RESUMO
Coronavirus disease 2019 (COVID-19) is a highly infectious type of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has rapidly become a global pandemic. COVID-19, SARS and Middle East respiratory syndrome (MERS) are all caused by members of the Coronaviridae family. As expected, emerging genetic and clinical evidence from patients with COVID-19 has indicated that the pathway of infection is similar to that of SARS and MERS. Additionally, much like SARS and MERS, chest imaging serves an important role in the diagnosis, management and follow-up of patients with COVID-19. Although these related viruses present a similar pneumonic pathogenesis, the imaging results have distinguishable features. The current review evaluated the imaging results of patients with SARS and MERS and explored the potential similarities and differences among patients with COVID-19, SARS and MERS at early, progressive, severe and recovery stages, with the aim of improving our understanding of SARS-CoV-2 infections by comparing the features of COVID-19 images with those of SARS and MERS. The current review assessed whether imaging results had implications for the administration of corticosteroids as treatment for COVID-19. Whether corticosteroids can inhibit inflammatory cytokine storms and reduce the mortality of patients with viral pneumonia remains controversial. However, his review may help radiologists and clinicians to identify viral pneumonia and guide appropriate COVID-19 treatment.
RESUMO
OBJECTIVE: To understand the clinical features of critically ill patients with pandemic 2009 influenza A (H1N1) and investigate the risk factors associated with death cases. METHODS: The clinical features of 55 critically ill patients with pandemic 2009 influenza A (H1N1) viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15, 2009 were retrospectively analyzed, and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. RESULTS: There were 31 males and 24 females. The age ranged from 10 months to 84 year old, and the mean (SD) was 38 (20) year old. The critically ill cases were more in patients under age 65 (48/55), with obesity (33/49), with underlying diseases (26/49), and pregnancy (6/24). Both the survivors and non-survivors of patients had high fever, cough, sputum (some sputum with blood), dyspnea, räles of both lungs fields, and all further developed severe pneumonia. The patients also showed respiratory failure (54/55) and ARDS (26/55). All of them received oseltamivir therapy, and 38 patients received mechanical ventilation and 30 were given steroid therapy. Secondary infection occurred in 27 cases, and ventilator-associated pneumonia happened in 10 patients. In the early stage of onset, C-reactive protein (CRP) increased [(131 ± 130) mg/L] and low counts of T lymphocytes were present [CD(4)(+), CD(8)(+) T was (217 ± 139)/µl and (162 ± 82)/µl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P < 0.05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks (OR was 6.512, 19.631 respectively, both of P value was low than 0.05). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. CONCLUSIONS: Critical illness in pandemic 2009 influenza A (H1N1) was associated with patients under age 65, with obesity, underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.
