Bronchiactasis as Atypical Presentation in COVID-19

bronchiectasis is achronic inflammatory lung disease. It is defined by the presence of permanent and abnormal dilatation of the bronchi. which leads to chronic sputum production and impaired bacterial clearance. The affected parts of the lungs develop a vicious cycle of failed pathogen clearance leading to frequent infections, chronic inflammation and ongoing structural damage. The main symptoms are daily cough, daily sputum production and frequent respiratory infections. There is low frequency of non cystic fibrosis bronchiectasis The prevalence rate of NCFB in the general population was calculated to be 39.9 cases per 100,000.

There is an increasing prevalence of bronchiectasis in the elderly, affecting approximately 10 patients per 1,000 population.

A retrospective cohort study of health claims between 1999-2001 in the US suggested the prevalence of bronchiectasis to be 4.2 per 100,000 population aged 1834 years and 271.8 per 100,000 population aged >75 years . This usually occurs in the context of chronic airway infection causing inflammation. The main clinical manifestation is a productive cough. Bronchiectasis is currently nearly always diagnosed using high-resolution computed tomography (HRCT) scanning. The main diagnostic features are: 1) internal diameter of a bronchus is wider than its adjacent pulmonary artery; 2) failure of the bronchi to taper; and 3) visualization of bronchi in the outer 12 cm of the lung fields.

Coronaviruses (CoVs) are a group of highly diverse, enveloped, positive-sense, and single-stranded RNA viruses.

In late December 2019, an outbreak of an unknown disease called pneumonia of unknown cause occurred in Wuhan, Hubei province, China.1 The outbreak has spread substantial to infect 9720 people in China with 213 deaths and to infect 106 people in 19 other countries up to 31 January 2020 . A few days later, the causative agent of this mysterious pneumonia was identified as a novel coronavirus (nCoV) by several independent laboratories.2-4 The causative virus has been temporarily named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the relevant infected disease has been named as coronavirus disease 2019 (COVID-19) by the World Health Organization, respectively. According to the daily report of the World Health Organization, the epidemic of SARS-CoV-2 so far registered 78630 cases and 2747 deaths in China, spread to 46 other countries that reported a total of 3664 cases by 27 February 2020 . COVID-19 epidemic has become a global health threat. Coronaviruses (CoVs) are a group of highly diverse, enveloped, positive-sense, and single-stranded RNA viruses.5 They cause several diseases involving respiratory, enteric, hepatic, and neurological systems with vary severity among humans and animals.6,7 The envelope spike (S) protein is important for CoV.19 The S protein mediates receptor binding and membrane fusion and is crucial for determining host tropism and transmission capacity.8,9,10 The final etiologic diagnosis of COVID-19 is nessary can be farther further confirmed with a positive real-time RT-PCR assay for COVID-19 using respiratory or blood samples or by means of viral gene sequencing of respiratory or blood samples that are highly homologous with COVID-19.

The typical chest CT findings include multifocal bilateral ground-glass opacities (GGOs) with patchy consolidations, prominent peripherally subpleural distribution, and posterior part or lower lobe predilection.

The long-term sequelae of COVID-19 remain to be investigated, although several publications have reported a fibrotic phase with reticulation characteristics, interlobar septal thickening, and traction bronchiectasis.

The onset and development of bronchiectasis during the follow-up of COVID-19 patients with pneumonia are under-reported.