misdiagnosis of COVID-19 pneumonitis delayed appropriate intervention. Case description A 38-year-old male from Liberia presented in March 2022 with progressive shortness of breath, fatigue, arthralgia, and generalised weakness. He was initially evaluated by rheumatology for possible undifferentiated inflammatory arthritis and autoimmune ILD, and commenced on oral corticosteroids and methotrexate. In July 2022, he was hospitalised with worsening breathlessness and a non-productive cough. He tested positive for COVID-19. CT pulmonary angiogram (CTPA) revealed scattered airspace opacities and ground-glass changes, interpreted as COVID pneumonitis. Methotrexate was withheld, and he received dexamethasone. One month later, he was re-admitted with chest pain. CT imaging demonstrated diffuse reticular changes, suggestive of fibrotic lung disease. Multidisciplinary discussion in an ILD meeting concluded ongoing post-COVID interstitial changes. Pulmonary function testing revealed a restrictive defect. He remained on steroids. A repeat CT chest in September 2022 continued to show extensive basal fibrotic changes. Autoimmune screening, including rheumatoid factor, anti-CCP, ANCA, and ANA, returned negative. He was referred to an ILD specialist clinic, where he received intravenous methylprednisolone (1 g for 3 days). A myositis panel subsequently revealed anti-MDA5 antibody positivity. By March 2023, on rheumatology review, he described new dermatological symptoms including hyperpigmented, scaling rashes over the face, hands, and feet; tender palmar papules; and ulcerated lesions on the knuckles. He also reported polyarthritis with morning stiffness involving MCPs, PIPs, wrists, elbows, knees, and feet. Examination revealed erythematous, tender nailfolds; synovitis of multiple MCPs; bilateral Gottron’s papules; and healing rashes across the forehead, nasolabial folds, and cheeks. Fine basal crackles were noted on chest auscultation. A final diagnosis of anti-MDA5 positive dermatomyositis with associated ILD was made. He was treated with two cycles of rituximab, commenced on mycophenolate mofetil, and a steroid taper was initiated. Follow-up pulmonary function tests showed gradual improvement, alongside clinical and dermatological symptom resolution. Discussion Anti-MDA5 dermatomyositis is a distinct phenotype of dermatomyositis, typically presenting with minimal muscle involvement but prominent cutaneous features and a high risk of rapidly progressive interstitial lung disease. Without early diagnosis and aggressive treatment, MDA5-associated ILD can have high mortality. During the COVID-19 pandemic, there has been increasing recognition of phenotypic overlap between COVID-19 and autoimmune conditions like dermatomyositis, including respiratory symptoms, ground-glass changes on imaging, and cutaneous manifestations. This diagnostic ambiguity can delay timely immunosuppression in patients with underlying autoimmune disease. In this case, the initial assumption of post-COVID pneumonitis obscured the underlying MDA5-associated ILD. Despite treatment for presumed viral pneumonitis, the patient’s condition failed to improve. The eventual identification of MDA5 antibodies, in conjunction with cutaneous signs and progressive respiratory decline, confirmed the autoimmune diagnosis. This case reinforces the importance of maintaining a broad differential in post-COVID patients, especially those with persistent symptoms and atypical radiological features. Early use of myositis-specific panels, particularly in patients with subtle cutaneous or articular features, may help detect MDA5-positive dermatomyositis before irreversible pulmonary damage occurs. Key learning points 1. Anti-MDA5 dermatomyositis may present with non-specific symptoms, cutaneous findings, and interstitial lung disease, with little or no muscle involvement. 2. COVID-19 infection and anti-MDA5-associated ILD can present with similar respiratory and imaging features, making early differentiation difficult. 3. Delayed diagnosis of MDA5-positive DM due to misattribution of symptoms to COVID-19 pneumonitis can lead to missed treatment windows for aggressive immunosuppression. 4. Myositis-specific antibody testing should be considered in patients with ILD, skin rashes, and joint involvement, especially when standard treatment for viral or inflammatory conditions fails. 5. Early multidisciplinary input and immunosuppressive therapy are key to improving outcomes in MDA5-DM with RP-ILD.

