Letters to Editor
cells to clean up the phosphorus ion from the alveolar space and in the process halting the accumulation of calcium and phosphorus rich microliths in the alveoli. Activation of such a mechanism can be the clue towards the development of new area of research for the treatment of PAM.
2. 3. 4.
2013;13:375. Kashyap S, Mohapatra PR. Pulmonary alveolar microlithiasis. Lung India 2013;30:143‑7. Pracyk JB, Simonson SG, Young SL, Ghio AJ, Roggli VL, Piantadosi CA. Composition of lung clavage in pulmonary alveolar microlithiasis. Respiration 1996;63:254‑60. Dahabreh M, Najada A. Pulmonary alveolar microlithiasis in an 8‑month‑old infant. Ann Trop Paediatr 2009;29:55‑9.
Surender Kashyap, Prasanta R. Mohapatra1 Access this article online
Kalpana Chawla Government Medical College, Karnal, Haryana, 1Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India E‑mail: [email protected]
Quick Response Code:
Website: www.lungindia.com
REFERENCES 1.
Moslehi AM. Pulmonary alveolar microlithiasis. Lung India
Filariasis and pleural effusion Sir,
Hainan Medical University, Haikou, Hainan, China, 2 Faculty of Medicine, University of Nis, Nis, Serbia, 3 Joseph Ayobabalola University, Ikeji-Arakeji, Osun, Nigeria. E-mail: [email protected] 1
The recent report on filariais and pleural effusion is very interesting.[1] In the present case, Navaz et al. reported for a case of isolated pleural effusion of filarial etiology.[1] In fact, the finding of filarial parasite in pleural cavity is rare and there might be other underlying disclosed pathology. As noted, the concomitant presentation with malignancy should be kept in mind.[2] In case with signs and symptoms of malignancy, especially for extremely weight loss, seeking for the malignancy is needed. Nevertheless, the detection of malignant cell within pleural fluid is difficult and requires the experience of the microscopist. Detection of parasite can be easier and this might lead to the misdiagnosis of malignancy.
REFERENCES 1. 2.
Navaz AK, Raikar MP, Acharya V, Shetty SK. Pleural effusion: An unusual cause and association. Lung India 2013;30:158-60. Singh SK, Pujani M, Pujani M. Microfilaria in malignant pleural effusion: An unusual association. Indian J Med Microbiol 2010;28:392-4.
Access this article online Quick Response Code:
Website: www.lungindia.com DOI:
Somsri Wiwanitkit, Viroj Wiwanitkit1,2,3
10.4103/0970-2113.120622
Wiwanitkit House, Bangkhae, Bangkok, Thailand,
Organizing pneumonia in swine flu Sir, The recent publication on organizing pneumonia (OP) in swine flu is very interesting.[1] In fact, the pulmonary sequel of swine flu is an interesting concern in chest medicine.[2,3] Zanetti et al., raised an interesting issue on pulmonary fibrosis and OP and proposed that “The diagnosis of 376
secondary OP after H1N1 infection is important because proper treatment of OP requires corticosteroid therapy.[1]” In fact, OP as a complication of swine flu is mentioned in many reports.[4,5] Ajlan et al., studied on radiographic and computed tomography (CT) findings of cases with swine flu and reported that “predominant peribronchovascular and subpleural distribution, resembling OP” is common.[4] Lung India • Vol 30 • Issue 4 • Oct ‑ Dec 2013
Letters to Editor
This finding can be observed in both immunocompetent and immunocompromised host and it is “regardless of the timing of CT relative to the onset of symptoms”.[5] It is no doubt that lung complication of swine flu can be serious and it is extremely serious in cases with underlying lung fibrosis.[6]
3.
Beuy Joob, Viroj Wiwanitkit1,2,3
6.
4. 5.
