Cough Research Articles

The resurgence of pertussis in Central Serbia in the period from June to December 2023

Abstract Background There was a registered increase in the number of confirmed pertussis cases in Central Serbia between June and December 2023. Among the possible causes of pertussis resurgence are increased awareness of pertussis among healthcare workers, availability of the sensitive RT PCR method in diagnostic, the limited duration of vaccine-induced immunity as well as decline of immunization coverage influenced by the COVID-19 pandemic. Methods The nasopharyngeal samples from clinics and primary care departments were transferred to Institute of Public Health of Serbia. DNA was extracted from each sample using the MagMAX Viral/Pathogen kit. The presence of B. pertussis was determined using two PCR assays, VIASURE Bordetella Real Time PCR Detection Kit and Bosphore B. pertussis/parapertussis Genotyping Kit, Anatolia Geneworks. Results RT-PCR confirmed a total of 338 pertussis cases in Institute of Public Health of Serbia during the observed period. Most of confirmed cases were among children 9-14 years old (49,7%) followed by infants younger than 12 months (21,9%). The more severe cases were among the unvaccinated and uncomplete vaccinated infants, 78,4% of which required hospitalization with two deaths in this age group. Conclusions Based on the analysis of the obtained results, we can highlight the importance of using sensitive methods in pathogen detection. Rapid diagnosis, laboratory confirmation and notification ensure early public health intervention to minimize the spread of disease. Despite long tradition of mandatory immunization against pertussis in the Republic of Serbia, wanning of vaccine induced immunity poses potential risk for the resurgence of pertussis. For pertussis control, in the future, it will be essential to achieve high immunization coverage as well as to introduce a booster dose of pertussis containing vaccine for children aged 14 and to implement vaccination of pregnant women. Key messages • For the better pertussis control vaccination of adolescents and adults, as well as vaccination of pregnant women should be considered in the future vaccination policies. • Clinicians should consider pertussis in the differential diagnosis of persistent cough illness in people of all ages, even those previously immunized.

TB or Not TB, That is the Question?

A 26-year-old female presented with a 3-month history of dry cough, unintentional weight loss, night sweats and fatigue. Her background history was significant for ulcerative colitis, managed with Adalimumab for almost 2 years. Clinical examination was unremarkable, apart from some mild pallor. Abnormal chest x-ray findings prompted a computerised tomography (CT) thorax which demonstrated multifocal peri-bronchial consolidation. The differential diagnosis was multifocal organising pneumonia and tuberculosis (TB). Extensive investigations, including invasive bronchial imaging and biopsy, ultimately ruled out TB. This paper reports a case of Adalimumab-induced organising pneumonia and discusses its clinical implications.

Tuberculous Pleurisy in a Patient with a History of Breast Cancer: Diagnostic Challenges and Management Options

Background: Tuberculosis (TB) and cancer are increasingly prevalent diseases that can be challenging to diagnose due to similarities in clinical and radiological findings. This case report describes a 46-year-old woman with a history of breast cancer who developed tuberculous pleurisy (TP). Case presentation: A 46-year-old woman who underwent mastectomy and chemotherapy for BC in 2023 had hypertension, but no history of TB. The patient presented with dry cough, fever, and stomach discomfort, with an oxygen saturation level of 60%, but no respiratory distress before their appointment. Microscopy and culture tests were negative for Mycobacterium TB, A positive result was observed with an IFN-γ level of 0.35 IU/ml and 26% of the negative control after TB antigen stimulation. Histological analysis using hematoxylin and eosin staining showed Langhans giant cells, epithelioid cell granulomas, caseous necrosis, and necrotic foci. These findings indicate granulomatous inflammation with no signs of malignancy. Following the diagnosis, the patient received a daily dose of 300 mg isoniazid, 600 mg rifampin, 1500 mg pyrazinamide, and 10 mg pyridoxine for six months without any adverse effects. Conclusion: Physicians must employ a combination of diagnostic techniques, including morphological and microbiological confirmation, to accurately diagnose pleural effusion in this patient population.

