Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Interstitial pneumonitis includes more than a hundred diseases in which alveolitis is the main manifestation of the affected lung. Symptoms such as dry cough and exertional dyspnea, fine crackles on chest auscultation, interstitial infiltrates on chest X-ray films and CT scans, respiratory function tests, and Ga-67 scintigraphy have been used for the diagnosis and the evaluation of disease activity. However, the poor prognosis of some types of interstitial pneumonitis has not been improved. We discovered a high molecular weight mucin-like antigen, designated KL-6, which is also known as MUC1. The serum level of KL-6/MUC1 was elevated in 70-100% of patients with interstitial pneumonitis, such as pulmonary fibrosis (either idiopathic or related to collagen-vascular disorders), hypersensitivity pneumonitis, sarcoidosis, and radiation pneumonitis. The levels were significantly higher in patients with active disease than in those with inactive disease. In contrast, patients with noninterstitial lung disease did not show a significant elevation of KL-6/MUC1. Furthermore, the serum KL-6/MUC1 level was found to be an early predictive marker of the therapeutic effect of high-dose corticosteroids in patients with rapidly progressing idiopathic pulmonary fibrosis. These results indicate that KL-6/MUC1 may be a useful serum marker for the diagnosis and monitoring of patients with interstitial pneumonitis.
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PMID:Serum marker KL-6/MUC1 for the diagnosis and management of interstitial pneumonitis. 1068 9

Hypersensitivity pneumonitis (HP) is the clinical manifestation of an pulmonary immunological reaction to inhaled antigens. The list of provocative antigens and specific illnesses grows permanently. A woman of 56 years consulted for dyspnea and cough of two months of evolution. She worked in a factory of sausages removing the dust that recovers the salamis during their stationing. She presented hypoxemia and the pulmonary function test revealed a predominantly obstructive pattern. The x-ray of the thorax was normal and the high resolution computed tomography showed a mosaic pattern. A lung biopsy confirmed the diagnosis of HP. She improved with systemic corticosteroids and the avoidance of antigen exposure. In the cultures of the material that recovers the salamis, Penicillium spp. was recovered and was interpreted as the probable etiological agent of this HP, which we have denominated "the salami worker's lung".
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PMID:[Salami worker's lung]. 1075 2

Extrinsic allergic alveolitis often occures as bird fancier's lung or is caused by occupational treatment with antigenic materials. In housing environments antigens of allergic alveolitis are also found, especially mould fungi. lf a source of antigens is absent in the anamnesis and the clinical picture as well as the clinical findings are ambiguous, the diagnosis of extrinsic allergic alveolits is delayed or unobtained. The following example shows that in spite of a detailed allergic anamnesis the source of antigens may remain occult and only an inspection of the dwelling rooms leads to an elucidation. - A sixty-one year old non-smoking women was twice admitted to hospital with a temperature of more than 39 degrees C, intense dyspnea on exertion and a strong dry cough under the persumed diagnosis pneumonia. The laboratory values showed nonspecific signs of inflammation, the blood gas analysis was changed to a heavy hypoxemia (pO subset2 49.2 mmHg) and in the chest x-ray there were seen miliary and partly reticular alterations. The chest computed tomography showed extensive densities in both upper and lower parts of the lungs and the pulmonary function test corresponded with a low-grade to middle-grade restriction (VC subsetin = 67%, TLC = 69%). A high dose of corticosteroids produced an improvement of the radiological findings and of the pulmonary function. Also the specialized diagnostic in a hospital for pulmonary diseases yielded no new knowledge, and an interstitial pneumonia was diagnosed. Only the new formation of an acute pneumonic clinical picture on the day of returning to the patients own habitation suggested a noxious substance in the domestic environment. The inspection of the rooms finally showed the source of antigen to be from a condensation water soaked, moulded tapestry on the embrasure of a small unopenable window in the bedroom just on the head of the bed. The nutritive mediums left in the rooms furnished evidence of the mould-species Penicillium, Cladosporium and Botrytis, in the bedroom however mostly Penicillium. The RAST of specific IgG proved a positive result of all three mould species (Penicillium sp. 1 : 100, Cladosporium sp. 1 : 200 and Botrytis sp. 1 : 200). The diagnosis of an extrinsic allergic alveolitis caused by mould was confirmed by a controlled re-exposure test, which promptly gave rise to a relapse and forced the patient to change habitation with the result of no further ailments. - Characteristic for the extrinsic allergic alveolitis in the described case is the inefficiency of antibiotic therapy, the immediate recovery by corticosteroids and furthermore the outbreak of relapses caused by re-exposure. If the source of antigens is unclear, the inspection of the habitation by an experienced allergologist may lead to success.
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PMID:Extrinsic allergic alveolitis in domestic environments (Domestic allergic alveolitis) caused by mouldy tapestry 1075 68

