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

Reported are the results of a randomized trial of sulfamethoxazole + trimethoprim versus procaine penicillin for the outpatient treatment of pneumonia in 614 children aged 3 months to 12 years at primary health care clinics in Chitungwiza, a large town near Harare, Zimbabwe. Diagnosis and treatment were carried out by nurses, without medical supervision. The presence of lower respiratory tract infection that required antibiotics was diagnosed on the basis of a recent history of a cough and the presence of a respiratory rate of greater than 50 per minute. Patients were followed up by a research nurse with minimal drop-out losses. Referred children were examined and assessed by a doctor at the Chitungwiza General Hospital. Of the study children, 65 (11%) were referred to hospital, but only 8 (1.3%) had pneumonia that required a change in the treatment (5 in the sulfamethoxazole + trimethoprim group and 3 in the procaine penicillin group). There were no significant differences in outcome between the two treatment groups. One child, who had evidence of infection with human immunodeficiency virus (HIV), died. Sulfamethoxazole + trimethoprim and procaine penicillin were highly and equally effective for the outpatient treatment of children who had been clinically diagnosed to have pneumonia by primary health care workers.
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PMID:Randomized trial of sulfamethoxazole + trimethoprim versus procaine penicillin for the outpatient treatment of childhood pneumonia in Zimbabwe. 219 87

From June 1988 to February 1989, we enrolled 36 patients with human immunodeficiency virus into a randomized double-blind placebo-controlled trial assessing the efficacy and toxicity of aerosolized pentamidine (AP) as secondary prophylaxis for Pneumocystis carinii pneumonia. Each patient underwent spirometric evaluations before and after aerosolized treatment. There was no significant difference in the results of baseline pulmonary function tests between the two groups. Eleven patients (65 percent) in the AP group developed cough but only four demonstrated significant reduction in the forced expiratory flow rates after AP; four patients (21 percent) in the placebo group developed cough, but no significant change in the expiratory flow rates was noted. All bronchospastic episodes were self-limited and symptomatically responded to remedial inhaled albuterol (salbutamol) treatment. We conclude that AP treatment is frequently associated with coughing attacks (65 percent), but the actual incidence of bronchospasm on spirometry is much lower (24 percent) and is generally quite mild.
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PMID:Acute pulmonary effects of aerosolized pentamidine. A randomized controlled study. Toronto Aerosolized Pentamidine Study (TAPS) Group. 191 90

Sixty-eight patients infected with human immunodeficiency virus (HIV) and Cryptococcus neoformans who presented to three major medical centers in New Orleans, Louisiana, were studied retrospectively. In patients with meningitis the most common presenting symptoms were fever and headache. Those without central nervous system involvement generally had an isolated pulmonary infection due to C. neoformans and presented with cough and dyspnea. CSF parameters were abnormal in 41% of patients, and the India ink preparation was positive in 88% of patients with cultures of CSF positive for C. neoformans. The overall median survival time for the 47 patients who died was 5 months, with a range of 0-22 months. Of the 27 patients who received maintenance therapy with amphotericin B, two (7%) relapsed. The only factors found to be associated with a poor prognosis were abnormal computed tomography of the head and altered mental status on presentation. C. neoformans infections in HIV-infected patients remain difficult to treat and have a poor prognosis.
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PMID:Spectrum of Cryptococcus neoformans infection in 68 patients infected with human immunodeficiency virus. 223 16

During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. 'Tru-cut' lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.
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PMID:Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa. 261 33

Immunosuppression due to human immunodeficiency virus type 1 (HIV) infection has led to a marked increase in Pneumocystis carinii pneumonia (PCP). Prophylaxis against PCP is standard practice in pediatric cancer patients but is associated with unique problems in HIV-infected patients, including the need for lifelong therapy, adverse reactions, and drug interactions. HIV-infected patients at highest risk for PCP are those with a prior episode of PCP and/or a CD4 lymphocyte count of less than 200 cells/microL. A combination of trimethoprim and sulfamethoxazole is effective prophylactically, although a significant rate of adverse reactions makes long-term prophylaxis difficult. Other oral medications such as dapsone and a combination of pyrimethamine and sulfadoxine are promising but not yet adequately tested. Inhalation of aerosolized pentamidine is an effective and safe means of prophylaxis if the proper dose and nebulizer are used. The only common adverse effects with the latter are airway irritation manifested by cough or wheezing. Zidovudine appears to have a synergistic benefit in further reducing the attack rate of PCP when used with aerosolized pentamidine.
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PMID:Prophylaxis of Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus type 1. 269 54

Two cases of Pneumocystis carinii pneumonia occurred in human immunodeficiency virus infected patients who were diagnosed by the aspiration-lung-biopsy. They were treated with 4 mg/kg of pentamidine isethionate intravenously administered followed by pentamidine aerosol inhalation. Although clinical and laboratory findings were improved by the fifth or seventh day of intravenous therapy, substantial leukocytopenia, from 3,000/cmm to 600/cmm and from 2,700/cmm to 1,000/cmm, occurred. At this point, the method of pentamidine administration was switched to inhalation. Pentamidine 600 mg in 30 ml distilled water was aerosolised using ultrasonic nebuliser and exposed for a 30-minute period once daily. In both cases, chest x-rays showed improvements: The disappearance of P. carinii were obtained in two weeks. Mild coughing was the sole adverse reaction encountered during the course of aerosol inhalation.
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PMID:Two cases of Pneumocystis carinii pneumonia occurred in human immunodeficiency virus infected patients: supplemental treatment with aerosolised pentamidine isethionate. 278

