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)

A prospective study was conducted at Bamrasnaradura Hospital, Nonthaburi Province, Thailand from November 11, 2002 to January 5, 2003. A total of 59 HIV/AIDS patients with interstitial infiltrates on chest radiographs were included in the study. The objectives of this study were to describe the clinical manifestations and determine the etiologies of interstitial pneumonitis, assess the short-term outcomes and determine the accuracy of the clinical diagnosis of the etiologies of interstitial pneumonitis in HIV/AIDS patients at Bamrasnaradura Hospital, Nonthaburi, Thailand. Tuberculosis was the most common diagnosis (44%), followed by Pneumocystis carinii pneumonia (25.4%), bacterial pneumonia (20.3%) and fungal pneumonia (10.2%). In tuberculosis, compared to other diagnoses, a mild cough (p = 0.031), pallor (p = 0.021), lymphadenopathy (p < 0.001), absence of skin lesions (p = 0.003), higher mean body temperature (p = 0.004) and an absence of dyspnoea on exertion (p = 0.042) were significant findings. On multivariate analysis, however, only an absence of skin lesions (p = 0.023) remained a statistically significant predictor of TB. In Pneumocystis carinii pneumonia compared to other diagnoses, dyspnea on exertion (p = 0.014), non-purulent sputum production (p = 0.047), a higher mean respiratory rate (p < 0.001), absence of lymphadenopathy (p < 0.001) and lack of purulent sputum (p = 0.030) were significant factors. By multivariate analysis, only an absence of lymphadenopathy were shown to be independently and statistically significantly associated (p = 0.040). In bacterial pneumonia, compared to other diagnoses, production of purulent sputum (p = 0.014), hemoptysis (p = 0.006), pallor (p = 0), skin lesions (p = 0.002) and a severe cough (p = 0.020) were significantly associated factors. On multivariate analysis, none of these factors were statistically significant. In fungal pneumonia, compared to other diagnoses, headache and papulonecrotic skin lesions were common findings, but no factor had a significant association. After four weeks, 59.3% of the patients were alive, 13.6% died and 27.1% were lost to follow-up. Among the alive patients 88.6% had clinically improved. On multivariate analysis, no factor was shown to be a statistically significant predictor of death. The cumulative survival after 28 days was highest among PCP patients, followed by bacterial pneumonia, tuberculosis and fungal pneumonia, but this difference was not statistically significant (p = 0.0453).
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PMID:Clinical features, etiology and short term outcomes of interstitial pneumonitis in HIV/AIDS patients. 1661 Jun 49

We report a case of severe eosinophilic pneumonia induced by several antibiotics, requiring mechanical ventilation. A 44-year-old man had been admitted previously to a different hospital because of a high fever and dry cough continuing for a week. Although bacterial pneumonia was diagnosed and he had been treated with several antibiotics, his respiratory state worsened gradually and he was refered to our hospital with severe hypoxia. He needed mechanical ventilation on the fifth hospital day. TBLB identified eosinophilic pneumonia. Although we discontinued all antibiotics and started steroid therapy, he became feverish and his leukocyte count, which was neutrophil dominant, elevated again. We suspected bacterial pneumonia and administered antibiotics that he had never received before. However we had to discontinue these antibiotics soon because of a further inflammatory response. His condition then improved gradually and he was weaned from mechanical ventilation. It is rare for drug-induced eosinophilic pneumonia to become so severe that mechanical ventilation is necessary. We thought that an allergic reaction may have been induced by the series of several antibiotics, inducing severe pneumonia.
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PMID:[Case of severe eosinophilic pneumonia, induced by several antibiotics, requiring mechanical ventilation]. 1708 34