We report a case with rheumatoid arthritis and hypersensitivity pneumonitis. A 66-year-old female was admitted to our hospital because of fever, cough, and progressive dyspnea on October 10, 1997. She had a history of rheumatoid arthritis from 1987 and was treated with cyclophosphamide when she developed pulmonary symptoms in September 1997. On admission arthritis was subsided. Fine crackles on ausculation of lung, hypoxia, ground-glass appearance on chest X-ray were detected. The computed tomography of the chest disclosed diffuse interstitial shadow with patchy destruction of alveolar structures. Bronchoalveolar lavage demonstrated an increase in lymphocytes with predominance of suppressor-cytotoxic T cell subset (CD 8+). The histopathological examination of transbronchial lung biopsy showed interstitial inflammation with marked predominance of lymphocyte with intraalveolar exudate. Her condition got better and she discharged without definitive diagnosis and treatment for her respiratory symptoms. Eight hours after she went back home, she suddenly presented high fever and cough and gradually developed dyspnea. She was readmitted 5 days after the previous discharge. Although no specific precipitin antibody against various microorganisms was detected in her sera, the diagnosis of hypersensitivity pneumonitis was made. Thirty mg per day of prednisolone was resolved her symptoms promptly. There was no reported case with hypersensitivity pneumonitis and rheumatoid arthritis of other collagen diseases. The clinical course that arthritis and pulmonary symptoms appeared alternatively is of considerable interest to investigate for the pathogenesis of these two immune disorders.
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PMID:[Hypersensitivity peumonitis in a patient with rheumatoid arthritis]. 1077 70

A 38-year-old woman was admitted to the Iiyama Red Cross Hospital with a non-productive cough. She had been working with Strophariaceae cultures for 4 years, and in January 1999 a cough had developed. On admission, hypoxemia was noted. The serum level of lactate dehydrogenase was slightly elevated. Chest radiography and CT scanning showed diffuse ground glass opacity and small centrilobular nodules in both lower lobes. In the bronchoalveolar lavage fluid, the total cell count was normal, the CD4/CD8 ratio was reduced, and the lymphocyte fraction was very high. A transbronchial lung biopsy revealed alveolitis with lymphocytic infiltration and organizing changes like Masson bodies. The lymphocyte stimulation test was positive for Strophariaceae. Hypersensitivity pneumonitis caused by Strophariaceae was diagnosed. Prednisolone was administered because of persistent symptoms and prolonged abnormal chest radiography findings. These abnormalities disappeared 2 weeks after prednisolone treatment was initiated. There is one previous report of hypersensitivity pneumonitis caused by Strophariaceae. The symptoms are coughing and sputum production as in the common cold. The occupational history must be carefully considered in making a diagnosis.
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PMID:[A case of hypersensitivity pneumonitis caused by Strophariaceae]. 1101 68

We encountered two sisters with hypersensitivity pneumonitis caused by Lyophyllum aggregatum. In Case 1, the patient was a 47-year-old woman who consulted Iiyama Red Cross Hospital because of a non-productive cough. She had worked with Lyophyllum aggregatum cultures for 7 years. In 1996, she complained of a dry cough, and had had a severe cough in November 1998. She was admitted to Iiyama Red Cross Hospital because of dyspnea on effort. Laboratory data revealed a high level of C-reactive protein. Chest radiography and CT scanning showed ground glass opacities in both lower lobes, and centrilobular nodules. Bronchoalveolar lavage fluid revealed a decrease in the CD4/CD8 ratio, and the lymphocyte fraction was very high. Transbronchial lung biopsy revealed lymphocytic granuloma and interstitial thickening, and the lymphocyte stimulation test was positive for Lyophyllum aggregatum. Case 2 occurred in the 51-year-old sister of Patient 1. She had worked with Lyophyllum aggregatum cultures for 10 years. In 1994, she had experienced dyspnea and a dry cough while working. In January 1999, she was admitted to Iiyama Red Cross Hospital because of a dry cough, sputum and chest oppression. Chest radiography and CT scanning revealed ground glass opacities in both lower lobes and centrilobular nodules. The CD4/CD8 ratio in the bronchoalveolar lavage fluid was low, and the lymphocyte fraction conspicuously high. The transbronchial lung biopsy revealed lymphocytic granuloma and interstitial thickening. The lymphocyte stimulation test was negative for Lyophyllum aggregatum. She was discharged and returned to work, but the dry cough and low-grade fever recurred. However, the occupational provocation test is not regarded as positive because chest radiography, laboratory examinations, and a pulmonary function test were not performed. The symptoms of both cases were eliminated only on isolation of the antigen. There has not been any previous report of hypersensitivity pneumonitis caused by Lyophyllum aggregatum.
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PMID:[Hypersensitivity pneumonitis caused by Lyophyllum aggregatum in two sisters]. 1106 Oct 85

