scholarly journals Community-acquired pneumonia in children in the era of the COVID-19 pandemic. What has changed?

2021 ◽  
pp. 214-219
Author(s):  
Olga V. Zaytseva ◽  
Svetlana V. Zaytseva ◽  
Evelina E. Lokshina ◽  
Dmitriy V. Khaspekov ◽  
Nadezhda V. Tkachenko ◽  
...  
Keyword(s):  
Pleural Cavity ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Infusion Therapy ◽  
Pediatric Hospital ◽  
Interstitial Syndrome ◽  
Rational Therapy ◽  
Coronavirus Infection ◽  
The Right ◽  
Contrast Ct

During COVID-19 pandemic the issue of diagnosis and rational therapy of community-acquired pneumonia in children became acute. This is caused by difficulties in verification of the diagnosis of community-acquired pneumonia in the outpatient department, peculiarities of interpretation of the respiratory system lesions. The article presents clinical cases of communityacquired pneumonia in children admitted to the pulmonology department of a pediatric hospital.Clinical case 1. 5-year-old child, medical history: acutely fell ill, on 28.11.20, had a sore throat and fever up to 39.0 C. Received Kagocel, Miramistin, Nurofen. PCR for COVID-19 on 08.12.20 was positive, on 18.12.2020, 22.12.2020, 20.01.2021 - negative. Immunoassay (ELISA) on 12.23.20: IgM - 4.47, IgG - 255.25. Lung and pleural cavity ultrasound: echo signs of sharply pronounced interstitial syndrome, massive fibrinothorax on both sides, indirect signs of bronchopleural fistulas; lung radiography: bilateral polysegmental pneumonia, bilateral hydrothorax, bilateral fibrinothorax, with no marked progression; CT scan with IV contrast: CT picture of hydrothorax on the left, hydropneumothorax on the right, pleurisy on both sides, compression atelectasis of lower lobe segments of both lungs. With no marked progression. Treatment. Thoracentesis; antibiotic therapy, antimycotics, infusion therapy, immunotherapy, partial parenteral nutrition. Against the background of the therapy, positive dynamics was obtained. Clinical examples are also given: an 8-year-old child with suspected new coronavirus infection and a 5-year-old child with bilateral polysegmental pneumonia.

scholarly journals Quick diagnostic and management community acquired pneumonia at Sumbawa hospital: a case report

2018 ◽  
Vol 7 (1) ◽  
pp. 297
Author(s):  
Muhammad Ahmad Syammakh ◽  
Elim Jusri ◽  
Gede Agung Setya ◽  
Made Aryadi Sukartika
Keyword(s):  
Emergency Department ◽  
Lung Ultrasound ◽  
Lower Lobe ◽  
Symptomatic Treatment ◽  
Community Acquired Pneumonia ◽  
Pulmonary Parenchyma ◽  
The Right ◽  
Hospital Acquired ◽  
B Lines ◽  
Good Oxygenation

Pneumonia is most common cause of respiratory distress an infection of the pulmonary parenchyma. Despite being the cause of significant morbidity and mortality, it is often misdiagnosed, mistreated, and underestimated. Pneumonia historically was Typically classified as community-acquired (CAP), hospital-acquired (HAP), or ventilator-associated (VAP). A 68-year-old male was sent to the emergency department from clinic with an oxygen saturation of 86%. She has fevers with cough and generalized weakness for one week. She had been evaluated by her primary care provider on day two of illness and was started empirically on cefixime without improvement of her symptoms. The patient arrived febrile, tachycardic, tachypneic, and hypoxic on room air with right-sided crackles on exam. Lung Ultrasound of the right lower lobe demonstrates lung hepatization, a classic finding for pneumonia. In addition, a shred sign is present with both air bronchograms and focal B lines-all suggestive of poorly aerated, consolidated lung. Authors critically evaluate the evidence for the use lung ultrasound for rapid diagnostic. It is important to understand this disease, rapid diagnostic with ultrasound and when treated promptly and effectively, these patients will rapidly recovery. Good oxygenation, intravenous Antibiotic, intravenous fluids and symptomatic treatment which should be started within minutes of the patients’ arrival to emergency department.