Scientifc Validation and Chromatographic Method Development for the Estimation of Piperine in Herbal Formulation Babbularishta: A Quality Control Strategy for Critical Quality Attributes

Background: Babbularishta is an Ayurvedic medicine in liquid form used for the treatment of phthisis, skin diseases, urinary disorders,, and breathing problems. It is also beneficial in cases of blood disorders, acne, dermatitis, hemoptysis, lung injury, asthma, persistent cough, whooping cough, etc. Objective: The functional role of this study is to develop a simple, novel, precise, accurate, reliable, and selective RP-HPLC method for the estimation of piperine content in herbal drug formulations (Babbularista). Methods: A traditional approach to method development could fail to meet the desired separation. Consideration of the current regulatory requirement for analytical method development and RP-HPLC method for routine analysis of piperine in the herbal formulation has been optimized using an analytical Quality by Design (QbD) approach. Three laboratory formulations and three marketed preparations of Babularishta were investigated for organoleptic parameters, physicochemical parameters, and validation. The mobile phase composition (methanol and water % as A), pH (B), and flow rate (mL/min as C) were selected as independent variable,. In contrast, retention time (min. as Y2), area (AU as Y1) is selected as dependent variables. Results: The fingerprinting method was developed and optimized by using the AQbD approach. Piperine content was found to be in Piper nigrum (Marica) 3.01±0.01527 % w/w and in Piper longum (Pipali) 2.74±0.01154% w/w in Babbularista. Conclusion: An attempt has been made to develop quality control parameters of Babbularista by developing a suitable and sensitive HPLC methods for the quantitation of piperine in herbal drug formulations (Babbularista). The developed method was found to be simple, accurate, precise,, and economical for the estimation of piperine in herbal formulations.

An expert consensus on managing cough in Indian pediatric practice: airway disease education and expertise 2.0 (2024)

Cough in children is one of the most frequent presenting symptoms in health care settings. Coughing can significantly affect a child's sleep and level of activity, which often causes parents’ distress. Promptly addressing chronic cough may enhance the quality of life in children and reduce the considerable stress on parents. In 2017, airway disease education and expertise (ADEX) NEXT recommendations for diagnosis, management, and follow-up of persistent (chronic) cough were published. For the present work 27 modified Delphi consensus statements were prepared, and a survey was undertaken involving 30 expert pediatricians from across India. The opinions of the expert panel on the updates related to pediatric chronic cough awareness, diagnosis, and management were collected. Consensus was predetermined to be obtained if more than 75% of the participants agreed or remained neutral for the statement. All the statements were supported by the latest data from the literature search. All the statements reached consensus after an agreement of more than 75%. Consequently, all the opinions from experts were consolidated and expert recommendations were framed. Children presenting with cough should be treated in accordance with child-specific guidelines. The present expert recommendations can be utilized by pediatricians to make well-informed decisions when treating pediatric patients with cough. The management of cough in children should be determined by the underlying cause, where a prompt and efficient therapy can result in early resolution.

“The complexity of what to do” – clinical perspectives of tailored physiotherapy interventions in patients with respiratory symptoms in post-COVID condition

Purpose Knowledge gaps exist regarding the effects of interventions due to continuing respiratory symptoms in patients with post-COVID condition. The aim of the present study was to present the clinical outcomes of individualised treatments for patients with remaining respiratory symptoms due to post-COVID condition. Methods This prospective longitudinal study included a consecutive series of 57 patients with remaining respiratory post-COVID symptoms. Breathing pattern, thoracic pain/mobility, occurrence of cough, and respiratory muscle strength were assessed before and after the administration of individually tailored physiotherapy interventions. Results The median treatment duration was 3 months (range 1–36 months). Dysfunctional breathing pattern was the most common symptom (n = 55/57) at inclusion. After treatment, 95% of patients had a normalised or improved breathing pattern (p < 0.001). The treatments for pain, productive and unproductive cough, and respiratory muscle strength resulted in significantly improved symptoms (p < 0.01). With other targeted treatments, inspiratory muscle strength improved by 20 cmH2O and expiratory muscle strength by 11 cmH2O (both p < 0.001). Conclusions This study indicates positive outcomes of physiotherapy treatment based on the patient’s symptomatology and test results. Therefore, individualised physiotherapy treatment of post-COVID conditions may have an impact on recovery.