Severe Acute Respiratory Distress Syndrome (ARDS) in an Infant With Disseminated Herpes Simplex Virus Pneumonitis

A newly discovered coronavirus called COVID-19 poses the greatest threat to mankind in the twenty-first century. Mortality has dramatically increased in all cities and countries due to the virus's current rate of spread. A speedy and precise diagnosis is also necessary in order to treat the illness. This study identified three groups for chest X-ray images: Covid, normal, and pneumonia. This study's objective is to present a framework for categorizing chest X-ray images into three groups of pneumonia, normal, and Covid scenarios. To do this, chest X-ray images from the Kaggle database which have been utilized in previous studies were obtained. It is suggested to use an Efficientnet_b0 model to identify characteristics in raw data hierarchically. An unedited X-ray image of the chest is enhanced for more reasonable assumptions in order to apply the proposed method in real-world situations. With an overall accuracy of 93.75%, the proposed network correctly identified the chest X-ray images to the classes of Covid, viral pneumonia, and normal on the test set. 90% accuracy rate for the test dataset was attained for the viral pneumonitis group. On the test dataset, the Normal class accuracy was 94.7%, while the Covid class accuracy was 96%. The findings indicate that the network is robust. In addition, when compared to the most advanced techniques of identifying pneumonia, the concluded findings from the suggested model are highly encouraging. Since the recommended network is successful at doing so utilizing chest X-ray imaging, radiologists can diagnose COVID-19 and other lung infectious infections promptly and correctly.

SARS-CoV-2 often causes viral pneumonitis, hyperferritinemia, elevations in D-dimer, lactate dehydrogenase (LDH), transaminases, troponin, CRP, and other inflammatory markers. Lung ultrasound is increasingly used to diagnose and stratify viral pneumonitis severity. We retrospectively reviewed 427 visits in patients aged 14 days to 21 years who had had a point-of-care lung ultrasound in our pediatric emergency department from 30/November/2019 to 14/August/2021. Lung ultrasounds were categorized using a 6-point ordinal scale. Lung ultrasound abnormalities predicted increased hospitalization with a threshold effect. Increasingly abnormal laboratory values were associated with decreased discharge from the ED and increased admission to the ward and ICU. Among patients SARS-CoV-2 positive patients ferritin, LDH, and transaminases, but not CRP or troponin were significantly associated with abnormalities on lung ultrasound and also with threshold effects. This effect was not demonstrated in SARS-CoV-2 negative patients. D-Dimer, CRP, and troponin were sometimes elevated even when the lung ultrasound was normal.

Introduction: The acute respiratory distress syndrome (ARDS), secondary to viral pneumonitis, is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019)-ongoing SARS-CoV-2 infection- reached more than 0.7 billion registered cases. Methods: Recently, we elaborated a non-surgical and reproducible method of the unilateral total diffuse alveolar damage (DAD) of the left lung in ICR mice-a publicly available imitation of the ARDS caused by SARS-CoV-2. Our data read that two C-C chemokine receptor 5 (CCR5) ligands, macrophage inflammatory proteins (MIPs) MIP-1α/CCL3 and MIP-1β/CCL4, are upregulated in this DAD model up to three orders of magnitude compared to the background level. Results: Here, we showed that a nonpeptide compound TAK-779, an antagonist of CCR5/CXCR3, readily prevents DAD in the lung with a single injection of 2.5mg/kg. Histological analysis revealed reduced peribronchial and perivascular mononuclear infiltration in the lung and mononuclear infiltration of the wall and lumen of the alveoli in the TAK-779-treated animals. Administration of TAK-779 decreased the 3-5-fold level of serum cytokines and chemokines in animals with DAD, including CCR5 ligands MIP-1α/β, MCP-1, and CCL5. Computed tomography revealed rapid recovery of the density and volume of the affected lung in TAK-779-treated animals. Discussion: Our pre-clinical data suggest that TAK-779 is more effective than the administration of dexamethasone or the anti-IL6R therapeutic antibody tocilizumab, which brings novel therapeutic modality to TAK-779 and other CCR5 inhibitors for the treatment of virus-induced hyperinflammation syndromes, including COVID-19.