scholarly journals Development of Rhabdomyolysis in the Long-term Period of Previous New Coronavirus Infection COVID-19 (Clinical Case Report)

2021 ◽  
Vol 10 (3) ◽  
pp. 452-459
Author(s):  
G. A. Berdnikov ◽  
N. Y. Kudryashova ◽  
E. V. Migunova ◽  
S. I. Rey ◽  
E. V. Gurok ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Infusion Therapy ◽  
Dynamic Observation ◽  
Three Phase ◽  
One Step ◽  
Coronavirus Infection ◽  
The Right

Relevance. Rhabdomyolysis is one of the complications of the new coronavirus infection COVID-19, which may cause acute kidney injury (AKI). The reason for the development of rhabdomyolysis in our observation in a patient after suffering COVID-19 in the long-term period was an increased muscle load.Aim of study. Presentation of a case of rhabdomyolysis with AKI in a patient after COVID-19 in the long-term period.Material and methods. In clinical observation, a 25-year-old patient L. is presented, who was being treated in the Department for the Treatment of Acute Endotoxicosis of the N.V. Sklifosovsky Research Institute for Emergency Medicine. In 2020, he developed COVID-19, complicated by rhabdomyolysis and AKI in the long term period.Results. Examination revealed an increase in creatinine phosphokinase (CPK) — 106,000.0 U/L, alanine aminotransferase (ALT) — 553.0 U/L, aspartate aminotransferase (AST) — 1582.0 U/L, lactate dehydrogenase (LDH) — 2809.0 U/L, levels of serum creatinine 164 μmol/L and myoglobin — 201 ng/ml. Virological research: IgM — 0.27 units per ml; IgG — 7.28 units per ml. 3 Three-phase scintigraphy with 99mTc-pyrfotech revealed signs of necrotic changes in the muscles of the upper half of the back, muscles of the chest (mainly on the right), muscles of the shoulder and upper half of the forearm on both sides. Kidneys: decreased perfusion of the right kidney (relative to the left), moderate slowdown of urodynamics at the level of the calyx-pelvis complex on both sides.Conclusions. The reason for the development of rhabdomyolysis in the long-term period in the patient after suffering from COVID-19 was an increased muscle load. Targeted research and medical history can help identify signs of rhabdomyolysis. The use of the radionuclide diagnostic method makes it possible to identify areas of soft tissue damage with a one-step assessment of renal function in rhabdomyolysis in the acute period of the disease, as well as to evaluate the effectiveness of treatment with dynamic observation. When rhabdomyolysis is confirmed, it is necessary to carry out detoxification and infusion therapy, to monitor renal function in order to detect acute kidney injury, and in case of deterioration of renal function and intoxication, renal replacement therapy is indicated.

scholarly journals Relationship between Radiological Findings with Bacterial Etiology of Community Acquired Pneumonia in Pediatric Population

2021 ◽  
Author(s):  
Nidhi Pandey ◽  
Garima Mittal ◽  
Nitika Agarwal ◽  
Barnali Kakati ◽  
R.K. Agarwal
Keyword(s):  
Sample Size ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
World Health ◽  
Care Hospital ◽  
Number Of Patients ◽  
The Right

