History Of Recurrent Cough Research Articles

6 Year Girl with Acute Exacerbation of Chronic Tonsillitis with Adenoid Hypertrophy

Acute bacterial tonsillitis is an acute inflammation of the palatine tonsils caused by viral and bacterial infections. The main causative viruses are Epstein bar virus, H. influenzae virus, and Coxsackie virus. Tonsillitis is most common in children but rare in children < 2 years old. Adenoid hypertrophy is an obstructive condition associated with an increase in the size of the adenoids. This condition may occur with or without acute or chronic adenoid infection. The problem is described using descriptive case study method, starting from history taking, physical examination, supporting examination, diagnosis, to qualitative intervention management given to the patient. A case of a six-year-old girl with complaints of fever, nausea, and vomiting since six days before admission to the hospital is reported. Complaints were accompanied by pain when swallowing and a lump in the throat. History of recurrent cough and cold for about six months. For about two months, complaints of snoring at night that disturbed the patient's sleep. The patient also complained that sometimes his nose felt full. On physical examination, the throat mucosa was found to be pink, palatine tonsils T4/T4 and hyperemic, tonsil crypts were wide, and the pharynx and adenoids were difficult to assess. On supporting examination, adenoid hypertrophy was found. The patient was then diagnosed with Acute Exacerbation of Chronic Tonsillitis with Adenoid Hypertrophy and given therapy such as ceftriaxon inj 1gr IV 2x600mg, cetirizine syr 2x1cth, methylprednisolone inj IV 3x25mg. After control a week later, the patient's condition showed significant changes, and complaints were reduced a lot.

Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report

BackgroundDisseminated nocardiosis is liable to be misdiagnosed owing to the non-specific clinical manifestations and laboratory/imaging findings. Metagenomic next-generation sequencing (mNGS) is a culture-independent and rapid method for direct identification of all microorganisms in clinical specimens.Case presentationA 72-year-old man was admitted to our hospital on February 20, 2019 with a history of recurrent cough, expectoration, fever, and diarrhea since 1 month, and unconsciousness since 1 week. Contrast-enhanced magnetic resonance imaging of head showed multiple lesions in the bilateral cerebral hemispheres, brainstem, and cerebellar hemispheres. The presumptive diagnosis was disseminated tuberculosis, although all tests for mycobacterium were negative. However, the patient did not benefit from antituberculosis treatment. Repeat MRI showed multiple abnormal signals in the brain and progression of meningeal thickening. Cerebrospinal fluid and bronchoalveolar lavage fluid specimens were subsequently sent for PMSeq metagenomics sequencing; the results indicated Nocardia. farcinica as the predominant pathogen. The anti-TB treatment was stopped and the patient was prescribed sulphamethoxazole in combination with linezolid and meropenem for nocardiosis. He showed gradual neurological improvement and was transferred to Huashan Hospital. He was discharged from the hospital on April 19, 2019, but died of persistent diarrhea on May 26, 2019.ConclusionsPatients with suspected nocardiosis do not always respond to conventional treatment; therefore, mNGS can facilitate diagnosis and timely treatment decision-making.

Hybrid surgery in treatment of pulmonary sequestration with abdominal aorta feeding vessel: a case report

BackgroundPulmonary sequestration is a rare congenital pulmonary dysplasia, which requires surgical resection (either via open thoracotomy or video-assisted thoracoscopic surgery [VATS] or via endoluminal occlusion of the abnormal feeding vessel).Case presentationWe described a 51-year-old female patient with a history of recurrent cough and repeated pneumonia. She was referred to our hospital for further work-up of pulmonary sequestration. We performed a hybrid surgery (i.e., embolization of the aberrant feeding vessel of the sequestration combined with wedge resection of the left lower lobe lesion through VATS). The patient was discharged on the sixth postoperative day in good condition and without complications.ConclusionsWe believe that a hybrid operation is safer, more feasible, and more comprehensive than other treatments.