Sanitation 1 Medical Academic Center, Bangkok, Thailand, Hainan Medical University, Haikou, Hainan, China, 2University of Nis, Nis, Serbia, 3Joseph Ayobabalola University, Osun, Nigeria E-mail: [email protected]
Joob B, Wiwanitkit V. Pulmonary sequelae of swine flu. Lung India 2013;30:81-2. Ajlan AM, Quiney B, Nicolaou S, Müller NL. Swine-origin influenza A (H1N1) viral infection: Radiographic and CT findings. AJR Am J Roentgenol 2009;193:1494-9. Chandler TM, Leipsic J, Nicolaou S, Quiney B, Romney M, Müller NL, et al. Confirmed swine-origin influenza A (H1N1) viral pneumonia: Computed tomographic findings in the immunocompetent and the immunocompromised. J Comput Assist Tomogr 2011;35:602-7. Pabst D, Kuehn J, Schuler-Luettmann S, Wiebe K, Lebiedz P. Acute Respiratory Distress Syndrome as a presenting manifestation in young patients infected with H1N1 influenza virus. Eur J Intern Med 2011;22:e119-24.
1
Access this article online Quick Response Code:
Website:
REFERENCES
www.lungindia.com
1.
DOI:
2.
Zanetti G, Hochhegger B, Marchiori E. Organizing pneumonia as a pulmonary sequela of swine flu. Lung India 2013;30:171. Singh V, Sharma BB, Patel V. Pulmonary sequelae in a patient recovered from swine flu. Lung India 2012;29:277-9.
10.4103/0970-2113.120625
Authors’ reply Sir, We thank Drs. Joob and Wiwanitkit[1] for their interest in our publication on organizing pneumonia (OP) as a pulmonary sequelae of swine flu.[2] They commented on the increasing interest in the pulmonary sequelae of swine flu in chest medicine[3,4] and the importance of the diagnosis of secondary OP after H1N1 infection. Imaging studies play a fundamental role in the evaluation of swine flu sequelae, as noted in the recent literature.[5-10] We were particularly interested in the comments regarding the tomographic pattern of lesions observed in swine flu.[1] Based on the current literature, they stated that “predominant peribronchovascular and subpleural distribution of the lesions, resembling OP, is common, and this finding can be observed regardless of the timing of computed tomography (CT) relative to the onset of symptoms”. We would like to highlight that although the imaging patterns of these lesions are similar, the histological findings differ according to the phase of disease evolution. Gill et al.,[11] described pulmonary pathological findings in 34 people who died following confirmed H1N1 infection. Sixteen of these patients died during the acute infectious phase (average time in hospital, 3.4 days) and showed only acute diffuse alveolar damage (DAD); seven patients died after an average hospitalization time of 11.7 days and showed acute and organizing DAD. Two patients who died during convalescence (average time in hospital, 31.5 days) showed fibrosing and organizing DAD. A recent study[12] examining the correlation between CT features and pathological findings in five fatal cases of
H1N1 pneumonia (mean time in hospital, 2.8 (range, 1-6) days] described the main pathological features of DAD with hyaline membrane formation, associated with various degrees of pulmonary congestion, edema, hemorrhage, and inflammatory infiltration. No evidence of OP was found in these patients, but one patient who died 28 days after the first hospitalization showed typical elongated fibroblast plugs filling airspaces, compatible with OP.[12] Limited published data regarding CT aspects during the recovery phase after H1N1 infection are available. In the early stages (1st week) of the disease, lesions correspond to the viral infection in most cases. However, a differential diagnosis between bacterial infection and secondary OP should be considered in patients with opacities persisting for more than 2 weeks. This consideration is extremely important for therapeutic planning.
Gláucia Zanetti, Bruno Hochhegger, Edson Marchiori Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil E-mail: [email protected]
REFERENCES 1. 2. 3.
Joob B, Wiwantikit V. Organizing pneumonia in swine flu. Lung India 2013;30:376-7. Zanetti G, Hochhegger B, Marchiori E. Organizing pneumonia as a pulmonary sequela of swine flu. Lung India 2013;30:171. Singh V, Sharma BB, Patel V. Pulmonary sequelae in a patient recovered from swine flu. Lung India 2012;29:277-9.
