Spectrum of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) patients in India

Objective: The study aimed to describe the clinical and imaging course of reverse transcriptase polymerase chain reaction) confirmed coronavirus disease (COVID-19) patients who are asymptomatic at admission. Methods: This was a retrospective observational study. Severe acute respiratory syndrome coronavisrus-2 (SARS-CoV-2) positive cases that were asymptomatic at admission were retrospectively enrolled. Specific clinical information, laboratory test results, chest CT imaging features and outcome data during hospital stay were collected and analyzed. Results: 137 non-consecutive asymptomatic patients with reverse transcriptase polymerase chain reaction confirmed COVID-19 were enrolled in the present study. On admission, patients had no symptoms but chest CT findings were present in 61/137 (44.5%). Ground glass opacity (48, 78.7%) followed by ground glass opacity with crazy-paving pattern (9, 14.7%) were the commonest type of opacities with posterior, peripheral predominance and lower zone predilection. Among the initial CT positive group of 61 patients, follow-up imaging revealed progression of pulmonary opacities in 13/61 (21.4%), complete resorption in 21/61 (34.4%), partial resolution in 22/61 (36%) and no change in 5/61 (8.2%). The patients in progression group (54 ± 19.7 years) were older and had higher frequency of co-morbidities (46.2%) compared to the other three groups (10.4%). The patients in progression group had a significantly higher C-reactive protein, higher lactate dehydrogenase and lower lymphocyte count than the other groups (all p-values < 0.05). The duration of hospital stay was longer in the progression group (27.1 ± 11.4 days) compared to the other three groups (16.12 ± 5.8) (p =< 0.05). Conclusion: Nearly half of the asymptomatic cases with confirmed COVID-19 had abnormal chest CT imaging. Asymptomatic infections can have a variable clinicoradiological course. Clinically, some recover without developing symptoms, some present few mild symptoms whereas some deteriorate. Similarly, imaging follow-up may reveal resolution (partial or complete), progression or no change. Advances in knowledge: Clinicoradiological course of asymptomatic COVID-19 cases is diverse.

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“…Older age has been found to an important risk factor for severe disease and adverse outcome. 18,21,22 …”

Section: Discussionmentioning

confidence: 99%

Clinicoradiological course in coronavirus disease-19 (COVID-19) patients who are asymptomatic at admission

et al. 2020

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“…Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged in Hubai province in mainland China in December 2019, and is the etiological agent of coronavirus disease (COVID)-19 ( 1 ). SARS-CoV-2 can cause asymptomatic to severe lower respiratory tract infections in humans, with early clinical signs including fever, cough and dyspnea ( 2 , 3 ). Progression to severe disease may be marked by acute respiratory distress syndrome (ARDS), with pulmonary edema, bilateral diffuse alveolar damage and hyaline membrane formation ( 4 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

K18-hACE2 mice develop respiratory disease resembling severe COVID-19

Yinda

Port

Bushmaker

et al. 2020

Preprint

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SARS-CoV-2 emerged in late 2019 and resulted in the ongoing COVID-19 pandemic. Several animal models have been rapidly developed that recapitulate the asymptomatic to moderate disease spectrum. Now, there is a direct need for additional small animal models to study the pathogenesis of severe COVID-19 and for fast-tracked medical countermeasure development. Here, we show that transgenic mice expressing the human SARS-CoV-2 receptor (angiotensin-converting enzyme 2 [hACE2]) under a cytokeratin 18 promoter (K18) are susceptible to SARS-CoV-2 and that infection resulted in a dose-dependent lethal disease course. After inoculation with either 104 TCID50 or 105 TCID50, the SARS-CoV-2 infection resulted in rapid weight loss in both groups and uniform lethality in the 105 TCID50 group. High levels of viral RNA shedding were observed from the upper and lower respiratory tract and intermittent shedding was observed from the intestinal tract. Inoculation with SARS-CoV-2 resulted in upper and lower respiratory tract infection with high infectious virus titers in nasal turbinates, trachea and lungs. The observed interstitial pneumonia and pulmonary pathology, with SARS-CoV-2 replication evident in pneumocytes, were similar to that reported in severe cases of COVID-19. SARS-CoV-2 infection resulted in macrophage and lymphocyte infiltration in the lungs and upregulation of Th1 and proinflammatory cytokines/chemokines. Extrapulmonary replication of SARS-CoV-2 was observed in the cerebral cortex and hippocampus of several animals at 7 DPI but not at 3 DPI. The rapid inflammatory response and observed pathology bears resemblance to COVID-19. Taken together, this suggests that this mouse model can be useful for studies of pathogenesis and medical countermeasure development.

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“…Since the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Wuhan, China, in December 2019, the virus has spread across the globe and has caused over 70 million cases and 1.5 million deaths as of December 2020 [1]. Infection with SARS-CoV-2 can cause asymptomatic to severe lower respiratory tract infections in humans [2,3]. Peak respiratory shedding in humans occurs at the time of symptom onset or in the week thereafter, followed by a steady decline after the induction of a humoral immune response [4].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 disease severity and transmission efficiency is increased for airborne but not fomite exposure in Syrian hamsters

Port

Yinda

Owusu

et al. 2020

Preprint

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Transmission of SARS-CoV-2 is driven by contact, fomite, and airborne transmission. The relative contribution of different transmission routes remains subject to debate. Here, we show Syrian hamsters are susceptible to SARS-CoV-2 infection through intranasal, aerosol and fomite exposure. Different routes of exposure presented with distinct disease manifestations. Intranasal and aerosol inoculation caused more severe respiratory pathology, higher virus loads and increased weight loss. Fomite exposure led to milder disease manifestation characterized by an anti-inflammatory immune state and delayed shedding pattern. Whereas the overall magnitude of respiratory virus shedding was not linked to disease severity, the onset of shedding was. Early shedding was linked to an increase in disease severity. Airborne transmission was more efficient than fomite transmission and dependent on the direction of the airflow. Carefully characterized of SARS-CoV-2 transmission models will be crucial to assess potential changes in transmission and pathogenic potential in the light of the ongoing SARS-CoV-2 evolution.

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Spectrum of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) patients in India

Cited by 40 publications

References 20 publications

Clinicoradiological course in coronavirus disease-19 (COVID-19) patients who are asymptomatic at admission

Clinicoradiological course in coronavirus disease-19 (COVID-19) patients who are asymptomatic at admission

K18-hACE2 mice develop respiratory disease resembling severe COVID-19

SARS-CoV-2 disease severity and transmission efficiency is increased for airborne but not fomite exposure in Syrian hamsters

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