Follow-up chest radiographic findings in patients with MERS-CoV after recovery

Abstract

Purpose:To evaluate the follow-up chest radiographic findings in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) who were discharged from the hospital following improved clinical symptoms.Materials and Methods:Thirty-six consecutive patients (9 men, 27 women; age range 21–73 years, mean ± SD 42.5 ± 14.5 years) with confirmed MERS-CoV underwent follow-up chest radiographs after recovery from MERS-CoV. The 36 chest radiographs were obtained at 32 to 230 days with a median follow-up of 43 days. The reviewers systemically evaluated the follow-up chest radiographs from 36 patients for lung parenchymal, airway, pleural, hilar and mediastinal abnormalities. Lung parenchyma and airways were assessed for consolidation, ground-glass opacity (GGO), nodular opacity and reticular opacity (i.e., fibrosis). Follow-up chest radiographs were also evaluated for pleural thickening, pleural effusion, pneumothorax and lymphadenopathy. Patients were categorized into two groups: group 1 (no evidence of lung fibrosis) and group 2 (chest radiographic evidence of lung fibrosis) for comparative analysis. Patient demographics, length of ventilations days, number of intensive care unit (ICU) admission days, chest radiographic score, chest radiographic deterioration pattern (Types 1-4) and peak lactate dehydrogenase level were compared between the two groups using the student t-test, Mann-Whitney U test and Fisher's exact test.Results:Follow-up chest radiographs were normal in 23 out of 36 (64%) patients. Among the patients with abnormal chest radiographs (13/36, 36%), the following were found: lung fibrosis in 12 (33%) patients GGO in 2 (5.5%) patients, and pleural thickening in 2 (5.5%) patients. Patients with lung fibrosis had significantly greater number of ICU admission days (19 ± 8.7 days; P value = 0.001), older age (50.6 ± 12.6 years; P value = 0.02), higher chest radiographic scores [10 (0-15.3); P value = 0.04] and higher peak lactate dehydrogenase levels (315-370 U/L; P value = 0.001) when compared to patients without lung fibrosis.Conclusion:Lung fibrosis may develop in a substantial number of patients who have recovered from Middle East respiratory syndrome coronavirus (MERS-CoV). Significantly greater number of ICU admission days, older age, higher chest radiographic scores, chest radiographic deterioration patterns and peak lactate dehydrogenase levels were noted in the patients with lung fibrosis on follow-up chest radiographs after recovery from MERS-CoV.

A Comparative Analysis of Factors Influencing Two Outbreaks of Middle Eastern Respiratory Syndrome (MERS) in Saudi Arabia and South Korea

“…Follow-up chest radiographs of laboratory-confirmed positive individuals have shown lung fibrosis, and pleural thickening [26]. Blood tests of these patients also showed elevated lactate dehydrogenase levels after recovery.…”

International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting, and Imaging Study Recommendations

“…Syndrome (MERS), and Swine-Origin Influenza A (H1N1). [7][8][9][10][11][12][13][14] The panel met via a single live audio and video conference call to discuss chest imaging findings and recommendations.…”

“…As longterm data is not yet available for pediatric COVID-19 patients, recommendations currently presented in this article are based consensus expert opinion as well as long term follow-up experience with SARS and MERS. 8,11 For asymptomatic pediatric patients who had a mild disease course, no long term imaging follow-up is recommended. However, even pediatric patients with a mild disease course may develop long standing pulmonary injury and thus a follow-up standard two-view (PA and lateral) CXR should be considered in symptomatic patients with prior mild COVID-19.…”

Revisiting MERS-CoV Outbreak Chest Radiographic Initial Findings, Temporal Progression and Correlation to Outcomes: Insights for the COVID-19 Pandemic

“…A noteworthy observation is that interstitial opacities were also uncommon in our study and other reports. However, reticulations were observed in some patients where longer-term follow-up imaging was obtained 8,18,26 . Reticulations have been noticed, although rarely, in cases of current COVID-19 infection as well 27 .…”

“…Prior MERS-CoV research has shown that the risk of mortality signi cantly increases in proportion to the extent of lung involvement 2,8,10,26 . Such publications are in concordance with our observation that a bilateral diffuse pattern of lung abnormalities, as observed on the worst or nally imaged CXR, was independently related to higher death rates.…”