Influence of SARS-CoV-2 variants on COVID-19 epidemiological and clinical profiles: a comparative analysis of two waves of cases

BackgroundThe COVID-19 pandemic has been the most significant health challenge of the last century. Multiple and successive waves of COVID-19 cases, driven particularly by the emergence of new SARS-CoV-2 variants, have kept the world in a constant state of alert.MethodsWe present an observational, descriptive, cross-sectional study aimed at identifying SARS-CoV-2 variants circulating during two local waves of COVID-19 cases in southern Bahia, Brazil (late 2021 and late 2022), and analyzing the association between the detected variants and the epidemiological and clinical characteristics of the disease. For this purpose, data and nasopharyngeal samples from individuals in southern Bahia, Brazil, with suspected COVID-19 were included. Viral detection was performed by RT-qPCR, and SARS-CoV-2 variants were identified by next-generation viral sequencing.ResultsA total of 368 nasopharyngeal samples were tested. Approximately 23% of the samples from late 2021 tested positive for SARS-CoV-2, while in 2022, the positivity rate was about 56%. All sequenced samples from 2021 were identified as the Delta variant, while in 2022, all samples were classified as the Omicron variant. Overall, individuals who tested positive for SARS-CoV-2 in 2022 were younger than those who tested positive in 2021. Moreover, we observed significant differences in the clinical spectrum of SARS-CoV-2 infection when comparing the two periods. Individuals who presented with anosmia/ageusia were more likely to test positive for SARS-CoV-2 infection in 2021 but not in 2022. Additionally, fever, dry cough, pharyngalgia, headache, and rhinorrhea were more frequent among individuals infected with the Omicron variant than among those infected with the Delta variant.ConclusionsThe profile of COVID-19 in southern Bahia differed when analyzing two distinct waves of the pandemic in the region. These differences are likely related to the variants, which may differ in transmissibility and virulence, thereby altering the dynamics of the pandemic. This underscores the importance of genomic surveillance in better understanding the behavior of viral infections.

A Rare Case of a Child with Bended Scarf-Pin in Left Bronchus: Case Report with Systematic Review And Meta-Analysis.

In this report, we present the case of a 19-month-old female diagnosed with hijab pin aspiration after a week of persistent coughing, along with a meta analysis and systematic review of the relevant literature. A comprehensive search was conducted across multiple databases, including Ovid Medline, Cochrane, PubMed, Web of Science, and SCOPUS, yielding 182 records until August 2024. A total of 7 published study and our case included to final analysis. The complication, morbidity, and mortality analysis has been performed using Jamovi software v2.4 MAJOR proportion analysis section. A 19-month-old female was admitted to another hospital with a persistent cough complaint. In X-ray left hijab pin has been detected. The patient underwent a succesfull removal with rigid broncoscopy (RB). A total of 71 patients included this meta analysis. The thoracotomy rate was 8%. The bleeding rate was reported as 1.4%. The reoperation rate was reported as 9.8%. The postoperative intubation rate was reported as 1.4%. The calculated complication rate was found to be 5.6% based on the existing literature. The postoperative hemoptysis incidence was calculated as 0%. Mortality was not reported across any included studies. However, the mortality incidence was calculated as 0% based on included studies. Effective and timely intervention is crucial for managing pediatric hijab pin aspiration. Multidisciplinary approaches ensure successful outcomes and prevent serious complications.

Nonasthmatic Eosinophilic Bronchitis: A Systematic Review of Current Treatment Options.

Nonasthmatic eosinophilic bronchitis is characterized by persistent dry or barely productive cough and bronchial eosinophilia without airway obstruction or bronchial hyperreactivity. It is primarily a chronic disease, in which some patients have clinical and pathophysiological relapses, while others progress to asthma or chronic obstructive pulmonary disease. It accounts for 5% to 30% of cases referred for chronic cough. Exposure to common inhalants and occupational sensitizers has been proposed as a possible cause of the disease, although the etiology and underlying mechanisms are uncertain. Some features are similar to those of asthma, such as airway eosinophilia, inflammatory mediator levels, and airway remodeling. Differences in airway pathophysiology, such as the location of airway inflammation and levels of IL-13 and PGE-2, have been reported. Sputum cell count is the gold standard test for diagnosis, and other biomarkers, such as exhaled nitric oxide, could support the diagnosis. A systematic review of treatments for the disease shows that while inhaled corticosteroids are the primary option, the appropriate dose, the type of corticosteroid, and the duration of treatment remain unknown. Treatment duration is inversely correlated with the relapse rate. Increased doses of inhaled corticosteroids, oral corticosteroids, and leukotriene receptor antagonists are recommended in persistent disease. Anti-IL-5 biologics could be promising in this disease. Studies that investigate biomarkers for diagnosis and prognosis are necessary, as are randomized controlled studies for second-line treatments.

