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The incidence of new cases of extrapulmonary tuberculosis has remained constant, despite the decline in new cases of active pulmonary tuberculosis. This might be due to a delay in recognition, and particularly a lack of consideration of tuberculosis when the presenting symptoms are other than respiratory. Extrapulmonary tuberculosis should be considered in the differential diagnosis of bone, joint, genitourinary tract and central nervous system (CNS) diseases. To determine factors that might delay recognition and identification, 62 patients having extrapulmonary tuberculosis during 1969-1972 at the Los Angeles County-University of Southern California Medical Center were studied.Three quarters of these patients had had CNS, skeletal or genitourinary tuberculosis in equal distribution or 25 percent each. CNS involvement was seen frequently in the disseminated form. Presenting symptoms were protean and not specific, such as fever, anorexia, weight loss, cough, lymphadenopathy and neurologic abnormalities. Roentgenograms of the chest were abnormal in most. When a roentgenogram of the chest suggests pulmonary tuberculosis, signs and symptoms in other body systems should suggest extrapulmonary tuberculosis. If no abnormalities are seen on a roentgenogram of the chest, however, this does not preclude the diagnosis of extrapulmonary tuberculosis. Neither does a negative tuberculin skin test exclude the condition. Abnormal laboratory findings are common, especially in disseminated tuberculosis. These include various anemias, bone marrow disorders, hyponatremia due to inappropriate antidiuretic hormone syndrome. Analyses of pleural, peritoneal, pericardial and joint fluid usually show an exudate high in lymphocytes and occasionally low in glucose. Similar findings are seen in spinal fluid. The histological features of caseous or noncaseous granulomas are suggestive of but not specific for tuberculosis. Only culture of mycobacteria from sputum, urine, spinal fluid, pleural and other effusions and tissue biopsy specimens will yield a definitive diagnosis. Physicians must have a high index of suspicion to diagnose extrapulmonary tuberculosis, as it can resemble any disease in any organ system. Immediate therapy in the disseminated variety, sometimes even before a definite diagnosis can be made, may be lifesaving.
West J Med 1977 Apr
PMID:The spectrum of extrapulmonary tuberculosis. 85 17

There has been a noticeable increase in the incidence of pertussis in West Germany over the last decade. Since the availability of adequate bacteriological diagnosis a much broader clinical spectrum can be attributed to infections with B. pertussis. Three patients with an unusual clinical presentation of pertussis are presented. A three month old infant presented with severe apneic spells without cough as the sole clinical symptoms of the infection. B. pertussis was isolated in the nasopharyngeal swab. A nine month old premature infant with bronchopulmonary dysplasia after long time intubation and artificial ventilation presented with apneic spells, pulmonary and cardiac decompensation and required ventilatory support. The diagnosis was suggested by a massive leucocytosis with lymphocytosis. The diagnosis on the patient was established by serologic methods. Adult contacts of this patient developed longstanding cough and clinical signs of pertussis. The diagnosis of pertussis in these persons was established by nasopharyngeal culture. The third patient with trisomy 21 and a corrected AV canal suffered from nonspecific cough and gradually developed signs of congestive heart failure with pneumonia. B. pertussis was isolated from the nasopharynx. This patient showed neither the typical paroxysmal coughing spells nor disclosed the typical lymphocytosis in his white blood count. Microbiological investigations of patients with symptoms of respiratory tract infections should include the isolation of B. pertussis. Thus, additional cases of pertussis not suspected on the basis of their initial clinical presentation will be detected.
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PMID:[Pertussis--an illness with typical clinical symptoms?]. 143 95

Whooping cough continues to be a major childhood disease in parts of West Germany. At age six, more than one third of the children in our area have had pertussis according to parental information, whereas only 12% received a specific vaccination. During a four-year period from 1984 to 1987, a total of 2,881 clinically diagnosed cases of whooping cough were investigated. The children had a mean age of 4.1 years, 11% of all patients were younger than one year and 6% of the patients were adults with a mean age of 35.8 years. No sex difference was observed in children (less than 20 years) with clinically overt whooping cough. The seasonal distribution showed that whooping cough was present throughout the year, peaking in early winter. In relation to clinical symptoms, the isolation rate of Bordetella pertussis or Bordetella parapertussis from nasopharyngeal swabs continuously decreased with the duration of paroxysms, starting with 56% positive swabs on day 1. Titers (greater than or equal to 1:100) of IgA-antibodies to B. pertussis antigens increased with the duration of paroxysmal coughing. B. pertussis, however, was also isolated from 152 of 964 patients without the clinical signs of whooping cough. IgA-antibodies were also found in 522 patients with non-typical respiratory symptoms, but not in healthy blood donors. Children with clinically diagnosed whooping cough were compared to a group of children showing the symptoms but without any clinical or laboratory signs of whooping cough. We can assume from our data that the incidence and duration of non-paroxysmal coughing, the nocturnal increase in coughing, fever, auscultatory findings and a contact anamnesis occurred with a similar frequency in the whooping cough group and the control group. Apart from the typical paroxysmal fits, whooping and vomiting were found significantly more often in the pertussis group. At least 19% of patients with a recent infection with B. pertussis, however, were not diagnosed by clinical symptoms. The leukocyte count differed only marginally between the three groups and was of no great diagnostic value. A relative lymphocytosis, however, was found significantly more often in whooping cough patients and in patients with laboratory-diagnosed infection with B. pertussis. Our study indicates that part of the symptomatology and some laboratory findings in whooping cough patients in endemic areas of West Germany may differ from the classical form of the disease. Furthermore, our data stress the importance of an accurate procedure in diagnosing B. pertussis infection, and this can be facilitated by a combination of bacteriological and serological tests.
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PMID:The epidemiological situation of pertussis in the Federal Republic of Germany. 177 29

