The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review

Chong, Woon H.; Saha, Biplab K.; Conuel, Edward; Chopra, Amit

doi:10.1016/j.hrtlng.2021.02.015

Cited by 40 publications

(59 citation statements)

References 101 publications

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“…The occurrence of pneumothorax is similar for PJP patients, regardless of HIV-positivity status [ 5 , 6 , 28 , 30 ]. Compared to COVID-19 pneumonia, pneumothorax is a rare radiological finding and observed in less than 5% of cases [ 27 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

2021

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Background Pneumocystis jirovecii (P. jirovecii) is increasingly identified on lower respiratory tract specimens of COVID-19 patients. Our narrative review aims to determine whether the diagnosis of pneumocystis jirovecii pneumonia (PJP) in COVID-19 patients represents coinfection or colonization based on the evidence available in the literature. We also discuss the decision to treat COVID-19 patients with coinfection by PJP. Methods A literature search was performed through the Pubmed and Web of Science databases from inception to March 10, 2021. Results We identified 12 COVID-19 patients suspected to have PJP coinfection. All patients were critically ill and required mechanical ventilation. Many were immunosuppressed from HIV or long-term corticosteroids and other immunosuppressive agents. In both the HIV and non-HIV groups, severe lymphocytopenia was encountered with absolute lymphocyte and CD4+T cell count less than 900 and 200 cells/mm, respectively. The time to PJP diagnosis from the initial presentation was 7.8 (range 2–21) days. Serum lactate dehydrogenase and beta-D-glucan were elevated in those coinfected with PJP. All patients were treated with anti-PJP therapy, predominantly sulfamethoxazole-trimethoprim with corticosteroids. The overall mortality rate was 41.6%, and comparable for both HIV and non-HIV groups. Conclusion As the current evidence is restricted to case reports, the true incidence, risk factors, and prognosis of COVID-19 patients with PJP coinfections cannot be accurately determined. Comorbidities of poorly controlled HIV with lymphocytopenia and multiple immunosuppressive therapies are likely predisposing factors for PJP coinfection.

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Section: Discussionmentioning

confidence: 99%

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

2021

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“…Based on the reported case series and meta-analyses, the incidence has typically varied between 2-11% (Table 2) (13,(15)(16)(17)(41)(42)(43). A systematic review that included 47 observational studies reported an overall incidence of 7.3% (44). However, several small and single center studies had reported an incidence exceeding 20% (45)(46)(47)(48).…”

Section: Pleural Effusion In Covid-19mentioning

confidence: 99%

“…A small pediatric study of 16 patients reported the imaging findings in multisystem inflammatory syndrome and found the incidence of pleural effusion to be as high as 63% (49). The effusion can be unilateral or bilateral, with the majority being unilateral (44,50). The effusions are generally small to moderate sized, consistent with effusions seen with other viral pneumonia.…”

Section: Pleural Effusion In Covid-19mentioning

confidence: 99%

Pleural abnormalities in COVID-19: a narrative review

Saha

Chong²,

Austin³

et al. 2021

J Thorac Dis

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Objective: This narrative review aims to provide a detailed overview of pleural abnormalities in patients with coronavirus disease 19 or COVID-19.Background: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is a novel beta coronavirus responsible for COVID-19. Although pulmonary parenchymal and vascular changes associated with COVID-19 are well established, pleural space abnormalities have not been the primary focus of investigations.Methods: Narrative overview of the medical literature regarding pleural space abnormalities in COVID-19. The appropriate manuscripts were identified by searching electronic medical databases and by hand searching the bibliography of the identified papers. Pleural abnormalities on transverse and ultrasound imaging are discussed. The incidence, clinical features, pathophysiology, and fluid characteristics of pleural effusion are reviewed. Studies reporting pneumothorax and pneumomediastinum are examined to evaluate for pathogenesis and prognosis. A brief comparative analysis of pleural abnormalities among patients with COVID-19, severe acute respiratory syndrome (SARS), and Middle Eastern respiratory syndrome (MERS) has been provided.Conclusions: Radiologic pleural abnormalities are common in COVID-19, but the incidence of pleural effusion appears to be low. Pneumothorax is rare and does not independently predispose the patient to worse outcomes. SARS-CoV-2 infects the pleural space; however, whether the pleural fluid can propagate the infection is unclear.

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“…In a metaanalysis, Chong et al reviewed 47 observational studies with 4981 COVID-19 patients at risk of developing pleural effusion. They found a low incidence of 7.3% for parapneumonic pleural effusions which increased in those who were critically ill or had multisystem inflammatory syndrome [9] . They also suggested that the characteristic findings of COVID-19-related pleural effusion are exudative, lymphocytic or neutrophilic-predominant pleural fluid with markedly elevated LDH levels and a pleural fluid-to-serum (PF:S) LDH ratio of around 1.3.…”

Section: Discussionmentioning

confidence: 99%

Loculated Empyema and SARS-CoV-2 Infection: A Report of Two Cases and Review of the Literature

Ayad

Gergis

Elkattawy

et al. 2021

European Journal of Case Reports in Internal Medicine

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Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical manifestations are diverse and can vary from mild respiratory symptoms to severe hypoxic respiratory failure. In severe cases, infection can cause gastrointestinal, renal, cardiac, neurological and haematological complications and result in multi-organ failure. There are very few reports of parapneumonic effusion in patients with COVID-19. We describe two patients with COVID-19 who had loculated empyema and discuss the clinical course and therapeutic options.

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The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review

Cited by 40 publications

References 101 publications

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

Pleural abnormalities in COVID-19: a narrative review

Loculated Empyema and SARS-CoV-2 Infection: A Report of Two Cases and Review of the Literature

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