Spasmodic Cough Research Articles

Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study.

To study the clinical presentation of culture-confirmed pertussis in children and their contacts with cough illnesses in an outpatient setting. In conjunction with a large pertussis vaccine efficacy trial in Germany, a central laboratory to isolate Bordetella species from nasopharyngeal specimens was established in Erlangen in October 1990. Pediatricians in private practices in southern Germany, the Saar region, and Berlin were encouraged to obtain nasopharyngeal specimens and clinical characteristics from patients with cough illnesses >/=7 days' duration. Bordetella species were isolated by use of calcium alginate swabs, Regan-Lowe agar, and modified Stainer-Scholte broth. Clinical characteristics were determined by initial and follow-up questionnaires. From October 1990 to September 1996, 20 972 specimens were submitted, and B pertussis was isolated in 2592 instances (12.4%). Of the culture-proven cases, 50.7% were female, and the age range was 6 days to 41 years, with a mean and median of 4.3 years and 4.1 years, respectively. The following characteristics were noted. Only 4% of the patients had received pertussis vaccine. Of unvaccinated patients, 90.2% had paroxysmal cough, 78.9% demonstrated whooping, and 53.3% presented with posttussive vomiting; 5.7% had fever >/=38 degrees C. The duration of cough was </=4 weeks in 37.9% and </=3 weeks in 17.4%. Leukocytosis and lymphocytosis (values above the age-specific mean) were observed in 71.9% and 75.9% of unvaccinated patients, respectively. The overall complication rate was 5.8%, and pneumonia (29%) was the most frequent complication. In infants <6 months of age, the rate of complications was 23.8%. One death in a 7-month-old infant occurred. Typical symptoms of pertussis were observed in the great majority of patients regardless of age group. However, the duration of cough was surprisingly short in one sixth of the patients. These short illness cases would not be classified as pertussis according to the World Health Organization clinical case definition, which requires >/=21 days of spasmodic cough.

Efficacy of Acellular Pertussis Vaccine in Early Childhood After Household Exposure

To evaluate the efficacy of a three-dose primary vaccination with a diphtheria-tetanus tricomponent acellular pertussis vaccine against "typical" pertussis, defined as a spasmodic cough of 21 days or longer with confirmation of Bordetella pertussis infection by culture or serology. Passive monitoring for suspected first household (index) cases of typical pertussis in six areas in Germany comprising 22,505 children vaccinated with study vaccine at 3, 4, and 5 months of age. Blinded, prospective follow-up of household contacts of index cases for incidence and progression of pertussis. Six areas in Germany with a high incidence of pertussis. Four hundred fifty-three households with index cases comprising 360 evaluable contacts eligible for analysis of vaccine efficacy. Vaccine efficacy from attack rates of pertussis in household contacts classified by vaccination status. Of the 173 nonvaccinated household contacts, 96 developed typical pertussis, compared with seven of 112 contacts vaccinated with acellular pertussis vaccine. Vaccine efficacy was consequently calculated to be 88.7% (95% confidence interval, 76.6% to 94.6%). Protection did not wane until at least the time recommended for booster vaccination. None of the analyzed potential confounding factors--age, socioeconomic status, erythromycin treatment, household composition, center effect, and selection bias--influenced study results in favor of the vaccine. Under conditions of intense household exposure, primary vaccination with acellular vaccine protected against pertussis until at least the time recommended for booster vaccination. The vaccine can be expected to be equally or more effective in settings with lower infectious pressure.

Pertussis in Missouri: evaluation of nasopharyngeal culture, direct fluorescent antibody testing, and clinical case definitions in the diagnosis of pertussis.