The failure of up to half of all patients in developing countries to adhere to recommended drug regimens may reflect inadequate physician- provider communication rather than resistance to treatment. There is substantial evidence that patients are more likely to conform to treatment regimens when they are fully informed about their medical condition and the medication prescribed. To investigate the extent to which patients in Zimbabwe received this type of information, household heads in 910 households in the Mashonaland West Province were interviewed. The sample included equal numbers of respondents from urban, rural, and commercial farming areas. Diseases most commonly reported by rural residents and farmers were diarrhea, influenza, cough, hypertension, and malaria. Most of the illnesses were attributed to natural or supernatural causes, and 80% of respondents in these subsamples claimed to distrust their health care provider and never asked questions about medications prescribed. The rural residents perceived health care personnel as too busy to answer questions and did not believe they would understand any information offered. On the other hand, these respondents indicated they would like to have information on the cause of their illness, its duration and treatment, the best way to take prescribed drugs, actions to take when drugs produce side effects, and storage of medication. Physicians who treat semi-literate rural residents with indigenous health beliefs are urged to provide information about medication tailored to match the individual perceptions and needs of the patient. This need is less urgent in urban areas, where 60% of respondents had general knowledge about the action of various medicines and were able to obtain information from pharmacists.
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PMID:Drug information for patients in the community. 185 94

A survey was carried out in response to complaints of increased respiratory symptoms in children at schools near a foundry in Walsall, West Midlands. Air monitoring around the factory had shown concentrations of formaldehyde most of which were orders of magnitude below the current occupational exposure limit of 2.5 mg/m3, although concentrations up to 0.3 mg/m3 had been recorded over short periods. The study sample comprised children aged 6.8-7.8 years from 39 schools in the borough. Information about respiratory symptoms and potential risk factors for respiratory disease was elicited from parents by a self administered questionnaire. Data were obtained on 1334 children, a response rate of 81.8%. The prevalences of reported wheeze (11.1%), breathlessness (7.7%), and chest discomfort (8.6%) were similar to those in an earlier survey carried out in Southampton by the same method at the same time of year. Cough (prevalence = 18.4%) and chestiness at night (14.6%) were significantly less common than in Southampton. When sex, social class, housing tenure, passive smoking, and parental history of asthma were taken into account, the prevalences of symptoms at schools within one mile of the foundry were generally lower than in other parts of Walsall. These findings give no support to the hypothesis that foundry emissions cause respiratory disease in children, although an adverse effect in a few sensitive children cannot be ruled out.
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PMID:Respiratory symptoms in children at schools near a foundry. 191

The seroprevalence, clinical epidemiology, modes of transmission, clinical presentation in adults, pregnancy women and children, diagnosis, impact and control strategies of AIDS in Africa are covered in this review. HIV-1, the causative virus in AIDS, is epidemic in a central Africa belt from Gabon to the east coast, and from Uganda to Zimbabwe, with the highest prevalence in the lakes and highlands of Central Africa. HIV-2 causes a milder disease in Western Africa centered in Senegal. HIV infections occur primarily in young adult men aged 30-34, women aged 20-24, infants and children under 4, and a few girls. Transmission patterns vary widely depending on sexual customs in the ethnically diverse continent. Prevalence tends to be high in cities and among subgroups such as prostitutes, where promiscuity is restricted. Where female sexual permissiveness exists, seropositivity is high in women generally. Besides sexual behavior, risk factors for HIV in Africa also include uncircumcised man, oral contraception, STDs causing genital ulceration and Chlamydia infection. Transmission to neonates occurs, especially if the mother has advanced AIDS, but transmission by breast milk is uncertain. Transmission by blood transfusion is common because transfusion are up to 10 times as common in Africa as in the West, especially in obstetrics and pediatrics. Clinically, HIV infections present as herpes zoster in 95% of Africans, and commonly as slim disease: weakness, fever, chronic watery diarrhea and weight loss of unknown cause. Associated infection are candidiasis, cryptosporidiosis, isosporiasis, tuberculosis and salmonellosis. Other presenting symptoms are unusual sites of lymphadenopathy, cough and sepsis. Diagnosis can be made by the WHO clinical case definition, or be screening tests, which are now more reliable for African patients than formerly. In Africa, AIDS can cause destitution and disgrace for families, and will probable severely affect progress made national economies because of deaths of young productive adults. Strategies for control of HIV in Africa are outlined.
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PMID:AIDS in Africa. 218 39