Background and objective It is crucial to make early differentiation between coronavirus disease 2019 (COVID-19) and seasonal influenza infections at the time of a patient's presentation to the emergency department (ED). In light of this, this study aimed to identify key epidemiological, initial laboratory, and radiological differences that would enable early recognition during co-circulation. Methods This was a retrospective, observational cohort study. All adult patients presenting to our ED at the Watford General Hospital, UK, with a laboratory-confirmed diagnosis of COVID-19 (2019/20) or influenza (2018/19) infection were included in this study. Demographic, laboratory, and radiological data were collected. Binary logistic regression was employed to determinefeatures associated with COVID-19 infection rather than influenza. Results Chest radiographs suggestive of viral pneumonitis and older age (≥80 years) were associated with increased odds of having COVID-19 [odds ratio (OR): 47.00, 95% confidence interval (CI): 21.63-102.13and OR: 64.85, 95% CI: 19.96-210.69respectively]. Low eosinophils (<0.02 x 109/L) were found to increasethe odds of COVID-19 (OR: 2.12, 95% CI: 1.44-3.10, p<0.001). Conclusions Gaining awareness about the epidemiological, biological, and radiologic presentation of influenza-like illness can be useful for clinicians in ED to differentiate between COVID-19 and influenza. This study showed that older age, eosinopenia, and radiographic evidence of viral pneumonitis significantly increase the odds of having COVID-19 compared to influenza. Further research is needed to determine if these findings are affected by acquired or natural immunity.

BackgroundInter-facility transport of patients with acute respiratory distress syndrome (ARDS) in the prone position (PP) is a high-risk situation, compared to other strategies. We aimed to quantify the prevalence of complications during transport in PP, compared to transports with veno-venous extracorporeal membrane oxygenation (VV-ECMO) or in the supine position (SP).MethodsWe performed a retrospective, single center cohort study in Lyon university hospital, France. We included patients ≥ 16 years with ARDS (Berlin definition) transported to an ARDS referral center between 01/12/2016 and 31/12/2021. We compared patients transported in PP, to those transported in SP without VV-ECMO, and those transported with VV-ECMO (in SP), by a multidisciplinary and specialized medical transport team, including an emergency physician and an intensivist. The primary outcome was the rate of transport-related complications (hypoxemia, hypotension, cardiac arrest, cannula or tube dislodgement) in each study groups, compared using a Fisher test.ResultsOne hundred thirty-four patients were enrolled (median PaO2/FiO2 70 [58–82] mmHg), of which 11 (8%) were transported in PP, 44 (33%) with VV-ECMO, and 79 (59%) in SP. The most frequent risk factor for ARDS in the PP group was bacterial pneumonitis, and viral pneumonitis in the other 2 groups. Transport-related complications occurred in 36% (n = 4) of transports in PP, compared to 39% (n = 30) in SP and 14% (n = 6) with VV-ECMO, respectively (p = 0.33). VV-ECMO implantation after transport was not different between SP and PP patients (n = 7, 64% vs. n = 31, 39%, p = 0.19).ConclusionsIn the context of a specialized multi-disciplinary ARDS transport team, transport-related complication rates were similar between patients transported in PP and SP, while there was a trend of lower rates in patients transported with VV-ECMO.

Respiratory failure occurs in 0.1-0.2% of pregnancy patients. This can be due to pre-eclampsia, venous thromboembolism, asthma, gastric aspiration, and viral pneumonitis. Rarely exacerbation of underlying diseases (like asthma, Interstitial Lung Disease, ILD, etc.) can cause respiratory failure. The underlying disease can be recognized previously or presented as exacerbation in pregnancy for the first time. Respiratory failure leads to harm to both mother and fetus; hence, the cause should be evaluated as soon as possible. Here, we are describing the case of acute exacerbation of Hypersensitivity Pneumonitis (HP) in a pre-eclampsia patient.