No diagnostic test for pertussis in routine use in the United States has both high sensitivity and high specificity. During a statewide increase in the incidence of pertussis in Missouri, we studied the clinical features of 153 patients with suspected pertussis in the Greater St. Louis area from whom a specimen for pertussis culture had been taken between 15 May and 19 September 1989. In this cross-sectional study, nasopharyngeal cultures were more likely to be positive for persons whose specimens were collected < 21 days after cough onset (adjusted rate ratio [RRa] and 95% confidence interval = 3.4; 1.5-8.0) and who were not receiving erythromycin/sulfamethoxazole prior to the culture [RRa = 5.8; 0.8-40.6], who had received fewer than three prior doses of pertussis vaccine [RRa = 1.8; 0.8-4.2], and whose specimen was in transit to the laboratory for < 4 days [RRa = 2.0; 0.8-5.5]. Among children < 5 years of age, spasmodic cough plus a lymphocytosis of > 10,000/mm3 was the acute symptom complex associated with the highest predictive value for a positive culture result (67%). Cough for > or = 14 days plus whoop was sensitive (81%) and specific (58%) for identifying children with culture-confirmed pertussis. Direct fluorescent antibody staining performed well as a screening test for pertussis but requires substantial commitment of personnel and resources. In the absence of a positive culture result, clinical case definitions should be used for decision making (e.g., initiation of antimicrobial therapy and routine case reporting).

Inhalation of foreign bodies by children: Review of experience with 74 cases from Dubai

Seventy four out of 94 cases of bronchoscopy carried out over a five year period are reviewed. The clinical history of choking followed by recurrent spasmodic cough were found to be the most important element in making the diagnosis and proceeding to diagnostic and therapeutic bronchoscopy. Radiology was inferior as a diagnostic aid although radioactive scanning may be helpful in difficult cases.

TWO CASES OF INFANTILE APNEA CAUSED BY HYPERSENSITIVITY TO COW'S MILK

We reported two cases of infantile apnea caused by a cow's milk allergy.The first case was a 40 day-old, bottle feeding, female infant. The pt. was taken to our hospital because of spasmodic cough and apnea. The pt. experienced an abrupt onset of paroxysmal coughing and apnea soon after bottle feeding. Specific IgE antibody to cow's milk was not detected in her serum, but a rectal swab specimen obtained through rectal challenge test with a cow's milk showed increased eosinophils.The second case was a 30 day-old, mixed feeding, female infant. The pt. had been suffering from recurrent apnea after feeding. Specific IgE antibody to cow's milk was detected in her serum.Both cases revealed postive results in the cow's milk elimination tests.According to our experiences, possibility of food allergy as a cause of infantile apnea syndrome should be considered.

Bordetella Pertussis and Upper Respiratory Tract Infection Viruses in Egyptian Children with Whooping Cough

ABSTRACT Isolates of Bordetella pertussis and upper respiratory tract infection (URTI) viruses from nasopharyngeal secretions were studied in 100 Egyptian children with whooping cough. Thirteen (13...

Influence of cerebral cortex stimulation upon cough-like spasmodic expiratory response (SER) and cough in the cat

In 27 pentobarbitalized cats, the influence of electrical stimulation of the cerebral cortex upon the spasmodic expiratory response (SER) was studied and compared with cortical influences on coughing induced by stimulation of the superior laryngeal nerve (sup. laryngeal N.). This cortical influence was evoked by electrical stimulation of the cortical nucleus of amygdala (Aco), and was very similar to coughing accompanying changes in emotional behavior and was depressed more effectively by psychotropics than by centrally acting antitussives like codeine. When anterior cingulate gyrus (ant. cingulate G.) or orbital gyrus (orbital G.) were stimulated simultaneously with Aco or sup. laryngeal N., weak stimulation was sufficient to inhibit SER, while stronger stimuli were needed for the suppression of cough. If the same cortical regions were stimulated after initiation of SER or cough, SER was markedly suppressed but cough little affected. Production of SER was facilitated by simultaneous stimulation of the piriform lobe (piriform L.) or olfactory tract (olfactory T.), whereas cough production was facilitated by simultaneous stimulation of the suprasylvian gyrus. These results suggest that SER and coughing are differently controlled by the cerebral cortex, and that SER is modulated by the limbic cortex, in particular, by ant. cingulate G., orbital G. and piriform L. The mechanism of modulation for SER is discussed.

Gastroesophageal reflux and asthma.

