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Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
In most patients the acute illness lasts only seven to ten days and symptoms then improve. Some have a more severe illness with pleurisy, myocarditis and endocarditis. Although mild cases recover without treatment, antibiotics help in the more severe cases, and have reduced the mortality to under 1%. Tetracycline, erythromycin and rifampicin have been used, and the first of these appears to be the most effective. The organism often quickly becomes resistant to penicillin.
Chest
Published in Henry J. Woodford, Essential Geriatrics, 2022
COVID-19 pneumonia produces ground-glass opacities or consolidation on chest X-rays, which are usually bilateral and tend to affect lung peripheries and mid to lower zones.65 However, chest X-rays can appear normal in the early stages. Most people (70%) have an elevated serum CRP but rises may only be small.61 A lymphocyte count < 0.8 (109/L) is found in around 40% of cases.66 Hyponatraemia may be present. There is an increased risk of thromboembolism. The acute illness usually lasts two to three weeks. In people with severe disease, the median time from symptom onset to requiring ventilation is around 14 days and the median time from onset to death is around 18 days.66 ‘Long covid' is a term for symptoms persisting beyond the acute phase of infection. Prevalence estimates vary but it may affect around 22% of people at five weeks and 10% after 12 weeks.67 It affects people aged 35 to 69 more often than people aged over 70 years. Common symptoms include fatigue and breathlessness.
Methylmalonic acidemia
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Episodes of acute illness are recurrent. They may follow even minor infections. Furthermore, patients are unusually prone to infection. Episodes are also a consequence of feeding: these patients are intolerant of the usual quantities of dietary protein. More specifically, they are intolerant to the amino acids isoleucine, valine, threonine, and methionine, all of which are catabolized through the pathway of propionate and methylmalonate metabolism (see Figure 2.1). Episodic disease may follow a pattern in which the patient is admitted to hospital in extremis, treated vigorously with parenteral fluid and electrolytes, which leads to recovery; oral feedings are reintroduced and, following a sufficient time of ingestion of the usual dietary amounts of protein, another episode of crisis supervenes, and in one of these episodes, the patient dies.
Maintaining a ‘fit’ immune system: the role of vaccines
Published in Expert Review of Vaccines, 2023
Béatrice Laupèze, T. Mark Doherty
It has been postulated for over a century that vaccination can have, in some cases, health benefits significantly beyond those attributable to the prevention of acute illness from the vaccine-targeted infection. Such benefits have been attributed to induction of nonspecific immune responses, although the mechanisms were unknown [4]. Recent advances in immunology have paved the way for understanding how vaccines exert these broader effects [27,31,71,72]. At the same time, large-scale data analyses of public health databases suggest these beneficial effects may be more frequent and substantial than previously appreciated [2,3,6,7,89,90]. We have reached the point where the benefits of vaccination could be deliberately harnessed to maintain a fit immune system, leading to health benefits than can potentially eclipse the benefits due to prevention only of acute illness.
Pathophysiology and mechanism of long COVID: a comprehensive review
Published in Annals of Medicine, 2022
D. Castanares-Zapatero, P. Chalon, L. Kohn, M. Dauvrin, J. Detollenaere, C. Maertens de Noordhout, C. Primus-de Jong, I. Cleemput, K. Van den Heede
Patients with persisting symptoms constitute a very heterogeneous group. Initially, there was no globally accepted definition of long COVID. In December 2020, the National Institute for Health and Care Excellence (NICE) proposed a definition that was based on the time elapsed from the acute disease, when symptoms unexplained by an alternative diagnosis were still being reported [4]. The distinction was then made between “ongoing symptomatic COVID-19”, which applied to patients reporting symptoms at between 4 to 12 weeks following acute COVID-19, whereas “post-COVID-19 syndrome” was applied to those still experiencing symptoms 12 week after illness onset. In October 2021, the World Health Organization (WHO) proposed a consensus definition for what they referred to as “Post COVID-19 condition”. The condition was defined as the presence of symptoms lasting for at least 2 months in individuals with a history of probable or confirmed SARS-CoV-2 infection [5]. According to the WHO, this condition usually manifests 3 months from the onset of acute illness, yet cannot be explained by an alternative diagnosis. It is now clear that long COVID has become a meaningful public health concern, given that it now affects millions of people worldwide. The Office for National Statistics in the UK estimated that the prevalence of symptoms remaining following 12 weeks ranged from 3% to 11.7%, with a substantial deleterious impact on social and professional life, and day-to-day activities, as well [4].
Pathophysiology and clinical evaluation of the patient with unexplained persistent dyspnea
Published in Expert Review of Respiratory Medicine, 2022
Andi Hudler, Fernando Holguin, Meghan Althoff, Anne Fuhlbrigge, Sunita Sharma
An additional consideration should be made for patients presenting with persistent dyspnea following symptomatic infection with COVID-19 as patients in this population have an added diagnostic challenge due to the novel nature of the disease process. Patients dealing with long-term effects of COVID-19 are described as having post-acute COVID-19 syndrome (PCS) or ‘long-COVID’ when symptoms persist for more than four weeks after recovery from acute illness [51]. Rates of persistent dyspnea in this patient group were found to be 39.5% in a recent pooled analysis of various observational studies [52]. It should be of note that symptoms of PCS have been observed in patients across the spectrum of severity of acute COVID and patients did not need to experience severe, acute illness to have persistent symptoms. In addition, patients do not need to have radiographically significant fibrotic pulmonary changes to experience breathlessness [51]. The mechanism of persistent dyspnea in patients with PCS is likely multifactorial and requires further investigation to help better elucidate the underlying mechanisms causing symptoms in these patients.