A nomogram to predict long COVID risk based on pre- and post-infection factors: Results from a cross-sectional study in South China

ObjectivesLong COVID has received much attention as a complex multi-system disease due to its serious impact on quality of life. However, there remains inconsistent results in terms of risk factors, and a prediction model for the accurate prediction of long COVID is still lacking. Study designCross-sectional study. MethodsIn this retrospective study, a community population from the Futian District of Shenzhen, Guangdong Province, China, were included. Data were collected from September to December 2023 using an electronic questionnaire. Logistic regression analyses were used to identify predictors of long COVID. Pre-infection and post-infection prediction models (with/without post-infection characteristics) were developed, and the C-index was used to evaluate accuracy. ResultsIn total, 420 patients infected COVID-19 were included. The prevalence of long COVID was 32.9 %. The most common symptoms of long COVID were weakness/fatigue, persistent cough and cognitive dysfunction. Independent predictors of long COVID included in the pre-infection model were age, long-term medication, and psychological problems such as stress and doing things without enthusiasm/interest before COVID-19 infection (C-index: 0.721). Independent predictors included in the post-infection model were age, inability to concentrate before COVID-19 infection, and symptoms of weakness/fatigue, abnormal smell/taste, diarrhoea, eye conjunctivitis and headache/dizziness during the acute-phase (C-index: 0.857). ConclusionsAge, psychological problems before COVID-19 infection and acute-phase symptoms were important risk factors of long COVID. Results from the pre-infection model provide guidance for non-infected individuals on how to prevent long COVID. Results from the post-infection model can be used to accurately predict individuals who are at high risk of long COVID and help design treatment plans for patients in the acute phase.

Association of anthropogenic heat with asthma and related symptoms among children in China: A novel index reflecting climate change

BackgroundAnthropogenic heat (AH) is defined as the significant release of waste heat into the environment due to human activities, serving as a controllable heat source contributing to global climate change. However, epidemiological evidence establishing a clear association between AH and childhood asthma is currently lacking. ObjectivesTo explore the relationship between children's exposure to AH and asthma, as well as its related symptoms. MethodsThis population-based cross-sectional study, part of the National Chinese Children Health Study from 2012 to 2018, involved 188,145 children aged 6 to 18 years. We used multisource remote sensing images and ancillary data to estimate AH exposure. Data on asthma symptoms were collected through validated self-reported questionnaires. A generalized linear mixed model was applied to determine the associations. ResultsOur findings indicate a positive correlation between AH exposure and asthma risk in children. An interquartile range (IQR) increase in total AH was linked to higher odds of current asthma (OR: 1.15, 95 % CI: 1.10, 1.20) after adjusting for covariates. Categorizing AH by source, industrial AH exhibited the strongest effect, with an increased risk of current asthma (OR: 1.16, 95 % CI: 1.11, 1.22). Notably, younger children exhibited stronger associations between AH exposure and asthma-related symptoms, with boys showing heightened susceptibility, particularly for persistent cough. ConclusionThis study suggests that exposure to AH may elevate the risk of asthma and related symptoms, particularly in boys and younger children. Providing a foundation for developing practical strategies to mitigate the adverse impacts of global warming on respiratory health, while also guiding the formulation and evaluation of climate action and public health policies, and supporting sustainable urban development.

Anaplastic transformation of papillary thyroid carcinoma in the cervical lymph nodes showing a variety of rhabdoid, epithelioid and spindle cell phenotype