In summarizing the evolving relationship of GER and pulmonary disease, one cannot ignore the potential role of reflux in patients with recurrent pneumonia or atypical asthma. Infants with vomiting, failure to thrive, and wheezing, and patients with recurrent pulmonary infiltrates, spasmodic nocturnal cough, and choking should have an evaluation of esophageal function with attention to GER. Trie need to investigate GER in the wheezing patient who has a history of episodic difficulty related to specific inciting factors such as allergens and viral syndromes, or in the chronic asthmatic who is free of gastrointestinal complaints and rarely has nocturnal coughing or pneumonitis, is doubtful. If one finds that GER exists, one needs to understand that it may not be causing disease but may be coincidental or possibly caused by pharmacologic therapy. If GER is found, medical therapy should precede surgical intervention.

Pertussis. A reappraisal and report of 190 confirmed cases.

NOWADAYS, to many young physicians pertussis is a forgotten illness. Very recently, one member of our department who was visiting professor at a Children's Medical Center was presented with an infant suffering from a spasmodic cough. Numerous procedures including bronchoscopy and lung biopsy had been performed to establish a diagnosis. Pertussis, the condition with which the child was afflicted, had not been considered in the differential diagnosis. Many communicable diseases, which formerly contributed to a large proportion of hospitalized patients and caused considerable morbidity and mortality, have lost their importance to the modern physician. Pertussis has followed the course of these events. With the advent of improved care, mass immunization, and antimicrobial therapy, the frequency of pertussis has been altered significantly and its mortality rate has been markedly reduced. However, during the first year of life it represents a very dangerous condition, causing more deaths in this age group than

Circulatory and respiratory changes induced by electrical stimulation of limbic system (visceral brain).

ArticlesCIRCULATORY AND RESPIRATORY CHANGES INDUCED BY ELECTRICAL STIMULATION OF LIMBIC SYSTEM (VISCERAL BRAIN)B. K. Anand, and S. DuaB. K. Anand, and S. DuaPublished Online:01 Sep 1956https://doi.org/10.1152/jn.1956.19.5.393MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByGlutamatergic, GABAergic, and endocannabinoid neurotransmissions within the dorsal hippocampus modulate the cardiac baroreflex function in rats15 November 2017 | Pflügers Archiv - European Journal of Physiology, Vol. 470, No. 2Corticolimbic regulation of cardiovascular responses to stressPhysiology & Behavior, Vol. 172Differential effects of infralimbic vs. ventromedial orbital PFC lidocaine infusions in CD-1 mice on defensive responding in the mouse defense test battery and rat exposure testBrain Research, Vol. 1020, No. 1-2Cardiovascular Manifestations of Acute Intracranial Lesions: Pathophysiology, Manifestations, and Treatment30 June 2016 | Journal of Intensive Care Medicine, Vol. 18, No. 3Functional neuroanatomy of the prefrontal cortex: autonomic interactionsNeural Control of the Heart: Central and PeripheralNeurologic Clinics, Vol. 11, No. 2Differential distribution and non-collateralization of central amygdaloid neurons projecting to different medullary regionsNeuroscience Letters, Vol. 97, No. 3Cardiovascular and respiratory responses to electrical and chemical stimulation of the hippocampus in anesthetized and awake ratsBrain Research, Vol. 457, No. 2Differential effects of experimentally induced blood pressure changes on the release of catecholamines in hypothalamic and limbic areas of ratsLife Sciences, Vol. 41, No. 2Projections of supraspinal structures to the phrenic motor nucleus in cats studied by a horseradish peroxidase microinjection methodJournal of the Autonomic Nervous System, Vol. 16, No. 1The involvement of the anterior cingulate cortex in blood pressure controlBrain Research, Vol. 340, No. 1Influence of cerebral cortex stimulation upon cough-like spasmodic expiratory response (SER) and cough in the catBrain Research, Vol. 306, No. 1-2Insular interconnections with the amygdala in the rhesus monkeyNeuroscience, Vol. 6, No. 7Neurophysiology and neuropharmacology of cardiovascular regulation and stressNeuroscience & Biobehavioral Reviews, Vol. 5, No. 1Amygdala central nucleus lesions: Effect on heart rate conditioning in the rabbitPhysiology & Behavior, Vol. 23, No. 6Cardiac arrhythmias in experimental subarachnoid hemorrhage.Stroke, Vol. 8, No. 4Effects of hippocampal lesion on cardiovascular, adrenocortical and behavioral response patterns in micePhysiology & Behavior, Vol. 18, No. 6The Effect of Acute Stroke on Cardiac Functions as Observed in an Intensive Stroke Care UnitStroke, Vol. 5, No. 6Respiratory effects mapped by focal stimulation in the rostral brain stem of the anaesthetised rabbitBrain Research, Vol. 75, No. 1Cardiovascular responses to electrical stimulation of the amygdala in the ratExperimental Neurology, Vol. 39, No. 1Renal failure in intracranial lesionsThe American Journal of Medicine, Vol. 54, No. 2Limbic forebrain and midbrain modulation and phase-switching of expiratory neuronsBrain Research, Vol. 39, No. 1Changes in phrenic activity and heart rate elicited by localized stimulation of amygdala and adjacent structuresElectroencephalography and Clinical Neurophysiology, Vol. 32, No. 1Modulation of spontaneous and reflex activity of the jaw musculature by orbital cortical stimulation in the freely-moving catBrain Research, Vol. 19, No. 1Atrial fibrillation with ventricular slowing in a patient with spontaneous subarachnoid hemorrhageThe American Journal of Cardiology, Vol. 23, No. 3Central nervous system mechanisms mediating cardiac rate and rhythmAmerican Heart Journal, Vol. 74, No. 1ELECTROCARDIOGRAPHIC CHANGES ASSOCIATED WITH A CEREBROVASCULAR ACCIDENTThe Lancet, Vol. 284, No. 7357Renal tubular necrosis following lesions of the brainThe American Journal of Medicine, Vol. 29, No. 2Amygdaloid propagation to the brain stem (electrophysiological study)Electroencephalography and Clinical Neurophysiology, Vol. 12, No. 2 More from this issue > Volume 19Issue 5September 1956Pages 393-400 https://doi.org/10.1152/jn.1956.19.5.393PubMed13367870History Published online 1 September 1956 Published in print 1 September 1956 Metrics

