Unexpected exposure to Mycobacterium tuberculosis during bronchoscopy using radial probe endobronchial ultrasound

Background Bronchoscopy using radial probe endobronchial ultrasound (EBUS) is performed when a peripheral lung lesion (PLL) is suspected to be malignant. However, pulmonary tuberculosis is diagnosed in some patients, and healthcare workers could therefore be exposed to tuberculosis if sufficient precautions are not taken. In this study, we examined the proportion of and factors associated with unexpected exposure to Mycobacterium tuberculosis during bronchoscopy using radial probe EBUS. Methods This retrospective study included 970 patients who received bronchoscopy using radial probe EBUS between December 2015 and November 2018. Clinical, histological, radiological, and microbiological data were reviewed. Results Pulmonary tuberculosis was diagnosed in 31 patients (3.2%) during bronchoscopy using radial probe EBUS. Patients with a lower age were significantly more likely to be diagnosed with tuberculosis than elderly patients (odds ratio [OR], 0.951; 95% confidence interval [CI], 0.924–0.978; P = 0.001). Among the various CT findings, a low HUs difference between pre- and post-enhanced CT (OR, 0.976; 95% CI, 0.955–0.996; P = 0.022), the presence of concentric cavitation (OR, 5.211; 95% CI, 1.447–18.759; P = 0.012), and the presence of satellite centrilobular nodules (OR, 22.925; 95% CI, 10.556–49.785; P < 0.001) were independently associated with diagnosis of tuberculosis. Conclusions The proportion of unexpected exposure to Mycobacterium tuberculosis during bronchoscopy using radial probe EBUS was 3.2%. A higher risk was independently associated with a younger age and CT findings of a small difference in HUs between pre- and post-enhancement images, concentric cavitation, and the presence of a satellite centrilobular nodule.

Clinical and CT manifestations of coronavirus disease 2019 (COVID-19): comparison of suspected cases of COVID-19 in isolation and non-COVID-19 pneumonia in a single-center study conducted in Beijing, China

Background: The clinical and CT manifestations of COVID-19 pneumonia and non-COVID-19 pneumonia in the same period have not been compared in detail. The purpose of this study is to analyze the clinical and CT manifestations of COVID-19 pneumonia and perform a comparison of those isolated patients for presumed COVID-19 infection and of non-COVID-19 pneumonia in the same period.Methods: 173 patients with pneumonia from January 1, 2020 to March 20, 2020 were retrospectively enrolled and classified into three groups: patients with COVID-19 pneumonia (Group I, N=4), patients in hospital-isolation for presumed COVID-19 pneumonia (Group Ⅱ, N=5), and patients with non-COVID-19 pneumonia (Group III, N=163). Clinical symptoms, laboratory test results and CT imaging features were compared among three groups.Results: Fever and cough were the most common clinical symptoms in the three groups. 30/163 (18.4%) patients were asymptomatic in Group III. Leukopenia, lymphocytopenia, and elevated C-reactive protein was identified in 1 (25%), 1 (25%), and 1 (25%) patient in Group I; 1 (20%), 1 (20%), and 2 (40%) patients in Group II; 10/157 (6.4%), 33/157(21.0%), and 94/136 (69.1%) patients in Group III. Demarcated GGO/mixed GGO, ill-defined GGO/mixed GGO, consolidation, centrilobular nodule, tree-in bud opacity, bilateral involvement, peripheral distribution, posterior part/lower lobe predilection was observed in 3/4 (75%), 2/4 (50%), 4/4 (100%), 2/4 (50%), 0, 3/4 (75%), 3/4 (75%), and 2/4 (50%) patients, respectively in Group I; 1/5 (20%), 5/5 (100%), 4/5 (80%), 4/5 (80%), 3/5 (60%), 4/5 (80%), 2/5 (40%), and 3/5 (60%) patients in Group Ⅱ; 1/163 (0.6%), 87/163 (54.3%), 115/163 (70.6%), 117/163 (71.8%), 95/163 (58.3%), 52/163 (31.9%), 9/163 (5.5%), and 9/163 (5.5%) patients in Group III, respectively.Conclusions: Demarcated GGO and consolidation prefer the diagnosis of COVID-19 pneumonia, whereas ill-defined GGO and consolidation, centrilobular nodule surrounded by GGO, and tree-in-bud opacity are preferred for non-COVID-19 pneumonia. chest CT has potential in early identification of COVID-19 and implementation of isolation for appropriate case.