Lung India • Vol 30 • Issue 4 • Oct ‑ Dec 2013 377
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
cells to clean up the phosphorus ion from the alveolar space and in the process halting the accumulation of calcium and phosphorus rich microliths in the alveoli. Activation of such a mechanism can be the clue towards the development of new area of research for the treatment of PAM.
2. 3. 4.
2013;13:375. Kashyap S, Mohapatra PR. Pulmonary alveolar microlithiasis. Lung India 2013;30:143‑7. Pracyk JB, Simonson SG, Young SL, Ghio AJ, Roggli VL, Piantadosi CA. Composition of lung clavage in pulmonary alveolar microlithiasis. Respiration 1996;63:254‑60. Dahabreh M, Najada A. Pulmonary alveolar microlithiasis in an 8‑month‑old infant. Ann Trop Paediatr 2009;29:55‑9.
Surender Kashyap, Prasanta R. Mohapatra1 Access this article online
Kalpana Chawla Government Medical College, Karnal, Haryana, 1Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India E‑mail: [email protected]
Quick Response Code:
Website: www.lungindia.com
REFERENCES 1.
Moslehi AM. Pulmonary alveolar microlithiasis. Lung India
Filariasis and pleural effusion Sir,
Hainan Medical University, Haikou, Hainan, China, 2 Faculty of Medicine, University of Nis, Nis, Serbia, 3 Joseph Ayobabalola University, Ikeji-Arakeji, Osun, Nigeria. E-mail: [email protected] 1
The recent report on filariais and pleural effusion is very interesting.[1] In the present case, Navaz et al. reported for a case of isolated pleural effusion of filarial etiology.[1] In fact, the finding of filarial parasite in pleural cavity is rare and there might be other underlying disclosed pathology. As noted, the concomitant presentation with malignancy should be kept in mind.[2] In case with signs and symptoms of malignancy, especially for extremely weight loss, seeking for the malignancy is needed. Nevertheless, the detection of malignant cell within pleural fluid is difficult and requires the experience of the microscopist. Detection of parasite can be easier and this might lead to the misdiagnosis of malignancy.
REFERENCES 1. 2.
Navaz AK, Raikar MP, Acharya V, Shetty SK. Pleural effusion: An unusual cause and association. Lung India 2013;30:158-60. Singh SK, Pujani M, Pujani M. Microfilaria in malignant pleural effusion: An unusual association. Indian J Med Microbiol 2010;28:392-4.
Access this article online Quick Response Code:
Website: www.lungindia.com DOI:
Somsri Wiwanitkit, Viroj Wiwanitkit1,2,3
10.4103/0970-2113.120622
Wiwanitkit House, Bangkhae, Bangkok, Thailand,
Organizing pneumonia in swine flu Sir, The recent publication on organizing pneumonia (OP) in swine flu is very interesting.[1] In fact, the pulmonary sequel of swine flu is an interesting concern in chest medicine.[2,3] Zanetti et al., raised an interesting issue on pulmonary fibrosis and OP and proposed that “The diagnosis of 376
secondary OP after H1N1 infection is important because proper treatment of OP requires corticosteroid therapy.[1]” In fact, OP as a complication of swine flu is mentioned in many reports.[4,5] Ajlan et al., studied on radiographic and computed tomography (CT) findings of cases with swine flu and reported that “predominant peribronchovascular and subpleural distribution, resembling OP” is common.[4] Lung India • Vol 30 • Issue 4 • Oct ‑ Dec 2013
Letters to Editor
This finding can be observed in both immunocompetent and immunocompromised host and it is “regardless of the timing of CT relative to the onset of symptoms”.[5] It is no doubt that lung complication of swine flu can be serious and it is extremely serious in cases with underlying lung fibrosis.[6]
3.
Beuy Joob, Viroj Wiwanitkit1,2,3
6.
4. 5.
