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

Human herpesvirus oesophagitis in human immunodeficiency virus positive patients is caused by cytomegalovirus and herpes simplex virus; no cases of oesophagitis and oesophagobrochial fistula as a result of varicella zoster virus (VZV) have been reported to date. This report describes the case of a patient with a 2-3 mm deep oesophageal ulcer whose viral culture was positive for VZV. The patient was treated with acyclovir with resolution of the symptomatology. After the end of the induction treatment, because of the onset of fever and fits of coughing during eating, the patient underwent oesophagography, which showed an ulcer with an oesophagobronchial fistula in the middle and lower third of the oesophagus. This case report stresses the role of VZV infection as a possible cause of oesophagobronchial fistula, a rare but benign condition in patients with AIDS.
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PMID:Oesophagobronchial fistula caused by varicella zoster virus in a patient with AIDS: a unique case. 1198 52

Health care providers are at risk for infection with bloodborne pathogens, including hepatitis B virus, human immunodeficiency virus, and hepatitis C virus. Recommended infection control practices are applicable to all settings in which dental treatment is provided. Dentists remain at low risk for occupationally acquired human immunodeficiency virus. Dental health care workers, through occupational exposure, may have a 10 times greater risk of becoming a chronic hepatitis B carrier than the average citizen. Tuberculosis is caused by Mycobacterium tuberculosis. In general, persons suspected of having pulmonary or laryngeal tuberculosis should be considered infectious if they are coughing, are undergoing cough-inducing or aerosol-generating procedures, or have sputum smears positive for acid-fast bacilli. Although the possibility of transmission of bloodborne infections from dental health care workers to patients is considered to be small, precise risks have not been quantified by carefully designed epidemiologic studies. Emphasis should be placed on consistent adherence to recommended infection control strategies, including the use of protective barriers and appropriate methods of sterilization or disinfection. Each dental facility should develop a written protocol for instrument reprocessing, operatory cleanup, and management of injuries. Such efforts may lead to the development of safer and more effective medical devices, work practices, and personal protective equipment.
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PMID:Risk and prevention of transmission of infectious diseases in dentistry. 1201 68

A 77-year-old man was in good health until he complained of fatigue 3 weeks before presentation. Two weeks before admission, he developed gradually worsening shortness of breath. One week before admission, he developed a cough that initially was nonproductive but later was associated with hemoptysis.His past medical history was remarkable for a history of colon cancer (Dukes' stage III), for which he underwent a hemicolectomy and treatment with adjuvant chemotherapy in 1993. He had a myocardial infarction in 1986 and underwent coronary artery bypass surgery in 1999. He also had a history of hypertension, type 2 diabetes, and gout. He smoked in the past but had stopped more than 30 years ago.He was initially evaluated by his primary care physician, who noted that he complained of diaphoresis but denied fevers, chills, or contact with others who were ill. His physical examination was remarkable for bilateral crackles that were more pronounced on the right. A chest radiograph demonstrated bilateral pulmonary infiltrates (Figure 1). He was treated with amoxicillin. The next day, however, his physician noted that his dyspnea had worsened and that his oxygen saturation on room air was poor. He was therefore admitted for further evaluation. The amoxicillin was discontinued, and he was treated with levofloxacin, followed by ceftriaxone and azithromycin as his pulmonary status continued to deteriorate. He received intravenous diuretic agents, which failed to improve his respiratory status. During the initial phase of hospitalization, he was anemic, with a hematocrit of 21.3%. His serum creatinine level, which had been 1.0 mg/dL in 1999, was now 2.5 mg/dL. Urinalysis was remarkable for the presence of numerous red blood cells. His oxygen requirement increased, and he eventually required a 100% nonrebreather mask. A computed tomographic scan of the chest demonstrated prominent alveolar opacities throughout the right upper, middle, and lower lobes, with similar opacities in the left upper and left lower lobes (Figure 2). An echocardiogram showed an ejection fraction of 50%, as well as mild mitral regurgitation. Serologies were remarkable for an antinuclear antibody titer of 1:320 and a P-antineutrophil cytoplasmic antibody (P-ANCA) titer of greater than 1:320. C-ANCA was negative. Anti-glomerular basement membrane and anti-human immunodeficiency virus antibodies were undetectable.
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PMID:Cases from the medical grand rounds of the Osler Medical Service at Johns Hopkins University. 1207 15

Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). According to the World Health Organization, 4 million people have developed AIDS since the beginning of the pandemic; by mid-1994, more than 16 million adults and over 1 million infants had been infected with HIV. The vast majority of those infected with HIV will develop AIDS; the average time between the two events is 10 years. For children and those with poor nutrition, the time is shorter. There is no cure for AIDS, and almost all of those with AIDS will die of it. Development of a vaccine has been unsuccessful. Since HIV destroys cells in the body's immune system, the infected person can easily develop tuberculosis, meningitis, and chronic diarrhea. Although an infected person may have no symptoms in the early stages of the disease, he or she can still transmit the disease to others. A person can be infected with HIV through contact with infected blood, semen, and cervical or vaginal fluids; through sexual intercourse; through transfusion of blood or blood products infected with HIV; through injection or piercing of the skin with an instrument contaminated with HIV; or from an HIV-positive mother to her child during pregnancy, birth, or breastfeeding. HIV cannot be transmitted by coughing or sneezing; handshakes; insect bites; contacts at work or school; touching or hugging; using toilets; water or food; using a telephone; kissing; swimming pools; or sharing cups, plates, or other eating and drinking utensils.
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PMID:What is AIDS? 1231 74

This is a critique of a paper which reports 2 studies. The 1st is a survey of acquired immunodeficiency syndrome (AIDS) cases admitted to the 4 Bujumbura hospitals during a 4-month period in 1986; the 2nd, a human immunodeficiency virus (HIV) serosurvey of pregnant women in dispensaries in different parts of the city. The 1st study revealed 258 AIDS cases; 211 of these were adults. An unselected sample of 120 were further analyzed by age, sex, marital status, and clinical features. The criteria used for AIDS diagnosis are unclear. The sex ratio was 1.3:1, females to males; and the peak age for women (20-29 years) was lower than for men (30-34 years). More of the female AIDS patients were separated or widowed. The most useful parts of the paper are tables of the clinical features. The serosurvey suffers from the lack of a defined denominator population from which the cases come. The data show the great geographical variation in HIV seroprevalence (1-28%) that can occur. The commentary makes the point that research is not easy in Africa--especially that involving AIDS. The authors define the opportunistic conditions that cause the clinical features of 120 AIDS cases. Further work should be aimed at determining the cause of the major symptoms of diarrhea, weight loss, fever, and cough.
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PMID:Acquired immunodeficiency syndrome and human immunodeficiency virus infection in Bujumbura, Burundi. 1234 68

PRESENTING FEATURES: A 42-year-old man was admitted with a chief complaint of cough and night sweats of 2 months' duration. The cough produced brown sputum but no blood. He also reported drenching sweats every night for the last several weeks before admission. He attributed his cough to exposure to dust while working on demolishing a funeral home 2 months ago; he denied any history of respiratory symptoms before this recent job. The patient smoked less than one pack of cigarettes per week during the previous year. He had no history of tuberculosis or contact with infected persons. He denied a history of severe lung infection, asthma, sinus disease, or overseas travel, as well as behaviors that are risk factors for human immunodeficiency virus (HIV) infection, such as intravenous drug use or multiple sexual partners.His physical examination was notable for a temperature of 101.4 degrees F and an oxygen saturation of 98% on room air. In general, he was thin, although well in appearance, and not visibly short of breath. His lungs were clear to auscultation. Laboratory studies and urinalysis were normal.A chest radiograph showed a 3-cm by 2-cm mass with a surrounding cavity in the right upper lobe (Figure 1). A subsequent chest computed tomographic scan showed a 5-cm by 4-cm cavity in the right upper lobe, with surrounding infiltrates as well as a mass within the cavity suspicious for a fungus ball (Figure 2). Patchy infiltrates were also seen in the left and right lower lobes. What is the diagnosis?
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. Scedosporium apiospermum mycetoma of the lung. 1251 68

