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

The field of application for fibreoptic bronchoscopy (FB) in the intensive care unit has been extended since the generalised introduction of fibroscopes of 4.9 mm in diameter (previously called paediatric fibroscopes). Paediatric and neonatal intensive care units have benefited from the availability in the market of these small endoscopes for 3.5 and 2.2 mm. The protected brush and alveolar lavage (LBA) enables a specific diagnosis to be made in bacterial pneumonia acquired during ventilation. The sensitivity of these techniques however is insufficient to be able to recommend their use as routine. Inversely, the FB with LBA remains a fundamental feature in the diagnosis of opportunistic infections in pneumonia. For the treatment of atelectasis, FB is overall not superior to physiotherapy. Aspiration with a fibroscope can however be recommended straight away in cases of alteration in blood gasses if cough is ineffective or if the atelectasis complicates endobronchial bleeding. The FB enables problems with difficult intubation to be resolved or for the positioning of probes. The conditions under which this is performed are more delicate than in routine anaesthesia (in cases of urgency, hypoxia). In the case of respiratory burns, tracheobronchial fracture and post intubation stenosis, FB enables both the diagnosis to be established and the level at which the lesion occurs. In paediatric intensive care, a fibroscope of 3.5 mm is used for performing LBA (opportunistic pneumonias), difficult intubation (facial dysmorphia), endoscopic diagnoses, in particular where there is a suspicion of an endobronchial foreign body, the assessment of unexplained dyspnoea (tracheal stenosis by vascular ring) and obstructive lesions. In neonatal intensive care, a fibroscope of 2.2 mm is used for difficult intubation and the localisation of lesions induced by ventilation.
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PMID:[Fibroscopic bronchoscopy in intensive care]. 949 16

Three manifestations of pneumonia that are associated with influenza are well recognized: primary influenza viral pneumonia, secondary bacterial pneumonia and mixed viral and bacterial pneumonias. In an outbreak of influenza, primary influenza viral pneumonia has occurred predominantly. After a typical onset of influenza, there is a rapid progression of fever, cough and dyspnea. Physical examination and chest roentgenography reveal bilateral findings but no consolidation. A Gram stain of the sputum fails to reveal significant bacteria, and bacterial culture yield sparse growth of normal flora, where as viral cultures yield high titers of influenza virus. Such patients do not respond to antibiotics. Secondary bacterial pneumonia often produces a syndrome that is clinically distinguishable from that of primary viral pneumonia. Recrudescence of fever is associated with symptoms and signs of bacterial pneumonia such as cough, sputum production, and an area of consolidation detected on physical examination and chest roentgenography. Gram staining and the culture of sputum reveals a predominance of a bacterial pathogen, most often H. influenzae, S. pneumoniae, B. catarrhalis, or S. aureus. Such patients usually respond to specific antibiotic therapy. During an outbreak of influenza many cases an observed that do not clearly fit into either of the aforementioned categories. The disease is not relentlessly progressive, and yet the fever pattern may not be biphasic. These patients may have primary viral, secondary bacterial, or mixed viral and bacterial infection of the lung.
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PMID:[Comparative features of pneumonia associated with influenza]. 936 Mar 92

We report a case of severe legionella pneumonia with acute respiratory failure, successfully managed with veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient presented with 4-day history of fever and cough. He was in critical condition, with exacerbated respiratory failure. Mechanical ventilation, volume replacement and antibiotic therapy were initiated. Despite increasing mechanical ventilatory support (FiO2 100%, TV 10 ml/kg, f 30/min, PEEP 5 cmH20), PaO2 fell below 40Torr and life sustaining measures were undertaken. VV-ECMO (flow 30 ml/kg/min) was commenced, and the patient responded well, with an elevation of PaO2. Erythromycin therapy was effective against the pneumonia. VV-ECMO was maintained for 92 hours, mechanical ventilation was successfully discontinued 11 days after and the patient was discharged 82 days after cessation of ventilator support. Serum antibody examination proved legionella infection. VV-ECMO may have a role in the management of patients with acute respiratory failure caused by bacterial pneumonia.
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PMID:[Extracorporeal membrane oxygenation for acute respiratory failure induced by Legionella pneumoniae. (Case report)]. 956 82

