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

Infection due to Staphylococcus aureus continues to be a source of significant morbidity and mortality. However, its treatment is increasingly complicated by the rising prevalence of resistance to antibiotics. Apart from the two recognized modes of staphylococcal resistance, namely, penicillinase production and intrinsic resistance, Sabath and associates have described a third type in which resistance is manifested by susceptibility to growth inhibition but tolerance to the lethal action of bactericidal agents. The mechanism of tolerance is attributed to a deficiency of autolytic enzyme activity in the part of bacteria, possibly secondary to an inhibition of autolysins in the tolerant staphylococcal strains. These strains are found in patients with infections responding poorly to treatment with cell-wall active antibiotics including vancomycin. Because of its unique mechanism of action and pharmacokinetic properties, rifampin has been reported to be the most active among 65 antistaphylococcal agents tested and have the capacity to kill intraleukocytic staphylococci. We present 2 cases who were cured following the addition of rifampin to previously established regimens. Case 1 was a 40-year-old male who had fever, cough, dyspnea, a right elbow abscess and left leg swelling for 2 weeks prior to admission. Culture of purulent material from the elbow abscess grew staphylococcus aureus. Chest X-ray showed bilateral septic embolism and phleborheography showed partial deep vein occlusion of the left ileofemoral vein. Case 2 was 22-year-old female with fever, chills and cough for 3 weeks. Blood culture grew staphylococcus aureus, and Chest X-ray revealed bilateral septic embolism with pneumonia. Neither of them responded to standard antibiotics which were judged adequate by in vitro sensitivity tests. Clinical cure was later obtained after rifampin was added to the regimens. These results suggest that rifampin may be a useful adjunct in the therapy of staphylococcal infections.
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PMID:[The use of rifampin in the treatment of infection due to Staphylococcus aureus]. 164 82

The bacteriologic characteristics of subacute maxillary sinusitis have not been delineated in the pediatric age group. Forty children between the ages of 2 and 12 years with respiratory symptoms for at least 30 but less than 120 days were evaluated. Nasal discharge and cough were the most prominent symptoms. Common radiographic findings were diffuse opacification and mucosal thickenings. Sinus aspiration was performed on 52 sinuses of 40 children. Bacterial colony counts greater than or equal to 10(4) colony-forming units per milliliter were found in 30 (58%) of 52 sinus aspirates obtained from 26 (65%) children. The bacterial species most commonly recovered were Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella catarrhalis. Twenty-five percent of the maxillary sinus isolates were beta-lactamase producing; however, many of these were recovered from patients who had recently received antimicrobial therapy. Subacute and acute maxillary sinusitis are similar in regard to causative organism, clinical presentation, and radiographic findings.
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PMID:Subacute sinusitis in children. 250 May 11

A study was made of the clinical features and therapeutic response of 144 patients from whose sputum Branhamella catarrhalis was isolated. Typically, features of bronchopulmonary infection with cough productive of moderate amounts of purulent sputum, fever and dyspnoea were present. Of 74 patients who were infected in the community, 50 required hospital admission. Nosocomial infection occurred in the remaining 70 patients. Most patients had chronic pulmonary diseases or carcinoma bronchus; pneumonia occurred in 12 patients. Acute tracheobronchitis developed in 4 healthy non-smokers after viral illnesses. B. catarrhalis contributed to the death of 8 patients. Overall, 59% of isolates produced beta-lactamase but the proportion had risen to 70% by the end of the study; half of these were community acquired. 41% of patients who were treated initially with ampicillin did not respond. Clavulanic acid plus amoxycillin, co-trimoxazole, erythromycin, tetracycline, cefuroxime and cefotaxime are useful alternative antibiotics. All strains of B. catarrhalis were resistant to trimethoprim.
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PMID:Bronchopulmonary infection due to B. catarrhalis. Clinical features and therapeutic response. 373 80