212 adults with symptomatology indicative of acquired immunodeficiency syndrome (AIDS) presented to the Ivory Coast's Dabou Hospital between January-November 1987. 163 were males and 49 were females; the majority (151) were from rural areas. In terms of the clinical profile, 99% had experienced severe weight loss (greater than 10% of body weight), 43% had generalized pruritus, 66% reported fever exceeding 1 month's duration, 75% reported diarrhea exceeding 1 month's duration, 55% had experienced coughing for longer than 1 month, and 56% demonstrated generalized adenopathies. 128 (60%) of these 212 individuals were positive for antibodies to human immunodeficiency virus (HIV)-1, 15 (7%) were HIV-2 positive, 61 (29%) were seropositive for both HIV-1 and HIV-2, and 8 (4%) were negative for both viruses. Clinical follow-up was possible in 173 of these cases. After 6 months, those infected with HIV-1 manifested 16 unfavorable outcomes (deterioration or death) and 11 favorable outcomes (stable or improved condition). Among those infected with HIV-2, there were no unfavorable and 4 favorable cases. The group positive for HIV-1 and HIV-2 exhibited a clinical course at 6 months similar to that found among the HIV-1 seropositives: 11 unfavorable and 9 favorable outcomes. The data from the Dabou hospital attest to a steady rise in AIDS detection, from 0.21% of all adult outpatient cases in the 1st quarter of 1987 to 1.03% of cases in the last quarter. Although data from this series suggest a milder evolution for HIV-2 associated cases, a clinical follow-up of individuals seropositive for HIV-1 or HIV-2, over a 2-year period, is underway to confirm whether there is indeed a distinct symptomatology and disease pattern for each viral infection.
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PMID:Clinical experience of AIDS in relation to HIV-1 and HIV-2 infection in a rural hospital in Ivory Coast, West Africa. 285 51

Co-infection with acquired immunodeficiency syndrome (AIDS) and Kaposi's sarcoma is not uncommon in Europe, but is rare in Africa and not previously reported in infants. This article documents the case of an 11-month-old African boy with lymphocutaneous Kaposi's sarcoma. The infant was brought to a hospital in the Central African Republic with chronic diarrhea and disseminated lymphadenopathy. Also present were fever, cough, weight loss, a gingivostomatitis with herpes-like vesicles, hepatomegaly, splenomegaly, and cervico-axillo-inguinal lymphadenopathy. The adenopathies 1st occurred when the infant was 7 months of age and were followed 1 month later by the emergence of 12 dark brown or black velvet raised cutaneous nodules. The diagnosis of Kaposi's sarcoma was confirmed by lymph node and skin nodule biopsies. Also indicative of Kaposi's sarcoma was the presence of abortive vascular foci at a distance from the skin's surface and the cell proliferation. Both the infant and his asymptomatic mother were seropositive for antibodies to human immunodeficiency virus (HIV)-1. The skin lesions in this case presented the special infiltrative characteristic of AIDS-related Kaposi's sarcoma. The infant died 2 months after presentation at the hospital. By the last weeks of his life, the cutaneous nodules had covered the entire body. Death was from pleuropneumopathy. Given the high prevalence of HIV-1 infection in the Central African Republic, more such cases can be expected.
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PMID:Lympho-cutaneous Kaposi's sarcoma in an African pediatric AIDS case. 292 57

Infections with human immunodeficiency virus are common in areas of the world where laboratory testing and sophisticated diagnostic facilities are unavailable. A World Health Organization clinical case definition for acquired immunodeficiency syndrome was developed in 1985 for use in such areas. In 1987, we tested this definition on 1328 inpatients and outpatients in 15 hospitals throughout Uganda. Five hundred sixty-two patients (42%) were positive by enzyme-linked immunosorbent assay for human immunodeficiency virus antibody. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. Modification of the case definition by excluding a known cough from tuberculosis as a minor criteria decreased sensitivity slightly to 52%, but specificity and positive predictive value increased to 92% and 83%, respectively. Amenorrhea, although not specifically asked about, was a symptom noted by many female patients (26% of females who were positive by enzyme-linked immunosorbent assay); as a symptom indicative of human immunodeficiency virus infection, amenorrhea had a specificity of 99%, with a positive predictive value of 89%. These findings support the generalizability of the World Health Organization clinical acquired immunodeficiency syndrome definition and its use (especially the modified version) in areas of Uganda without sophisticated facilities.
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PMID:Evaluation of the WHO clinical case definition for AIDS in Uganda. 305 90

A 3 1/2 year old girl presented with failure to thrive and a five month history of diarrhoea and recurrent cough. The results of sweat sodium tests suggested a diagnosis of cystic fibrosis; but atypical organisms were found (Haemophilus influenzae, Candida albicans, but no Staphylococcus aureus), she failed to respond to treatment, and her sweat sodium concentrations fell in response to fludrocortisone. She also had hyperglobulinaemia, neutropenia, and reduced numbers of T4 lymphocytes, which prompted the performance of a test for antibody to human immunodeficiency virus (HIV). This proved positive, and she was treated with co-trimoxazole, zidovudine, and human immunoglobulin. Both parents and two siblings were also positive for HIV, though all had normal sweat sodium concentrations. Children with symptoms suggestive of cystic fibrosis but who also show atypical features, as in this case, should have their HIV state checked.
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PMID:Abnormal sweat electrolytes in symptomatic human immunodeficiency virus infection in a child. 312 Oct 56


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