In 1998, equine influenza was diagnosed by serology and nucleoprotein enzyme-linked immunosorbent assay as the cause of acute respiratory disease in vaccinated and unvaccinated horses in the UK. The signs were generally milder in vaccinated horses and completely susceptible animals showed the most severe signs, including pyrexia, inappetence, coughing, mucopurulent nasal discharge and secondary bacterial pneumonia. In a detailed investigation of an outbreak among 52 vaccinated thoroughbreds in a flat racing yard, more than 60 per cent of the horses seroconverted on the evidence of paired serum samples tested by single radial haemolysis (SRH). Preliminary sequencing and characterisation of an isolate from this outbreak indicated that it was an 'American-like' strain. In addition, in this outbreak there was a larger proportion of horses with preinfection SRH titres greater than 140 mm2 that subsequently seroconverted than in other recent outbreaks from which 'European-like' strains have been isolated. This result suggested that the cross-protectivity between circulating 'American-like' strains and the 'European-like' strains of A/equine-2 viruses present in current vaccines may be decreasing.
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PMID:Equine influenza in the United Kingdom in 1998. 1057 77

We encountered a case of pulmonary nocardiosis that responded dramatically to combined ST and sparfloxacin treatment. A 55-year-old woman presented with fever, cough and yellowish sputum. She had been under treatment with oral prednisolone (15 mg per day) since July 1997 after a diagnosis of Evans syndrome. A high fever of 39.8 degrees C was noted on January 30, 1998. The patient was hospitalized for bloody sputum, bilateral hypochondriac pain and evidence of infiltrative opacities in the left lower lobe on chest radiography. Bacterial pneumonia was suspected, and she was treated with piperacillin, but her clinical symptoms did not improve. Sputum culture and serologic examination failed to lead to a definitive diagnosis. Nocardia farcinica was isolated by culturing tissue obtained by CT-guided transcutaneous pulmonary biopsy, leading to a diagnosis of pulmonary nocardiosis. The results of an MIC test for antimicrobial agents led to treatment with a combination of ST and sparfloxacin, and the clinical symptoms improved. These clinical observations suggest that, when pneumonia is diagnosed in patients who have been receiving oral steroids for a prolonged period, pulmonary nocardiosis should be considered in the differential diagnosis to enable selection of appropriate antimicrobial agents.
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PMID:[A case report of pulmonary nocardiosis successfully treated with a combination of sulfamethoxazole-trimethoprim (ST) and sparfloxacin]. 1110 9

A 69-year-old woman with myelodysplastic syndrome (MDS) was admitted to our hospital because of recurrent fever and pulmonary infiltration shadows. On the seventh day of hospitalization, she had an attack of high fever and cough and laboratory tests revealed an elevated leukocyte count and elevated serum C-reactive protein. Chest radiographs showed infiltration shadows in the right middle and lower lung fields. Because a diagnosis of bacterial pneumonia was initially suggested, she was treated with antibiotics. However, the infiltration shadows on the chest radiograph had not improve, so bronchofiberscopy was performed. Analysis of fluid obtained by bronchoalveolar lavage (BAL) showed an increase in the total cell count, predominantly in lymphocytes and neutrophils. A transbronchial biopsy specimen showed infiltration of numerous neutrophils with necrosis under the bronchial epithelium, and edematous septa were infiltrated with numerous neutrophils and lymphocytes. BAL, blood, urine, bone marrow, and sputum cultures were all free of bacteria, mycobacteria and fungi. Interstitial infiltration by numbers of neutrophils associated with MDS was diagnosed and steroid treatment was performed.
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PMID:[A case of pulmonary manifestation associated with myelodysplastic syndrome]. 1119 25

This study involves 106 infants (neonatal period ruled out), victims of severe bacterial infections managed from 1st january 1998 to 30 April 2001 by the four paediatric Mobile Intensive Care Unit (P.M.I.C.U.) teams AP-HP in Ile-de-France area. 46.2% of the whole infants are primary interventions (home, medical room, airport) and primary-secondary interventions (hospital emergencies) whereas 53.8% are related to secondary transports of infants who have been hospitalized and suffered from severe bacterial disorders complicating their original disease. 51% are meningitidis infections, rather due to streptococcus pneumoniae and meningococcis, associated with severe infectious purpura. 20.75% are toxic shock syndromes in patients suffering from chronic affections (sickle cell anemia), acquired or congenital immunodeficiencies; 19.8% of the cases are severe bacterial pneumonia (staphylococcal pleuro-pneumopathies, bordetella pertussis cough) or surinfected viral infections (VRS bronchiolitis, pneumonia due to mycoplasma pneumoniae and para-influenzae III). Authors study various characteristics of the two patient's groups, their immediate management by local medical team and by the P.M.I.C.U. team, their early term outcome. 65% of children recovered apparently without sequelae, 19% died, and 16% healed but with significant sequelaes, notably neurological damage. Meningitidis due to Streptococcus pneumoniae are particularly severe, because of their prognostic (10 deaths, 8 severe sequelae among the 26 cases). These observations prompted us to recommend early immunization of infants at 2-3 months post natal age by the new vaccine conjugated up to 7 valences such as "Prevenar". If this vaccine have been available for this patient series, may be avoided 8 deaths, 7 severe sequelae, with 1 septic shock syndrome due to streptococcus pneumoniae and another serious infection in a homozygous sickle cell disease.
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PMID:[Severe bacterial infections in children. Survey by the pediatric mobile intensive care unit AP/HP in the Ile-de-France area]. 1158 17