Pneumonia continues to be a major cause of morbidity and mortality in children. Pneumonia is the leading killer of children worldwide. For the diagnosis of pneumonia, the World Health Organization has introduced guidelines for the management of cases to reduce the mortality of these diseases on the basis of simple clinical signs followed by the empirical treatment with antibiotics. More than 99% of deaths related to pneumonia among children occur in countries having a low and middle income. To study the Radiological finding of Community-Acquired Pneumonia (CAP) in children. Across sectional study was conducted in which the sample size for the study was calculated from the expected prevalence of CAP based on other studies (74%). The sample size calculated by the required criterion for this study is 96. I was able to cover 118 patients as per the inclusion criteria in this study. The Patients of pediatric age groups and either sex attending tertiary care hospital with complaints suggestive of CAP. In this study total number of patients are 118 included who presented with the signs and symptoms suggestive of pneumonia. The findings of chest X-Ray of Right Lung with respect to different bacterial agents. Consolidation of the Right upper lobe is found to be statistically significant with respect to Streptococcus pneumonia and consolidation of the right lower lobe is found to be statistically significant with respect to bacteria Staphylococcus aureus whereas there is no statistically significant association with respect to other bacteria. The radiological finding of CAP in children attending pediatric OPD was observed that there was no association with any other bacteria.

scholarly journals Meningococcal Pneumonia in a Young Healthy Male

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Abdullah M. Al Alawi
Keyword(s):  
Emergency Department ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Cell Counts ◽  
History Of ◽  
Chest X Ray ◽  
White Blood Cell Counts ◽  
The Right ◽  
Local Guideline

A 23-year-old male presented to the emergency department with one-day history of right-sided pleuritic chest pain, haemoptysis, and fever. In the emergency department, the blood pressure was 140/60 mmHg, heart rate 89/min, body temperature 40°C, respiratory rates 20 breaths/min, and oxygen saturation 98% in room air. Physical examination revealed rales and bronchial breathing in the right infrascapular region. Laboratory analysis showed raised white blood cell counts and elevated inflammation markers. Chest X-ray showed right lower lobe consolidation. Intravenous(IV) ceftriaxone and doxycycline were started for the management of community-acquired pneumonia as per the local guideline. Later, on admission, blood culture was positive for Neisseria meningitidis (N. meningitidis). Ceftriaxone was continued for 4 days, and the patient was discharged while being on oral amoxicillin (1 gm TDS) for another 3 days. He remained well during the outpatient follow-up.

Surgical treatment of broncho­­pulmonary purulent­inflammatory complications due to permanent coronaviral ihfection — the first experience

2021 ◽  
pp. 7-14
Author(s):  
M.S. Opanasenko ◽  
B.M. Konik ◽  
S.M. Bilokon ◽  
O.V. Tereshkovich ◽  
S.M. Shalagay ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Respiratory System ◽  
Pleural Cavity ◽  
Left Lung ◽  
Lower Lobe ◽  
Pleural Empyema ◽  
Lung Abscess ◽  
Sublobar Resection ◽  
Surgical Interventions ◽  
Coronavirus Infection

