Organising pneumonia manifesting as a late-phase complication of COVID-19

Ng, Boon Hau; A, Bán; Abeed, Nik Nuratiqah Nik; Faisal, Mohamed

doi:10.1136/bcr-2021-246119

Cited by 16 publications

(21 citation statements)

References 12 publications

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“…Prednisone at a dosage of 0.75-1.5 mg/kg/day for 4 weeks, tapered over a period of 3-6 months, is the current recommendation (33). In COVID-19-associated OP, case reports and case series, including ours, have documented favorable outcomes with corticosteroid treatment, sometimes with high doses and prolonged therapy, often weeks to months (13)(14)(15)(16)(17)(18)(19)(22)(23)(24)(25). A single-center prospective observational study discovered that almost a quarter of post-COVID-19 pneumonia patients had recurrent dyspnea with radiological signs of OP, and that restarting corticosteroids resulted in clinical and radiological improvement in these patients (27).…”

Section: Discussionmentioning

confidence: 83%

“…Clinical and investigation data regarding COVID-19associated OP are limited. The diagnosis of OP was made in some cases, by using only radiological data (13)(14)(15)(16)(17)(18)(19), and in other cases, by performing transbronchial biopsy and a histological examination of the obtained tissue (14,(20)(21)(22)(23)(24)(25). The cases of COVID-19-associated organizing pneumonia reported in the literature are summarized in Table I.…”

Section: Discussionmentioning

confidence: 99%

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Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

et al. 2022

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Organizing pneumonia (OP) is a type of diffuse interstitial lung disease, which may be induced in the context of several clinical conditions, such as drug reactions, infections, autoimmune diseases and cancer. Coronavirus disease 2019 (COVID-19)-associated OP has been reported as a late-stage consequence of the infection or a histological form of COVID-19-associated pneumonia. Autopsies and postmortem lung biopsies have demonstrated that the majority of patients with COVID-19-associated pneumonia develop secondary OP, and COVID-19-associated pneumonia and OP have common radiological features. The diagnosis of COVID-19-associated OP should be suspected in patients with severe acute respiratory syndrome coronavirus 2 infection who exhibit clinical deterioration despite optimal care, or who have aggravating symptoms following an initial recovery. The use of corticosteroids is a typical treatment for OP. However, to date, at least to the best of our knowledge, there are a few reports regarding the role of corticosteroids in COVID-19-associated pneumonia; thus, the optimal time for administration, the dose and treatment duration have not yet been determined. The present study presents two cases of patients with COVID-19, who exhibited clinical deterioration following the initial phase of infection and with radiological characteristics of OP who received corticosteroids and had a favorable outcome. The early diagnosis of COVID-19-associated OP may lead to targeted treatment, decreased requirements for ventilatory support and an improved survival rate.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

et al. 2022

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“…Although effective vaccines and therapeutics are available in many countries, about one-third of COVID-19 survivors have residual abnormalities on chest CT 1 year after COVID-19 34 . Thus, familiarity with sequelae of COVID-19 pneumonia on chest imaging may be important to evaluate potential causes of chronic residual abnormalities or respiratory symptoms after COVID-19 35 , 36 .…”

Section: Discussionmentioning

confidence: 99%

Greater central airway luminal area in people with COVID-19: a case–control series

Jeltema

Gorman

Ovrom

et al. 2022

Sci Rep

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Respiratory epithelium in the conducting airways of the human body is one of the primary targets of SARS-CoV-2 infection, however, there is a paucity of studies describing the association between COVID-19 and physical characteristics of the conducting airways. To better understand the pathophysiology of COVID-19 on the size of larger conducting airways, we determined the luminal area of the central airways in patients with a history of COVID-19 compared to a height-matched cohort of controls using a case–control study design. Using three-dimensional reconstruction from low-dose high-resolution computed tomography, we retrospectively assessed airway luminal cross-sectional area in 114 patients with COVID-19 (66 females, 48 males) and 114 healthy, sex- and height-matched controls (66 females, 48 males). People with a history of smoking, cardiopulmonary disease, or a body mass index greater than 40 kg·m−2 were excluded. Luminal areas of seven conducting airways were analyzed, including trachea, left and right main bronchus, intermediate bronchus, left and right upper lobe, and left lower lobe. For the central conducting airways, luminal area was ~ 15% greater patients with COVID-19 compared to matched controls (p < 0.05). Among patients with COVID-19, there were generally no differences in the luminal areas of the conducting airways between hospitalized patients compared to patients who did not require COVID-19-related hospitalization. Our findings suggest that males and females with COVID-19 have pathologically larger conducting airway luminal areas than healthy, sex- and height-matched controls.

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“…In some cases, this OP can occur following an intervening period of clinical recovery. 19 A typical imaging pattern of OP pattern, devoid of findings of airway-centric infection, may support a delayed manifestation of COVID-19 infection. The presence of a RHS without accompanying findings of OP, however, is nonspecific.…”

Section: Airspace Opacities Several Weeks After Covid-19 Infectionmentioning

confidence: 98%

“…Imaging features of septic embolic may vary slightly based on the infecting organisms with emboli caused by gram-positive bacteria (e.g., Staphylococcus) tending to be slightly larger on the average and slightly more likely to cavitate (►Fig. 19). 58 Septic emboli from gramnegative pathogens may more commonly display a feeding vessel sign and a ground glass halo.…”

Section: Necrosis and Cavitationmentioning

confidence: 99%

Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19

Ketai

Febbo

Busby

et al. 2022

Semin Respir Crit Care Med

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The coronavirus disease 2019 (COVID-19) pandemic upended our approach to imaging community-acquired pneumonia, and this will alter our diagnostic algorithms for years to come. In light of these changes, it is worthwhile to consider several postpandemic scenarios of community-acquired pneumonia: (1) patient with pneumonia and recent positive COVID-19 testing; (2) patient with air space opacities and history of prior COVID-19 pneumonia (weeks earlier); (3) multifocal pneumonia with negative or unknown COVID-19 status; and (4) lobar or sublobar pneumonia with negative or unknown COVID-19 status. In the setting of positive COVID-19 testing and typical radiologic findings, the diagnosis of COVID-19 pneumonia is generally secure. The diagnosis prompts vigilance for thromboembolic disease acutely and, in severely ill patients, for invasive fungal disease. Persistent or recurrent air space opacities following COVID-19 infection may more often represent organizing pneumonia than secondary infection. When COVID-19 status is unknown or negative, widespread airway-centric disease suggests infection with mycoplasma, Haemophilus influenzae, or several respiratory viruses. Necrotizing pneumonia favors infection with pneumococcus, Staphylococcus, Klebsiella, and anaerobes. Lobar or sublobar pneumonia will continue to suggest the diagnosis of pneumococcus or consideration of other pathogens in the setting of local outbreaks. A positive COVID-19 test accompanied by these imaging patterns may suggest coinfection with one of the above pathogens, or when the prevalence of COVID-19 is very low, a false positive COVID-19 test. Clinicians may still proceed with testing for COVID-19 when radiologic patterns are atypical for COVID-19, dependent on the patient's exposure history and the local epidemiology of the virus.

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Organising pneumonia manifesting as a late-phase complication of COVID-19

Cited by 16 publications

References 12 publications

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

Greater central airway luminal area in people with COVID-19: a case–control series

Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19

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