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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article summarizes the principles of judicious antimicrobial therapy for three of the five conditions--cough, pharyngitis, the common cold--that account for most of the outpatient use of these drugs in the United States. The principles governing the other two conditions, otitis media and acute sinusitis, were presented in the previous issue. This article summarizes evidence against the use of antibiotic treatment for illness with cough or bronchitis in children, unless the cough is prolonged. Although empiric treatment may be started in patients with pharyngitis when streptococcal infection is suspected, the authors recommend withholding antibiotic treatment until antigen testing or culture is positive. There is never any indication for antibiotic treatment of the common cold; it is important to understand the natural history of colds, because symptoms such as mucopurulent rhinitis or cough, even when they persist for up to two weeks, do not necessarily indicate bacterial infection.
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PMID:Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. The Pediatric URI Consensus Team. 980 98

A case of concurrent canine systemic lupus erythematosus (SLE) and generalized bacterial infection in a six-year-old female Beauceron is reported. The dog presented with purulent nasal and ocular discharges, skin lesions (including seborrhea, hyperkeratotic areas, and papules as well as ecchymoses around the eyes, on both sides of the pinnae, and on the vulva), generalized lymph node enlargement, a mitral murmur, and lameness. Later, facial swelling, a retrobulbar abscess, and a cough also developed. Occurrence of a generalized bacterial infection was established by culture of group-C, beta-hemolytic Streptococcus from the throat, the mouth, a biopsy site (popliteal lymph node area), the retrobulbar abscess, and the lung. The diagnosis of SLE was based on the clinical signs and particularly on the occurrence of antinuclear antibody (ANA) and antidoublestranded-desoxyribonucleic acid (ds-DNA) antibody. Interestingly, the latter type of antibodies were also detected in two young female puppies whelped by this dog. Salient histological findings included an extreme cell depletion of the lymph nodes and spleen and severe pneumonitis and peribronchiolitis. The results of this case indicate that a definite diagnosis of canine SLE can, at times, be made on the basis of the presence of serum ANA and ds-DNA antibodies.
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PMID:Nonresponsive generalized bacterial infection associated with systemic lupus erythematosus in a Beauceron. 1033 60

In the D ward of Nagoyashi-Koseiin geriatric hospital (36-beds), upper respiratory illnesses were recognized in all the inpatients between July and August in 1995, and we studied 7 elderly subjects with parainfluenza 3 infection diagnosed by serology and viral culture. The outbreak of upper respiratory illnesses occurred in the ward during the 17 days from July 21 through August 6, 1996. Fifteen of the 18 elderly persons with upper respiratory illnesses were tested by serology; parainfluenza 3 infection was identified in 7. One of the 7 patients, parainfluenza 3 virus was isolated. Seven elderly subjects with parainfluenza 3 infection were 2 males and 5 females and five of them (71.4%) were bedridden. The most common complaint was fever and coughing in 7/7 (100%), followed by sputum in 5/7 (71.4%), wheezing in 4/7 (42.9%). The pyrexial period in the parainfluenza-infected group ranged from 1 to 4 days (average 3.1 days), and was significantly shorter than that of the influenza group. The maximum recorded temperature in the parainfluenza-infected group ranged from 37.0 to 39.2 degrees C (average 38.1 degrees C), and was significantly lower than that of the influenza group. Two of the 7 patients with parainfluenza 3 virus infection had pneumonia, but nobody died, and all 7 patients recovered without sequele. It is possible that parainfluenza 3 virus infection among elderly subjects cause secondary bacterial infection, so we think that prevention of nosocomial parainfluenza infection should be a high priority in the case of outbreak of such an infection in a ward.
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PMID:[An outbreak of parainfluenza 3 virus infection in the elderly in a ward]. 1035 86

