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Comparative Study
. 2005 May 11;6(1):42.
doi: 10.1186/1465-9921-6-42.

Persistence of lung inflammation and lung cytokines with high-resolution CT abnormalities during recovery from SARS

Chun-Hua Wang  1 , Chien-Ying Liu, Yung-Liang Wan, Chun-Liang Chou, Kuo-Hsiung Huang, Horng-Chyuan Lin, Shu-Min Lin, Tzou-Yien Lin, Kian Fan Chung, Han-Pin Kuo
Affiliations
Comparative Study

Persistence of lung inflammation and lung cytokines with high-resolution CT abnormalities during recovery from SARS

Chun-Hua Wang et al. Respir Res. .

Abstract

Background: During the acute phase of severe acute respiratory syndrome (SARS), mononuclear cells infiltration, alveolar cell desquamation and hyaline membrane formation have been described, together with dysregulation of plasma cytokine levels. Persistent high-resolution computed tomography (HRCT) abnormalities occur in SARS patients up to 40 days after recovery.

Methods: To determine further the time course of recovery of lung inflammation, we investigated the HRCT and inflammatory profiles, and coronavirus persistence in bronchoalveolar lavage fluid (BALF) of 12 patients at recovery at 60 and 90 days.

Results: At 60 days, compared to normal controls, SARS patients had increased cellularity of BALF with increased alveolar macrophages (AM) and CD8 cells. HRCT scores were increased and correlated with T-cell numbers and their subpopulations, and inversely with CD4/CD8 ratio. TNF-alpha, IL-6, IL-8, RANTES and MCP-1 levels were increased. Viral particles in AM were detected by electron microscopy in 7 of 12 SARS patients with high HRCT score. On day 90, HRCT scores improved significantly in 10 of 12 patients, with normalization of BALF cell counts in 6 of 12 patients with repeat bronchoscopy. Pulse steroid therapy and prolonged fever were two independent factors associated with delayed resolution of pneumonitis, in this non-randomized, retrospective analysis.

Conclusion: Resolution of pneumonitis is delayed in some patients during SARS recovery and may be associated with delayed clearance of coronavirus, Complete resolution may occur by 90 days or later.

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Figures

Figure 1
Figure 1
Residual abnormality on HRCT of a SARS patient with high HRCT score at 60 days (A). HRCT became almost normal at 90 days (B).
Figure 2
Figure 2
Correlation of the cell counts of (A) total lymphocytes, (B) CD4 and (C) CD8 T cells, or the (D) CD4/CD8 ratio with HRCT scores in SARS patients. The analysis is made by Spearman rank test and the number and significance are indicated.
Figure 3
Figure 3
Ultrastructural characteristics of a Coronavirus-Infected cell in BAL fluid from a SARS patient at 60 days, with several intracellular particles. The virions are indicated by the arrowheads in Panel A. Panel B shows the area indicated by the asterisk in Panel A at higher magnification. The bar in Panel A (500 nm) and Panel B (100 nm) is indicated.
See this image and copyright information in PMC

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