Objective — to acquaint doctors of different profiles with thoracic pathology in patients with coronavirus infection. Materials and methods. Since the beginning of the SARSCoV-2 pandemic, on the basis of the clinical department for the surgical treatment of tuberculosis and NZL complicated by purulent septic infections 70 patients were treated, of which 39 (55.7 %) had various broncho-pulmonary purulent-inflammatory complications of coronavirus infection. Results and discussion. The distribution of treated patients with bronchopulmonary purulent-inflammatory complications of coronavirus infection by nosology is presented in Table 1. According to the table presented, pleural empyema was a frequent bacterial complication of the respiratory system — 18 (46.1 %) cases; only 6 (33.3 %) patients were diagnosed with broncho-pleural communication, while in 12 (66.7 %) patients, already at the stage of hospitalization, a functioning broncho-pleural fistula was observed.17 (94.4 %) patients with empyema underwent videothoracoscopic (VATS) debridement of the pleural cavity with polydrainage and the use of prolonged active aspiration in the postoperative period. The management of such patients was no different, except for 2 points: the need to continue GCS therapy and the obligatory long-term prescription of anticoagulants and antiplatelet drugs.In 1 (5.6 %) case, due to the extremely serious condition of the patient, only drainage of both pleural cavities was performed (this case was fatal). In another case, after 2 VATS of the pleural cavity, bronchial blocking of the upper lobe and intermediate bronchi of the right lung was performed, followed by active aspiration. Nonspecific exudative pleurisy was diagnosed in 8 (20.5 %) patients after coronavirus infection. There were 13 patients with abscess pneumonia and abscesses (33.3 %). This group of patients underwent drug therapy for a long time, which consisted in the appointment of broad-spectrum antibiotics, anticoagulants, pathogenetic therapy and symptomatic treatment.After a course of conservative treatment, 9 (69.2 %) patients underwent the following surgical interventions — sublobar resection for a sanitized lung abscess in 4 (44.5 %) cases, lobectomy in the presence of sanitized residual large cavities in 3 (33.3 %) patients, partial pleurectomy with decortication of the lung and sublobar resection of the lower lobe of the left lung in 2 (22.2 %) patients.Conservative therapy was successful only in 4 (30.7 %) patients. All 13 patients with abscess pneumonia and abscesses were discharged from the institute with full recovery or improvement (small sanitized destruction cavities up to 2 cm in diameter remained in the lung parenchyma). There were no lethal outcomes.The overall effectiveness of the treatment of this contingent of patients was 97.4 %, and the general mortality rate — 2.6 %.Videothoscopic treatment was effective in 25 (64.1 %) patients with pleural empyema and nonspecific pleurisy, and in 4 (16 %) patients it allowed to stabilize the condition and carry out resection surgery. Conclusions. Purulent-destructive complications of the respiratory system in coronavirus infection have a causal component, and therefore timely exposure to all parts of the pathogenesis can significantly reduce their level. Preference should be given to videothoracoscopic intervention in the complicated course of coronavirus infection. The high level of diagnosis (25.4 %) of concomitant pathology of the chest with the widespread use of radiological methods in the pandemic of coronavirus infection may indicate a low level of preventive medicine in the state.

scholarly journals Peculiarities of radiological and laboratory values in patients with community-acquired pneumonia during COVID-19 pandemic

2021 ◽  
Vol 9 (4) ◽  
pp. 15-22
Author(s):  
V.I. Trykhlib ◽  
K.P. Bieliaieva ◽  
N.R. Tsyurak ◽  
L.O. Palatna
Keyword(s):  
Age Groups ◽  
Left Lung ◽  
Lower Lobe ◽  
Personal Data ◽  
Severe Form ◽  
Community Acquired Pneumonia ◽  
Lower Lung ◽  
The Right ◽  
Almost All ◽  
Frequent Localization

Literature and personal data on community-acquired pneumonia during the epidemic of a new coronavirus infection COVID-19 are presented. It was found that men and patients with moderately to severe form were treated for community-acquired pneumonia more often. The most common localizations were as follows (in descending frequency): bilateral multisegmental, right-sided lower lobe, left-sided lower lobe. Men as compared to women more often had the following localization of pneumonia: right-sided lower lobe pneumonia at the age of 20–30, 51–60; right-sided multisegmental in all age groups; left-sided lower lobe pneumonia at the age of 51–60, left-sided upper lobe pneumonia at the age of 20–50; left-sided multisegmental pneumonia in all age groups; slightly more frequent bilateral lower lobe pneumonia in different age groups; bilateral multisegmental pneumonia at the age of 20–30 and over 60. Conversely, the most common localization in women was as follows: right-sided lower lobe pneumonia at the age 31–50, right-sided upper lobe pneumonia at the age 20–30, left-sided lower lobe pneumonia at the age 20–50 and over 60, left-sided upper lobe pneumonia at the age over 60, bilateral lower lobe pneumonia at the age 31–40, bilateral multisegmental pneumonia at the age 41–60. Right-sided lower lobe pneumonia was equally often registered irrespective of gender in persons older than 60 years old. Right-sided upper lobe pneumonia was not registered in patients aged 31–40 and 41–50 years, and over 60 years old. The most frequent localization of pneumonia in mild form was left-sided lower lobe (35.3 %), right-si­ded lower lobe (20.6 %), and bilateral lower lobe (14.7 %). The least frequent were upper lobe localization of pneumonia in the right, left, and both lungs (2.94 % each), and left multisegmental pneumonia was not observed at all. The most frequent localization of pneumonia in the moderate form was the lower lobes of the right lung (29.4 %), left lung (18.3 %), and multisegmental in both lungs (28.8 %). It was least frequently registered in the upper lobe of the right lung (2.6 %), left lung (3.9 %) but was not registered in the upper lobes of both lungs. The most frequent localization of pneumonia in severe form was bilateral multisegmental (37.5 %). Right-sided multisegmental, left-sided lower lung and bilateral lower lung were the least common — 12.5 % for each. Subfebrile fever was registered more frequently in almost all localizations. More often normal or subfebrile temperature was registered in all localizations, except for right-sided upper lobe pneumonia, in which higher (febrile, pyretic) temperature was registered more often. In all localizations within three days after hospitalization most patients had normal leukocyte count, leukopenia was slightly more frequent in left-sided lower lobe pneumonia, leukocytosis — in the bilateral upper lobe, bilateral lower lobe, and right-sided upper lobe. In general, leukocytosis in community-acquired pneumonia was registered in 38.8 % of patients. In the first three days after hospitalization, a normal amount of lymphocytes was registered in the majority of patients, lymphopenia was observed in one-third of patients with right-sided upper and left-sided lower lobe localization.

