Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 55-year-old man was given a diagnosis of pulmonary tuberculosis. He was treated with isoniazid (INH), rifampicin (RFP), ethmbutol (EB) and pyrazinamide (PZA). After three weeks of treatment, he developed fever, dyspnea and dry cough. A chest X-ray taken at that time showed new reticulo-nodular shadows bilaterally and right pleural effusion. Ga scintigram showed strong uptake in both lungs. Transbronchial lung biopsy revealed alveolitis, suggesting drug-induced pneumonitis. Drug lymphocyte stimulation tests for INH, RFP, EB and PZA were negative. Because his symptoms were severe, all drugs were discontinued and daily predonisolone (30 mg) therapy was started. The symptoms and bilateral reticulo-nodular shadows soon resolved. The antituberculosis drugs were changed to streptomycin and levofloxacin, but these were ineffective. Therefore, EB, RFP and PZA, which only rarely induce pneumonitis, were carefully restarted in that order. Pneumonitis did not recur and the pulmonary tuberculosis improved. This clinical course suggests INH-induced pneumonitis.
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PMID:[A case of isoniazid-induced pneumonitis]. 961 86

An 82-year-old man was treated with isoniazid (INH) because of a low-grade fever. On the 9th day of treatment, dry coughing and general malaise developed. On the 30th day, he was admitted to our hospital. A chest-X ray film showed infiltrative shadows in the right middle and lower lung fields, but a chest CT scan showed an abnormal lung density in the right lower lobe. Abnormal laboratory findings included leucocytosis, liver dysfunction, hypoxemia, low vital capacity, low diffusing capacity and a high level of C-reactive protein. A differential cell count of the bronchoalveolar lavage fluid (BALF) showed many neutrophils and lymphocytes; examination of a specimen obtained by transbronchial lung biopsy (TBLB) revealed edema of alveolar walls, lymphocyte infiltration, and proliferation of type II alveolar epithelial cells. A drug lymphocyte stimulation test (DLST) against INH was positive. After discontinuation of INH, symptoms resolved, laboratory findings became normal, and the infiltrative shadows in the right middle and lower lung fields disappeared. The clinical course and the findings of BALF, TBLB, and DLST suggested the diagnosis of pneumonitis caused by INH.
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PMID:[Isoniazid-induced pneumonitis]. 974 62

The patient was a 25-year-old man who had been admitted to a local hospital due to fever and trachelophyma. Tubercle bacillus was detected in pus culture obtained by biopsy of the trachelophyma, but not in sputum culture. Because combined therapy with 3 antituberculous drugs (RFP, INH and SM) failed to reduce the fever or drainage from the biopsy region, the patient was transferred to our hospital. Chest X-ray films taken on admission revealed dilatation of the superior mediastinal shadow; chest CT images revealed cervical and mediastinal lymphadenopathy and an anterior mediastinal abscess, but no pulmonary lesion. About 2 months after admission, cough developed and Gaffky type 2 was detected in the patients sputum. Bronchoscopy and bronchography revealed a bronchomediastinal fistula. Forty days after the onset of cough, reticulogranular shadows were observed in the right upper lobe on chest X-ray films, and a diffuse centrilobular lesion was observed in the right upper lobe on chest CT images. From these clinical observations, the patient was given a diagnosis of cervical-mediastinal lymph node tuberculosis, which had progressed to pulmonary lesion through a bronchial fistula due to lymphadenitis.
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PMID:[A case of cervical-mediastinal lymph node tuberculosis progressed to pulmonary lesion through a bronchial fistula]. 1006 61

In order to assess the clinical features and clinical courses of endobronchial tuberculosis, which included trachea to segmental bronchus, we studied 34 cases of patients who were admitted to TB ward of International Medical Center of Japan from 1994 to 1997. We noticed a higher incidence in females and in the main bronchus. Cough was the most common complaint seen in 97% of cases. The duration of symptoms before the initiation of antituberculous chemotherapy was long (on the average 6 months), and they were often treated as bronchial asthma or bronchitis. Bronchoscopic examination is necessary for diagnosis. The scars sometimes gave rise to severe stenosis, especially when the lesion developed to an advanced stage or circumscribed the lumen before treatment. We tried INH inhalation with systemic chemotherapy. Although rapid improvement was suggested by this method, yet no significant difference was seen in the results for the efficacious prevention of stenosis. Five cases required surgical intervension (bronchoplasty and lobectomy) in order to avoid atelectasis or secondary infection. Early diagnosis and appropriate treatment are most important, and bronchoscopic examination is essential in early diagnosis.
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PMID:[Clinical investigation on endobronchial tuberculosis]. 1035 20

