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

Lower respiratory tract infection is easily suggested on clinical signs (cough and sputum) associated with fever. To discriminate between pneumonia and acute bronchitis is crucial because of the mortality associated with pneumonia and of its specific management. Chest X-ray is a key exam for the diagnosis and should be performed on the basis of validated clinical signs that are however of weak diagnostic value. Clinical as well as radiological signs cannot be reliably used to identify the causative germ. Sputum examination, the search for pneumococcal and legionella urinary antigens are of good diagnostic value. An associated COPD may lead to an acute respiratory failure. Acute exacerbation of chronic bronchitis results from various causes but infection is involved in about 50% of the cases, mostly viral and most often due to a rhinovirus. Viral infection can be associated to bacterial infection and the most frequently isolated germs are Streptococcus pneumoniae, Haemophilus influenzae, and B. catarrhalis. Severity assessment relies on the value of basal FEV1 that is often non available. Therefore Afssaps suggests using a dyspnea index to assess exacerbation severity.
Med Mal Infect
PMID:[Definition of low respiratory tract infections]. 1683 58

European Union has recently approved a form of insulin intended to be inhaled. This innovative presentation has the potential to partially or completely replace the injections and thus facilitate starting insulin therapy which is considered with apprehension and too often differed. On this occasion, we reviewed the issues raised by this pulmonary route for systemic absorption (anatomical and cytological limits, cellular mechanisms, relevant physical parameters, facilitating chemical cofactors, role of tobacco smoking and of common respiratory diseases). The pharmacokinetics of inhaled and injectable insulins are comparable, apart from an appreciably faster absorption of the former and both show the same intra-individual variability. The total biodisponibility is definitely lower with the inhaled way but it is notably increased in smokers. These characteristics can vary according to the inhalation system used. A frequent induced cough, the increase in circulating anti-insulin antibodies and a potentially higher cost are not really determining obstacles. The indications will have to be clearly specified and the long-term inocuity of long term inhalation of such a mitogene especially in children and former smokers remains to be formally proven.
Rev Mal Respir 2008 Feb
PMID:[Inhaled insulin: a model for pulmonary systemic absorption?]. 1844 82

Between November 2003 and January 2004 in the North of France a large outbreak of legionnaire's disease affected 85 patients. The clinical, biological and radiological characteristics of the patients were investigated to determine factors associated with mortality. Two populations were defined and compared: patients who died within 28 days and those who survived. Eighty-five patients were included in this study. The median age was 75 years. The median fever was 39.3 +/- 0.1 degrees. Fifteen patients (17.6%) had at least 3 underlying co-morbidities. Cough, dyspnoea, confusion and diarrhoea were found in respectively 46, 68, 47, and 15% of the patients. The median of urea was 0.7 +/- 0.05 g/L, creatinine 16 +/- 1.5 mg/L, CRP 332 +/- 15 mg/L. On the chest X-ray, lung infiltrates were present in 64% and multilobar in 40%. The overall mortality rate was 21%. In univariate analysis, diabetes mellitus, dyspnoea, urea>0.90 g/l and CRP>350 mg/l were predictive factors of mortality. In multivariate analysis, diabetes mellitus, urea>0.90 g/l, and bilateral infiltrates on chest X ray were retained as independent risk factors for death.
Rev Mal Respir 2008 Mar
PMID:[Factors predicting mortality during an outbreak of Legionnaire's disease in the north of France]. 1844 94

The origin of contamination in pertussis of young infants is generally the close relatives. From 2000 to 2004, only serology and culture were available in our hospital. The families of 16 young infants (age below one year) hospitalized for pertussis were screened using serological tests: 21/48 contacts were positive. After 2004, PCR was available for exploration of index cases and families: 35/85 contacts were positive. Of the mothers tested 23/46 were positive compared to 14/41 fathers. Only one parent presented with a typical paroxystic pertussis cough, 60% presented with a nonparoxystic cough having lasted for more than five days and 40% of positive adults did not present with cough. Despite official recommendations, none of these young parents had received an antipertussis booster vaccination. This study shows the high frequency of atypical or nonsymptomatic pertussis in adults in the close family of infected young infants. These adults contribute to spreading the disease.
Med Mal Infect 2008 Sep
PMID:[Systematic family screening in case of infant pertussis]. 1871 31

The first case report concerns a 59-year-old man presenting a chronic cough and the second a 23-year-old woman farmer presenting with worsening dyspnoea associated with cough, expectoration and haemoptysis. In the second case, the woman died 7 months after the onset of the respiratory symptoms. In both cases, chest radiography and thoracic CT scans showed multiple, bilateral pulmonary nodules, bronchial endoscopy was normal and surgical biopsy revealed epithelioid haemangioendothelioma. It is a rare primary pulmonary tumour which is usually found in soft tissue, bone or liver. Epithelioid haemangioendothelioma is a vascular tumour usually affecting women less than 40 years of age. The histological appearance is characteristic and may be confirmed by immunohistochemistry. Chemotherapy and radiotherapy are generally ineffective and surgery is sometimes impossible because of the multifocal lesions. Epithelioid haemangioendothelioma is considered a sarcoma without precise histological prognostic criteria. In its pulmonary location it is responsible for death due to respiratory failure in 50% of cases.
Rev Mal Respir 2008 Sep
PMID:[Pulmonary epithelioid haemangioendothelioma: two different clinical courses]. 1894 14

