Severe Acute Respiratory Syndrome Complicated by Spontaneous Pneumothorax

Abstract

Severe acute respiratory syndrome (SARS) presents an unprecedented diagnostic and therapeutic challenge to clinicians. Despite recent progress in identifying and analyzing the coronavirus that is responsible for it, few reports have addressed the clinical complications of SARS. The present study was a two-center retrospective cohort study. All patients in the study had SARS, were managed in the two major Hong Kong hospitals (ie, Prince of Wales Hospital and United Christian Hospital), and had developed spontaneous pneumothorax during their hospitalization between March 10, 2003, and April 28, 2003. Spontaneous pneumothorax was reported in 6 of 356 SARS patients who were treated at the two hospitals during the period. This represents an incidence of 1.7%. None of the six patients had a history of smoking or pulmonary disease. The rate of admission to the ICU was 66.7% and the crude mortality rate was 33.3% in this group of patients. There was a trend for the mean neutrophil count in these patients to be higher than in previously reported cohorts of comparable SARS patients (14.5 x 10(9) vs 4.6 x 10(9) neutrophils per liter, respectively). Conservative measures like tube thoracostomy or observation alone offered satisfactory initial symptomatic management in five of six patients. Spontaneous pneumothorax is a specific and potentially life-threatening complication in SARS patients. Patients with extensive lung injury, as indicated by severe clinical courses, and in particular high neutrophil counts, appear to be most at risk. The benefits of surgical management must be balanced against the potential risks to health-care workers.

Spontaneous Pneumothorax as Unusual Presenting Symptom of Covid-19 Pneumonia: Surgical Management and Pathological Findings

“…In 2004, Sihoe et al reported a 1.7% incidence of SP in Severe Acute Respiratory Syndrome (SARS) patients 8 . In this series, pneumothorax was a late complication of SARS, occurring from 14 to 37 days after initial diagnosis, suggesting that a sustained period of lung in ammation is rst required.…”

The use of multi-detector computed tomography and ultrasonography for evaluation of pleural lesions

“…They can originate from a broad spectrum of pathologies. [3,4]. Pleural plaques are deposits of hyalinized collagen fibers in the parietal pleura.…”

The human side of influenza

“…These studies highlight an important concept, whereby infection too early results not in protective immunity but immunopathogenesis. Consistent with an age-dependent defect in adaptive immunity, during RSV and influenza infection of infants, few CD4 ϩ or CD8 ϩ T cells or CD56 ϩ NK cells are found in the upper and lower airways [100,103,104], in contrast to the observed infiltration of lymphocytes in adult A/H5N1 influenza [106] and SARS CoV infections [196,197]. Moreover, fatal cases of A(H1N1)pdm09 had increased numbers of CD8 ϩ T cells and granzyme B ϩ cells in their lungs [33].…”