Influenza viruses represent Orthomyxoviridae family. Spherical virions are 80-120 nm in diameter and have two-layer lipid envelope. The following proteins are coded by 8 or 7 segments of the single-stranded RNA: nucleoprotein (NP), polymerase PB2, PB1 and PA, member protein--M1 and M2, glycoproteins--hemagglutinin (HA) and neuraminidase (NA). HA and NA form spikes on the virion surface. On the basis of antigenic differences there are distinguished three types of influenza virus-A, B and C. Besides, influenza A viruses occur in different subtypes, depending on the features of HA and NA. One of influenza characteristics is its antigenic changeability: antigenic drift and antigenic shift. Infection occurs by droplet route, sometimes through direct contact with infected person or surface. Influenza virus attacks epithelial cells of upper respiratory tract, where replication takes place resulting in the production of approximately 1000 of progeny virions during a single 6-12 h cycle in one cell. Necrosis of ciliary cells of mucosa facilitates invasion of bacterial pathogens. Incubation period lasts on average 1-2 days. Influenza illness without complications characterizes the sudden onset of respiratory symptoms and systemic symptoms. Regression of symptoms usually occurs after 3-5 days, but cough and malaise may be observed for over 2 weeks. Reasons for the severe course of the disease or even death are post-influenza complications, e.g. viral pneumonia and bronchitis, bronchiolitis in children, secondary bacterial pneumonia, otitis media, myocarditis and pericarditis, Reye's syndrome, myositis, myoglobinuria, neurological complications and exacerbation of existing chronic diseases. In the case of influenza there is no possible to make the unquestionable diagnosis only on the basis of clinical picture of the disease. Therefore in some circumstances there is important to make some diagnostic laboratory tests as RT-PCR, immunofluorescence assay or isolation of virus and detection of the specific antibodies. The main determinants of the immunity to influenza virus infection are antihemagglutinin (anti-HA) antibodies and antineuraminidase antibodies (anti-NA). The former play fundamental role for the protection against the infection, while anti-NA antibodies limit virus spreading and contribute to a milder course of the disease. In the response to influenza infection there are observed serum immunoglobulines IgG and IgM (after the first contact with the antigen), while immunoglobulines IgA are produced rarely. The latter are produced locally in the high concentrations on the mucus of respiratory tract. Cellular immunological response is important for recovery from influenza where a significant role of cytotoxic T lymphocytes should be emphasized. These lymphocytes are able to kill infected cells in the earliest phases of replication before the progeny virions are formed.
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PMID:[Various sides of influenza, part I--structure, replication, changeability of influenza viruses, clinical course of the disease, immunological response and laboratory diagnostics]. 1716 90

In December, 2001, a 67-year-old woman was given a diagnosis of having systemic sclerosis and organizing pneumonia. Steroid treatment improved her condition, and she received no further medication for approximately three years thereafter. In October 2005, she visited Kurume University Hospital because of cough and fever. Chest X-ray film and high-resolution computed tomography (HRCT) showed bilateral patchy consolidation with air-bronchogram sign and ground-glass opacities, predominantly in the right lower lung field, suggesting relapse of organizing pneumonia. However, bronchoalveolar lavage fluid (BALF) analysis showed an increase of neutrophils (79%) and the CD4/CD8 ratio (4.04). Streptococcus dysgalactiae subsp. equisimilis (beta-hemolytic, Lancefield group G) was detected by bacterial culture of the BALF. Treatment with sulbactam sodium/ampicillin sodium (SBT/ ABPC) rapidly improved her symptoms. The patchy consolidations on chest X-ray and HRCT also disappeared after the treatment. On the basis of these clinical and bacteriological findings, we diagnosed the patient as having bacterial pneumonia caused by Streptococcus dysgalactiae subsp. equisimilis.
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PMID:[A case of bacterial pneumonia caused by Streptococcus dysgalactiae subsp. equisimilis, showing patchy consolidations resembling organizing pneumonia]. 1731 25

An otherwise well 21-year-old man from Northwestern Ontario presented to our emergency department in Winnipeg, Manitoba, with a 2-month history of cough, progressively increasing dyspnea, hemoptysis and a 15-kg weight loss. His symptoms were worsening despite antibiotic treatment for presumed bacterial pneumonia. His past history included work as a seasonal labourer clearing brush. He was not hypoxic on room air, but his chest radiograph revealed a miliary pattern and bilateral infiltrates. A Mantoux test for tuberculosis was non-reactive, and the sputum gram stain was unremarkable. Empiric therapy was initiated for blastomycosis and the diagnosis was confirmed with a calcofluor stain of the sputum. Although blastomycosis is rare in most regions in North America, there is an unusually high incidence of blastomycosis in Northwestern Ontario. This case highlights the intolerance and utility of knowledge of the local epidemiology in establishing difficult diagnoses of regional importance, such as fungal pneumonias.
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PMID:Using local epidemiology to make a difficult diagnosis: a case of blastomycosis. 1735 74

We examined 18 horses with clinical signs of chronic obstructive pulmonary disease (COPD) using physical examination, cytological and bacteriological evaluation of bronchoalveolar fluid, and percutaneous lung biopsy. In 16 cases, histological examination of lung tissue confirmed the diagnosis of COPD. Two horses were excluded: one had uncomplicated bacterial pneumonia and in the other a satisfactory lung biopsy could not be obtained. In horses with COPD, the most common historical complaint was coughing, which was reported in 88%. The most frequently detected abnormal finding on physical examination was abnormal lung sounds; these were detected in 69% of horses at rest and in 88% of horses breathing deeply into a bag. A novel finding was that 29% of horses had lung sounds that were quieter than would be expected for the degree of respiratory effort. Horses with COPD had increased percentages of neutrophils and decreased percentages of lymphocytes and macrophages in their bronchoalveolar lavage fluid. Bronchiolar neutrophil infiltration and peribronchiolar mast cell accumulation in lung biopsy tissue had the highest correlation with clinical condition. The severity of pathological changes in biopsies of lung did not predict whether the horse would die in the two to four year follow-up period. Horses that died in the follow-up period were more severely affected clinically at initial presentation than horses that were alive at the end of the follow-up period.
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PMID:Chronic obstructive pulmonary disease: Usefulness of clinical signs, bronchoalveolar lavage, and lung biopsy as diagnostic and prognostic aids. 1742 75