Cannabis is widely smoked in Europe and its increasing use is becoming a major public health problem. Adulterating cannabis with glass beads or sand is a new trick used by dealers to increase the weight and boost profits. These recent practices are not without danger. We report two cases of respiratory symptoms related to the use of this kind of adulterated cannabis. The first case is a 33 year-old patient admitted for an acute inhalation pneumonitis secondary to smoking cannabis adulterated with grit sand. The CT scan showed patchy ground-glass opacities, mainly in the upper lobes. A broncho-alveolar lavage, examined under polarized light, revealed birefringent intracellular particles, identified as silica, in alveolar macrophages. Spontaneously clinical and radiological improvements were observed after stopping the use of contaminated cannabis. The second patient, who smoked cannabis mixed with glass beads, described epistaxis, mouth ulcers, sore throats and cough. CT scan and BAL were normal. Adulteration of cannabis with microscopic glass beads, alone or mixed with sand, is a recent and widespread practice in Europe. These anecdotal reports prompted the French Department of Health to advise cannabis smokers of the harmfulness of these contaminants.
Rev Mal Respir 2009 May
PMID:[Respiratory consequences of inhalation of adulterated cannabis]. 1954 75

Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B. holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.
Med Mal Infect 2010 May
PMID:[Bordetella holmesii bacteremia in a 26-year-old patient with sickle cell disease]. 1958 32

On April 2009, a new swine-origin A(H1N1) influenza virus, A(H1N1)v, was identified in the United States. Today (June 12, 2009), more than 29,000 cases have been reported in the world, and 73 in France. This is the first report of secondary transmission in France. The three patients presented with common influenza signs including cough, fever, and sore throat. The incubation period could last from two to four days; it should be kept in mind that the first international data mentioned one to seven days. The buildup and maintenance of an infectious focus involve secondary transmissions.
Med Mal Infect 2010 Jan
PMID:[First cases of secondary transmission of a novel swine-origin influenza A (H1N1) virus in France]. 1963 75

The European Union recently approved a form of insulin intended to be inhaled. This innovative presentation has the potential to partially or completely replace the injections and thus facilitate starting insulin therapy which is considered with apprehension and often differed. On this occasion, we reviewed the issues raised by this pulmonary route for systemic absorption (anatomical and cytological limits, cellular mechanisms, relevant physical parameters, facilitating chemical cofactors, role of tobacco smoking and of common respiratory diseases). The pharmacokinetics of inhaled and injectable insulins are comparable, apart from an appreciably faster absorption of the former, and both show the same intra-individual variability. The total bioavailability is definitely lower with the inhaled route but is notably increased in smokers. These characteristics can vary according to the inhalation system used. A frequent induced cough, the increase in circulating anti-insulin antibodies, and a potentially higher cost are not really determining obstacles. The indications will have to be clearly specified and the long-term innocuousness of repeated inhalation of such a mitogen, especially in children and former smokers, remains to be fully proven.
Rev Mal Respir 2010 Oct
PMID:Inhaled insulin: a model for pulmonary systemic absorption? 2096 94

Pseudotumour is a rare presentation of bronchopulmonary tuberculosis, occurring in immunocompetent patients, which simulates lung cancer and may thus cause diagnostic difficulty. To assess the frequency and clinical features of tuberculous pseudotumour in immunocompetent patients, we analyzed all cases of pulmonary tuberculosis hospitalized in our department. Tuberculous pseudotumour was defined by the presence of a bronchial or pulmonary lesion suggestive of lung cancer. Over a period of 11 years, 12 cases of tuberculous pseudotumour were collected among 341 cases of pulmonary tuberculosis (3.5%). Mean age was 45 years. All patients were smokers. Symptoms were not specific and were dominated by cough and chest pain. Radiological investigations showed consolidation in five cases and a mass lesion in five cases. Fibreoptic bronchoscopy visualized a tumour in four cases and stenosing bronchial wall infiltration in one case. Mean delay to diagnosis was 47 days. The confirmation of tuberculosis was bacteriologic in only three cases but histological in the others (four bronchial biopsies, two transbronchial biopsies, one pleural biopsy, four surgical specimen). The positive diagnosis of tuberculous pseudotumour is difficult because the clinical and radiological presentation may closely mimic lung cancer, especially as the cases are usually smear negative, leading to a very late diagnosis.
Rev Mal Respir 2011 Jan
PMID:[Diagnostic difficulty in bronchopulmonary tuberculous pseudotumor]. 2127 69


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