Respiratory failure occurs in 0.1-0.2% of pregnancy patients. This can be due to pre-eclampsia, venous thromboembolism, asthma, gastric aspiration, and viral pneumonitis. Rarely exacerbation of underlying diseases (like asthma, Interstitial Lung Disease, ILD, etc.) can cause respiratory failure. The underlying disease can be recognized previously or presented as exacerbation in pregnancy for the first time. Respiratory failure leads to harm to both mother and fetus; hence, the cause should be evaluated as soon as possible. Here, we are describing the case of acute exacerbation of Hypersensitivity Pneumonitis (HP) in a pre-eclampsia patient.

SARS-CoV-2, a novel coronavirus within the Coronaviridae family, is the causative agent behind the respiratory ailment referred to as COVID-19. Operating on a global scale, COVID-19 has led to a substantial number of fatalities, exerting profound effects on both public health and the global economy. The most frequently reported symptoms encompass fever, cough, muscle or body aches, loss of taste or smell, headaches, and fatigue. Furthermore, a subset of individuals may manifest more severe symptoms, including those consistent with viral pneumonitis, which can be so profound as to result in fatalities. Consequently, this situation has spurred the rapid advancement of disease diagnostic technologies worldwide. Predominantly employed in diagnosing COVID-19, the real-time quantitative reverse transcription PCR has been the foremost diagnostic method, effectively detecting SARS-CoV-2 viral RNA. As the pandemic has evolved, antigen and serological tests have emerged as valuable diagnostic tools. Antigen tests pinpoint specific viral proteins of SARS-CoV-2, offering swift results, while serological tests identify the presence of antibodies in blood samples. Additionally, there have been notable strides in sample collection methods, notably with the introduction of saliva-based tests, presenting a non-invasive substitute to nasopharyngeal swabs. Given the ongoing mutations in SARS-CoV-2, there has been a continuous need for genomic surveillance, encompassing full genome sequencing and the identification of new variants through Illumina technology and, more recently, nanopore metagenomic sequencing (SMTN). Consequently, while diagnostic testing methods for COVID-19 have experienced remarkable progress, no test is flawless, and there exist limitations with each technique, including sensitivity, specificity, sample collection, and the minimum viral load necessary for accurate detection. These aspects are comprehensively addressed within this current review.

ABSTRACT Recently, huge concerns have been raised in diagnosing chest diseases, especially after the COVID-19 pandemic. Regular diagnosis processes of chest diseases sometimes fail to distinguish between Corona and Viral Pneumonia diseases through Polymerase Chain Reaction (PCR) tests which are a time-engrossing process that needs convoluted manual procedures. Artificial Intelligence (AI) techniques have achieved high performance in aiding medical diagnostic processes. The innovation of this work lies in using a new diagnostic technique to distinguish between COVID-19 and Viral Pneumonia diseases using advanced AI technologies. This is done by extracting novel features from chest X-ray images based on Wavelet analysis, Scale Invariant Feature Transformation (SIFT), and the Mel Frequency Cepstral Coefficient (MFCC). Support vector machines (SVM) and artificial neural networks (ANN) were utilized to build classification algorithms using 1200 chest X-ray mages for each case. Using Wavelet features, the results of evaluating the SVM and ANN models were 97% accurate, and with SIFT features, they were closer to 99%. The proposed models were very effective at identifying COVID-19 and Viral Pneumonitis, so physicians can determine the best treatment course for patients with the support of this high accuracy. Moreover, this model can be used in hospitals and emergency rooms when a massive number of patients are waiting, as it is faster and more accurate than the regular diagnosis processes as each step takes few seconds on average to complete.