We describe a unique presentation of polymyositis-associated pneumonitis. A 45-year-old man with a history of polymyositis presented with an episode of fever, cough, dyspnea, rapidly progressive respiratory failure, and unilateral pulmonary infiltrates. Although bacterial pneumonia was initially suspected, all cultures, including bronchoalveolar cultures, remained negative, and the patient's condition worsened despite wide-spectrum antibiotics. Lung biopsy showed organizing pneumonia. The patient was treated with systemic corticosteroids and had complete resolution of respiratory failure and pulmonary infiltrates. We discuss polymyositis/dermatomyositis-associated pneumonitis.
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PMID:Acute unilateral pneumonitis in a patient with polymyositis: a unique presentation of polymyositis-associated pneumonitis. 1802 70

The currently circulating H3N2 and H1N1 subtypes of influenza A virus cause a transient, febrile upper respiratory illness in most adults and children ("seasonal influenza"), but infants, the elderly, immunodeficient and chronically ill persons may develop life-threatening primary viral pneumonia or complications such as bacterial pneumonia. By contrast, avian influenza viruses such as the H5N1 virus that recently emerged in Southeast Asia can cause severe disease when transferred from domestic poultry to previously healthy people ("avian influenza"). Most H5N1 patients present with fever, cough and shortness of breath that progress rapidly to adult respiratory distress syndrome. In seasonal influenza, viral replication remains confined to the respiratory tract, but limited studies indicate that H5N1 infections are characterized by systemic viral dissemination, high cytokine levels and multiorgan failure. Gastrointestinal infection and encephalitis also occur. The licensed anti-influenza drugs (the M2 ion channel blockers, amantadine and rimantadine, and the neuraminidase inhibitors, oseltamivir and zanamivir) are beneficial for uncomplicated seasonal influenza, but appropriate dosing regimens for severe seasonal or H5N1 viral infections have not been defined. Treatment options may be limited by the rapid emergence of drug-resistant viruses. Ribavirin has also been used to a limited extent to treat influenza. This article reviews licensed drugs and treatments under development, including high-dose oseltamivir; parenterally administered neuraminidase inhibitors, peramivir and zanamivir; dimeric forms of zanamivir; the RNA polymerase inhibitor T-705; a ribavirin prodrug, viramidine; polyvalent and monoclonal antibodies; and combination therapies.
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PMID:Current and future antiviral therapy of severe seasonal and avian influenza. 1832 78

The clinical features of Lophomonas blattarum infection in 26 patients with bacterial pneumonia were analyzed. Common manifestation included fever, cough and breathlessness. Computed tomography (CT) showed interstitial change and alveolar exudation. The parasites were found in sputum smear and from the bronchoalveolar lavage fluid (BALF). Metronidazole was effectively used to cure the pulmonary infection of L. blattarum.
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PMID:[Diagnosis and treatment of Lophomonas blattarum infection in 26 patients with bacterial pneumonia]. 1844 4

A 24-year-old Vietnamese woman presented with a 3-month history of non-itchy erythematous plaques on the face, trunk and limbs. Borderline lepromatous leprosy was confirmed by clinical findings, acid-fast bacilli on skin biopsy specimen and skin smear and a history of exposure. Around the twentieth day of World Health Organization (WHO) multibacillary standard treatment (rifampin 600 mg per month, dapsone 100 mg per day, clofazimine 300 mg per month and 50 mg per day for 1 year), she developed fever, general malaise, blurred vision, cough, nausea, epigastric pain, and arthralgia. The skin lesions also became swollen. During hospitalization, her illness was complicated by retrobulbar optic neuritis, secondary bacterial pneumonia, pleuritis, ascites, hepatitis, antral gastritis, progressive normocytic anemia, and peripheral sensory loss. The patient recovered after receiving systemic steroid pulse therapy (prednisolone equivalent dose 1250 mg) with systemic antibiotics (cefuroxime), adjustment of her anti-lepromatous therapy, and supportive care. She resumed the WHO multibacillary regimen uneventfully. This patient presented with a diverse type 1 reaction, which is a complex immune response in leprosy. We found that the judicious use of high dose steroids followed by a slow tapering course is beneficial in managing patients with a severe type 1 reaction. At the 1-year follow up, the patient had generalized skin hyperpigmentation resulted from long-term clofazamine use and numbness on feet without other systemic sequelae.
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PMID:Corticosteroid pulse therapy for leprosy complicated by a severe type 1 reaction. 1856 21


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