Laryngeal complications after thyroid operation: Symptoms, prognosis and treatment

LTHOUGH thyroid operations are A performed by genera1 surgeons, their compIications are seen by the Iaryngologist. Most of these comphcations are due to damage to the nerves which occurs during the operation, and cause anxious moments for the operator who does not have a clear conception of what changes take pIace in the larynx. My aim is to cIarify this picture and show the changes that wiI1 be encountered if one or more Iaryngeal nerve is affected. The symptoms foIIowing these injuries are manifoId, but they can be divided into two main groups: first, changes in the voice; second, changes in the breathing. There are other symptoms such as spasmodic cough, difhcuIty in deglutition, and inabiIity to cIear the Iarynx of mucus. To be able to expIain what takes place, it is necessary to discuss the normaI innervation of the Iarynx and its physioIogy. (Figs. I and 2.) Some controversy stiI1 exists over the reIationship of the IaryngeaI nerve to the thyroid gIand, and aIso over the innervation of the Iarynx itseIf. It is known that the Iarynx is suppIied by two nerve trunks which originate in the vagus: (I) the Iaryngeal inferior, or recurrent nerve which suppIies a11 the IaryngeaI muscIes with motor fibers except the cricothyroid muscIe; (2) the IaryngeaI superior nerve which carries sensory fibers in the strong externa1 portion to the Iarynx, and motor fibers in the weaker internal portion to the cricothyroid. The schematic picture (Fig. 3), the work of Professor Onodi, who did the pioneer work on the nerve suppIy of the larynx, is stiI1 accepted by most Iaryngologists. It is evident from Onodi’s picture that besides the two main nerve trunks, the Iowest branch of the IaryngeaI superior nerve is connected with the media1 branch of the inferior nerve under the mucosa which covers the crico-arytenoid posterior muscIe, forming the so-caIIed ansa GaIeni. Both nerves have connections with the sympathetic nerves. Besides these cIear cut cases there are many irregmarities of innervation or overIapping innervation. The recurrent nerve may send some motor Iibers to the abductors, adductors and tensors. The compIexity of this innervation is evident from the different, and by no means cIearIy expIainabIe, Iaryngeal conditions which are found when these cases are folIowed up, and which cannot be interpreted as injury to only one specific nerve. The most important structure which is frequentIy affected by the nerve injuries is the crico-arytenoideus posterior, also caIIed the posticus or abductor muscle, innervated by the IaryngeaI inferior or recurrent nerve. Second in importance is the interarytenoid muscIe. WhiIe the innervation of the abductor is cIear cut, there is considerabIe difference of opinion regarding the nerve suppIy of the interarytenoid muscle. Heyd,’ quoting Frazier,2 states that the interarytenoid muscIe is supplied by the internal branch of the superior IaryngeaI nerve, whiIe ZiegeIman” cIaims that a combination of recurrent and superior nerves is