ABSTRACT Introduction: Stereotactic body radiotherapy (SBRT) has been found to be an effective and safe modality with excellent oncological outcome in medically inoperable primary renal cell carcinoma (RCC) and oligometastases. There is scarcity of data on the synchronous delivery of SBRT to primary and oligometastatic RCC in patients unfit for nephrectomy. Here, we report the findings of a retrospective study of prospectively collected data on “total ablative SBRT.” Methods: Oligometastatic RCC patients with intact primary tumors were enrolled between May 2021 and June 2022. SBRT was synchronously delivered to the primary tumor and metastases. Demographics, treatment, oncologic outcomes, and toxicity were assessed. Kaplan–Meier estimates were generated for oncologic outcomes. The primary endpoint of this study was feasibility and tolerability. Results: Eleven patients were enrolled between May 2021 and June 2022. One patient died at 2 months after SBRT due to viral pneumonitis (possibly COVID pneumonia). Nine patients (82%) had metastatic disease, while 2 (18%) were stage II. The average maximal diameter of primary was 68.7 mm (range, 23–128 mm). The SBRT doses for primary and metastasis ranged from 40 to 55 Gray (Gy) in 5 to 7 fractions and 22 to 40Gy in 2 to 5 fractions, respectively. The median follow-up period was 10.5 months (Range: 4–15 months). Response assessment was available for ten patients. Local control, marginal control, regional control and initial oligometastatic control (OMC) rates were 100%. OMC declined to 87.5% as one patient had recurrence in irradiated subcarinal lymphnode at 7 months. The metastatic control rate was 80% and loco-regional progression-free survival was 8 months (range, 4–15 months). Toxicities were minimal and manageable. At the last follow–up, 7 of 11 patients were alive with an overall survival of 63.5%. Six patients received systemic therapy after SBRT. Conclusions: Synchronous delivery of SBRT to primary and oligometastatic sites in patients unfit for nephrectomy was feasible and tolerable with good locoregional control. The total ablative SBRT strategy needs to be explored in similar cohorts.

Background: Isolated ground glass opacities are often seen in the lungs and these are a diagnostic challenge. There are numerous different causes of ground glass opacities in the lungs. The broad list of etiologies are infectious causes, interstitial disease, alveolar disease, neoplastic, and drug toxicity. In the era of SARS Cov-2, it becomes very difficult to differentiate the ground glass opacities due to inflammatory bronchiolitis and other viral pneumonitis from those which are due to SARS CoV-2. Aims and Objectives: We aim to look for vascular signs seen in association with ground glass opacities which increase our level of confidence to call them ground glass opacities due to SARS-CoV-2 as an etiology. Materials and Methods: We present an observational study on 34 patients who presented with only patchy focal ground glass opacities in the lungs. All these patients were also subjected to nasopharyngeal swab test. The vascular signs seen on CT scan were of help to establish definite diagnosis of SARS-CoV-2 only on the basis of ground glass opacities. Results: Out of 31 patients showing CT scan finding of prominent intralesional vessel, 27 were positive for COVID-19 on reverse transcription-polymerase chain reaction (RT-PCR) test. Four patients showing prominent intralesional vessel on CT scan were negative for COVID-19 infection on RT-PCR test. These four patients who were tested negative on RT-PCR were treated symptomaticaly for inflammatory bronchiolitis. Follow-up CT scan of two such patients were done after 4 days, which showed resolution of the focal ground glass opacities. Conclusion: The parenchymal imaging findings of SARS-Cov-2 are well described as ground glass opacities associated with septal thickening and consolidation. However, in some cases, only few focal isolated ground glass opacities are seen without any other typical features. In such cases, the vascular signs are of help to increase our level of diagnostic confidence.

Idiopathic CD4 lymphocytopenia (ICL) is a rare condition characterized by an unexplained deficit of circulating CD4 T cells leading to increased risk of serious opportunistic infections. Reactivation and severe symptomatic CMV is also a rare case, except in immunocompromised patient. Patient concerns are 36-year-old male patient complained seizure, fever, cough, and dyspnea. History of chronic urticaria and prolonged Mebhydrolin consumption. HIV was negative. CD4 was low. Diagnosis in this case is Viral encephalitis, Viral pneumonitis, CMV reactivation, hemophagocytic lymphohistiocytosis immunodeficiency state. The results in this study indicate that the patients were treated with conventional therapies for Severe CMV infection with Acyclovir. Steroid was given for the last five days. The first day after administration of therapy showed clinical and laboratory improvement. Laboratory values returned to normal values on the fifth day of therapy. Since the second day after the therapy was given, the patient had no complaints. In cases of CMV reactivation, an immunodeficiency condition should be suspected. A comprehensive history, physical examination, laboratory and radiological examination, adequate therapy and and policy support are required to establish a definite diagnosis and reduce the risk of mortality.