Exacerbations of COPD, which include combinations of dyspnea, cough, wheezing, increased sputum production (and a change in its color to green or yellow), are common. The role of bacterial infection in causing these episodes and the value of antibiotic therapy for them are debated. An assessment of the microbiological studies indicates that conventional bacterial respiratory pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae, are absent in about 50% of attacks. The frequency of isolating these organisms, which often colonize the bronchi of patients in stable condition, does not seem to increase during exacerbations, and their density typically remains unchanged. Serologic studies generally fail to show rises in antibody titers to H influenzae; the only report available demonstrates none to Haemophilus parainfluenzae; and the sole investigation of S pneumoniae is inconclusive. Trials with vaccines against S pneumoniae and H influenzae show no clear benefit in reducing exacerbations. The histologic findings of bronchial biopsies and cytologic studies of sputum show predominantly increased eosinophils, rather than neutrophils, contrary to what is expected with bacterial infections. The randomized, placebo-controlled trials generally show no benefit for antibiotics, but most have studied few patients. A meta-analysis of these demonstrated no clinically significant advantage to antimicrobial therapy. The largest trials suggest that antibiotics confer no advantage for mild episodes; with more severe attacks, in which patients should receive systemic corticosteroids, the addition of antimicrobial therapy is probably not helpful.
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PMID:Do bacteria cause exacerbations of COPD? 1117 60

A 48-year-old caucasian male was admitted to hospital with right-sided chest pain, pyrexia and cough. He had no history of dysentery. He was treated with erythromycin and cotrimoxazole for right lower lobe pneumonia but failed to respond. Tender hepatomegaly developed and ultrasound scan demonstrated multiple abscesses in the liver. Entamoeba histolytica was identified in his faeces. He was treated with intravenous metronidazole, chloramphenicol and gentamicin and then oral tinidazole, after which improvement was rapid. He was later transferred to Australia. Subsequent abdominal CAT scan and aspiration of abscesses confirmed the diagnosis of multiple amoebic liver abscesses with secondary bacterial infection. Final treatment was with oral ciprofloxacin and metronidazole for four weeks. Ultrasonography is a noninvasive technique which is invaluable in the diagnosis of abdominal and especially liver pathology. This technique should be available in larger centres in tropical countries. Anyone living in or visiting the tropics should be aware of possible exotic diseases presenting in unusual ways.
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PMID:Multiple liver abscesses: an unusual case which demonstrates the importance of ultrasonography in the detection of liver pathology. 1093 48

A 69-year-old woman visited her physician on October 1 complain of dry cough. However, the chest radiograph revealed no abnormalities. She was later admitted to our hospital because a radiograph taken by another physician on November 26 revealed a massive lesion in the right upper mediastinum. Computed tomographic findings showed a massive lesion containing a branching structure with a few calcifications, suggesting a case of atelectasis of the left upper lobe with mucus plug. Bronchoscopic examination revealed complete obstruction of the orifice of the left upper lobe bronchus, and so a diagnosis of bronchial atresia was made. However, since the patient had a history of tuberculous peritonitis and the mass lesion was somewhat calcified, the possibility that this was an acquired case could not be ruled out. After treatment with oral antibiotics, the size of the atelectasis was decreased. Therefore, we considered that the expansion of the atelectasis could have been due to superimposed bacterial infection.
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PMID:[Bronchial atresia with atelectasis of the left upper lobe]. 1119 24

In order to investigate the role of infectious agents in the aetiology of lower respiratory tract disease in Thoroughbred racehorses, a matched case-control study was conducted. Cases were identified by the presence of coughing, and were compared to a control population matched on time of sample collection and location within the same training establishment. Tracheal wash samples were collected from 100 cases and 148 controls. Case horses were more likely than controls to have endoscopic and cytological evidence of airway inflammation. There was no significant association between serological evidence of infection by commonly implicated respiratory viruses and coughing. Similarly, mycoplasma were rarely isolated and were not associated with disease. In contrast, there was a strong association between isolation of greater than a total of 10(3) colony-forming units/ml of tracheal wash and coughing. Individual bacterial species associated with disease included Streptococcus zooepidemicus, Streptococcus pneumoniae, Streptococcus suis, Streptococcus sanguis, Pasteurella spp and Bordetella bronchiseptica. This study provides evidence of the role of bacterial infection in the aetiology of lower respiratory tract inflammation in racehorses. However, in 58% of cases, few or no bacteria were isolated. Hence, at the time of identification of disease, there was no evidence of viral, bacterial or mycoplasmal infection in the majority of coughing horses. The aetiology of the signs observed in these horses requires further investigation.
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PMID:A case-control study of respiratory disease in Thoroughbred racehorses in Sydney, Australia. 1135 41

