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Respiratory Disease in the COVID-19 Era

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 28585

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Dr. Masaki Okamoto

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Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
Interests: respirology; diffuse lung disease
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Dear Colleagues,

Coronavirus disease 2019 (COVID-19) is a new respiratory disease caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused a global pandemic. COVID-19 patients often develop acute respiratory distress syndrome (ARDS), which involves acute and lethal respiratory failure. In a meta-analysis, the median incidence of ARDS in COVID-19 patients was found to be 35 (2-79)%, while the mortality rate in COVID-19-associated ARDS patients was found to be 39 (12.5-73.1)% (Hasan, et al. Expert Rev Repoir Med. 2020; 14: 1149). As of 12 December 2021, 270,373,764 cases had been confirmed as COVID-19 and 5,321,321 cases had resulted in death, according to the World Health Organization webpage.

Various symptoms such as persistent fatigue, myalgia, and insomnia can persist after recovery from COVID-19; these symptoms are called “long COVID-19”. Patients with COVID-19 who survive but develop pulmonary fibrosis may experience persistent dyspnea upon exertion, a decrease in pulmonary function, and/or a radiological abnormal shadow. Antifibrotic drugs including nintedanib and pirfenidone are candidate drugs for the treatment of pulmonary fibrosis due to COVID-19; randomized controlled trials are ongoing.

However, there are limited studies about respiratory disease caused by COVID-19. Given the clinical significance of this topic and its impact on clinical practice and public health, Medicina is launching a Special Issue entitled “Respiratory Disease in the COVID-19 Era” with the aim of gathering accurate and up-to-date scientific information of this topic. We are pleased to invite you and your co-workers to submit your original articles. We also encourage the submission of original manuscripts spanning basic to clinical research and focusing on respiratory disease due to COVID-19. We would also like to invite you to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding its pharmacological aspects. Interesting case reports of respiratory disease due to COVID-19 are also welcome.

Dr. Masaki Okamoto
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

COVID-19 (coronavirus disease 2019)
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)
acute respiratory distress syndrome
dyspnea

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Editorial

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2 pages, 218 KiB

Open AccessEditorial

Special Issue: “Respiratory Disease in the COVID-19 Era”

by Masaki Okamoto

Medicina 2023, 59(5), 886; https://doi.org/10.3390/medicina59050886 - 5 May 2023

Viewed by 1268

Abstract

The outbreak of the viral infection known as coronavirus disease 2019 (COVID-19), caused by the novel pathogen severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first reported in Wuhan, China, in December 2019 [...] Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

Research

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9 pages, 688 KiB

Open AccessArticle

Thoracic Mobilization and Respiratory Muscle Endurance Training Improve Diaphragm Thickness and Respiratory Function in Patients with a History of COVID-19

by Yang-Jin Lee

Medicina 2023, 59(5), 906; https://doi.org/10.3390/medicina59050906 - 9 May 2023

Cited by 4 | Viewed by 2533

Abstract

Background and Objectives: Common problems in people with COVID-19 include decreased respiratory strength and function. We investigated the effects of thoracic mobilization and respiratory muscle endurance training (TMRT) and lower limb ergometer (LE) training on diaphragm thickness and respiratory function in patients with a history of COVID-19. Materials and Methods: In total, 30 patients were randomly divided into a TMRT training group and an LE training group. The TMRT group performed thoracic mobilization and respiratory muscle endurance training for 30 min three times a week for 8 weeks. The LE group performed lower limb ergometer training for 30 min three times a week for 8 weeks. The participants’ diaphragm thickness was measured via rehabilitative ultrasound image (RUSI) and a respiratory function test was conducted using a MicroQuark spirometer. These parameters were measured before the intervention and 8 weeks after the intervention. Results: There was a significant difference (p < 0.05) between the results obtained before and after training in both groups. Right diaphragm thickness at rest, diaphragm thickness during contraction, and respiratory function were significantly more improved in the TMRT group than in the LE group (p < 0.05). Conclusions: In this study, we confirmed the effects of TMRT training on diaphragm thickness and respiratory function in patients with a history of COVID-19. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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11 pages, 2080 KiB

