FOR THE MEDICAL PRACTITIONER
General Surgery
doi: 10.25005/2074-0581-2024-26-2-322-332
REASONS FOR UNSATISFACTORY TREATMENT RESULTS OF ACUTE PURULENT DESTRUCTIVE LUNG DISEASES IN PATIENTS WITH SARS-COV-2 INFECTION

A.O. OKHUNOV

Department of General and Pediatric Surgery, Tashkent Medical Academy, Tashkent, Republic of Uzbekistan

Objective: To identify the reasons for unsatisfactory treatment results for acute purulent destructive lung diseases (APDLD) in patients with SARS-CoV-2

Methods: Sixty-five patients with APDLD on the background of SARS-CoV-2 infection were included in the study; 37 (57%) patients (Group 1) with APDLD were treated in a Tashkent Specialized Clinic for Infectious Diseases, and 28 (43%) patients with APDLD (Group 2) were hospitalized in the clinic of the General and Children’s Surgery Department of the Tashkent Medical Academy with a history of a recent SARS-CoV-2 infection. The patients were investigated using clinical, laboratory, and instrumental methods; the results were processed using statistical methods

Results: Complete recovery of patients was achieved in 16% of patients of Group 1 and 32% of Group 2 (p>0.05); clinical recovery was shown in 30% and 43% of patients in Groups 1 and 2 respectively (p>0.05). In Group 1 the results of treatment were more frequently disappointing than in Group 2 (54% vs. 25%, p=0.036), of which 19% were fatal in Group 1 and 11% in Group 2 (p>0.05). For the fatal outcome, the most dangerous was the early period after hospitalization. Morphological changes in the lungs of deceased patients included homogeneous fibrin deposits, which were combined with pronounced interstitial edema and capillary microthrombi around purulent foci.

Conclusion: Traditional clinical and laboratory methods for assessing the severity of the condition of patients of both groups during and after SARSCoV-2 infection do not reflect the complete objective picture of the disease, as an accurate picture can only be obtained by applying the criteria for septic complications. Traditional treatment for APDLD is acceptable for patients of Group II. In patients of Group I with a severe, complicated, and progressive course, many methods of conventional therapy proved to be ineffective.

Keywords: Acute purulent destructive diseases of the lungs, SARS-CoV-2, endothelial dysfunction of the lungs, treatment results, complications.

Download file:

References
  1. Xu Z, Pan A, Zhou H. Rare CT feature in a COVID-19 patient: Cavitation. Diagn Interv Radiol. 2020;26(4):380-1. https://doi.org/10.5152/dir.2020.20181
  2. Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020;92(10):1902-14. https:// doi.org/10.1002/jmv.25884
  3. Blonz G, Kouatchet A, Chudeau N, Pontis E, Lorber J, Lemeur A, et al. Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: A multicenter retrospective study in 188 patients in an un-inundated French region. Crit Care. 2021;25(1):72. https://doi.org/10.1186/s13054-021- 03493-w
  4. Hui DS, Memish ZA, Zumla A. Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Curr Opin Pulm Med. 2014;20(3):233-41. https:// doi.org/10.1097/MCP.0000000000000046
  5. Gragueb-Chatti I, Lopez A, Hamidi D, Guervilly C, Loundou A, Daviet F, et al. Impact of dexamethasone on the incidence of ventilator-associated pneumonia and bloodstream infections in COVID-19 patients requiring invasive mechanical ventilation: A multicenter retrospective study. Ann Intensive Care. 2021;11(1):87. https://doi.org/10.1186/s13613-021-00876-8
  6. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): A study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9. https:// doi.org/10.1007/s00330-020-06731-x
  7. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622- 9. https://doi.org/10.1016/j.cmi.2020.07.016
  8. Renaud-Picard B, Gallais F, Riou M, Zouzou A, Porzio M, Kessler R. Delayed pulmonary abscess following COVID-19 pneumonia: A case report. Respir Med Res. 2020;78:100776. https://doi.org/10.1016/j.resmer.2020.100776
  9. Gavriatopoulou M, Ntanasis-Stathopoulos I, Korompoki E, Fotiou D, Migkou M, Tzanninis IG, et al. Emerging treatment strategies for COVID-19 infection. Clin Exp Med. 2021;21(2):167-79. https://doi.org/10.1007/s10238-020-00671-y
  10. Rouzé A, Martin-Loeches I, Povoa P, Makris D, Artigas A, Bouchereau M, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med. 2021;47(2):188-98. https://doi.org/10.1007/ s00134-020-06323-9
  11. Luyt CE, Sahnoun T, Gautier M, Vidal P, Burrel S, Pineton de Chambrun M, et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: A retrospective cohort study. Ann Intensive Care. 2020;10(1):158. https://doi.org/10.1186/s13613- 020-00775-4
  12. Beaucoté V, Plantefève G, Tirolien JA, Desaint P, Fraissé M, Contou D. Lung abscess in critically ill coronavirus disease 2019 patients with ventilator-associated pneumonia: A French monocenter retrospective study. Crit Care Explor. 2021;3(7):e0482. https://doi.org/10.1097/CCE.0000000000000482
  13. Ripa M, Galli L, Poli A, Oltolini C, Spagnuolo V, Mastrangelo A, et al. Secondary infections in patients hospitalized with COVID-19: Incidence and predictive factors. Clin Microbiol Infect. 2021;27(3):451-7. https://doi.org/10.1016/j. cmi.2020.10.021
  14. Umamoto K, Horiba M. Lung abscess as a secondary infection of COVID-19: A case report and literature review. J Infect Chemother. 2023;29(7):700-2. https://doi.org/10.1016/j.jiac.2023.02.005
  15. Zamani N, Aloosh O, Ahsant S, Yassin Z, Abkhoo A, Riahi T. Lung abscess as a complication of COVID-19 infection, a case report. Clin Case Rep. 2021;9(3):1130-4. https://doi.org/10.1002/ccr3.3686
  16. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032
  17. Taylor E, Novakov I. Post-COVID-19 pulmonary infarction complicated by spontaneous pneumothorax: A case report. Cureus. 2022;14(6):e26464. https:// doi.org/10.7759/cureus.26464
  18. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): A pictorial review. Eur Radiol. 2020;30(8):4381- 9. https://doi.org/10.1007/s00330-020-06801-0
  19. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi. org/10.1056/NEJMoa2001017
  20. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8. https://doi.org/10.1016/S0140-6736(20)30937-5
  21. Stahl K, Bräsen JH, Hoeper MM, David S. Absence of SARS-CoV-2 RNA in COVID-19-associated intestinal endothelialitis. Intensive Care Med. 2021;47(3):359-60. https://doi.org/10.1007/s00134-020-06326-6
  22. Katzenstein AL, Bloor CM, Leibow AA. Diffuse alveolar damage – the role of oxygen, shock, and related factors. A review. Am J Pathol. 1976;85(1):209-28.
  23. Porfidia A, Pola R. Venous thromboembolism in COVID-19 patients. J Thromb Haemost. 2020;18(6):1516-7. https://doi.org/10.1111/jth.14842