Abstract Introduction/Objective Anaplastic thyroid carcinoma (ATC) is a rare undifferentiated tumor of thyroid follicular cells with a dismal prognosis. Most ATCs derive from pre-existing, well-differentiated thyroid carcinomas, most commonly papillary thyroid carcinoma (PTC). In nearly all instances, ATC arises within the thyroid gland. Completely divergent morphologies of this tumor between the bilateral cervical nodes as well as the almost exclusive presence of ATC in the metastatic and nodal locations are very unusual and are reported here. Methods/Case Report A 67-year-old man presented with a rapidly enlarging left cervical mass, hoarseness, dry cough, and drooping left eye. MRI demonstrated bilateral enlarged cervical lymph nodes spanning levels II to V, and nodules in thyroid lobes. Subsequent total thyroidectomy with bilateral radical neck dissection was performed. Histologically, the left lateral cervical masses revealed undifferentiated tumor cells with rhabdoid, epithelioid and spindle cells features. Conversely, the tumor within the thyroid lobes and the right cervical lymph nodes exhibited PTC with tall cell features. All undifferentiated tumor components stained positive with AE1-3, CK7, PAX8, and negative with thyroglobulin, EMA, CD34, S100, Melan-A, Sox 10, desmin, myogenin, and P40. INI-1 staining is retained. Only the spindle cell component stained positive with TTF1. Based on the morphology and immunoprofile, a diagnosis of anaplastic thyroid carcinoma was rendred. Results (if a Case Study enter NA) NA Conclusion Diagnosing anaplastic thyroid carcinoma outside the thyroid lesion can be challenging. In our case, only extensive sampling of the surgical specimen identified a small focus of well-differentiated PTC, staining positive for thyroglobulin, in the left cervical anaplastic carcinoma component, identifying its origin. This case adds to the scarce literature documenting unilateral anaplastic transformation in the left cervical metastatic lymph nodes, while the right cervical lymph nodes contained pure well differentiated PTC. This represents a significant potential pitfall in presurgical fine needle aspiration (FNA) evaluation of patients with ATC.

APERFEIÇOAMENTO SOBRE O RASTREIO DA TUBERCULOSE PARA OS AGENTES COMUNITÁRIOS DE SAÚDE DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA DO NASCENTE I E II EM ARARIPINA-PE.

Tuberculosis (TB), a disease formerly described as typhus, was known in the 19th century as the white plague, decimating hundreds of thousands of people around the world. TB can be caused by any of the seven species that make up the Mycobacterium tuberculosis complex: M. tuberculosis, M. bovis, M. africanum, M. canetti, M. microti, M. pinnipedi and M. caprae. M. tuberculosis is transmitted by air, from a person with pulmonary or laryngeal TB, who eliminates bacilli in the environment (source case), to another person, by inhaling aerosols from coughing, talking or sneezing. Primary pulmonary TB usually occurs after the individual's first contact with the bacillus and is therefore more common in children. Its main characteristic is a dry or productive cough. Evening fever, without chills, does not usually exceed 38.5ºC. Night sweats and anorexia are common. Tuberculosis is a serious disease, but it is curable in the vast majority of cases, as long as the treatment is followed correctly. In Brazil, treatment is standardized and free of charge, provided by the National Tuberculosis Control Program (PNCT) in Health Units. In Brazil, tuberculosis treatment is standardized and consists of two phases: intensive and maintenance. The basic regimen recommended by the Ministry of Health (BRASIL, 2019) for adults and adolescents aged 10 and over includes rifampicin, isoniazid, pyrazinamide and ethambutol (RHZE). Directly Observed Treatment (DOT) is a fundamental strategy for ensuring patient adherence to tuberculosis treatment and reducing abandonment rates. Adopted by the Ministry of Health (MoH) based on WHO recommendations, DOT consists of direct observation of drug intake by health professionals. Community health workers (CHWs) are essential for tuberculosis control, from diagnosis to the outcome of cases. Their duties include Spreading the word to their community about tuberculosis as an important current public health problem. Educate the population about airborne transmission of tuberculosis and the preventive measures that can be adopted. To be aware of the main symptoms of tuberculosis (cough, fever, weight loss and night sweats) at all meetings with the community, as well as publicizing them, and referring suspected cases to the health unit.

Clinical presentation and treatment of a bronchocutaneous fistula with intrathoracic abscessation in a yearling

SummaryThis case report describes the clinical presentation, surgical treatment, post‐operative management and outcome of a bronchocutaneous fistula with intrathoracic abscessation in a yearling horse. The animal was presented with a history of several months of persistent coughing and a cutaneous fistula located over the right ventral hemithorax. The yearling had purulent discharge similar in character from both nares and draining out of the fistula. A bronchocutaneous fistula with intrathoracic abscessation was diagnosed by endoscopic examination of the cutaneous fistula. The treatment initially consisted of cyanoacrylate applied topically to the affected bronchi under endoscopic guidance, which was not successful. The fistula was successfully sealed with a diode laser used to create local inflammation at the site. One week after the second intervention, the patient's clinical signs resolved and the fistula was completely sealed 10 weeks following intervention. Follow‐up at 16 months revealed that the patient was doing well and clinically normal.