Open AccessArticle

Patients with Diabetes Experienced More Serious and Protracted Sickness from the COVID-19 Infection: A Prospective Study

by Muiez Bashir, Wani Inzamam, Irfan Robbani, Tanveer Rasool Banday, Fahad A. Al-Misned, Hamed A. El-Serehy and Carmen Vladulescu

Medicina 2023, 59(3), 472; https://doi.org/10.3390/medicina59030472 - 27 Feb 2023

Cited by 3 | Viewed by 2056

Abstract

Background and Objectives: In December 2019, a flu-like illness began in the Chinese city of Wuhan. This sickness mainly affected the lungs, ranging from a minor respiratory tract infection to a severe lung involvement that mimicked the symptoms of Severe Acute Respiratory Syndrome (SARS). The World Health Organization (WHO) labelled this sickness as a pandemic in March 2020, after it quickly spread throughout the world population. It became clear, as the illness progressed, that people with concomitant illnesses, particularly diabetes mellitus (DM) and other immunocompromised states, were outmatched by this illness. This study was aimed to evaluate the correlation between Computed Tomographic Severity Score (CTSS) and underlying diabetes mellitus in coronavirus disease (COVID)-19 patients. Materials and Methods: This was a hospital-based prospective study in which a total of 152 patients with reverse transcriptase polymerase chain reaction (RT-PCR) positive COVID status who underwent high-resolution computed tomography (HRCT) of the chest were evaluated and categorized into mild, moderate and severe cases based on the extent of lung parenchymal involvement. A total score from 0–25 was given, based on the magnitude of lung involvement. Statistical analysis was used to derive a correlation between DM and CTSS, if any. Results: From our study, it was proven that patients with underlying diabetic status had more severe involvement of the lung as compared to non-diabetics, and it was found to be statistically significant (p = 0.024). Conclusions: On analysis of what we found based on the study, it can be concluded that patients with underlying diabetic status had a more prolonged and severe illness in comparison to non-diabetics, with higher CTSS in diabetics than in non-diabetics. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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11 pages, 1336 KiB

Open AccessArticle

Lung Ultrasound Is Useful for Evaluating Lung Damage in COVID-19 Patients Treated with Bamlanivimab and Etesevimab: A Single-Center Pilot Study

by Sebastiano Cicco, Marialuisa Sveva Marozzi, Carmen Alessandra Palumbo, Elisabetta Sturdà, Antonio Fusillo, Flavio Scarilli, Federica Albanese, Claudia Morelli, Davide Fiore Bavaro, Lucia Diella, Annalisa Saracino, Fabrizio Pappagallo, Antonio Giovanni Solimando, Gianfranco Lauletta, Roberto Ria and Angelo Vacca

Medicina 2023, 59(2), 203; https://doi.org/10.3390/medicina59020203 - 19 Jan 2023

Cited by 1 | Viewed by 2066

Abstract

Background and Objectives: COVID-19 induces massive systemic inflammation. Researchers have spent much time and effort finding an excellent and rapid image tool to evaluate COVID-19 patients. Since the pandemic’s beginning, lung ultrasound (LUS) has been identified for this purpose. Monoclonal antibodies (mAb) were used to treat mild patients and prevent respiratory disease worsening. Materials and Methods: We evaluated 15 Caucasian patients with mild COVID-19 who did not require home oxygen, treated with Bamlanivimab and Etesevimab (Group 1). A molecular nose–throat swab test confirmed the diagnosis. All were office patients, and nobody was affected by respiratory failure. They were admitted to receive the single-day infusion of mAb treatment in agreement with the Italian Drug Agency (AIFA) rules for approval. LUS was performed before the drug administration (T0) and after three months (T1). We compared LUS at T1 in other outpatients who came for follow-up and were overlapping at the time of diagnosis for admittance criteria to receive mAb (Group 2). Results: Our COVID-19 outpatients reported no hospitalization in a follow-up visit after recovery. All patients became SARS-CoV-2 negative within one month since T0. LUS score at T0 was 8.23 ± 6.46. At T1 we found a significant decrease in Group 1 LUS score (5.18 ± 4.74; p < 0.05). We also found a significant decrease in the LUS score of Group 1 T1 compared to Group2 T1 (5.18 ± 4.74 vs 7.82 ± 5.21; p < 0.05). Conclusion: Early treatment of the SARS-CoV-2 virus effectively achieves a better recovery from disease and reduces lung involvement after three months as evaluated with LUS. Despite extrapolation to the general population may be done with caution, based on our data this ultrasound method is also effective for evaluating and following lung involvement in COVID-19 patients. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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10 pages, 994 KiB

