Comparison of initial high resolution computed tomography features in viral pneumonia between metapneumovirus infection and severe acute respiratory syndrome

Wong, Chi Kuen; Lai, Vincent S.; Wong, Yiu Chung

doi:10.1016/j.ejrad.2011.02.050

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…A broad range of respiratory diseases have been associated with viral infections. Hence, testing for viruses in BALF may be considered in patients with a wide spectrum of clinical and radiological abnormalities [16,17]. However, our study suggests that viral tests are unlikely to return positive except in two, nonexclusive, situations: (i) immunocompromised patients; (ii) bilateral ground-glass attenuations on CT scan.…”

Section: Discussionmentioning

confidence: 78%

Which patients should be tested for viruses on bronchoalveolar lavage fluid?

Jouneau

Poineuf

Minjolle³

et al. 2012

Eur J Clin Microbiol Infect Dis

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Bronchoalveolar lavage (BAL) is a major diagnostic tool in lung diseases, including viral respiratory infections. We aimed to better define the situations where viral tests should be performed on BAL fluid (BALF). We retrospectively studied all cases where viral tests [immunofluorescence, immunocytochemistry, viral culture, and/or polymerase chain reaction (PCR)] were performed on BALF during a period of 1 year (2008) in our institution. We compared the characteristics of patients with virus-positive versus virus-negative BALF. Of the 636 BALF samples sent to the microbiology laboratory, 232 underwent viral tests. Of these, 70 (30 %) were positive and identified 85 viruses: herpes simplex virus (HSV)-1 (n = 27), cytomegalovirus (CMV, n = 23), Epstein-Barr virus (EBV, n = 18), human herpesvirus (HHV)-6 (n = 12), respiratory syncytial virus (RSV, n = 3), rhinovirus (n = 1), and adenovirus (n = 1). The variables associated with positive viral tests on univariate analysis were immunosuppression [human immunodeficiency virus (HIV), corticosteroids >10 mg/day for ≥3 weeks, or other immunosuppressive therapy], ground-glass attenuations on computed tomography (CT) scanning, late-onset ventilator-associated pneumonia (VAP), and durations of (i) hospital stay, (ii) intensive care unit (ICU) stay, and (iii) mechanical ventilation before BAL (p < 0.01 for each comparison). On multivariate analysis, only immunosuppression [odds ratio (OR) 6.4, 95 % confidence interval (CI) [2.8-14.3], p < 0.0001] and ground-glass attenuations (OR 3.7, 95 % CI [1.8-7.7], p = 0.0004) remained associated with virus-positive BAL. None of the viral tests performed on BALF for the initial assessment of diffuse infiltrative lung disease (n = 15) was positive. PCR improved the diagnostic yield of viral tests on BALF by 50 %. Testing for viruses on BALF should be mostly restricted to immunocompromised patients with acute respiratory diseases and/or patients with unexplained ground-glass attenuations on CT scanning.

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Section: Discussionmentioning

confidence: 78%

Which patients should be tested for viruses on bronchoalveolar lavage fluid?

Jouneau

Poineuf

Minjolle³

et al. 2012

Eur J Clin Microbiol Infect Dis

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“…In 1 study of high-resolution computed tomography findings in 4 patients with hMPV, groundglass opacities, consolidation, and parenchymal bands were present in all patients. 147 Although uncommon, hMPV infection can lead to severe disease. In a single study from Korea of 198 patients with severe pneumonia requiring admission to the ICU, hMPV infection was identified by RT-PCR in 13 patients including 5 (8%) with CAP.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Severe Respiratory Viral Infections

Walter

Wunderink

2017

Infectious Disease Clinics of North America

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Lower respiratory tract infection is a leading cause of death in the United States. Advances in diagnostic testing have improved our ability to detect pathogens. Viral pathogens are important causal pathogens in immunocompetent patients. As the number of elderly adults and those with chronic medical conditions increases, the burden of viral respiratory infections will increase. Clinicians must be familiar with the characteristics of rhinovirus, human adenoviruses, respiratory syncytial virus, and human metapneumovirus. Major challenges include distinguishing true infection from asymptomatic carriage and characterizing patients admitted with severe lower respiratory tract infection who do not have a causative pathogen identified.

