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| CHEST IMAGE |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 123-124 |
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Omicron variant coronavirus disease with rapid progression to ARDS
Reddy Ravikanth
Department of Radiology, St. John’s Hospital, Bengaluru, India
| Date of Submission | 12-Feb-2022 |
| Date of Acceptance | 04-May-2022 |
| Date of Web Publication | 19-Dec-2022 |
Correspondence Address:
MD, DNB, EDiR, FRCR Reddy Ravikanth
Department of Radiology, St. John’s Hospital, Bengaluru
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jacp.jacp_4_22
How to cite this article:
Ravikanth R. Omicron variant coronavirus disease with rapid progression to ARDS. J Assoc Chest Physicians 2022;10:123-4 |
| Case Description | |  |
A 46-year-old male patient of Indian ethnicity presented with complaints of 5-days history of dry cough, fever, headache, and generalized fatigue. He had a recent travel history to South Africa and developed symptoms within 5 days of arrival in India. Coronavirus disease-2019 (COVID-19) which is rampant in 223 countries and territories of the world,[1] the patient was advised admission in an isolation ward of the hospital. Initial computed tomography (CT) images obtained on day 1 of admission showed subpleural areas of mixed ground-glass opacities in basal segments of bilateral lower lobes [Figure 1]. No pleural effusion/lymphadenopathy were evident. Nasopharyngeal and oropharyngeal swab and sputum samples of the patient were collected to detect COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR). RT-PCR confirmed positivity to Omicron variant on day 3 of admission and follow-up CT revealed patchy consolidation in bilateral basal lung segments [Figure 2]. The patient succumbed to the disease on day 7 of admission and CT performed on the day of demise demonstrated features of acute respiratory distress syndrome (ARDS). The cause of death was ascertained to be severe respiratory failure. | Figure 1 Coronal reformatted computed tomography (CT) image obtained on day 1 of admission demonstrating subpleural areas of mixed ground-glass opacities in basal segments of bilateral lower lobes.
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 | Figure 2 Follow-up axial CT image on day 3 of admission demonstrating subpleural distribution of reticular pattern opacities suggesting fibrosis in the posterior zone of left upper lobe and basal zone of right lower lobe.
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| Discussion | | |
A novel strain of coronavirus was found in bronchoalveolar lavage samples of patients with a lower respiratory tract infection, first traced from the city of Wuhan, Hubei Province of the People’s Republic of China in December 2019.[2] On January 9, 2020, the World Health Organization (WHO) termed the pulmonary syndrome as COVID-19.[3] At the time of writing this short communication on February 6, 2022, the number of confirmed cases stand at 394,120,647 with 5,752,671 reported deaths, this is according to an online virus tracker created by The Lancet, and hosted by Johns Hopkins University.[4] The estimated R0 (basic reproduction number) of novel coronavirus was calculated to be 2.2 and average incubation period to be 5.2 days.[5] The Omicron (B.1.1.529) variant of coronavirus, first identified on November 24, 2021, has changed the evolution of the pandemic and has begun to spread faster than previous variants of coronavirus which are of concern to the general population.[6] Globally, more than 9 billion vaccine doses have been administered. However, the B.1.1.529 variant is noted to circumvent some of the current vaccines and this feature is most likely due to mutations in the spike protein. Nevertheless, the Omicron variant is touted to cause less severe ARDS as compared to its predecessor Delta variant. Preexisting chronic lung disease is also a factor related to disease progression. Severity of COVID-19 with Omicron variant is defined as ARDS with requirement of supplemental oxygen or invasive mechanical ventilation.[7] Typical CT findings of COVID-19 in the first week of infection include ground-glass opacification with bronchovascular thickening, crazy paving appearance, and confluent consolidation in a pattern that is typically basal, multifocal, peripheral, and bilateral. In the second week of disease progression, a reticular pattern with propensity toward fibrosis is a hallmark feature. Mixed and multifocal patterns of consolidation with features of ARDS were observed in the third week of coronavirus disease. Implementation of prevention strategies to minimize transmission, double vaccination, prompt usage of personal protective equipment, and undertaking measures to improve ventilation have shown promising results in patients infected with COVID-19 with higher likelihood of ARDS development. In conclusion, an in-depth understanding of pathophysiology and radiological progression of disease findings in patients with COVID-19-related ARDS is conducive for prompt identification of the coronavirus disease and precise treatment.
| References | | |
| 1. | Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;26;382:1199-207.  |
| 2. | WHO. We now have a name for the #2019nCoV disease: COVID-19. I’ll spell it: C-O-V-I-D hyphen one nine − COVID-19. Tweet, February 11, viewed February 11, 2020. Available from: https://twitter.com/WHO/status/1227248333871173632. [Accessed February 6, 2022]. |
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| 4. | Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. |
| 5. | Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. J Am Med Assoc 2020;323:1239-42. |
| 6. | Mohiuddin M, Kasahara K. Investigating the aggressiveness of the COVID-19 Omicron variant and suggestions for possible treatment options. Respir Med 2022;191:106716. doi:10.1016/j.rmed.2021.106716 |
| 7. | Abdullah F, Myers J, Basu D, Tintinger G, Ueckermann V, Mathebula M et al. Decreased severity of disease during the first global omicron variant Covid-19 outbreak in a large hospital in tshwane, South Africa. Int J Infect Dis 2022;116:38-42. doi:10.1016/j.ijid.2021.12.357 |
[Figure 1], [Figure 2]
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