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Efficacy of Therapeutic Plasma Exchange in Severe Acute Respiratory Distress Syndrome in COVID-19 Patients from the Western Part of Romania

by Tamara Mirela Porosnicu, Ciprian Gindac, Sonia Popovici, Adelina Marinescu, Daniel Jipa, Valentina Lazaroiu, Dorel Sandesc, Cristian Oancea, Roxana Folescu, Alexandra-Simona Zamfir, Carmen Lacramioara Zamfir, Laura Alexandra Nussbaum and Ioan Ovidiu Sirbu

Medicina 2022, 58(12), 1707; https://doi.org/10.3390/medicina58121707 - 23 Nov 2022

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Abstract

Background and Objectives: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has surprised the medical world with its devastating effects such as severe acute respiratory distress syndrome (ARDS) and cytokine storm, but also with the scant therapeutic solutions which have proven to be effective against the disease. Therapeutic plasma exchange (TPE) has been proposed from the very beginning as a possible adjuvant treatment in severe cases. Our objective was to analyze the evolution of specific biological markers of the COVID-19 disease before and one day after a therapeutic plasma exchange session, how a change in these parameters influences the patient’s respiratory status, as well as the impact of TPE on the survival rate. Materials and Methods: In this retrospective study, we include 65 patients with COVID-19 admitted to the intensive care unit department of our hospital between March 2020 and December 2021, and who received a total of 120 sessions of TPE. Results: TPE significantly reduced the following inflammation markers (p < 0.001): interleukin-6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase (LDH), fibrinogen, ferritin, and erythrocyte sedimentation rate. This procedure significantly increased the number of lymphocytes and decreased D-dimers levels (p = 0.0024). TPE significantly improved the PaO₂/FiO₂ ratio (p < 0.001) in patients with severe acute respiratory distress syndrome (PaO₂/FiO₂ < 100). Survival was improved in intubated patients who received TPE. Conclusions: TPE involved the reduction in inflammatory markers in critical patients with COVID-19 disease and the improvement of the PaO₂/FiO₂ ratio in patients with severe ARDS and had a potential benefit on the survival of patients with extremely severe COVID-19 disease. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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5 pages, 290 KiB

Open AccessCommunication

COVID-19 Pneumonia in Fully Vaccinated Adults during the Dominance of the Omicron Sublineages BA.1.1 and BA.2 in Mexico

by Efrén Murillo-Zamora, Xóchitl Trujillo, Miguel Huerta, Mónica Riós-Silva, José Guzmán-Esquivel, Jaime Alberto Bricio-Barrios, Oliver Mendoza-Cano and Agustin Lugo-Radillo

Medicina 2022, 58(8), 1127; https://doi.org/10.3390/medicina58081127 - 19 Aug 2022