Branhamella catarrhalis--a Gram-negative diplococcus--differs biochemically from other Neisseriaceae and possesses a specific protein with antigenic properties. Although scattered cases of meningitis and endocarditis have been reported since 1907, B. catarrhalis has been considered a non-pathogenic, pharyngeal commensal. However, relatively recent reports have shown B. catarrhalis to play a significant role in the etiology of otitis media and bronchopulmonary infections. Some reports also indicate a pathogenic role in sinusitis and longstanding cough in children, and in acute laryngitis in adults. B. catarrhalis is susceptible to co-trimoxazole, erythromycin, cephalosporins and tetracyclines. Most strains are also susceptible to penicillin, but the frequency of beta-lactamase producing B. catarrhalis has increased from 4% to 25% during the last six years (Sweden). First choice antibiotics in infections with penicillin-resistant strains would be erythromycin and co-trimoxazole.
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PMID:Pathogenicity of Branhamella catarrhalis. 633 74

The purpose of this study was to compare the pathogens obtained by oropharyngeal suction (OPS) and bronchoalveolar lavage (BAL) in children with chronic pulmonary infections. Forty-four children (mean age of 6.1 years; range 4 months to 15 years) were included in the study (27 children with recurrent localized lung infection, 5 with bronchiectasis, 5 with cystic fibrosis, 2 with foreign body aspiration, 2 with bronchiolitis obliterans, and 3 with recurrent episodes of cough and shortness of breath). In 27 out of 44 BAL samples (61%) bacterial cultures were positive. The sensitivity of OPS in detecting the same BAL pathogen was 89% (24/27 samples), the specificity was 94% (16/17 samples), and the predictive value was 91% (40/44 samples). Hemophilus influenzae beta-lactamase negative was the main organism recovered from BAL in non-cystic fibrosis patients with recurrent or persistent pneumonia. We conclude that OPS is a simple and efficient noninvasive procedure which may be helpful in the diagnosis and treatment of recurrent or chronic pulmonary infection.
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PMID:Sensitivity and specificity of oropharyngeal suction versus bronchoalveolar lavage in identifying respiratory tract pathogens in children with chronic pulmonary infection. 747 80

Bordetella pertussis is the causative agent of whooping cough, a severe disease of infants characterised by repeated of paroxysmal coughing. Pertussis toxin (PT) is a major virulence factor of B. pertussis and is a typical A/B bacterial toxin consisting of five subunits S1-S5 in a ratio of 1:1:1:2:1. The PT subunit genes are organized into an operon which is not expressed in Escherichia coli, thus hampering the use of this organism for vaccine production. We have expressed the five PT subunits individually in E. coli by replacing the wild-type transcriptional and translational signals, and in the case of the S4 subunit the leader peptide has been exchanged with a modified E. coli beta-lactamase leader sequence. We have developed a stepwise cloning method to construct a synthetic PT operon which simultaneously expresses the five PT subunits in E. coli. Western blot analysis indicated that in E. coli KS476 containing the synthetic PT operon, S4 and S5 were completely processed, S1 was partially processed, whilst the majority of S2 and S3 remained unprocessed. Periplasmic extracts contained soluble S1 and S3; however, the processed form of S2, S4 and S5 were not detected, suggesting that these subunits may be membrane associated or in an insoluble form. This work should allow an investigation of the potential of E. coli to produce detoxified PT in a background free of other pertussis virulence factors that may contribute to the side-effects of some vaccine preparations currently in use.
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PMID:Expression of a synthetic pertussis toxin operon in Escherichia coli. 926 43

A prospective study was carried out on 157 patients admitted to a paediatric hospital in Dhaka, Bangladesh to determine the bacteria present in the induced sputum of paediatric patients with X-ray proven pneumonia. Their ages ranged from 21 days to 11 years; 65 per cent of them were male and 35 per cent were female. The most affected age group was between 6 months and 2 years old. Respiratory secretions produced by induced cough were taken by swab from the oropharynx for culture and smear. The predominant bacteria were Haemophilus influenzae, Streptococcus pneumoniae, Branhamella catarrhalis and Gram-negative bacilli. Serotyping of H. influenzae revealed that 76 per cent were non-typable and 18 per cent were of type b; 23.5 per cent of isolates of H. influenzae were beta-lactamase producing. MIC90 of penicillin against S. pneumoniae and H. influenzae were 0.025 and 3.13 micrograms/ml respectively. Ampicillin, penicillin G (benzylpenicillin), amoxycillin, and gentamicin were administered for the treatment of these patients. All cases were apparently improved, on the basis of clinical evaluation, and discharged from the hospital.
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PMID:Isolation of pathogenic bacteria from induced sputum from hospitalized children with pneumonia in Bangladesh. 997 76