Authors' information:

Okhunov Alisher Oripovich,
Doctor of Medical Sciences, Full Professor, Head of the Department of General and Pediatric Surgery, Tashkent Medical Academy
Researcher ID: HKO-2361-2023
Scopus ID: 6508358215
ORCID ID: 0000-0003-3622-6805
SPIN: 2943-1604
Author ID: 989103
E-mail: general-surgery@mail.ru

Information about support in the form of grants, equipment, medications

The research was carried out in accordance with the research plan of Tashkent Medical Academy (state registration number – 142001/20018). The author did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Okhunov Alisher Oripovich
Doctor of Medical Sciences, Full Professor, Head of the Department of General and Pediatric Surgery, Tashkent Medical Academy

100109, Republic of Uzbekistan, Tashkent, Farobi str., 2

Tel.: +998 (781) 507825

E-mail: general-surgery@mail.ru

Materials on the topic:
  1. PREDICTION OF PERSISTENT PERITONITIS IN THE POSTOPERATIVE PERIOD
  2. CLEAR CELL RENAL CANCER IN RENAL ALLOGRAFT: CASE STUDY AND LITERATURE REVIEW
  3. MODERN ASPECTS OF NONPARASITIC LIVER CYSTS
  4. ENDOSCOPIC DIAGNOSTICS AND TREATMENT OF INTRABILIARY RUPTURE OF LIVER HYDATID CYST
  5. SURGICAL WOUND SUPPURATIVE COMPLICATIONS AFTER TENSION-FREE HERNIOPLASTY
  6. THE ROLE OF ENDOTHELIAL DYSFUNCTION IN THE PATHOGENESIS OF LIVER FAILURE IN OBSTRUCTIVE JAUNDICE OF BENIGN ORIGIN
  7. SURGICAL TREATMENT OF INGUINAL HERNIA COMBINED WITH CRYPTORCHIDISM
  8. CLINICAL AND MORPHOLOGICAL EVIDENCE OF THE EFFECTIVENESS OF HYDROGEN PEROXIDE (PERHYDROL) APPLICATION FOR THE RECURRENCE PREVENTION AFTER HYDATID CYSTECTOMY FOR HEPATIC ECHINOCOCCOSIS
  9. CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH UNCOMPLICATED LIVER ECHINOCOCCOSIS
  10. SURGICAL TREATMENT STRATEGIES FOR GIANT ANTERIOR ABDOMINAL WALL HERNIAS

◄ Back to the list