Cited by 1 | Viewed by 2494

Abstract

Background and Objectives: A nationwide retrospective cohort study was conducted to evaluate the factors associated with the risk of laboratory-confirmed coronavirus disease 2019 (COVID-19)-related pneumonia in fully vaccinated adults during the dominance of the Omicron sublineages in Mexico. Materials and Methods: Fully COVID-19-vaccinated adults with laboratory-positive illness and symptom onset from April to mid-June 2022 were eligible. We computed the eta-squared (η²) to evaluate the effect size of the study sample. The characteristics predicting pneumonia were evaluated through risk ratios (RRs), and the 95% confidence intervals (CIs) were computed through generalized linear models. Results: The data from 35,561 participants were evaluated, and the overall risk of pneumonia was 0.5%. In multiple analyses, patients aged ≥ 60 years old were at increased risk of developing pneumonia (vs. 20–39 years old: RR = 1.031, 95% CI = 1.027–1.034). Chronic pulmonary obstructive disease, type 2 diabetes mellitus, arterial hypertension, chronic kidney disease (any stage), and immunosuppression (any cause) were also associated with a higher pneumonia risk. The η² of all the variables included in the multiple models was <0.06. Conclusions: Our study suggests that, even when fully COVID-19-vaccinated, older adults and those with chronic conditions were at increased risk of pneumonia during the dominance of the Omicron sublineages BA.1.1 and BA.2. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

13 pages, 1433 KiB

Open AccessArticle

Eight Weeks of Supervised Pulmonary Rehabilitation Are Effective in Improving Resting Heart Rate and Heart Rate Recovery in Severe COVID-19 Patient Survivors of Mechanical Ventilation

by María Fernanda del Valle, Jorge Valenzuela, Gabriel Nasri Marzuca-Nassr, Consuelo Cabrera-Inostroza, Mariano del Sol, Pablo A. Lizana, Máximo Escobar-Cabello and Rodrigo Muñoz-Cofre

Medicina 2022, 58(4), 514; https://doi.org/10.3390/medicina58040514 - 5 Apr 2022

Cited by 7 | Viewed by 3429

Abstract

Background and Objectives: Patients who survive severe COVID-19 require significant pulmonary rehabilitation. Heart rate (HR) has been used as a safety variable in the evaluation of the results of interventions in patients undergoing pulmonary rehabilitation. The aim of this research was to analyse HR during a pulmonary rehabilitation program in post-severe COVID-19 patients who survived mechanical ventilation (MV). The study includes the initial and final evaluations and aerobic training sessions. Materials and Methods: Twenty patients (58 ± 13 years, 11 men) were trained for 8 weeks. A 6-minute walk test (6 MWT) was performed and, subsequently, a supervised and individualised training plan was created. Resting heart rate (RHR), heart rate recovery (HRR), heart rate at minute 6 (HR6 min) and the product of HR6 min and systolic blood pressure (HR6 min^xSBP) were measured at 6 MWT. In addition, HR was measured at each training session. Results: After 8 weeks of pulmonary rehabilitation, patients decreased their RHR from 81.95 ± 9.36 to 73.60 ± 9.82 beats/min (p < 0.001) and significantly increased their HRR from 12.45 ± 10.22 to 20.55 ± 7.33 beats/min (p = 0.005). HR6 min presented a significant relationship with walking speed and walked distance after the pulmonary rehabilitation period (r = 0.555, p = 0.011 and r = 0.613, p = 0.011, respectively). HR6 min^xSBP presented a significant relationship with walking speed and walked distance after training (r = 0.538, p = 0.014 and r = 0.568, p = 0.008, respectively). In the pulmonary rehabilitation sessions, a significant decrease in HR was observed at minutes 1, 6 and 15 (p < 0.05) between sessions 1 and 6 and at minute 1 between sessions 1 and 12. Conclusions: Eight weeks of individualised and supervised pulmonary rehabilitation were effective in improving RHR and HRR in COVID-19 patients surviving MV. HR is an easily accessible indicator that could help to monitor the evaluation and development of a pulmonary rehabilitation program in COVID-19 patients who survived MV. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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9 pages, 723 KiB

Open AccessCase Report

Case Series of Patients with Coronavirus Disease 2019 Pneumonia Treated with Hydroxychloroquine

by Tomohiro Tanaka, Masaki Okamoto, Norikazu Matsuo, Yoshiko Naitou-Nishida, Takashi Nouno, Takashi Kojima, Yuuya Nishii, Yoshihiro Uchiyashiki, Hiroaki Takeoka and Yoji Nagasaki