A 73-year-old woman was admitted to our hospital with a low-grade fever, dry cough and dyspnea on exertion as the chief complaints. She had been a professional shiitake mushroom grower for 50 years. Three years before visiting our hospital, she had been suspected of having hypersensitivity pneumonitis as a result of chest X-ray examination, bronchoalveolar lavage and transbronchial lung biopsy performed at another clinic. No antigens were identified at that time, but prednisolone was administered. On admission to our hospital, chest radiography and chest computed tomography revealed an interstitial shadow with subpleural honey-combing in both lower lung fields. After steroid pulse therapy, dyspnea on exertion and hypoxia improved moderately. Because of recurrence of the dyspnea, however, she was admitted on four separate occasions. On the second admission, an increase in lymphocytes was found by bronchoalveolar lavage, and septal lymphocytic infiltration accompanying fibrosis was demonstrated by transbronchial lung biopsy. On the fourth admission, a detailed immunological examination and an environmental survey were performed. The environmental provocation test yielded clinical symptoms similar to those experienced at the mushroom farm. Furthermore, tests of precipitation and lymphocyte proliferation in response to shiitake mushroom extracts were positive. Finally a diagnosis of chronic hypersensitivity pneumonitis induced by shiitake mushrooms was confirmed.
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PMID:[A case of chronic hypersensitivity pneumonitis induced by shiitake mushroom spores]. 1124 26

Migrating pulmonary infiltrates present a difficult diagnostic and therapeutic challenge. We report on eight patients (mean age 51 years, range 32-78 years, with a prolonged history of migrating pulmonary infiltrates of unknown aetiology despite a very elaborate search for infectious causes, hypersensitivity pneumonitis or inhalation fever due to occupational or domestic exposure to fungi, or to other environmental causes, and for humoral or cellular immunological incompetence. These patients (one male, seven females) presented with recurrent episodes (mean 6, range 2-13) of a flu-like illness, often with cough, wheezing and pleuritic chest pain, but without systemic involvement. Previous medical histories were unremarkable. There was no relation with smoking habits, occupation, drug use or other possible exposures. Biochemical data were non-specific. There was no peripheral nor pulmonary eosinophilia; total IgE was normal, with negative RASTs and precipitins to a variety of antigens. Cultures and serological tests for bacteria, viruses, fungi, etc were non-contributory. Chest X-ray and computed tomography (CT) scan showed bilateral migratory pulmonary infiltrates, with a predilection for the middle and lower lung zones, often with a minor-to-moderate pleural effusion. Lung function tests were usually normal; at the most a slight decrease in diffusing capacity was noted in some patients. There was no or only a slight response to antimicrobials; systemic corticosteroids were not given. Further evolution was benign with patients being asymptomatic between the episodes. Despite elaborate investigations, the cause of these 'pneumonias' remains frustratingly unknown.
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PMID:Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology. 1139 75

A 61-year-old woman was admitted to the Oita Medical University Hospital because of a nonproductive cough and exertional dyspnea. Interstitial changes had been seen on her chest radiograph 5 years previously, but no respiratory symptoms were identified at that time. On admission, chest radiography revealed linear and ground-glass opacities in the middle and lower lung fields. Computed tomography provided evidence of bronchiectasis and micro-honeycombing of the lungs, while lymphocyte and neutrophil counts in the bronchoalveolar lavage fluid were increased. Transbronchial lung biopsy demonstrated alveolitis and Masson's bodies. The patient was not a pigeon breeder, but she could have been exposed to pigeons at her workplace. Indeed, she had specific antibodies against pigeon serum and droppings, and her peripheral lymphocytes showed proliferation in response to pigeon serum. A positive provocation test involving inhalation of pigeon serum confirmed that she had chronic hypersensitivity pneumonitis caused by allergy to pigeons. This is a rare case of chronic hypersensitivity pneumonitis associated with wild pigeons, that progressed to pulmonary fibrosis. Antigen provocation testing proved to be of great value.
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PMID:[A case of chronic hypersensitivity pneumonitis due to wild pigeons]. 1143 19

A 47-year-old automobile painter developed dry cough, chills and dyspnea after four months of painting work. The spray contained isocyanates (HDI). A chest radiograph showed bilateral ground-glass shadows. The serum KL-6 level was very high: 11,100 U/ml. Marked lymphocytosis and a striking decrease in the CD4/CD8 ratio were observed in the bronchoalveolar lavage fluid. Transbronchial lung biopsy specimens showed alveolitis and bronchiolitis. Cessation of exposure to isocyanates improved the symptoms and laboratory data. We suspected that the patient was suffering from hypersensitivity pneumonitis induced by isocyanates. Specific IgG antibodies for TDI, MDI, and HDI were not demonstrated by enzyme-linked immunosorbent assay. Because abnormal shadows in the chest radiograph did not improve quickly after admission, we administered glucocorticoids which improved the symptoms, the chest radiograph findings, and the serum KL-6 level.
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PMID:[A case of pneumonitis possibly due to isocyanate associated with high levels of serum KL-6]. 1153 Mar 96


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