Comparative clinical trial of Langenlianqiao oral liquid and Lianhuaqingwen capsule in the treatment of mild cases of coronavirus disease 2019 (COVID-19)

ObjectiveTo evaluate the clinical efficacy of Langenlianqiao (LGLQ) oral liquid treatment and provide a reference basis for the clincal treatment of coronavirus disease 2019 (COVID-19).DesignAn experimental clinical study was conducted on three groups with confirmed diagnoses of COVID-19.SiteThis study was conducted at Changde Hospital.ParticipantsA total of 253 patients were enrolled in this study.MethodsThe patients were divided into the LGLQ treatment group (100 cases), the Lianhuaqingwen (LHQW) treatment group (100 cases) and the placebo control group (53 cases), according to the treatment each group received. The occurrence of major clinical symptoms, the duration of symptom disappearance, the number of days in hospitalisation and the duration of infection were compared among the three groups.ResultsCompared with the placebo control group (10.0 [1.2] d, 9.4 [1.3] d), the duration of infection and hospitalisation effectively decreased in the LGLQ group (6.8 [0.6] d, 7.4 [0.8] d) and the LHQW group (6.8 [1.0] d, 7.3 [1.0] d). Furthermore, the incidence of fatigue in the LGLQ group (4.0%) was lower compared to the LHQW group (14.0%) and the placebo control group (15.1%), but this difference was not statistically significant (P = 0.580 for LGLQ vs. LHQW, P = 0.246 for LGLQ vs. placebo). In the treatment of cough, the LGLQ group showed a significantly different effect compared to both the LHQW group (P = 0.014) and the placebo group (P = 0.016). Additionally, for dry cough specifically, LHQW was effective in reducing its incidence compared to the placebo control group (P < 0.05), while LGLQ showed no statistically significant difference from either LHQW (P = 0.39) or the placebo group (P = 0.14). However, neither the LGLQ group nor the LHQW group showed a reduction in the duration of symptom disappearance in patients with pre-existing symptoms (P > 0.05).ConclusionsCompared with the placebo control group, the LGLQ group showed an improvement in the clinical symptoms of COVID-19 and a decrease in the duration of hospitalisation and infection, which confirmed that the LGLQ treatment had the same antiviral effect as the LHQW treatment. This may provide in-depth insights for antiviral therapy research.

Pneumocystis jirovecii pneumonia in hemato-oncological patients; 10 years of experience at Hospital Infantil Teletón de Oncología

Abstract Background Pneumocystis jirovecii pneumonia is an opportunistic infection that most frequently affects immunocompromised people, especially patients with HIV; clinical presentation is nonspecific and mortality rate in patients without HIV ranges are between 30% and 75%. In the international literature, there are few case reports of pediatric oncology patients. A series of cases is presented with the objective of describing the epidemiological characteristics, clinical presentation, treatment, and outcomes of Pneumocystis jirovecii pneumonia in this population group. Methods An observational, descriptive, and retrospective study was carried out in cancer patients under 18 years, with clinically compatible symptoms, an imaging study suggestive of the pneumonia, and identification of P. jirovecii using a PCR test of bronchial aspirate at Hospital Infantil Teletón de Oncología in Querétaro Mexico, since November 2014 to June 2023. Results A total of 17 events were reported with a median age of 9.8 years, 14/17 (82%) with a diagnosis of acute leukemias, 1/17 (6%) Ewing sarcoma, 1/17 (6%) lymphoma large cell anaplastic and 1/17 (6%) neuroblastoma. Regarding their therapeutic phases, 7/17 (41%) were in consolidation, 4/17 (23%) induction, 3/17 (18%) allogeneic HSCT (Hematopoietic stem-cell transplantation), 2/17 (12%) in surveillance, and 1/17 (6%) in maintenance. The clinical presentation in our patients was characterized by the presence of fever in 15/17 (88%), dry cough in 10/17 (59%) and 17/17 (100%) developed acute respiratory distress syndrome, which was classified as mild in 7/17 (41%), moderate in 5/17 (29%) and severe in 5/17 (29%). 13/17 (75%) presented distributive shock. All our patients underwent chest x-rays, 12/17 (70.5%) presented bilateral interstitial infiltrate, 4/17 (23.5%) consolidation, and 1/17 (6%) pleural effusion. Lung CT (computed tomography) was performed in 4/17 (23.5%), and 4/4 (100%) presented ground glass opacities. All of our patients were admitted to the PICU (Pediatric intensive care unit) and 16/17 (94%) required invasive mechanical ventilation. All receive treatment with TMP-SMX (Trimethoprim-sulfamethoxazole). 4/17 patients died (23%) of whom none received prophylaxis. 3/17 patients (18%) received prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX). Conclusion The present study is the first study in Mexico that compiles cases of Pneumocystis Jirovecii pneumonia in pediatric oncology patients. P. jirovecii pneumonia remains a rare cause, but represents a potentially fatal cause in oncology patients, so it is important to have a high clinical suspicion during the evaluation of an immunocompromised patient with evidence of pneumonia during all treatment phases with chemotherapy, in order to start treatment promptly. Thus, we also emphasize the importance of adequate prophylaxis as the most important preventive measure.