Acute bacterial sinusitis (ABS) is an extremely common problem in both children and adults. There are three clinical presentations of acute sinusitis: (1) onset with persistent symptoms (nasal symptoms or cough or both for > 10 but < 30 d without evidence of improvement); (2) onset with severe symptoms (high fever and purulent nasal discharge for 3-4 consecutive days); and (3) onset with worsening symptoms (respiratory symptoms, with or without fever, which worsen after several days of improvement). Images to confirm the presence of acute sinusitis are necessary in older children (> 6 years) and adults to enhance the certainty of diagnosis. The predominant bacterial species that are implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children. In the last decade, there has been an increasing prevalence of penicillin-resistant S. pneumoniae, and beta-lactamase-producing H. influenzae and M. catarrhalis. Although there has been some controversy in the literature regarding the effectiveness of antibiotics in the treatment of ABS, most studies in which the diagnosis of acute bacterial sinusitis is confirmed with images and appropriate anti-biotics are prescribed show superior outcomes in recipients of antibiotics. Therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate. In penicillin-allergic patients or those who are unresponsive to amoxicillin, amoxicillin-clavulanate is appropriate. Alternatives include cefuroxime, cefpodoxime, or cefdinir. In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed. The optimal duration of therapy is unknown. Some recommend treatment until the patient becomes free of symptoms and then for an additional 7 d.
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PMID:Beginning antibiotics for acute rhinosinusitis and choosing the right treatment. 1678 86

An 80-year-old woman presenting with fever and cough was given a diagnosis of community-acquired pneumonia. She was hospitalized and treated with ampicillin/sulbactam (ABPC/SBT) and clarithromycin (CAM). Gram stain images and sputum culture results led us to believe that the causative agent was Haemophilus influenzae. Drug sensitivity testing indicated that the H. influenzae was a beta-lactamase-positive, ABPC-resistant (BLPAR) strain. Treatment with ABPC/SBT was not clinically effective. We considered the possibility of beta-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) strains. Further testing revealed that the MIC of ABPC was 128 microg/ml, that of SBT/ABPC was 8 microg/ml, and that of AMPC/CVA was 4 microg/ml. Furthermore, genetic analysis indicated the H. influenzae to be a BLPACR-I strain. The poor clinical course eventually led to a diagnosis of BLPACR. When beta-lactamase-producing H. influenzae is cultured, the possibility of a BLPACR strain resistant to ABPC/SBT and AMPC/CVA must be considered.
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PMID:[Case of pneumonia caused by beta-lactamase-producing and amoxicillin/clavulanate resistant strains of H. influenzae]. 1893 21

We assessed the clinical efficacy of tebipenem pivoxil (TBPM-PI) in 30 children with pneumonia who, despite having received oral administration of beta-lactam antibiotics at the standard dose for at least 3 days, had no relief of symptoms and showed an abnormal shadow on the chest X-ray and elevated serum CRP levels of 3.0 mg/dl or more between December 2009 and November 2010. TBPM-PI was administered at a single dose of 4 mg/kg twice a day for 3 days. The children ranged in age from 8 months to 5 years. The serum CRP level ranged from 3.05 to 12.9 mg/dl. In 28 of the 30 children, either Streptococcus pneumoniae or Haemophilus influenzae or both were detected. Of the 28 children, 7 carried penicillin resistant S. pneumoniae; 9 carried beta-lactamase nonproducing ampicillin resistant H. influenzae; and 3 carried both. In all children, defervescence was observed within 48 hours of the start of TBPM-PI administration, and the severity of coughing/wheezing reduced significantly by the 3rd to 5th day. Thus, TBPM-PI was determined to be effective. Diarrhea or loose stool was observed as an adverse reaction in 4 children (13.3%).
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PMID:[Clinical efficacy of tebipenem pivoxil treatment in children with pneumonia, who had no relief despite having administered oral beta-lactam antibiotics]. 2186 8


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