scholarly journals Burkholderia cepacia Sepsis in a Previously Healthy Full-Term Infant

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Carlos A. Carmona ◽  
Alberto Marante ◽  
Fatma Levent ◽  
Sarah Marsicek
Keyword(s):  
Blood Culture ◽  
Chronic Granulomatous Disease ◽  
Burkholderia Cepacia ◽  
Lower Lobe ◽  
Severe Hypoglycemia ◽  
Community Acquired Pneumonia ◽  
Term Infant ◽  
Granulomatous Disease ◽  
Febrile Infant ◽  
The Right

Burkholderia cepacia causes sepsis in neonates who are immunocompromised or exposed via nosocomial transmission. We report a case of B. cepacia sepsis in a previously healthy 5-week-old male originally treated for bacterial pneumonia per chest X-ray findings and 3 days of fevers. Regardless of appropriate antibiotics and an initial negative blood culture, he developed severe hypoglycemia, circulatory collapse with disseminated intravascular coagulopathy, and expired. A second blood culture taken following transfer to the intensive care unit resulted positive for B. cepacia postmortem. Review of the newborn screen and family history was otherwise normal. Subsequent postmortem autopsy showed multifocal bilateral pneumonia with necrotizing granulomatous and suppurative portions of lung tissue. Additionally, there was a prominent cavitary lesion 2.5 cm in the right lower lobe with branching and septate fungal hyphae. Stellate microabscesses with granulomas were present in the liver and spleen. These findings plus B. cepacia bacteremia are highly suggestive of an immunocompromised status. Review of the literature shows that its presence has been associated with chronic granulomatous disease. Therefore, in a persistently febrile infant not responding to antibiotics for common microbes causing community-acquired pneumonia, immunodeficiency workup should ensue in addition to respective testing for chronic granulomatous disease especially if B. cepacia culture-positive as it is strongly associated with neutrophil dysfunction.

scholarly journals Unusual Pneumonia Mimic

2019 ◽  
Author(s):  
Joana Ricardo Pires ◽  
Maria José Moreira ◽  
Margarida Martins ◽  
Clarinda Neves
Keyword(s):  
Clinical Presentation ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Diagnostic Challenge ◽  
X Ray ◽  
Severe Hypoxaemia ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion ◽  
Exploratory Laparoscopy