The clinical modification of whooping cough by the use of alum-precipitated diphtheria toxoid: Experimental and clinical studies

<h2>Summary</h2> In this experimental and clinical study of whooping cough we haveobserved the utility of the diphtheria toxoid precipitated in alum combined with pertussis vaccine. It has protected rabbits against necrotic lesions when they are injected intracutaneously with live <i>B. pertussis</i>. Rabbits to which a combination of pertussis vaccine and diphtheria toxoid precipitated in alum was given were better protected than rabbits to which pertussis vaccine alone was given and rabbits injected with diphtheria toxoid. As a result of the clinical study of fifty-four children with whooping cough injected with diphtheria toxoid precipitated in alum, thirty-seven improved within two weeks after the beginning of the spasmodic cough and eleven after three weeks, while in six children no improvement was noted.

THE REPRESENTATION OF RESPIRATORY MOVEMENTS IN THE CEREBRAL CORTEX

THE REPRESENTATION OF RESPIRATORY MOVEMENTS IN THE CEREBRAL CORTEX

The blood picture in the early stages of pertussis

Although the number of cases observed at the beginning of pertussis is small, some conclusions can be made: 1.In the majority of cases no marked increase is observed in the total number of white blood cells or in the percentage of lymphocytes during the catarrhal stage of pertussis. These changes were observed only in the youngest child of this series (age of 3 months). 2.An abrupt increase in the total number of white blood cells, with an increase in the percentage and absolute number of lymphocytes, occurs in a number of cases with the beginning of the spasmodic cough. The increase in the total number of lymphocytes is more striking than the increase in the percentage of these cells. 3.The number of lymphocytes in 1 cu. mm. remains high during febrile bronchitis complicating pertussis. 4.While a high lymphocyte count is characteristic for pertussis and should be considered a diagnostic sign, when present, some cases may reach the paroxysmal stage without any leucocytosis, or a relative or absolute lymphocytosis. 5.Although the percentage of neutrophils in pertussis diminishes with the appearance of lymphocytosis, the absolute number of these cells does not drop, and may show an increase. 6.Absolute figures for various blood cells, together with the percentage of these cells, give a more valuable hematologic picture than the percentage figures alone. Although the number of cases observed at the beginning of pertussis is small, some conclusions can be made: 1.In the majority of cases no marked increase is observed in the total number of white blood cells or in the percentage of lymphocytes during the catarrhal stage of pertussis. These changes were observed only in the youngest child of this series (age of 3 months). 2.An abrupt increase in the total number of white blood cells, with an increase in the percentage and absolute number of lymphocytes, occurs in a number of cases with the beginning of the spasmodic cough. The increase in the total number of lymphocytes is more striking than the increase in the percentage of these cells. 3.The number of lymphocytes in 1 cu. mm. remains high during febrile bronchitis complicating pertussis. 4.While a high lymphocyte count is characteristic for pertussis and should be considered a diagnostic sign, when present, some cases may reach the paroxysmal stage without any leucocytosis, or a relative or absolute lymphocytosis. 5.Although the percentage of neutrophils in pertussis diminishes with the appearance of lymphocytosis, the absolute number of these cells does not drop, and may show an increase. 6.Absolute figures for various blood cells, together with the percentage of these cells, give a more valuable hematologic picture than the percentage figures alone.