Sanitation 1 Medical Academic Center, Bangkok, Thailand, Hainan Medical University, Haikou, Hainan, China, 2University of Nis, Nis, Serbia, 3Joseph Ayobabalola University, Osun, Nigeria E-mail: [email protected]
Joob B, Wiwanitkit V. Pulmonary sequelae of swine flu. Lung India 2013;30:81-2. Ajlan AM, Quiney B, Nicolaou S, Müller NL. Swine-origin influenza A (H1N1) viral infection: Radiographic and CT findings. AJR Am J Roentgenol 2009;193:1494-9. Chandler TM, Leipsic J, Nicolaou S, Quiney B, Romney M, Müller NL, et al. Confirmed swine-origin influenza A (H1N1) viral pneumonia: Computed tomographic findings in the immunocompetent and the immunocompromised. J Comput Assist Tomogr 2011;35:602-7. Pabst D, Kuehn J, Schuler-Luettmann S, Wiebe K, Lebiedz P. Acute Respiratory Distress Syndrome as a presenting manifestation in young patients infected with H1N1 influenza virus. Eur J Intern Med 2011;22:e119-24.
1
Access this article online Quick Response Code:
Website:
REFERENCES
www.lungindia.com
1.
DOI:
2.
Zanetti G, Hochhegger B, Marchiori E. Organizing pneumonia as a pulmonary sequela of swine flu. Lung India 2013;30:171. Singh V, Sharma BB, Patel V. Pulmonary sequelae in a patient recovered from swine flu. Lung India 2012;29:277-9.
10.4103/0970-2113.120625
Authors’ reply Sir, We thank Drs. Joob and Wiwanitkit[1] for their interest in our publication on organizing pneumonia (OP) as a pulmonary sequelae of swine flu.[2] They commented on the increasing interest in the pulmonary sequelae of swine flu in chest medicine[3,4] and the importance of the diagnosis of secondary OP after H1N1 infection. Imaging studies play a fundamental role in the evaluation of swine flu sequelae, as noted in the recent literature.[5-10] We were particularly interested in the comments regarding the tomographic pattern of lesions observed in swine flu.[1] Based on the current literature, they stated that “predominant peribronchovascular and subpleural distribution of the lesions, resembling OP, is common, and this finding can be observed regardless of the timing of computed tomography (CT) relative to the onset of symptoms”. We would like to highlight that although the imaging patterns of these lesions are similar, the histological findings differ according to the phase of disease evolution. Gill et al.,[11] described pulmonary pathological findings in 34 people who died following confirmed H1N1 infection. Sixteen of these patients died during the acute infectious phase (average time in hospital, 3.4 days) and showed only acute diffuse alveolar damage (DAD); seven patients died after an average hospitalization time of 11.7 days and showed acute and organizing DAD. Two patients who died during convalescence (average time in hospital, 31.5 days) showed fibrosing and organizing DAD. A recent study[12] examining the correlation between CT features and pathological findings in five fatal cases of
H1N1 pneumonia (mean time in hospital, 2.8 (range, 1-6) days] described the main pathological features of DAD with hyaline membrane formation, associated with various degrees of pulmonary congestion, edema, hemorrhage, and inflammatory infiltration. No evidence of OP was found in these patients, but one patient who died 28 days after the first hospitalization showed typical elongated fibroblast plugs filling airspaces, compatible with OP.[12] Limited published data regarding CT aspects during the recovery phase after H1N1 infection are available. In the early stages (1st week) of the disease, lesions correspond to the viral infection in most cases. However, a differential diagnosis between bacterial infection and secondary OP should be considered in patients with opacities persisting for more than 2 weeks. This consideration is extremely important for therapeutic planning.
Gláucia Zanetti, Bruno Hochhegger, Edson Marchiori Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil E-mail: [email protected]
REFERENCES 1. 2. 3.
Joob B, Wiwantikit V. Organizing pneumonia in swine flu. Lung India 2013;30:376-7. Zanetti G, Hochhegger B, Marchiori E. Organizing pneumonia as a pulmonary sequela of swine flu. Lung India 2013;30:171. Singh V, Sharma BB, Patel V. Pulmonary sequelae in a patient recovered from swine flu. Lung India 2012;29:277-9.
Lung India • Vol 30 • Issue 4 • Oct ‑ Dec 2013 377
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
