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

Karuna M Das; Edward Y Lee; Rajvir Singh; Mushira A Enani; Khalid Al Dossari; Klaus Van Gorkom; Sven G Larsson; Ruth D Langer

doi:10.4103/ijri.IJRI_469_16

Indian Journal of Radiology and Imaging, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(03): 342-349
DOI: 10.4103/ijri.IJRI_469_16

Thoracic Imaging

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

Karuna M Das

Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE; Department of Medical Imaging, King Fahad Medical City, Riyadh, KSA

,

Edward Y Lee

Department of Radiology and Medicine, Pulmonary Division, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA

,

Rajvir Singh

Department of Cardiology and Biostatistics, Hamad Medical Corporation, Doha, Qatar

,

Mushira A Enani

Department of Medicine (Infectious Disease), King Fahad Medical City, Riyadh, KSA

,

Khalid Al Dossari

Department of Medical Imaging, King Fahad Medical City, Riyadh, KSA

,

Klaus Van Gorkom

Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE

,

Sven G Larsson

Department of Medical Imaging, King Fahad Medical City, Riyadh, KSA

,

Ruth D Langer

Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE

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Abstract

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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.

Keywords

Lung fibrosis - MERS-CoV - Chest radiograph

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Referenzen

References
1 Zaki AM, Van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814-20.
2 MERS-an uncertain future, Editorial review. Lancet Infect Dis 2015;15:1115.
3 World Health Organization. Global Alert and Response (GAR). Corona virus infections. http://www.who.int/csr/disease/corona virus_infections/en/.
4 World Health Organization. Preliminary clinical description of severe acute respiratory syndrome. www.who.int/csr/sars/clinical/en/. [Accessed 2003March 21].
5 Das KM, Lee EY, Jawder SE, Enani MA, Singh R, Skakni L, et al. Acute Middle East Respiratory Syndrome Coronavirus: Temporal Lung Changes Observed on the Chest Radiographs of 55 Patients. AJR Am J Roentgenol 2015;205:W267-74.
6 Das KM, Lee EY, Enani MA, Jawder SE, Enani MA, Singh R, Skakni L, et al. CT correlation with outcomes in 15 patients with acute Middle East respiratory syndrome corona virus. AJR Am J Roentgenol 2015;204:736-42.
7 Das KM, Lee EY, Langer RD, Larsson SG. Middle East Respiratory Syndrome Coronavirus: What Does a Radiologist Need to Know? AJR Am J Roentgenol 2015;206:1193-01.
8 Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 1999;281:354-60.
9 Howling SJ, Evans TW, Hansell DM. The significance of bronchial dilatation on CT in patients with adult respiratory distress syndrome. Clin Radiol 1998;53:105-9.
10 Zapol WM, Trelstad RL, Coffey JW, Tsai I, Salvador RA. Pulmonary fibrosis in severe acute respiratory failure. Am Rev Respir Dis 1979;119:547-54.
11 The Who Mers-Cov Research Group. State of Knowledge and Data Gaps of Middle East Respiratory Syndrome Coronavirus (MERS-Cov) in Humans. PLoS Curr 2013;12:5.
12 Wong KT, Antonio GE, Hui DS, Lee N, Yuen EH, Wu A, et al. Severe acute respiratory syndrome: Radiographic appearances and pattern of progression in 138 patients. Radiology 2003;228:401-6.
13 Wong KT, Antonio GE, Hui DS, Lee N, Yuen EH, Wu A, et al. Thin-section CT of severe acute respiratory syndrome: Evaluation of 73 patients exposed to or with the disease. Radiology 2003;228:395-400.
14 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: Glossary of terms for thoracic imaging. Radiology 2008;246:697-722.
15 Ooi GC, Daqing M. SARS: Radiological features. Respirology 2003;8:S15-9.
16 Austin JH, Müller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, et-al. Glossary of terms for CT of the lungs: Recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 1996;200:327-31.
17 Collins J, Stern EJ. Chest radiology: The essentials. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008. p. 34-47.
18 Copley S, Hansell DM, Kanne JP. Thoracic imaging, CRC Press 2014:158-9.
19 Muller NL, Silva CIS. Mediastinum. In: Muller NL, Silva CIS, editors. Imaging of the chest. Philadelphia, Pa: Elsevier Saunders: 2008. p. 1447-572.
20 Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1986-94.
21 Chiang CH, Shih JF, Su WJ, Perng RP. Eight-month prospective study of 14 patients with hospital-acquired severe acute respiratory syndrome. Mayo Clin Proc 2004;79:1372-79.
22 Ooi GC, Khong PL, Müller NL, Yiu WC, Zhou LJ, Ho JC, et al. Severe acute respiratory syndrome: Temporal lung changes at thin-section CT in 30 patients. Radiology 2004;230:836-44.
23 Razer RS, Muller NL, Colman N, Pare PD. Viruses, mycoplasmas, chlamydiae, and rickettsiae. In: Fraser and Pare's diagnosis of diseases of the chest. 4th ed. Philadelphia, PA: Saunders: 1999. p. 979-1032.
24 Mineo G, Ciccarese F, Modolon C, Landini MP, Valentino M, Zompatori M. Post-ARDS lung fibrosis in patients with H1N1 pneumonia: Role of follow-up CT. Radiol Med 2012;117:185-200.
25 Antonio GE, Wong KT, Hui DS, Wu A, Lee N, Yuen EH, et al. Thin-section CT in patients with severe acute respiratory syndrome following hospital discharge: Preliminary experience. Radiology 2003;228:810-5.
26 Naik PK, Moore BB. Viral infection and aging as cofactors for the development of lung fibrosis. Expert Rev Respir Med 2010;4:759-71.
27 Moore BB, Moore TA. Viruses in Idiopathic Pulmonary Fibrosis. Etiology and Exacerbation. Ann Am Thorac Soc 2015;12:S186-92.
28 Molyneaux PL, Cox MJ, Willis-Owen SA, Mallia A, Russell KE, Russell AM, et al. The role of bacteria in the pathogenesis and progression of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2014;190:906-13.