Uhl's anomaly of the right ventricle in a 1-year-old child requiring a transplant: A brief report

Uhl's anomaly of the right ventricle is a rare anomaly. At present, only about 84 cases have been reported in over a century. We report a case of a 1-year-old male child who presented to our outpatient pediatric cardiology clinic with a history of recurrent cough and difficulty in breathing and failure to gain weight in the preceding 2 months. Chest X-ray showed cardiomegaly, whereas electrocardiogram showed a normal sinus rhythm with poor right ventricular (RV) forces. Echocardiography showed severely dilated right ventricle with thinned out right ventricle wall and poor RV function with severe tricuspid regurgitation. He has been placed on aspirin, lasilactone, and clexane. However, there was no satisfactory surgical option available, and heart transplant was recommended. Uhl's anomaly of the right ventricle is a very rare anomaly which defies all surgical option except transplant. Early recognition institution of drugs that improves cardiac function may improve the quality of life of the child.

Paediatric Multidrug-Resistant Tuberculosis with HIV Coinfection: A Case Report

Background. Tuberculosis is a major public health problem, and its control has been facing a lot of challenges with emergence of HIV. The occurrence of multidrug-resistant strain has also propounded the problem especially in children where diagnosis is difficult to make. Multidrug-resistant tuberculosis (MDR-TB) is in vitro resistant to isoniazid (H) and rifampicin (R). Paediatric multi-drug resistant tuberculosis with HIV coinfection is rare, and there is no documented report from Nigeria. Objective. To report a case of paediatric MDR-TB in Nigeria about it. Methods. The case note of the patient was retrieved, and relevant data were extracted and summarized. Results. A 9-year-old female HIV-positive pupil with a year history of recurrent cough, 3 months history of recurrent fever, and generalized weight loss was diagnosed and treated for tuberculosis but failed after retreatment. She was later diagnosed with MDR-TB and is presently on DOT-Plus regimen. Conclusion. Paediatric MDR-TB with HIV co-infection is rare. Early diagnosis and treatment is important to prevent spread of the disease. The use of Isoniazid preventive therapy is recommended for children who come in contact with patients with active tuberculosis and also for HIV patients without active tuberculosis.

Follicular bronchiolitis in a child

Follicular bronchiolitis (FB) is an uncommon but important pulmonary manifestation in children. In this report, we present the clinical presentations and histopathological data of an 8-year-old boy with FB. The patient had a history of recurrent cough and dyspnea for 5 years with progressive worsening of symptoms. An initial pulmonary function test showed an obstructive ventilatory defect. Chest X-ray demonstrated miliary nodules. High-resolution computed tomography showed reticulonodular opacification and central consolidation. Histopathological examination revealed that lymphoid follicles with reactive germinal centers distributed along the bronchioles. The boy responded favorably to corticosteroid therapy and recovered well. Diagnosis of FB should be considered when a child presents with chronic bronchial obstruction. Open lung biopsy is necessary for confirmation of the diagnosis.

