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

Chun Huan Wang, 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

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39 Citations (Scopus)

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-α, 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. Conclusions: 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.

Original languageEnglish
JournalRespiratory Research
Volume6
DOIs
Publication statusPublished - May 11 2005
Externally publishedYes

Keywords

  • Aalveolar macrophages
  • Bronchoalveolar lavage
  • Coronavirus
  • Cytokines
  • SARS
  • T lymphocyte

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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