In August, 1999, a 46-year-old man with fever, cough, and dyspnea was admitted to a hospital. On the basis of the clinical and radiographic findings, bacterial pneumonia was suspected. Antibiotics were not effective, because of atypical lymphocytes in the peripheral blood and positive anti-human T-cell leukemia virus antibody, and he was transferred to our hospital. A chest radiograph and a CT scan revealed bilateral ground-glass opacities with huge multiple cysts. Intensive treatment of Pneumocystis carinii pneumonia associated with human T-cell leukemia was unsuccessful. Pneumocystis carinii was found in the bronchoalveolar lavage fluid. Human T-cell leukemia and Pneumocystis carinii pneumonia were diagnosed. In this case, numerous pulmonary cysts were progressing rapidly, the largest cyst being 8.7 cm in diameter, and the largest cyst in our experience either in clinical practice or in reading of the literature in Pneumocystis carinii pneumonia. The maximum serum KL-6 was markedly increased to 15,200 U/ml, which is the highest level reported for Pneumocystis carinii pneumonia.
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PMID:[A case of Pneumocystis carinii pneumonia with pulmonary cysts and increased level of serum KL-6]. 1187 17

A 80-year-old male visited an outpatient department of a nearby hospital complaining of fever, cough, and poor appetite on June 2000. The patient was diagnosed as bacterial pneumonia and was treated with antibiotics although specific cause could not be identified. After one month, he was hospitalized due to lack of improvement. After admission, acid-fast bacilli (AFB) was found from the bronchial washing. The patient was then transferred to our hospital. Upon admission, sputum smear examination was positive for AFB and MTB was confirmed by PCR. Therapy was initiated with INH 300 mg, RFP 450 mg, EB 1000 mg, and PZA 1000 mg, orally daily. However, on the day following the admission, he became unconscious. Brain MRI showed several small granulomas on the cortex of the bilateral anterior and temporal brain. Although AFB was not detected from the cerebrospinal fluid, tuberculous meningitis was suspected and steroid was given. Nine days after admission, the patient died due to tuberculous meningitis. The isolation of MTB had been attempted on Ogawa culture medium using patient's sputum and liquor, and it took 14 weeks to find colony growth both from sputum and liquor. In the autopsy, numerous granulomas were detected in his lung, liver, kidney, and pancreas. These findings indicate that disseminated growth of MTB occurred in vivo in spite of very slow growth of MTB in vitro.
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PMID:[A case of disseminated tuberculosis requiring extended period for the identification of Mycobacterium tuberculosis on culture]. 1190 31

In HIV-infected patients with intrathoracic lymphadenopathy, it is not known whether clinical and radiographic findings are useful in predicting a specific diagnosis. We determined the etiology and predictors of the etiology of computed tomography (CT)-diagnosed intrathoracic lymphadenopathy in HIV-infected patients evaluated from June 1993 through April 1999. Multivariate analyses were performed to determine clinical and radiographic predictors of the three most common diagnoses. Of 318 patients, 110 (35%) had lymphadenopathy on chest CT. Among these 110 patients, tuberculosis/nontuberculous mycobacterial disease ( = 31), bacterial pneumonia ( = 26), and lymphoma ( = 21) were the most common diagnoses. Multivariate analysis identified cough and necrosis of lymph nodes on chest CT as independent predictors of tuberculosis/nontuberculous mycobacterial disease. African-American race, symptoms for 1 to 7 days, dyspnea, and presence of airways disease on chest CT were independent predictors of bacterial pneumonia; symptoms for >7 days, absence of cough, and absence of pulmonary nodules on CT independently predicted lymphoma. Intrathoracic lymphadenopathy is a frequent chest CT finding in HIV-infected patients. Opportunistic infections and lymphoma are the most common causes, and specific clinical and radiographic features can suggest these particular diagnoses.
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PMID:Clinical and radiographic predictors of the etiology of computed tomography-diagnosed intrathoracic lymphadenopathy in HIV-infected patients. 1243 4


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