Relapsing Polychondritis

Relapsing Polychondritis

Relapsing acute myeloid leukaemia manifesting as uveitis with hypopyon

A 5-year-old boy presented with a history of recurrent cough, lethargy and weight loss. On examination he had generalised lymphadenopathy, hepatosplenomegaly and bilateral pleural effusions. His full blood count at diagnosis was: haemoglobin 98 g/l, white cell count 138 × 109/l and platelet count 43 × 109/l. Bone marrow examination confirmed acute myeloid leukaemia and a cerebrospinal fluid cytospin was clear. Cytogenetic analysis showed 46,XY,der (1) t (1;1) (p36;q2?3) and trisomy 8. Pleural fluid aspirate was consistent with leukaemic infiltration. He was treated with chemotherapy, according to the protocol of the Acute Myeloid Leukaemia 15 trial, into which he was entered. He achieved complete morphological and cytogenetic remission post-induction phase. He re-presented with an 8-day history of left eye pain and low-grade temperature of 37·5°C. His full blood count was as follows: haemoglobin 119 g/l, white cell count 9·2 × 109/l and platelet count 268 × 109/l. He was prescribed neomycin eye ointment and oral cephalexin. He continued to deteriorate with worsening left eye symptoms, photophobia, lethargy and feeling generally unwell. He was reviewed by an ophthalmologist and was found to have an inflamed sclerae and marked inflammatory activity at the anterior chamber with a 2–3 mm hypopyon. He was re-examined under a general anaesthetic and was found to have corneal oedema of the left eye with a markedly thickened pale iris with dilated circumferential vessels; a clinical diagnosis of leukaemic infiltration of the iris was made (right and left panel). A diagnostic tap was felt to be unnecessary. A bone marrow aspirate and lumbar puncture were performed and confirmed bone marrow and central nervous system relapse. He was commenced on FLAG-I (fludarabine, cytarabine, idarubicin, granulocyte colony-stimulating factor) and weekly intrathecal chemotherapy. He had a further course of chemotherapy and underwent an allogeneic bone marrow transplantation. He engrafted but died <6 months later with extramedullary disease. Leukaemic hypopyon, as seen in this patient, is a rare manifestation of acute myeloid leukaemia.

Clinical spectrum of bronchiectasis in children.

The prevalence of bronchiectasis decreased due to the effective use of vaccines and advances of antibiotic therapy after 1970. However, it remains an important long-term morbidity of lower respiratory tract infection in developing country. To evaluate the clinical features of bronchiectasis in a tertiary hospital, we collected 21 patients with a diagnosis of bronchiectasis in Taipei Veterans General Hospital from May, 1984 to Dec, 2001 in pediatric outpatient with the admission of age below 18 years old. The diagnosis was based on the history of recurrent cough with fetid sputum, hemoptysis, or recurrent lobar pneumonia for months at least and radiological findings of lobar infiltration, tram-track like patterns, bronchiolar dilatation or honeycomb patterns. The diagnostic examinations included chest plain radiography, bronchography and chest computed tomography (CT) scans. Respiratory tract infections were the commonest cause predisposing to bronchiectasis in our study. Tuberculosis is not rare in this study. In recent years, immunodeficiency disorders have been recognized. Most patients suffered from recurrent cough and fetid sputum for years before diagnosis was established. Hemoptysis was the second common symptom in our study. The plain chest radiograph of bronchiectasis revealed dilatation of bronchial trees with honeycomb pattern or infiltration only. In recent years, chest CT became the most accurate and being noninvasive diagnostic tool. The initial treatment was primarily medical conservative therapy. Only five patients in our cases underwent pulmonary resection due to persistent hemoptysis, recurrent bacterial pneumonia or pulmonary parenchyma destruction. Most patients still suffered from recurrent pneumonia or occasional exacerbation in the long-term follow-up. In conclusion, bronchiectasis is not uncommon in pediatric population in northern Taiwan. The history of recurrent cough with fetid sputum, hemoptysis, or recurrent pneumonia were the most important clues to early diagnosis of this disease. Early diagnosis and appropriate treatment are effective in order to prevent lung abscess, empyema and pneumothorax, bronchopleural fistula, hemoptysis or cor pulmonale.

Lung function after pertussis.

The relationship between pertussis infection and subsequent abnormalities of pulmonary function is not clear. Thirty subjects (16 male, 14 female) aged 14.3 years (s.e.m. = 1.9) were studied who had been hospitalized with culture-proven pertussis when less than 6 months of age. Details of respiratory symptoms in the subjects and their families were obtained. Standard spirometry, lung volumes by body plethysmography, maximum flows at low lung volumes and histamine challenges were performed. Nine of 30 (30%) subjects were symptomatic with a history of recurrent cough and wheeze while 11 of 30 (37%) had abnormal pulmonary function tests. Seven of nine symptomatic subjects had abnormal pulmonary function including positive histamine challenges. Twenty-one per cent had a family history of asthma. This study indicates that children hospitalized in infancy with pertussis can subsequently be shown to have recurrent lower airways symptomatology and abnormal pulmonary function, but the incidence is not significantly higher than a control group from the same socio-economic background.