In Japan, the number of tuberculosis infected patients has been increasing again, especially in the elderly. The incidence of newly registered tuberculosis patients who are over 70 years is 34%. The outbreak of tuberculosis also has been increasing, and has become a serious social problem. The elderly have a high risk of developing tuberculosis because of their immunosuppressed condition due to underlying disease and aging. Elderly active tuberculous people also confer a risk of tuberculosis infection to the non-tuberculosis infected young generation. In this symposium, we discussed about 1) the tuberculosis outbreak related to the strategy for tuberculous prevention, 2) the health examination to detect tuberculous people in the middle-aged and elderly, 3) the nosocomial transmission of tuberculosis in the hospital, 4) the nutritional damage and immunosuppressive state in elderly people related to developing active tuberculosis in latent tuberculous infection, and 5) the organ transplantation and tuberculosis focusing on living related liver transplantation. Seven cases of tuberculosis outbreak were reported in Osaka from 1989 to 1998, 2 cases in the hospital and 5 in others. Tuberculous infection index (maximum sputum Gaffky score multiplied by the number of months of persisted cough) was 8 and 15 in the hospital, 3, 0, 84, 14, and 27 in others. Three cases (43%) were observed in persons with less than 10 of this index. It is essential to evaluate carefully for tuberculosis outbreak in extraordinary examination, if the tuberculous infectious index is low. There are various immunosuppressive patients with malignancy and other underlying disease in the hospital, so we have to pay careful attention for tuberculous outbreak when there is an active tuberculous patient. In these seven cases of extraordinary examination for tuberculous epidemic, only one (0.4%) of 241 cases who received isoniazide prophylactic therapy developed active tuberculosis. Isoniazide prophylactic therapy was an important strategy for the prevention of tuberculous outbreak. (Isamu TAKAMATSU, Osaka Prefectural Habikino Hospital, Osaka). It is essential to prevent tuberculosis in the elderly to achieve tuberculosis control in public health. The health examination was an important strategy for the detection of tuberculosis in the middle-aged and elderly. The incidence of tuberculosis detection is only 9.3% by the health examination at this age. However, the health examination has well detected active tuberculosis patients in elderly (34.5%), and also 16.8% in smear positive cases with pulmonary cavitary formation. The early detection of persons with active tuberculosis is essential, and further discussion regarding cost-performance and accuracy of the health examination for tuberculosis should also be essential. Prophylactic therapy of isoniazide also might be considered for the high risk middle-aged and elderly people with underlying diseases. (Masako OMORI et al., Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo). The cases of nosocomial transmission of tuberculosis in the hospital have been increasing. In younger persons, the incidence of tuberculosis infected nurses and doctors is relatively higher than healthy control. The transmission of tuberculosis from elder active tuberculosis patients to healthy non-tuberculosis infected medical workers has been well recognized. It is very essential to follow guidelines for the prevention of tuberculous transmission in the hospital from the Japan Tuberculosis Society including routine tuberculin skin test for fresh medical workers. Primary education for tuberculosis in medical and nursing school is also an important strategy. Further discussion might be essential that BCG could prevent tuberculosis transmission in tuberculin skin test negative adults. (ABSTRACT TRUNCATED)
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PMID:[Tuberculous infection and prevention]. 1110 78

A clinical study of 38 patients (28 men and 10 women) with tuberculous pleurisy was conducted. The age of these patients ranged from 19 to 92 years, with an average age of 48.9 years. In 30 patients, the chief complaint was fever, and other common complaints included chest pain, dyspnea, and coughing. Bacillus tuberculosis was found in the pleural fluid of 7.9% of the patients. Tuberculous pleurisy was diagnosed histologically, based on pleural biopsy, in 23.7% of the patients. The diagnosis rate of pleural biopsy was 47.4%. There were no significant differences in results of blood and pleural fluid tests between idiopathic pleurisy and concomitant pleurisy, but the tuberculin skin test was positive in only 50% of the patients with concomitant pleurisy. The tendency was that the longer the time period between symptom onset and first examination, the greater the pleural fluid retention. The diagnosis rate of pleural biopsy was influenced by the severity of pleural fluid retention. A thoracic cavity drain was inserted for continuous drainage in 15 patients, and every patient underwent INH + RFP-based chemotherapy. Tuberculous pleurisy is an important disease among patients with pleural fluid retention, thus clinicians need to know how to treat this disease.
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PMID:[A clinical study of tuberculous pleurisy]. 1185 70

A 80-year-old male visited an outpatient department of a nearby hospital complaining of fever, cough, and poor appetite on June 2000. The patient was diagnosed as bacterial pneumonia and was treated with antibiotics although specific cause could not be identified. After one month, he was hospitalized due to lack of improvement. After admission, acid-fast bacilli (AFB) was found from the bronchial washing. The patient was then transferred to our hospital. Upon admission, sputum smear examination was positive for AFB and MTB was confirmed by PCR. Therapy was initiated with INH 300 mg, RFP 450 mg, EB 1000 mg, and PZA 1000 mg, orally daily. However, on the day following the admission, he became unconscious. Brain MRI showed several small granulomas on the cortex of the bilateral anterior and temporal brain. Although AFB was not detected from the cerebrospinal fluid, tuberculous meningitis was suspected and steroid was given. Nine days after admission, the patient died due to tuberculous meningitis. The isolation of MTB had been attempted on Ogawa culture medium using patient's sputum and liquor, and it took 14 weeks to find colony growth both from sputum and liquor. In the autopsy, numerous granulomas were detected in his lung, liver, kidney, and pancreas. These findings indicate that disseminated growth of MTB occurred in vivo in spite of very slow growth of MTB in vitro.
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PMID:[A case of disseminated tuberculosis requiring extended period for the identification of Mycobacterium tuberculosis on culture]. 1190 31