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“…Chest CT scans can assist diagnosis and guide treatment decision for community-acquired pneumonia ( 18 , 19 ). Quantitative imaging provided reliable and objective biomarkers in the management of severe acute respiratory syndrome and middle-east respiratory syndrome ( 20 , 21 ). Recent studies reported that AI-powered CT diagnosis may outperform lab testing for screening of COVID-19 with sensitivity of 97% ( 22 ), and CT quantification as indictors may assess disease severity and predict prognosis in the management of COVID-19 ( 23 , 24 ).…”

Section: Introductionmentioning

confidence: 99%

CT Quantification and Machine-learning Models for Assessment of Disease Severity and Prognosis of COVID-19 Patients

Cai

Xue

et al. 2020

Academic Radiology

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This study was to investigate the CT quantification of COVID-19 pneumonia and its impacts on the assessment of disease severity and the prediction of clinical outcomes in the management of COVID-19 patients. Materials Methods: Ninety-nine COVID-19 patients who were confirmed by positive nucleic acid test (NAT) of RT-PCR and hospitalized from January 19, 2020 to February 19, 2020 were collected for this retrospective study. All patients underwent arterial blood gas test, routine blood test, chest CT examination, and physical examination on admission. In addition, follow-up clinical data including the disease severity, clinical treatment, and clinical outcomes were collected for each patient. Lung volume, lesion volume, nonlesion lung volume (NLLV) (lung volume À lesion volume), and fraction of nonlesion lung volume (%NLLV) (nonlesion lung volume / lung volume) were quantified in CT images by using two U-Net models trained for segmentation of lung and COVID-19 lesions in CT images. Furthermore, we calculated 20 histogram textures for lesions volume and NLLV, respectively. To investigate the validity of CT quantification in the management of COVID-19, we built random forest (RF) models for the purpose of classification and regression to assess the disease severity (Moderate, Severe, and Critical) and to predict the need and length of ICU stay, the duration of oxygen inhalation, hospitalization, sputum NAT-positive, and patient prognosis. The performance of RF classifiers was evaluated using the area under the receiver operating characteristic curves (AUC) and that of RF regressors using the root-mean-square error. Results: Patients were classified into three groups of disease severity: moderate (n = 25), severe (n = 47) and critical (n = 27), according to the clinical staging. Of which, a total of 32 patients, 1 (1/25) moderate, 6 (6/47) severe, and 25 critical (25/27), respectively, were admitted to ICU. The median values of ICU stay were 0, 0, and 12 days, the duration of oxygen inhalation 10, 15, and 28 days, the hospitalization 12, 16, and 28 days, and the sputum NAT-positive 8, 9, and 13 days, in three severity groups, respectively. The clinical outcomes were complete recovery (n = 3), partial recovery with residual pulmonary damage (n = 80), prolonged recovery (n = 15), and death (n = 1). The %NLLV in three severity groups were 92.18 § 9.89%, 82.94 § 16.49%, and 66.19 § 24.15% with p value <0.05 among each two groups. The AUCs of RF classifiers using hybrid models were 0.927 and 0.929 in classification of moderate vs (severe + critical), and severe vs critical, respectively, which were significantly higher than either radiomics models or clinical models (p < 0.05). The root-mean-square errors of RF regressors were 0.88 weeks for prediction of duration of hospitalization (mean: 2.60 § 1.01 weeks), 0.92 weeks for duration of oxygen inhalation (mean: 2.44 § 1.08 weeks), 0.90 weeks for duration of sputum NAT-positive (mean: 1.59 § 0.98 weeks), and 0.69 weeks for stay of ICU (mean: 1.32 § 0.67 weeks), respectively....

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Comparison of initial high resolution computed tomography features in viral pneumonia between metapneumovirus infection and severe acute respiratory syndrome

Abstract: Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS.

Cited by 14 publications

References 23 publications

Which patients should be tested for viruses on bronchoalveolar lavage fluid?

Which patients should be tested for viruses on bronchoalveolar lavage fluid?

Severe Respiratory Viral Infections

CT Quantification and Machine-learning Models for Assessment of Disease Severity and Prognosis of COVID-19 Patients

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