The most common infectious complication after first month of solid organ transplants is cytomegalovirus (CMV). Both direct such as viral syndrome, hepatitis, pneumonitis, colitis, etc. and indirect consequences such as rejection, infections by other microorganisms and graft dysfunction, are carried on by the virus. Latent infection, active infection, viral syndrome, and invasive disease are the four types of infection that can emerge due to transmission from the transplanted organ, reactivation of latent infection, or after a primary infection in seronegative individuals. Typically, this syndrome appears 30 to 90 days following transplantation. Several antiviral medications, including acyclovir, valacyclovir, ganciclovir, and valganciclovir, are being used for CMV prophylaxis and therapy. Furthermore, these antiviral medications are toxic and have serious adverse effects, including drug resistance, leukopenia, thrombocytopenia, renal failure, and neuropsychiatric symptoms. We attempted to discuss CMV risk factors, laboratory diagnosis, prevention, treatment and therapeutic in this review study with regard to organ transplantation.

BackgroundIt is unclear if the impact of frailty on mortality differs between patients with viral pneumonitis due to COVID-19 or other causes. We aimed to determine if a difference exists between patients with and without COVID-19 pneumonitis.MethodsThis multicentre, retrospective, cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database included patients aged ≥ 16 years admitted to 153 ICUs between 01/012020 and 12/31/2021 with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome, and Clinical Frailty Scale (CFS). The primary outcome was hospital mortality.ResultsA total of 4620 patients were studied, and 3077 (66.6%) had COVID-19. The patients with COVID-19 were younger (median [IQR] 57.0 [44.7–68.3] vs. 66.1 [52.0–76.2]; p < 0.001) and less frail (median [IQR] CFS 3 [2–4] vs. 4 [3–5]; p < 0.001) than non-COVID-19 patients. The overall hospital mortality was similar between the patients with and without COVID-19 (14.7% vs. 14.9%; p = 0.82). Frailty alone as a predictor of mortality showed only moderate discrimination in differentiating survivors from those who died but was similar between patients with and without COVID-19 (AUROC 0.68 vs. 0.66; p = 0.42). Increasing frailty scores were associated with hospital mortality, after adjusting for Australian and New Zealand Risk of Death score and sex. However, the effect of frailty was similar in patients with and without COVID-19 (OR = 1.29; 95% CI: 1.19–1.41 vs. OR = 1.24; 95% CI: 1.11–1.37).ConclusionThe presence of frailty was an independent risk factor for mortality. However, the impact of frailty on outcomes was similar in COVID-19 patients compared to other causes of viral pneumonitis.Graphical

