IntroductionPneumothorax and pneumomediastinum have both been noted to complicate cases of COVID-19 requiring hospital admission. We report the largest case series yet described of patients with both these pathologies that includes non-ventilated patients.MethodsCases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival.ResultsSeventy-one patients from 16 centres were included in the study, of whom 60 patients had pneumothoraces (six also with pneumomediastinum), whilst 11 patients had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication whilst intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1%±6.5%) or isolated pneumomediastinum (53.0%±18.7%; p=0.854). The incidence of pneumothorax was higher in males. The 28-day survival was not different between the sexes (males 62.5%±7.7% versus females 68.4%±10.7%; p=0.619). Patients above the age of 70 had a significantly lower 28-day survival than younger individuals (≥70 years 41.7%±13.5% survival versus <70 years 70.9%±6.8% survival; p=0.018 log-rank).ConclusionThese cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage active treatment to be continued where clinically possible.
In the middle of a pandemic, patients with cough and fever are thought to have SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It should be remembered that in the desert southwest of the United States, we have an ongoing epidemic of coccidioidomycosis (CM). There are additionally many other respiratory illnesses that could be confused with CoV-2 or overlooked. This is a case report of CoV-2 engrafted on chronic cavitary pulmonary CM. In a time where the coronavirus pandemic is becoming rampant, we demonstrate the case of a coinfection with cavitary pulmonary CM. In this case, the importance of detection of the coronavirus and treatment of the coinfection is explored.
ObjectivesCOVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is limited. We sought to investigate Long COVID outcomes, aiming to compare outcomes in adult hospitalised survivors with known variants of concern during our first and second UK COVID-19 waves, prior to widespread vaccination.DesignProspective observational cross-sectional study.SettingSecondary care tertiary hospital in the UK.ParticipantsThis study investigated Long COVID in 673 adults with laboratory-positive SARS-CoV-2 infection or clinically suspected COVID-19, 6 weeks after hospital discharge. We compared adults with wave 1 (wildtype variant, admitted from February to April 2020) and wave 2 patients (confirmed Alpha variant on viral sequencing (B.1.1.7), admitted from December 2020 to February 2021).Outcome measuresAssociations of Long COVID presence (one or more of 14 symptoms) and total number of Long COVID symptoms with SARS-CoV-2 variant were analysed using multiple logistic and Poisson regression, respectively.Results322/400 (wave 1) and 248/273 (wave 2) patients completed follow-up. Predictors of increased total number of Long COVID symptoms included: pre-existing lung disease (adjusted count ratio (aCR)=1.26, 95% CI 1.07, 1.48) and more COVID-19 admission symptoms (aCR=1.07, 95% CI 1.02, 1.12). Weaker associations included increased length of inpatient stay (aCR=1.02, 95% CI 1.00, 1.03) and later review after discharge (aCR=1.00, 95% CI 1.00, 1.01). SARS-CoV-2 variant was not associated with Long COVID presence (OR=0.99, 95% CI 0.24, 4.20) or total number of symptoms (aCR=1.09, 95% CI 0.82, 1.44).ConclusionsPatients with chronic lung disease or greater COVID-19 admission symptoms have higher Long COVID risk. SARS-CoV-2 variant was not predictive of Long COVID though in wave 2 we identified fewer admission symptoms, improved clinical trajectory and outcomes. Addressing modifiable factors such as length of stay and timepoint of clinical review following discharge may enable clinicians to move from Long COVID risk stratification towards improving its outcome.
BackgroundMDR-TB requires an intense treatment course with multiple drugs, many of which have significant recognised side effects. Frequency of monitoring to prevent long term complications is not fully established, but recent guidelines have gone some way to addressing this. In light of this we wanted to review the side effects of MDR-TB treatment in our population to identify whether our previous practice was in line with the current recommendations and if not, whether the currently recommended frequency could have identified these complications sooner.Methods26 patients referred to our trust over 13 years (between 2002 and 2015) had a diagnosis of MDR-TB on a basis of isoniazid and rifampicin resistance on culture and/or PCR. Medical records were reviewed; diagnostic tests, resistance profiles, baseline investigations, treatment, drug monitoring tests and side effects were recorded on 21 of these patients. These were compared with current European Respiratory Society guidelines for MDR-TB management.ResultsAll baseline tests were completed except for magnesium and electrocardiogram. 6 patients had care transferred elsewhere. Amikacin/cycloserine levels were performed in line with recommendations. Interval blood testing was not always undertaken as recommended, particularly near the end of treatment. 11/15 (73%) of patients experienced at least 1 complication to treatment. Most frequent were: amikacin induced ototoxicity in 5/15 (33%), PAS/prothionamide induced hypothyroidism in 3/15 (20%). Other complications included photosensitivity with pyrazinamide, clofazimine associated erythema, peripheral neuropathy secondary to linezolid/cycloserine, amikacin induced renal impairment and ureteric colic secondary to calculi. Audiometry revealed high frequency hearing loss prior to development of symptoms. One patient developed ototoxicity despite monthly audiometry testing. Hypothyroidism developed despite monthly thyroid function.ConclusionsIn our population there was a high incidence of significant side effects to MDR-TB regimes. Ototoxicity with amikacin is a significant concern. While frequent testing is advocated we found that complications were not necessarily negated by this. Frequency of testing was easier to achieve whilst an inpatient than an outpatient. With the advent of the World Health Organisation shorter MDR-TB regimen, the need for regular monitoring remains crucial, but the shorter duration of injectable drugs may also help decrease complication rates in the future.
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