N-acetylcysteine – a drug for basic and symptomatic therapy of chronic bronchitis/chronic obstructive pulmonary disease

Prevention and successful treatment of the disease exacerbations are crucial for patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). At present, a sufficient number of efforts are being made to improve both prevention of exacerbations in patients with stable disease progression and treatment of the exacerbations. According to international and domestic recommendations, mucolytic drugs are among the key therapies for both bronchitis phenotype of COPD and chronic bronchitis, the main clinical manifestation of which is a long-term productive cough. The aim of the review is to analyze modern literature data that reflect the role of N-acetylcysteine (NAC) in prevention of exacerbations during the stable course and treatment of exacerbations of chronic bronchitis and COPD.

Bilateral chronic cavitary pulmonary aspergillomas in an adult patient with recurrent tuberculosis: a case report and literature review

BackgroundAspergillomas are globular growths of Aspergillus fumigatus, a benign aspergillosis of the lungs. It usually affects patients who are immunocompromised and have anatomically defective lung structures. The majority of aspergilloma cases are asymptomatic, despite the fact that 10% of cases spontaneously resolve. Most patients do not have any symptoms from their lesions. Direct serological or microbiological evidence of an Aspergillus species along with radiologic evidence is required for the diagnosis of an aspergilloma.CaseWe describe a 35-year-old adult Oromo male patient who had been experiencing night sweats, an intermittent productive cough with sparse whitish sputum, loss of appetite, and easy fatigability for 3 months. At 5 years prior, he received treatment for pulmonary tuberculosis that was smear-positive and was subsequently certified healed. Objectively, he was tachypneic and had intercostal, subcostal, and supraclavicular retractions with symmetric chest movement. A high-resolution computed tomography scan revealed bilateral apical cavitary lesions with core soft tissue attenuating spherical masses and an air crescentic sign suggestive of aspergillomas, which were confirmed by sputum light microscopic examination. The patient was managed with antibiotics and antifungals.ConclusionAspergilloma is a symptom of chronic pulmonary aspergillosis, a category of lung disorders caused by a persistent Aspergillus infection. Primary aspergillomas are uncommon and frequently occur in people with compromised immune systems. A prolonged cough, fever, chest pain, and hemoptysis are all symptoms of pulmonary aspergillomas. The majority of the time, pulmonary aspergillosis is difficult to identify. Despite high mortality and morbidity rates, surgery is still the most effective treatment for pulmonary aspergilloma.

Spontaneous Pneumomediastinum and bilateral subcutaneous emphysema; a rare case presentation in Asthmatic patient

The presence of free air or gas in the mediastinal structures and the pericardial sac without a clear precipitating cause is known as spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium. Young, healthy persons without a major underlying lung condition are less likely to experience it. Here we presented a 15 years old female known asthmatic patient presented with sudden onset of shortness of breath, dry cough and swelling over the neck down to the abdomen. This patient was managed with asthmatic medication and oxygen conservatively and discharged from the hospital with significant improvement. Spontaneous pneumomediatinum should be taken into consideration after excluding out common illnesses when a youngster complains of chest pain or tightness. Clinical characteristics and a chest CT scan can be used to diagnose SPM. Most patients with spontaneous pneumomediastinum and subcutaneous emphysema had mild to moderate sequel and responded well to conservative therapy

Pulmonary artery pseudoaneurysm in young male with pulmonary hypertension

Pulmonary artery aneurysms and pseudoaneurysms are rare abnormalities but associated morbidity causes recognition importance. Here we report a clinical case of a 15-year-old male who arrived at our clinic complaining of hemoptysis and dry cough. Diagnosis revealed the mass lesion of the left lung. CT-angiography and intervention of pulmonary arteries confirmed pulmonary artery aneurysms, which explained hemoptysis caused by aneurysm rupture. The pulmonary artery intervention confirmed the condition.