Post-COVID Pulmonary Sequelae: The Management Strategy

Abstract

COVID-19 pandemic has placed a huge burden on health authorities worldwide. The epidemiology, clinical characteristics, management and complication of acute phase of COVID-19 has been well described. 1,2 However, the data for its long-term complications and management remain still unclear. Post-COVID patients may continue to report variety of signs and symptoms which may range from milder ones to serious organ specific manifestations. 3,4 Recently, some management strategies for Long COVID-19 has been formulated by Goel and co-authors, published in this issue of the journal. 5The terms like 'Post-COVID syndrome', Long Haul COVID' and 'Post-COVID Sequelae' have been used in the literature for such persistent signs and symptoms. 6 NICE (National Institute for Health and Care Excellence) describe Acute COVID, Ongoing COVID and Post-COVID having symptoms ≤4 weeks, 4-12 weeks, >12 weeks, respectively. It has coined the term 'Long-COVID' for symptoms persistent beyond four weeks from acute COVID-19 infection. 7,8 In most of the studies 8-12 , the most common observed post-COVID symptom are fatigue and weakness (63%), dyspnoea (26%), sleeping difficulty (26%), anxiety and depression (23%), hoarseness (22%), smell disorder (11%), palpitation (9%), joint pain (9%), etc. Post-COVID symptoms mostly depends on the severity of the infection during acute phase, patients who were more severely ill during their hospital stay had more sever impaired pulmonary diffusion capacity and abnormal chest imaging manifestations. 10,11 In another study 13 , at 8-12 weeks post admission, 74% persisted with symptoms (notably breathlessness and excessive fatigue) with reduced health related quality-of-life (HRQoL). Further 59%, 75%, 89% at least one symptom persisted in mild COVID (without oxygen), moderate COVID (with oxygen), and severe COVID (NIV [noninvasive ventilation]) at 8-12 weeks, respectively. The study demonstrate the persistence of symptom at 12 weeks in majority of patients even those with mild disease initially.

Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital

“…Infection with multidrug-resistant tuberculosis (MDR) has been reported. Therapy with a combination of first- and second-line drugs that include kanamycin, ofloxacin, ethionamide, para-aminosalicylic acid (PAS), pyrazinamide, and isoniazid should be instituted [ 39 , 40 ].…”