Disease in atypical organ locations can mimic other pathologies, hampering the right diagnosis. Such conditions may even be emergencies, like appendicitis. Subhepatic appendix is a very rare entity which may be caused by caecum dehiscence failure. The authors present the case of a 55-year-old immunocompetent man admitted to the Emergency Department with sepsis and severe hypoxaemia. Chest x-ray showed right lower lobe infiltrate, and community-acquired pneumonia was diagnosed. The patient was started on broad-spectrum antibiotics, but he continued to deteriorate and after 3 days developed abdominal complaints. Exploratory laparoscopy revealed an abscess caused by perforated subhepatic appendicitis. Subhepatic appendicitis presents a diagnostic challenge and its clinical presentation may mimic that of other entities. This case highlights an atypical presentation, where the early development of inflammatory lung injury mimicked common pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial.

scholarly journals ECG changes in COVID-19

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 16-22
Author(s):  
G. V. Ryabykina
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Community Acquired Pneumonia ◽  
P Wave ◽  
Research Centre ◽  
Bundle Branch Block ◽  
National Medical ◽  
Myocardial Stress ◽  
Coronavirus Infection ◽  
The Right

Aim      To evaluate changes in 12-lead ECG in patients with coronavirus infection.Materials and methods This article describes signs of electrocardiographic right ventricular “stress” in patients with COVID-19. 150 ECGs of 75 COVID-19 patients were analyzed in the Institute of Cardiology of the National Medical Research Centre for Therapy and Preventive Medicine. The diagnosis was based on the clinical picture of community-acquired pneumonia, data of chest multispiral computed tomography, and a positive test for COVID-19. ECG was recorded both in 3-6 and in 12 leads. Signs of right ventricular (RV) stress, so-called systolic overload (high R and inverted TV1–3 and TII, III, aVF), and diastolic overload (RV wall hypertrophy and cavity dilatation; complete or incomplete right bundle branch block) were evaluated.Results The most common signs for impaired functioning of the right heart include emergence of the RV P wave phase (41.3 %), incomplete right bundle branch block (42.6 %), ECG of the SIQ IIITIII type (33.3 %) typical for thromboembolic complications, and signs of RV hypertrophy, primarily increased SV5–6 (14.7 %). These changes are either associated with signs of RV myocardial stress (16 %) or appear on the background of signs for diffuse hypoxia evident as tall, positive, sharp-ended T waves in most leads (28 %).Conclusion      A conclusive, comprehensive assessment of the reversal of hemodynamic disorders and electrocardiographic dynamics in patients with COVID-19 will be possible later, when more data become available.

scholarly journals Acute Fibrinous and Organizing Pneumonia: A Case Report and Review of the Literature

2020 ◽  
Author(s):  
Ailing Cao ◽  
Qian Wang ◽  
Xianmei Zhou
Keyword(s):  
Lung Biopsy ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Histopathological Diagnosis ◽  
Organizing Pneumonia ◽  
Delay In Diagnosis ◽  
Clinical Presentations ◽  
Percutaneous Lung Biopsy ◽  
The Right ◽  
Specific Symptoms

Abstract Background Acute fibrinous and organizing pneumonia is an unusual histopathological pattern of acute lung injury. To improve the understanding of acute fibrinous and organizing pneumonia, we herein present one case of a patient with acute fibrinous and organizing pneumonia proven by percutaneous lung biopsy along with clinical features, chest imaging and pathology. Case presentation A 70-year-old man was admitted to our department and was initially diagnosed to have community-acquired pneumonia. He had no specific symptoms and signs on presentation. Chest computed tomography scan showed a high-density shadow in the right basement of the lower lobe. The patient was preliminarily diagnosed with community-acquired pneumonia; however, antibacterial treatment was ineffective. To confirm the diagnosis, we performed twice percutaneous lung biopsy, and pathology was consistent with acute fibrinous and organizing pneumonia. After he was treated with glucocorticoids, the shadow seen on imaging dissipated during the follow-up period. Conclusion Acute fibrinous and organizing pneumonia is a rare histopathological diagnosis, which often has a delay in diagnosis. Clinicians need to consider the possibility of acute fibrinous and organizing pneumonia in the case of invalid antibacterial therapy. Further studies are needed to better classify acute fibrinous and organizing pneumonia, and characterise its clinical presentations, course and treatment.

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