THE EXECUTION OF ROBERT H. WHITE BY HYDROCYANIC ACID GAS

Robert H. White was executed by hydrocyanic acid gas at the Nevada State Prison, June 2, 1930. A study of the heart and respiratory action was made at the time of the execution, a Bowles stethoscope being applied on the bare chest wall over the apex of the heart. The tube leading to the ear pieces on the outside of the prison wall was connected to the stethoscope while the prisoner was being strapped to the chair. This was at 4:36 a. m. The heart action at that time was 108, strong and regular. The gas was started generating at 4:37½ At 4:38 the pulse rate was 120, regular and strong. A small inspiration was taken at 4:37¾ at which time the prisoner indicated that he smelled the gas. At 4:38 he took a very deep inspiration, turning his head toward the gas. He gave a spasmodic cough, his head

RESPIRATORY DISTURBANCES FOLLOWING EPIDEMIC ENCEPHALITIS

Disturbances of respiration during the acute stage of epidemic encephalitis are common and include respiratory paralysis, tachypnea, bradypnea and various types of irregularity of rate or amplitude. They may be due to inflammatory changes in the respiratory organs, to bulbar lesions or to myoclonic contractions of respiratory muscles. Less commonly among the sequelae, or in what we now regard as the chronic stage of the disease, similar disturbances occur. These phenomena were classified by Marie1into (1) disturbances of respiration proper, as tachypnea (either permanent or paroxysmal with periods of apnea), and bradypnea; (2) spasmodic cough, and (3) respiratory tics. They may be associated with other disturbances, such as the pseudo-Parkinson syndrome, or may be the predominating symptom. The most striking of these disturbances are attacks of alternate polypnea and apnea, which seem to be characteristic of this disease. Such cases have been reported by Vincent and Bernard,2

INTRACUTANEOUS REACTIONS IN PERTUSSIS

During the last four years, several epidemics of pertussis have occurred in a large institution for the care of children harboring about 400, ranging in age from 1 day to 6 years. The opportunity was thus afforded us to study the disease with special reference to ( a ) natural immunity, ( b ) acquired immunity, and ( c ) the diagnosis of the disease in its earliest stages, and before the onset of the characteristic spasmodic cough, whoop and vomiting. Children exposed in previous epidemics and not acquiring the disease were considered as possessing a natural immunity. Other children giving a history of having had the disease before admission, or having had an attack of pertussis while in the institution, were grouped as those possessing an acquired immunity. To possess a method whereby it would be possible to designate a child as having a natural or acquired immunity, and to be able to diagnose pertussis

INFLUENZAL SINUS DISEASE AND ITS RELATION TO EPIDEMIC INFLUENZA

A typical attack of influenza usually begins as a rhinitis and spreads from the nasal mucosa throughout the respiratory tract. As the chief symptoms are produced by the involvement of the bronchial tree, attention is naturally directed to the lungs and bronchi as the most important foci for the infection. However, in studying acute cases one is often impressed by the fact that the severity of the disease, best evidenced by the general prostration of the patient, is out of all proportion to the physical signs. Tracheobronchitis with abundant mucopurulent sputum, a particularly distressing and often spasmodic cough, and moist râles uniformly present in both lungs, almost exhaust the positive findings for the respiratory tract. It becomes difficult to understand why a vigorous, previously healthy young adult, should succumb to an infection which in many cases appears to be almost wholly confined to the tracheobronchial mucosae. It might even be

Case of Spasmodic Cough

Case of Spasmodic Cough

Chloroform and Gaslight Intoxication.

200Oakwood Boul., Chicago, Oct. 25, 1898. To the Editor: —A note under the above title, in theJournalof October 22, suggests a degree of ignorance or carelessness on the part of the doctors responsible for the occurrence, which I hope is, but may not be, entirely absent from the profession in this country. At any rate, it seems to me to be of sufficient importance to justify a further notice. The case is as follows: A patient was anesthetized with chloroform in the presence of a gaslight. The narcosis lasted three hours and during that time the doctors and nurse experienced a spasmodic cough. Patient died in six hours, the nurse in twenty-four hours and the doctor was at the point of death for two or three days. The fatal results were attributed to the inhalation of the fumes produced from the combustion of the vapor of chloroform