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Tidsskrift For Den Norske Laegeforening... Aug 2021The diagnosis of pulmonary tularaemia can be challenging. We present a case illustrating how pulmonary tularaemia may be an important radiological differential diagnosis...
BACKGROUND
The diagnosis of pulmonary tularaemia can be challenging. We present a case illustrating how pulmonary tularaemia may be an important radiological differential diagnosis to lung cancer.
CASE PRESENTATION
A man in his fifties presented with several weeks of dry cough, weight loss and profuse night sweats. The physical examination was normal. A chest computer tomography showed evidence of lymphadenopathy and two consolidated lung masses. The lung masses and lymph nodes showed signs of necrosis. The radiological findings were described as suspicious of lung cancer. A detailed history revealed that he had chopped wood prior to symptom onset. He tested positive for Francisella tularensis IgM and IgG, confirming the diagnosis of pulmonary tularaemia.
INTERPRETATION
The radiological findings in pulmonary tularaemia may mimic lung cancer. Serology is an easy way to confirm the diagnosis, if faced with clinical or radiological suspicion of pulmonary tularaemia.
Topics: Antibodies, Bacterial; Cough; Diagnosis, Differential; Francisella tularensis; Humans; Lung Neoplasms; Male; Tularemia
PubMed: 34423953
DOI: 10.4045/tidsskr.21.0245 -
Clinical Infectious Diseases : An... Jul 2020In December 2019, coronavirus 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China.
BACKGROUND
In December 2019, coronavirus 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China.
METHODS
Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from 10 January to 12 February 2020 were collected and analyzed. The data on laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between patients with severe and nonsevere infection.
RESULTS
Of the 452 patients with COVID-19 recruited, 286 were diagnosed as having severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough, and myalgia. Severe cases tend to have lower lymphocyte counts, higher leukocyte counts and neutrophil-lymphocyte ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and were more impaired in severe cases. Both helper T (Th) cells and suppressor T cells in patients with COVID-19 were below normal levels, with lower levels of Th cells in the severe group. The percentage of naive Th cells increased and memory Th cells decreased in severe cases. Patients with COVID-19 also have lower levels of regulatory T cells, which are more obviously decreased in severe cases.
CONCLUSIONS
The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis, and treatment of COVID-19.
Topics: Adult; Aged; Aged, 80 and over; Betacoronavirus; COVID-19; China; Coronavirus Infections; Cough; Critical Illness; Cytokines; Female; Fever; Hospitalization; Humans; Leukocyte Count; Lymphocytes; Male; Middle Aged; Monocytes; Neutrophils; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Young Adult
PubMed: 32161940
DOI: 10.1093/cid/ciaa248 -
Lung India : Official Organ of Indian... 2015Cough is the most common symptom for which medical treatment is sought in the outpatient setting. Chronic dry cough poses a great diagnostic and management challenge due... (Review)
Review
Cough is the most common symptom for which medical treatment is sought in the outpatient setting. Chronic dry cough poses a great diagnostic and management challenge due to myriad etiologies. Chronic cough has been commonly considered to be caused by gastroesophageal reflux, post-nasal drip or asthma. However, recent evidences suggest that many patients with these conditions do not have cough, and in those with cough, the response to specific treatments is unpredictable at best. This raises questions about the concept of a triad of treatable causes for chronic cough. This article discusses the mechanism and etiology of cough, along with recent advances in the field of cough, highlighting some of the diagnostic and management challenges.
PubMed: 25624596
DOI: 10.4103/0970-2113.148450 -
Clinical Medicine (London, England) Dec 2016Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological,... (Review)
Review
Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological, social and physical consequences. Patients typically complain of a dry irritating cough, driven by a strong urge to cough associated with a sensation or irritation located in the throat. Treatment of potential 'causes', ie asthma, gastro-oesophageal reflux disease and rhino-sinusitis, may produce a complete or partial response, but the response of some patients to opiates and alpha-2-delta ligand antagonists (gabapentin and pregabalin) supports the concept that this is primarily a neurological disorder, characterised by hyper-responsiveness of the nerves. Novel and highly effective neuronal treatments are in development and offer hope of better symptom control with fewer side effects within a few years. This review focuses on understanding the mechanism of chronic cough, current management approaches and research that may lead to novel therapies.
Topics: Chronic Disease; Cough; Humans; Practice Guidelines as Topic
PubMed: 27956447
DOI: 10.7861/clinmedicine.16-6-s92 -
The Journal of the American Osteopathic... Jan 2019Dry needling is a widely used alternative therapy for musculoskeletal disorders, such as myofascial pain. The procedure involves placing a solid monofilament needle into...
Dry needling is a widely used alternative therapy for musculoskeletal disorders, such as myofascial pain. The procedure involves placing a solid monofilament needle into myofascial trigger points or connective tissue to relieve pain. Some of the complications secondary to this procedure include cardiac tamponade, hematoma, infection, nerve injury, and pneumothorax. Although the incidence is low, the complications can be potentially life threatening. We present the case of a 44-year-old man who had dry needling of the infraspinatus, supraspinatus, rhomboid, and paraspinal muscles with subsequent development of a left apical pneumothorax. Given that the pneumothorax was small, the patient had good recovery with supplemental oxygen. Although the incidence of pneumothorax is very low, it is an important diagnosis to consider for a patient presenting with dry cough, malaise, chest pain, or shortness of breath after a dry needling procedure. Patients should be made aware of these potential complications as part of an informed consent.