The prevalence of bronchiectasis decreased due to the effective use of vaccines and advances of antibiotic therapy after 1970. However, it remains an important long-term morbidity of lower respiratory tract infection in developing country. To evaluate the clinical features of bronchiectasis in a tertiary hospital, we collected 21 patients with a diagnosis of bronchiectasis in Taipei Veterans General Hospital from May, 1984 to Dec, 2001 in pediatric outpatient with the admission of age below 18 years old. The diagnosis was based on the history of recurrent cough with fetid sputum, hemoptysis, or recurrent lobar pneumonia for months at least and radiological findings of lobar infiltration, tram-track like patterns, bronchiolar dilatation or honeycomb patterns. The diagnostic examinations included chest plain radiography, bronchography and chest computed tomography (CT) scans. Respiratory tract infections were the commonest cause predisposing to bronchiectasis in our study. Tuberculosis is not rare in this study. In recent years, immunodeficiency disorders have been recognized. Most patients suffered from recurrent cough and fetid sputum for years before diagnosis was established. Hemoptysis was the second common symptom in our study. The plain chest radiograph of bronchiectasis revealed dilatation of bronchial trees with honeycomb pattern or infiltration only. In recent years, chest CT became the most accurate and being noninvasive diagnostic tool. The initial treatment was primarily medical conservative therapy. Only five patients in our cases underwent pulmonary resection due to persistent hemoptysis, recurrent bacterial pneumonia or pulmonary parenchyma destruction. Most patients still suffered from recurrent pneumonia or occasional exacerbation in the long-term follow-up. In conclusion, bronchiectasis is not uncommon in pediatric population in northern Taiwan. The history of recurrent cough with fetid sputum, hemoptysis, or recurrent pneumonia were the most important clues to early diagnosis of this disease. Early diagnosis and appropriate treatment are effective in order to prevent lung abscess, empyema and pneumothorax, bronchopleural fistula, hemoptysis or cor pulmonale.
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PMID:Clinical spectrum of bronchiectasis in children. 1260 83

A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for Gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.
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PMID:Disseminated gonococcemia. 1265 17

Nitric oxide (NO) is involved in the host defence against tuberculosis (TB). Patients with TB exhibit increased catabolism and reduced energy intake. Thus the hypothesis for this study was that restoring a relative deficiency in the amino acid arginine, the substrate for mycobactericidal NO production, would improve the clinical outcome of TB by increasing NO production. In a randomised double-blind study, patients with smear-positive TB (n = 120) were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. Primary outcomes were sputum conversion, weight gain, and clinical symptoms after week 8. Secondary outcomes were sedimentation rate and levels of NO metabolites, arginine, citrulline, and tumour necrosis factor-a. Compared with the human immunodeficiency virus (HIV)-/TB+ placebo group, the HIV-/TB+ patients in the arginine group showed significant improvement, defined as increased weight gain, higher sputum conversion rate and faster reduction of symptoms, such as cough. The arginine level increased after week 2 in the HIV-/TB+ arginine group (100.2 microM (range 90.5-109.9) versus 142.1 microM (range 114.1-170.1)) compared with the HIV-/TB+ placebo group (105.5 microM (range 93.7-117.3) versus 95.7 microM (range 82.4-108.9)). HIV seroprevalence was 52.5%. No clinical improvement or increase in serum arginine was detected in arginine supplemented HIV+/TB+ patients compared with placebo. Arginine is beneficial as an adjuvant treatment in human immunodeficiency virus-negative patients with active tuberculosis, most likely mediated by increased production of nitric oxide.
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PMID:Arginine as an adjuvant to chemotherapy improves clinical outcome in active tuberculosis. 1266 6

A total of 1078 human immunodeficiency virus (HIV) type 1-infected women from Tanzania were randomized in a placebo-controlled trial using a factorial design to examine the effects of supplementation with vitamin A (preformed vitamin A and beta carotene) and/or multivitamins (vitamins B, C, and E). Supplements were given during pregnancy and lactation. Children of women in the multivitamin arms had a significantly lower risk of diarrhea than did those in the no-multivitamin arm (P=.03). The mean CD4+ cell count was 151 cells/microL higher among children in the multivitamin arms than among those in the no-multivitamin arm (P=.0006). HIV-positive children experienced a benefit apparently similar to that in HIV-negative children (P=.34, by test for interaction). Maternal receipt of vitamin A significantly reduced the risk that the child would have cough with a rapid respiratory rate, a proxy for pneumonia (P=.03), but receipt of vitamin A had no effect on diarrhea or CD4+ cell count. Provision of multivitamin supplements (including those with vitamins B, C, and E) to HIV-infected, lactating women may be a low-cost intervention to improve their children's health.
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PMID:Effect of providing vitamin supplements to human immunodeficiency virus-infected, lactating mothers on the child's morbidity and CD4+ cell counts. 1268 19


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