Basidiobolus ranarum is a saprophytic fungus in the environment that also is a part of the endogenous microflora in the gastrointestinal tract of several vertebrates. These organisms may penetrate skin or muscosa of humans and other animals, causing granulomatous inflammation. Two dogs infected with B. ranarum had prolonged or repeated exposure to water or soil in their environment. One dog had progressive subcutaneous infection of all the limbs, and the other dog had recurrent coughing and dyspnea caused by tracheobronchitis. In both dogs, secondary bacterial infection of the lesions was evident. Treatment of the dog with subcutaneous infection involved cutaneous dressings and sequential use of enrofloxacin and itraconazole; however, this resulted in suspected liver damage without clinical improvement. Subsequent treatment with potassium iodide and a lipid formulation of amphotericin B was also unsuccessful, and the dog was euthanatized. The other dog was treated alternately with enrofloxacin and itraconazole. When the clinical signs and infection returned, combination treatment with both drugs was more effective; however, the dog developed liver damage. Subsequent treatment with enrofloxacin on an intermittent basis controlled the dog's coughing during a 3-year period.
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PMID:Infection with Basidiobolus ranarum in two dogs. 1218 3

Respiratory viruses and their complications are the most common diseases after dental caries, and the most important single cause of medical consultations. They are the 2nd leading cause of hospitalization and mortality in infants. The challenge in respiratory infections is to prevent complications. Since most respiratory infections are treated in the home, preventive interventions should begin there. Respiratory infections do not depend greatly on environmental conditions, they are not preventable by vaccination, and their course in the great majority of cases is self-limiting and benign. Respiratory viruses are characterized by a symptom complex which represents the reaction of the organism to the viral infection. Although the symptoms may be annoying, they play an important role in preventing bacterial complications. Nasal secretions contain substances that limit the virus and impede secondary bacterial infection. Nasal congestion should be treated only by aiding the evacuation of secretions. Nasal obstruction and resulting respiration through the mouth allow unfiltered air to reach the bronchial passages, causing irritation or contamination. Use of local or systemic decongestants or antihistamines may contribute to complications by decreasing defenses. Treatment of inflamed pharynx or tonsils with antiinflammatories is counterproductive because it too interferes with the body's defenses against viral invasion. Viral laryngitis should be treated only with steam vapor and never with steroids, which diminish the body's antiviral defenses and can produce serious side effects. Coughs are the body's means of evacuating viral secretions and should be aided only by ensuring adequate hydration to maintain the fluidity of the secretions. Expectorants should be used only in cases of chronic bronchitis. Coughs resulting from bronchial obstruction, cases in which bronchial dynamics are hyperactive, and dry and unproductive coughs resulting from pharyngeal irritation are the only ones that should be treated. Fever it probably the defense mechanism that has elicited the greatest treatment efforts. Lowering the fever through medication does nothing to fight the virus but makes children feel well enough to resume playing outside, thereby increasing the risk of secondary bacterial infection. Children with fevers should be kept hydrated. Only in the case of pain should medication be given to lower the fever. Aspirin should be avoided in children. An untreated fever provides information on the course of the disease: spontaneous decline followed by a rise may indicate bacterial infection.
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PMID:[Combatting fever, phlegm and cough]. 1234 10

Two types of pneumonia are well recognized during influenza: primary viral pneumonia and secondary bacterial pneumonia. Primary viral pneumonia occurs after a typical onset of influenza with rapid progression of dyspnea and cough leading to acute respiratory distress syndrome. Treatment consists of respiratory assistance, but mortality is high. Secondary bacterial pneumonia occurs more frequently in the elderly and in patients with chronic pulmonary diseases. Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae are the most frequently isolated bacteria. After an initial phase of clinical improvement, manifestations of bacterial infection with pulmonary consolidation occur. The outcome is favorable with antibiotics but depends on the patient's underlying conditions.
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PMID:[Influenza pneumonia]. 1455 65


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