Medicina 2023, 59(3), 541; https://doi.org/10.3390/medicina59030541 - 10 Mar 2023

Cited by 1 | Viewed by 2050

Abstract

The efficacy of hydroxychloroquine (HCQ) therapy, a previous candidate drug for coronavirus disease 2019 (COVID-19), was denied in the global guideline. The risk of severe cardiac events associated with HCQ was inconsistent in previous reports. In the present case series, we show the tolerability of HCQ therapy in patients treated in our hospital, and discuss the advantages and disadvantages of HCQ therapy for patients with COVID-19. A representative case was a 66-year-old woman who had become infected with severe acute respiratory syndrome coronavirus 2 and was diagnosed as having COVID-19 pneumonia via polymerase chain reaction. She was refractory to treatment with levofloxacin, lopinavir, and ritonavir, while her condition improved after beginning HCQ therapy without severe side effects. We show the tolerability of HCQ therapy for 27 patients treated in our hospital. In total, 21 adverse events occurred in 20 (74%) patients, namely, diarrhea in 11 (41%) patients, and elevated levels of both aspartate aminotransferase and alanine transaminase in 10 (37%) patients. All seven grade ≥ 4 adverse events were associated with the deterioration in COVID-19 status. No patients discontinued HCQ treatment because of HCQ-related adverse events. Two patients (7%) died of COVID-19 pneumonia. In conclusion, HCQ therapy that had been performed for COVID-19 was well-tolerated in our case series. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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6 pages, 607 KiB

Open AccessCase Report

A Cluster of Paragonimiasis with Delayed Diagnosis Due to Difficulty Distinguishing Symptoms from Post-COVID-19 Respiratory Symptoms: A Report of Five Cases

by Jun Sasaki, Masanobu Matsuoka, Takashi Kinoshita, Takayuki Horii, Shingo Tsuneyoshi, Daiki Murata, Reiko Takaki, Masaki Tominaga, Mio Tanaka, Haruhiko Maruyama, Tomotaka Kawayama and Tomoaki Hoshino

Medicina 2023, 59(1), 137; https://doi.org/10.3390/medicina59010137 - 10 Jan 2023

Cited by 3 | Viewed by 2335

Abstract

Paragonimiasis caused by trematodes belonging to the genus Paragonimus is often accompanied by chronic respiratory symptoms such as cough, the accumulation of sputum, hemoptysis, and chest pain. Prolonged symptoms, including respiratory symptoms, after coronavirus disease 2019 infection (COVID-19) are collectively called post-COVID-19 conditions. Paragonimiasis and COVID-19 may cause similar respiratory symptoms. We encountered five cases of paragonimiasis in patients in Japan for whom diagnoses were delayed due to the initial characterization of the respiratory symptoms as a post-COVID-19 condition. The patients had consumed homemade drunken freshwater crabs together. One to three weeks after consuming the crabs, four of the five patients were diagnosed with probable COVID-19. The major symptoms reported included cough, dyspnea, and chest pain. The major imaging findings were pleural effusion, pneumothorax, and nodular lesions of the lung. All the patients were diagnosed with paragonimiasis based on a serum antibody test and peripheral blood eosinophilia (560–15,610 cells/μL) and were treated successfully with 75 mg/kg/day praziquantel for 3 days. Before diagnosing a post-COVID-19 condition, it is necessary to consider whether other diseases, including paragonimiasis, may explain the symptoms. Further, chest radiographic or blood tests should be performed in patients with persistent respiratory symptoms after being infected with COVID-19 to avoid overlooking the possibility of infection. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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8 pages, 1247 KiB

Open AccessCase Report

A Case of a Malignant Lymphoma Patient Persistently Infected with SARS-CoV-2 for More than 6 Months

by Yoji Nagasaki, Masanori Kadowaki, Asako Nakamura, Yoshiki Etoh, Masatoshi Shimo, Sayoko Ishihara, Yoko Arimizu, Rena Iwamoto, Seiji Kamamuta and Hiromi Iwasaki