We studied 8 adult patients with variable symptoms of cough, dyspnea, stridor, wheezing, or hemoptysis. Fiberoptic bronchoscopy in all showed complete or nearly complete endobronchial obstruction of a main-stem bronchus by neoplasm with a mean bronchial diameter of 1.9 mm +/- 1.6 mm (mean +/- standard deviation). In 4 patients, a lobar bronchus was also completely obstructed. No mass was visible on chest radiographs of any patient; however, computed tomography in each showed main-stem endobronchial obstruction, lobar obstruction (4 instances in 3 patients), and in 6 patients hypoperfusion of the involved lung. Computed tomographic scan showed additional abnormalities that were unsuspected on viewing chest radiographs or at bronchoscopy, including mediastinal adenopathy in 3 patients and an extraluminal tumor component in 4. After therapy with Nd-YAG laser, main-stem airway diameter increased to a mean of 9.6 mm +/- 1.0 mm (P less than .05) and pulmonary functions improved. Results suggest the complementary role of computed tomography and fiberoptic bronchoscopy in the detection and laser-treatment planning of chest radiographically occult severe neoplastic obstruction of the main-stem bronchus.
West J Med 1990 Oct
PMID:Computed tomography and bronchoscopy in chest radiographically occult main-stem neoplasm diagnosis and Nd-YAG laser treatment in 8 patients. 224 72

One hundred and twenty-five cases of biopsy proven sarcoidosis have been found during a prospective study since 1972 in Calcutta, Eastern India. The presentation, clinical course and radiological features are considerably different from those seen in the West. Elderly males over 40 years are more prone. Low grade fever, cough, dyspnoea, arthralgia are common symptoms while hepatosplenomegaly, hypercalcaemia, hypercalciuria and hyperglobulinaemia are frequent signs. Nearly 60% are MT negative (up to 100 TU). Serum angiotensin converting enzyme and high lymphocyte count in bronchoalveolar lavage fluid are usual findings in active disease. Chest X-ray usually shows mottled opacities or fibrosis in 60% cases. Clinico-radiological dissociation (i.e. remarkable dissociation between the alarming-looking chest X-ray and scanty physical signs and symptoms in chest) was a very remarkable feature in this series. Treatment with oral steroid or steroid aerosol with oxyphenbutazone and chloroquine give equally good results initially. However, most cases tend to relapse inspite of adequate initial treatment. The pattern of the disease is similar almost all over India with minor regional differences like more erythema nodosum and eye involvement in Chandigarh in the extreme north (which could also have been due to case selection). The pattern from Northern India (Delhi) and Western India is nearly similar to our figures.
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PMID:Sarcoidosis in India: a review of 125 biopsy-proven cases from eastern India. 234 18

A survey of respiratory symptoms were carried out among 200 female and 734 male workers in the Jute Factory at Kumasi. Dust concentration was also measured in various sections of the factory. The Batching and Preparing sections of the factory were the most dusty areas. Respiratory symptoms were commoner (or worse) in those working in dusty areas of the factory than office workers who work in a relatively clean environment. Occurrence of symptoms was related to degree but not the duration of exposure. Prevalence of symptoms was not influenced by age or sex but was increased by smoking. Cough, and sputum were the commonest symptoms. There were no significant objective signs of airways obstruction. Monday tightness and wheeze were rare complaints among the jute workers.
West Afr J Med
PMID:Respiratory symptoms and lung function tests in an African jute factory workers. 248 89

In late October 1986, an outbreak of influenza-like illness was detected at the Naval Air Station in Key West, Florida. Between October 10 and November 7, 1986, 60 active duty personnel reported experiencing a respiratory illness characterized by fever, cough, sore throat, and myalgia. Influenza A/Taiwan/1/86 (H1N1) virus was recovered from three symptomatic patients. Forty-one (68%) of 60 case-patients belonged to a 114-person squadron that had traveled to Puerto Rico for a temporary assignment from October 17-28, 1986. Among squadron members, the attack rate for persons previously vaccinated with the 1986-1987 trivalent influenza vaccine and for those unvaccinated was the same (37%). Transmission of infection among squadron personnel appeared to have commenced in Key West and continued in a barracks in Puerto Rico and aboard two DC-9 aircraft that transported the squadron back to Key West on October 28. There was no evidence that the outbreak spread to the surrounding civilian communities in Puerto Rico or Key West. This was the first reported outbreak of respiratory illness due to influenza A/Taiwan/1/86 (H1N1) in the continental United States in the 1986-1987 influenza season.
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PMID:An outbreak of influenza A/Taiwan/1/86 (H1N1) infections at a naval base and its association with airplane travel. 291 44


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