Changes in lung ultrasound of symptomatic healthcare professionals with COVID-19 pneumonia and their association with clinical findings.

PURPOSE: To evaluate ultrasound signs of coronavirus disease-19 (COVID-19) pneumonia in symptomatic healthcare professionals and to correlate those changes with clinical findings. METHODS: All patients underwent real-time polymerase chain reaction (RT-PCR), lung ultrasound (LUS) and clinical evaluation on the same day. In each of the 12 areas evaluated in the LUS, the LUS signs were scored to generate the aeration score. RESULTS: A total of 409 participants had positive PCR, with a median age of 41 (35-51) years. All participants had clinical symptoms, with cough in 84.1%, fever in 69.7%, and dyspnea in 36.2% of cases. In the LUS, 72.6% of participants had B-lines >2, 36.2% had coalescent B-lines, and 8.06% had subpleural consolidations. The median aeration score was 3 (2-7). The aeration score differed significantly regarding the presence of cough (P = .002), fever (P = .001), and dyspnea (P < .0001). The finding of subpleural consolidations in the LUS showed significant differences between participants with or without dyspnea (P < .0001). CONCLUSIONS: In healthcare professionals with COVID-19, LUS plays a key role in the characterization of lung involvement. Although B-lines are the most common ultrasound sign, subpleural consolidations are those that most impact the respiratory condition.

Assessment of short- and long-term functionality and quality of life in patients with post-acute COVID-19 syndrome.

BACKGROUND: Although the number of new cases of coronavirus 2019 (COVID-19) has been drastically reduced worldwide, patients who demonstrate long-term symptoms need more attention from health systems, as these symptoms can negatively affect functionality and quality of life. OBJECTIVE: To evaluate muscle function and quality of life at 3, 6, 9 and 12 months in patients with post-acute COVID-19 syndrome and to assess their associations with general fatigue and lung function. METHODS: This observational and longitudinal study evaluated patients with post-acute COVID-19 syndrome. Participants were subjected to the following evaluations: Short Form-36; handgrip strength; Functional Assessment of Chronic Illness Therapy-Fatigue scale; and spirometry. RESULTS: Among the 350 participants who were evaluated in the third month, 74.6%, 61.4% and 45.4% reported general fatigue, dyspnoea and cough, respectively. In the comparisons between the third month and the sixth month, there were significant increases in Functional Assessment of Chronic Illness Therapy-Fatigue scale, pulmonary function and several Short Form-36 domains. In the comparisons between the sixth month and the ninth month, there was a significant increase only in the social functioning domain of the Short Form-36. In the comparisons between the ninth month and the twelfth month, there was an increase only in some Short Form-36 domains. Significant correlations were observed between the Short Form-36 domains with Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength and pulmonary function. CONCLUSION: In patients with post-acute COVID-19 syndrome, there was a progressive improvement in quality of life, general fatigue and pulmonary function during the 12 months of follow-up, with this improvement being more pronounced in the first 6 months. There was a relationship between functionality and quality of life in these patients.

Chocolate-Colored Pseudochylothorax in a Woman with a History of Pleuropulmonary Tuberculosis.

BACKGROUND Pseudochylothorax is a rare entity, with only a few hundred case reports worldwide. It presents as a pleural effusion rich in lipids, typically with a cloudy, milky appearance. The diagnosis is made based on the levels of cholesterol and triglycerides in the pleural fluid. CASE REPORT This is the case report of a 55-year-old woman with a history of pleuropulmonary tuberculosis that was treated in childhood, with a new infection and treatment in adulthood that evolved to a left pleural effusion. Thirteen years after completing her last treatment for tuberculosis, the patient developed general fatigue and dyspnea on exertion. Computed tomography of the chest confirmed the presence of a pleural collection in the same location as in adolescence, suggesting a chronic evolution with encystation. The patient underwent ultrasound-guided diagnostic thoracentesis. The collected liquid was thick, chocolate-colored, with the following biochemical characteristics: pH, 7.3; glucose, 37.9 mg/dL; LDL, 2059.8 IU/L; total protein, 8.8 mg/dL; triglycerides, 90 mg/dL; adenosine deaminase, 56 U/L; and cholesterol, 300 mg/dL. The effusion was characterized as a pseudochylothorax. The cell count showed 631 000 leukocytes/µL, with 87.9% polymorphonuclear cells. Owing to the patient's respiratory symptoms, an evacuatory thoracentesis was performed. After the procedure, the patient's symptoms improved. CONCLUSIONS Although pseudochylothorax is a rare condition, its possibility must always be kept in mind to avoid the hazards of misdiagnosis. In addition to the 'classic' milky and machine oil appearance, a chocolate-colored appearance should also serve as a clue to the diagnosis of pseudochylothorax.

High levels of pro-inflammatory SARS-CoV-2-specific biomarkers revealed by in vitro whole blood cytokine release assay (CRA) in recovered and long-COVID-19 patients.