Topics: Adult; Humans; Male; Myofascial Pain Syndromes; Needles; Pneumothorax; Radiography; Tomography, X-Ray Computed; Trigger Points
PubMed: 30615043
DOI: 10.7556/jaoa.2019.009 -
BMJ Case Reports Dec 2021A 63-year-old woman with grade 2 infiltrating left breast carcinoma who was started on ribociclib complained of exertional dyspnoea along with dry cough. There were...
A 63-year-old woman with grade 2 infiltrating left breast carcinoma who was started on ribociclib complained of exertional dyspnoea along with dry cough. There were bilateral interscapular crackles and chest X-ray evidence of bilateral mid and lower zone non-homogeneous opacity. The patient's pulmonary function test (PFT) showed moderate restrictions and desaturation. CT was suggestive of organising pneumonia and drug administration was stopped. The patient was treated with steroids in tapering doses, which led to improvements. The drug was restarted with the probability of other aetiologies for interstetial lung disease (ILD). It was also considered the superior efficacy of ribociclib in managing breast cancer. But due to evidence indicating the reappearance of organising pneumonia following drug administration, it was again stopped, and steroid use was restarted for treatment. The patient showed improvements in subsequent follow-ups.
Topics: Aminopyridines; Cough; Dyspnea; Humans; Middle Aged; Pneumonia; Purines
PubMed: 34930762
DOI: 10.1136/bcr-2021-245187 -
Cough (London, England) Oct 2013Altitude-related cough is a troublesome condition of uncertain aetiology that affects many visitors to high altitude. The traditionally held belief that it was due...
Altitude-related cough is a troublesome condition of uncertain aetiology that affects many visitors to high altitude. The traditionally held belief that it was due solely to the inspiration of cold, dry air was refuted by observations and experiments in long duration hypobaric chamber studies. It is likely that altitude-related cough is a symptom of a number of possible perturbations in the cough reflex arc that may exist independently or together. These include loss of water from the respiratory tract; respiratory tract infections and sub-clinical high altitude pulmonary oedema. The published work on altitude-related cough is reviewed and possible aetiologies for the condition are discussed.
PubMed: 24175933
DOI: 10.1186/1745-9974-9-23 -
BMJ Open Respiratory Research 2019Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways...
INTRODUCTION
Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history. It has previously been shown that parental reporting of 'wheeze' is frequently inaccurate. This study aimed to determine whether parental reporting of the quality of a child's cough is likely to be accurate.
METHODS
Parents of 48 'new' patients presenting to a respiratory clinic with chronic cough were asked to describe the nature of their child's cough. They were then shown video clips of different types of cough using age-appropriate examples, and their initial report was compared with the types of cough chosen from the video.
RESULTS
In a quarter of cases, the parents chose a video clip of a 'dry' or 'wet' cough having given the opposite description. In a further 20% parents chose examples of both 'dry' and 'wet' coughs despite having used only one descriptor.
DISCUSSION
While the characteristics of a child's cough carry important information that may be helpful in reaching a diagnosis, clinicians should interpret parental reporting of the nature of a child's cough with some caution in that one person's 'dry' cough may very well be another person's 'wet' cough.
Topics: Adolescent; Child; Child, Preschool; Cough; Feasibility Studies; Humans; Medical History Taking; Parents; Reproducibility of Results; Self Report
PubMed: 31178996
DOI: 10.1136/bmjresp-2018-000375 -
Respiratory Medicine Feb 2017Idiopathic pulmonary fibrosis (IPF) is a progressive disease of dysregulated wound healing leading to unremitting scarring and loss of lung function. The predominant... (Review)
Review
Idiopathic pulmonary fibrosis (IPF) is a progressive disease of dysregulated wound healing leading to unremitting scarring and loss of lung function. The predominant symptoms are dyspnea on exertion and a persistent dry cough. For patients with IPF, cough is more than just bothersome; it has a significant negative impact on quality of life and is a marker of disease severity and progression. The etiology of cough in IPF is unclear but may be due to architectural distortion of the lungs, increased sensitivity of the cough reflex, airway inflammation, or changes in mucus production and clearance. There also may be an overlap between IPF cough and cough due to other common etiologies such as asthma, gastroesophageal reflux disease, upper airway cough syndrome, and medications. There are no approved therapies to specifically treat IPF cough, and recently approved medications for IPF have not been evaluated in cough. Few clinical trials have focused on treatments for IPF cough. To date, there is only one randomized, placebo control therapeutic study for IPF cough with thalidomide, which significantly reduced IPF cough and improved quality of life. Two additional cohort studies report that interferon-α and prednisolone also decrease IPF cough. However, no medication is approved to treat IPF cough. Currently, the mainstay of therapy for IPF cough is standard cough suppressants, which have limited efficacy and often intolerable side effects. Future studies are needed to determine an effective therapy to alleviate this particularly debilitating symptom and improve overall quality of life for patients suffering with IPF.
Topics: Antitussive Agents; Comorbidity; Cough; Gastroesophageal Reflux; Humans; Idiopathic Pulmonary Fibrosis; Interferon-alpha; Quality of Life; Thalidomide
PubMed: 28137504
DOI: 10.1016/j.rmed.2016.12.016 -
Journal of the American College of... Feb 2021
PubMed: 33554210
DOI: 10.1002/emp2.12376