Herpes simplex virus (HSV) pneumonitis is rare after cardiac surgery. A 36-year-old gentleman with ankylosing spondylitis underwent emergency surgery for a complex aortic aneurysmal disease. Preoperative treatment of aortitis with antitumor necrosis factor and steroid medication and surgical stress including cardiopulmonary bypass potentially created an immunosuppressive state and reactivation of undiagnosed HSV. Rapid HSV pneumonia ensued, culminating in fulminant organ failure and mortality. HSV pneumonia should be considered postoperatively in patients with severe respiratory distress, especially if immunocompromised.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectiveThis case highlights the presence of a self-limited respiratory mycosis in an immunocompetent host and need for fungal sequencing in diagnosis of such rare cases.Methods and ResultsMs X, a 25-year-old, apparently healthy software engineer, had an overnight journey in an air-conditioned bus from Hyderabad to Pune. The next day, she developed throat irritation followed 3 days later by fever and cough without dyspnea nor wheezing. Her chest X-ray was found to be normal at the time. Three days later she was admitted to our hospital, wherein X-ray chest and CT chest showed bilateral randomly scattered nodular shadows (Fig. 1). She was referred to ID as a case of suspected tuberculosis, but her presenting symptom being sore throat, the acuteness of symptoms, presence of nodular lung shadows which were absent on the X-ray chest done just 3 days earlier were against the diagnosis of TB. Inhalational fungal or viral pneumonitis were hence considered.Transbronchial biopsy showed an intense alveolar inflammatory exudate, but GMS staining did not reveal any fungal hyphae. BAL Galactomannan, Xpert MTB/RIF were negative. Both BAL and CT guided lung nodule biopsy samples grew a mold. Red pigment formation in culture and its morphological appearance on LPCB mount (Fig. 2) led to a diagnosis of Penicillium species infection. MALDI TOF MS, which had only a few Penicillium spp in its 2018 database, failed to identify the organism, leading us to believe that it could be a different Penicillium species.Since the patient was showing clinical improvement, a self-limited infection was thought of and therapy was withheld with cautious follow-up. The patient was completely asymptomatic after 10 days and CT chest done 20 days later showed complete resolution of the nodules.We believe that this illness was due to inhalation of spores from the air-conditioning vent, eliciting a brisk inflammatory response in the alveoli. The organism grew from BAL and CT guided biopsy from viable spores, but it failed to germinate into hyphae in the human host and hence was not seen on histopathology and did not produce galactomannan which is only released from the tips of growing hyphae.ConclusionFungi are often isolated from poorly maintained air conditioning vents. In this case, the Penicillium like organism failed to produce progressive disease in the immunocompetent host. If the same organism could be cultured from the AC vent, showed genetic relatedness with the clinical isolate; the source, transmission, and disease linkage could have been established in this case.

BackgroundThe COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.MethodsThis is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method.ResultsData were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.ConclusionsIn patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids.Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).Graphical abstract

BackgroundCoronavirus disease 2019 (COVID-19) is the largest pandemic that has affected people around the globe. Various researches have been conducted worldwide, but there is a scarcity of data from Central India on the relationship between several risk factors for infection and mortality. Our study assessed the predictors and patient profiles of those with COVID-19, which will aid in prioritizing patient treatment and preventive measures.MethodsA retrospective study was done between March and December 2020. The study included 5,552 COVID-19 patients admitted to the All India Institute of Medical Sciences (AIIMS), Raipur. A validated questionnaire form provided by the WHO was used. Data for multiple clinical and nonclinical parameters were collected, and analysis was done using SPSS version 26 (IBM Corp., Armonk, NY, USA) and STATA version 12 (StataCorp LLC, College Station, TX, USA). Mortality and risk assessment of patients was done using multivariate logistic regression.ResultIn our study cohort of 5,552 COVID-19 patients, the median age was found to be 47 years (interquartile range (IQR): 31-60 years; range: 14-100 years), and 3,557 (64%) were male. Predominantly, patients presented with fever (41.30%), cough (40.20%), and dyspnea (29.29%). The major comorbidities were hypertension (29.70%), diabetes (25.40%), and chronic cardiac disease (5.79%). The common complications were liver dysfunction (26.83%), viral pneumonitis (23.66%), acute renal injury (15.25%), and acute respiratory distress syndrome (ARDS) (13.41%). In multivariate analysis, age (more than 40 years) (odds ratio (OR): 2.63; 95% confidence interval (CI): 1.531-4.512; p<0.001), diabetes (OR: 1.61; 95% CI: 1.088-2.399; p=0.017), obesity (OR: 6.88; 95% CI: 2.188-12.153; p=0.004), leukocytosis (OR: 1.74; 95% CI: 1.422-2.422; p<0.001), lymphocytopenia (OR: 2.54, 95% CI: 1.718-3.826; p<0.001), thrombocytopenia (OR: 1.15; 95% CI: 1.777-8.700; p=0.001), and ferritin concentration > 1,000 ng/mL (OR: 4.67; 95% CI: 1.991-10.975; p<0.001) were the independent predictors of mortality among COVID-19 patients.ConclusionThe leading comorbidities in our study were hypertension, followed by diabetes. Patients who were 40 years or older, obese patients, and diabetic patients have a higher mortality risk. The poor prognostic predictors in COVID-19 patients were high ferritin levels (>1,000 ng/mL), leukocytosis, lymphocytopenia, and thrombocytopenia.