Medicina 2023, 59(1), 108; https://doi.org/10.3390/medicina59010108 - 4 Jan 2023

Cited by 6 | Viewed by 2806

Abstract

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). There are many unknowns regarding the handling of long-term SARS-CoV-2 infections in immunocompromised patients. Here, we describe the lethal disease course in a SARS-CoV-2-infected patient during Bruton’s tyrosine kinase inhibitor therapy. We performed whole-genome analysis using samples obtained during the course of the disease in a 63-year-old woman who was diagnosed with intraocular malignant lymphoma of the right eye in 2012. She had received treatment since the diagnosis. An autologous transplant was performed in 2020, but she experienced a worsening of the primary disease 26 days before she was diagnosed with a positive SARS-CoV-2 RT-PCR. Tirabrutinib was administered for the primary disease. A cluster of COVID-19 infections occurred in the hematological ward while the patient was hospitalized, and she became infected on day 0. During the course of the disease, she experienced repeated remission exacerbations of COVID-19 pneumonia and eventually died on day 204. SARS-CoV-2 whole-viral sequencing revealed that the patient shed the virus long-term. Viral infectivity studies confirmed infectious virus on day 189, suggesting that the patient might be still infectious. This case report describes the duration and viral genetic evaluation of a patient with malignant lymphoma who developed SARS-CoV-2 infection during Bruton’s tyrosine kinase inhibitor therapy and in whom the infection persisted for over 6 months. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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6 pages, 560 KiB

Open AccessCase Report

Massive Spontaneous Pneumomediastinum—A Form of Presentation for Severe COVID-19 Pneumonia

by Camelia Corina Pescaru, Monica Steluța Marc, Emanuela Oana Costin, Andrei Pescaru, Ana-Adriana Trusculescu, Adelina Maritescu, Noemi Suppini and Cristian Iulian Oancea

Medicina 2022, 58(11), 1525; https://doi.org/10.3390/medicina58111525 - 26 Oct 2022

Viewed by 1801

Abstract

For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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5 pages, 1275 KiB

Open AccessCase Report

Pneumocystis jirovecii Pneumonia Associated with COVID-19 in Patients with Interstitial Pneumonia

by Tomoyuki Takahashi, Atsushi Saito, Koji Kuronuma, Hirotaka Nishikiori and Hirofumi Chiba

Medicina 2022, 58(9), 1151; https://doi.org/10.3390/medicina58091151 - 24 Aug 2022

Cited by 5 | Viewed by 2194

Abstract

Here, we report two cases of patients with interstitial pneumonia (IP) on steroids who developed Pneumocystis jirovecii pneumonia (PJP) following coronavirus disease 2019 (COVID-19) infection. Case 1: A 69-year-old man on 10 mg of prednisolone (PSL) daily for IP developed new pneumonia shortly after his COVID-19 infection improved and was diagnosed with PJP based on chest computed tomography (CT) findings and elevated serum β-D-glucan levels. Trimethoprim–sulfamethoxazole (TMP–SMZ) was administered, and the pneumonia resolved. Case 2: A 70-year-old woman taking 4 mg/day of PSL for IP and rheumatoid arthritis developed COVID-19 pneumonia, which resolved mildly, but her pneumonia flared up and was diagnosed as PJP based on CT findings, elevated β-D-glucan levels, and positive polymerase chain reaction for P. jirovecii DNA in the sputum. The autopsy revealed diffuse alveolar damage, increased collagen fiver and fibrotic foci, mucinous component accumulation, and the presence of a P. jirovecii cyst. In conclusion, steroids and immunosuppressive medications are well-known risk factors for PJP. Patients with IP who have been taking these drugs for a long time are frequently treated with additional steroids for COVID-19; thus, PJP complications should be avoided in such cases. Full article

(This article belongs to the Special Issue Respiratory Disease in the COVID-19 Era)

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