A 27-year-old man was admitted to our hospital in September 18, 2000, complaining of fever, cough, appetite loss and body weight loss. He was diagnosed as advanced lung tuberculosis, because of chest X-ray findings and positive acid-fast bacilli in his sputum. He was administrated rifampicin (RFP), isoniazid (INH) and ethambutol (EB). Two days after starting treatment he complained of abdominal pain and the signs of perforating peritonitis. Emergency laparotomy was performed and we observed multiple ulcers and a perforation of ileum. We resected a part of distal ileum and ascending colon and made ileostomy. Histopathologic examination of resected ileum and colon showed multiple ulcers and epithelioid cell granulomas with caseous necrosis. Many acid bacilli were identified from the lesion by specially stained tissue sections. He was administrated streptomycin and INH by injection post-operatively while oral administration was impossible. Six days after the first operation, we found the signs of perforation in another part of the ileum. So we were obliged to perform second laparotomy and resect the part involved. Five days after the second operation, he was able to take RFP, INH, and levofloxacin per oral route. On February 8, 2001 we performed ileocolonal reconstruction with side to side anastomosis and closed ileostomy at the third laparotomy. He had continued chemotherapy and went back to Korea in April 7, 2001. Although intestinal tuberculosis has sharply declined in Japan thanks to development of effective antituberculous drugs, we should keep in mind that it could be a possible cause of the acute abdomen.
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PMID:[A case of perforative peritonitis complicated with lung and intestinal severe tuberculosis]. 1223 48

A 24-year-old woman was referred to another hospital because of a barking cough, but her chest radiograph showed no abnormality. Although she had been diagnosed as having other diseases and had been given medical treatment, the barking cough continued. Abnormalities of the chest radiograph appeared 11 months later, and endobronchial tuberculosis was diagnosed from the clinical history, chest CT and a sputum smear positive for acid-fast bacilli. We treated her with INH, RFP, EB for 6 months, and PZA for 2 months. However, truncus intermedius became obstructed nine months after treatment ended, and we re-opened it with a Dumon stent after coring it out using a rigid bronchoscope. Since the patient was a teacher, medical checkups of many people were required, and the number of prophylactic treatments carried out was 80. This was regarded as a mass infection. In the early stages, endobronchial tuberculosis may not show any abnormality on chest radiography, but may still cause mass infection. When a barking cough continues for a long time, endobronchial tuberculosis must be suspected, and examination of a sputum smear for acid-fast bacilli, as well as a sputum culture is necessary.
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PMID:[X-ray-negative endobronchial tuberculosis with persistent irritating cough that resulted in unpredicted mass infection]. 1450 40

Considering the high social activity, the trend of tuberculosis among young adults appears to be one of the key factors that influence the future morbidity rate of tuberculosis in Japan. To investigate its current characteristics, we analyzed new cases of tuberculosis aged 20 to 29 who were admitted to 7 national hospitals in Kanto- and Kinki-areas during the period of January 1st to December 31st, 2000. Data on the following items were compiled: sex, age, body height and weight, nationality; background factors such as life style, complications; course of the disease before the diagnosis; result of PPD skin test; severity of the disease estimated by the amount of M. tuberculosis in sputum and the grade of chest X-ray findings; therapeutic regimens and the response rate. Data were collected from 234 patients (129 males and 105 females) and the results were as follows: 1) about 80% of the patients were symptomatic and in 50% of patients who presented with cough, more than one month was needed before establishing the diagnosis as TB, 2) the disease was found in advanced stage in more than half of the patients, 3) foreigner patients, most of them were from Kanto-area, accounted for 11%, and were in advanced stage, some with drug-resistant tuberculosis, 4) INH resistance was noted in 7.7%, 5) pyrazinamide was included in the therapeutic regimens in 84.0% of the smear positive patients, 6) the admission period was within 90 days in 63.7% of the patients, however, the duration of treatment was 6 months in only 48.0% of patients who were treated with regimens containing pyrazinamide. More efforts for early detection of patients is needed to prevent the transmission of the disease, and more extensive use of directly observed therapy is essential for the prevention of dropout. We also argued about the shortening of the admission and duration of treatment in these patients.
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PMID:[A clinical study on tuberculosis among young adults in Japan: analysis on patients admitted to national hospitals in Kanto- and Kinki-areas in the year 2000]. 1450 24


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