Loretta Yin-Chun Yam

Pseudallescheria boydii or Aspergillus fumigatus in a lady with an unresolving lung infiltrate, and a literature review

Abstract:  A 53‐year‐old lady with blood‐stained sputum and pleuritic pain had a lingular opacity on CXR which failed to resolve. A bronchial aspirate and transbronchial biopsy revealed features of bronchocentric granulomatosis with dichotomous branching hyphae suggestive of Aspergillus infection. However, subsequent fungal culture grew Pseudallescheria boydii. This case demonstrates the similarity of clinical and histological features caused by these two fungi. This appears to be the first reported case of pulmonary pseudallescheria with a bronchocentric granulomatous response.

Outcome of coronavirus-associated severe acute respiratory syndrome using a standard treatment protocol.

Objective:  There is so far no consensus on the optimal treatment strategy for the coronavirus‐associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3‐week step‐down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration.

Corticosteroid treatment of severe acute respiratory syndrome in Hong Kong

Summary Background The patterns of corticosteroids usage in severe acute respiratory syndrome (SARS) and associated treatment outcomes in Hong Kong were studied. Method Patients≥18years old who either had not received corticosteroid or had taken corticosteroids within 14days from symptom onset were included. Patients receiving corticosteroids beyond 15days or other investigational treatment within 21days from symptom onset were excluded. Of 1313 eligible patients, 1287 with major corticosteroid dosage-type combinations were analysed. Results Crude death rate was lower among 1188 steroid-treated patients compared to 99 patients in Group No Steroid (17.0% vs. 28.3%). Among four corticosteroid groups studied, mortality was lowest in the low-dose oral prednisolone (Group P) and high-dose methylprednisolone (Group MP) groups. On multivariate analysis of the corticosteroid groups, independent factors related to death were: corticosteroid group, older age, co-morbidity, worse chest X-ray score, worse respiratory status at Days 8–10 and higher admission white cell count. Again Groups P and MP had significantly lower adjusted odds ratios for death and lower bacterial and fungal culture rates. Despite worse chest X-ray scores and higher cumulative corticosteroid dosages in Group MP compared to Group P, fewer patients required rescue pulsed corticosteroid. Patients on hydrocortisone (Group HC) had the highest positive culture rates. Conclusion We speculate that corticosteroid with higher in-vitro inflammatory potency administered at timing and dosages commensurate with disease severity may be conducive to better outcome from SARS as a consequence of more effective control of immunopathological lung damage.

Coronary plague instability in severe acute respiratory syndrome

Abstract In his second week of severe acute respiratory syndrome (SARS) illness, a patient developed an unusually complicated course of acute coronary syndrome. One day after initial stabilization of a non-ST-elevated anterior myocardial infarction (MI), he sustained an ST-elevated anterior MI. Eight hours after emergency coronary intervention to the culprit lesion, he developed another ST-elevated MI in the inferior territory. Acute inflammation and cytokine storm in the immunopathological phase of SARS may play a role in coronary plague instability. Physicians should be alert to this potentially fatal complication and adopt appropriate vigilant and aggressive management strategies.

Response to SARS as a prototype for bioterrorism: Lessons in a Regional Hospital in Hong Kong

Publisher Summary This chapter reviews the response to severe acute respiratory syndrome (SARS), which can serve as a prototype for combating acts of bioterrorism, in the setting of a Hong Kong acute-care hospital. After overcoming the onslaught of SARS, the Hong Kong community has become aware that emerging infections can occur at any time. This is reinforced by the recent avian influenza outbreaks, which act as a reminder of this looming threat. Hospitals have to evaluate their levels of preparedness against bioterrorism, which can simulate infectious disease outbreaks. The priority areas for improvement include community involvement, staff education, improved information technology, disease surveillance, and additional equipment and staff. Multidimensional and flexible-response plans require strong leadership and clear directions to be effective, and such plans must also consider human frailties during great stress, when every resource is stretched to its utmost limit. The chapter concludes by discussing the various infection-control measures implemented in Hong Kong.

Current status of therapy of SARS

The severe acute respiratory syndrome (SARS) caused by the SARSassociated coronavirus (SARS-CoV) has caused a worldwide outbreak in 2003. This chapter will start with a description of the pathogenesis of this disease, followed by a review of the various pharmacological treatments and supportive ventilatory strategies adopted during the outbreak. The principles used to design various combinations of therapeutic agents and treatment modalities will also be described based on the present knowledge.