BACKGROUND: Cytokines induced by SARS-CoV-2 infection play a crucial role in the pathophysiology of COVID-19 and hyperinflammatory responses have been associated with poor clinical outcomes, with progression to severe conditions or long-term subacute complications named as long-COVID-19. METHODS: In this cross-sectional study, we aimed to evaluate a set of antigen-specific inflammatory cytokines in blood from recovered COVID-19 individuals or who suffered a post-acute phase of SARS-CoV-2 infection compared to healthy individuals with no history of COVID-19 exposition or infection. Interferon-gamma (IFN-γ), IFN-γ-induced protein 10 (IP-10), tumor necrosis factor (TNF), IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, and IL-17A were quantified by multiplex cytometric bead assay and enzyme-linked immunosorbent assay after stimulation of whole blood with recombinant Spike protein from SARS-CoV-2. Additionally, all participants have evaluated for anti-(S) protein-specific IgG antibodies. Clinical specimens were collected within two months of COVID-19 diagnosis. RESULTS: A total of 47 individuals were enrolled in the study, a median age of 43 years (IQR = 14.5), grouped into healthy individuals with no history of infection or exposure to SARS-CoV-2 (unexposed group; N = 21); and patients from the Health Complex of the Rio de Janeiro State University (UERJ), Brazil, who were SARS-CoV-2 positive by RT-PCR (COVID-19 group)-categorized as recovered COVID-19 (N = 11) or long-COVID-19 (N = 15). All COVID-19 patients presented at least one signal or symptom during the first two weeks of infection. Six patients were hospitalized and required invasive mechanical ventilation. Our results showed that COVID-19 patients had significantly higher levels of IFN-γ, TNF, IL-1ß, IL-2, IL-6, IL-8, and IP-10 than the unexposed group. The long-COVID-19 group has presented significantly high levels of IL-1ß and IL-6 compared to unexposed individuals, but not from recovered COVID-19. A principal-component analysis demonstrated 84.3% of the total variance of inflammatory-SARS-CoV-2 response in the first two components, and it was possible to stratify IL-6, TNF, IL-1ß, IL-10, and IL-2 as the top-five cytokines which are candidates to discriminate COVID-19 group (including long-COVID-19 subgroup) and healthy unexposed individuals. CONCLUSION: We revealed important S protein-specific differential biomarkers in individuals affected by COVID-19, bringing new insights into the inflammatory status or SARS-CoV-2 exposition determination.

Small airway dysfunction on impulse oscillometry and pathological signs on lung ultrasound are frequent in post-COVID-19 patients with persistent respiratory symptoms.

BACKGROUND: Thousands of people worldwide are suffering the consequences of coronavirus disease-2019 (COVID-19), and impulse oscillometry (IOS) and lung ultrasound (LUS) might be important tools for the follow-up of this population. Our objective was to prospectively evaluate abnormalities detected using these two methods in a cohort of COVID-19 survivors with respiratory symptoms. METHODS: In this follow-up study, 59 patients underwent clinical evaluations, spirometry, IOS and LUS in the 2nd (M1) and 5th (M2) months after diagnostic confirmation of COVID-19 by real-time reverse transcriptase-polymerase chain reaction. Aeration scores were obtained from the LUS exams based on the following findings: B-lines >2, coalescent B-lines, and subpleural consolidations. RESULTS: Fifty-nine (100%) participants had cough and/or dyspnea at M1, which decreased to 38 (64.4%) at M2 (p = 0.0001). Spirometry was abnormal in 26 (44.1%) and 20 (33.9%) participants at M1 and M2, respectively, although without statistical significance (p = 0.10). Normal examination, restrictive patterns, and obstructive patterns were observed in 33 (55.9%), 18 (30.5%), and 8 (13.6%) participants, respectively, at M1 and in 39 (66.1%), 13 (22%), and 7 (11.9%) participants at M2 (p = 0.14). Regarding IOS, considering changes in resistive and reactive parameters, abnormal exams were detected in 52 (88.1%) and 42 (71.2%) participants at M1 and M2, respectively (p = 0.002). Heterogeneity of resistance between 4 and 20 Hz >20% was observed in 38 (64.4%) and 33 (55.9%) participants at M1 and M2, respectively (p = 0.30). Abnormal LUS was observed in 46 (78%) and 36 (61%) participants at M1 and M2, respectively (p = 0.002), with a reduction in aeration scores between M1 and M2 [5 (2-8) vs. 3 (0-6) points, p<0.0001]. CONCLUSIONS: IOS and LUS abnormalities are frequent in the first 5 months post-COVID-19 infection; however, when prospectively evaluated, significant improvement is evident in the parameters measured by these two methods.

One-month outcomes of patients with SARS-CoV-2 infection and their relationships with lung ultrasound signs.

BACKGROUND: The role of lung ultrasound (LUS) in evaluating the mid- and long-term prognoses of patients with COVID-19 pneumonia is not yet known. The objectives of this study were to evaluate associations between LUS signs at the time of screening and clinical outcomes 1 month after LUS and to assess LUS signs at the time of presentation with known risk factors for COVID-19 pneumonia. METHODS: This was a retrospective study of data prospectively collected 1 month after LUS screening of 447 adult patients diagnosed with COVID-19 pneumonia. Sonographic examination was performed in screening tents with the participants seated. The LUS signs (B-lines > 2, coalescent B-lines, and subpleural consolidations) were captured in six areas of each hemithorax and a LUS aeration score was calculated; in addition, the categories of disease probability based on patterns of LUS findings (high-probability, intermediate-probability, alternate, and low-probability patterns) were evaluated. The LUS signs at patients' initial evaluation were related to the following outcomes: symptomatology, the need for hospitalization or invasive mechanical ventilation (IMV), and COVID-19-related death. RESULTS: According to the evaluations performed 1 month after LUS screening, 36 patients were hospitalised, eight of whom required intensive care unit (ICU) admission and three of whom died. The presence of coalescent B-lines was associated with the need for hospitalization (p = 0.008). The presence of subpleural consolidations was associated with dyspnoea (p < 0.0001), cough (p = 0.003), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.002). A higher aeration score was associated with dyspnoea (p < 0.0001), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.003). In addition, patients with a high-probability LUS pattern had a higher aeration score (p < 0.0001) and more dyspnoea (p = 0.024) and more often required hospitalization (p < 0.0001) and ICU admission (p = 0.031). CONCLUSIONS: In patients with COVID-19 pneumonia, LUS signs were related to respiratory symptoms 1 month after LUS screening. Strong relationships were identified between LUS signs and the need for hospitalization and death.