1/6. The child with persistent cough.Coughing is a healthy reflex. Causes of a cough can vary from minor upper respiratory illnesses to malignancy. When a child's cough continues for weeks, parents worry. Primary care providers must decide when reassessment is needed and if a vigorous workup and referral to a pulmonologist are required. The above discussion should assist these physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Pertussis in an infant adopted from russia--May 2002.On May 2, 2002, the north carolina Department of Health and Human Services notified CDC about an infant aged 10 months adopted from russia who had culture-confirmed pertussis diagnosed. On April 8, the adoptive parents picked him up in the orphan ward at hospital A in Bryansk and noticed that the child had upper respiratory congestion and cough. The adoptive parents reported that the infant had not received any vaccinations and that another infant living in the same room in hospital A had a severe cough. The adopted infant subsequently was examined by a local physician, who diagnosed his condition as a "cold," and the infant was taken to the U.S. Embassy in moscow, where the parents were interviewed for an immigrant visa for the child.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. cough and fear of sleep: early clinical signs of bordetella pertussis in an adult.Pertussis is increasing in frequency among adults, but early diagnosis requires special attention to details in the medical history. We describe a 64 year-old male with classic signs and symptoms of pertussis and documented bordetella pertussis infection that were overlooked because he presented with a chief complaint of cough and fear of falling asleep. Coughing paroxysms and a feeling of suffocation (30-60 seconds) only occurred at night after short periods of deep sleep (30-45 minutes). The physicians did not observe these episodes during daytime examinations, and the basis of the patient's fear of sleep was not explored. We recommend reassessment of how adults describe symptoms of pertussis, including fear of sleep, and we suggest the use of PCR technology to allow early diagnosis and prompt treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Atypical bacterial infections explained by a concomitant virus infection.Because both viral and bacterial infections are common during early childhood, dual infections are not unexpected. However, the clinical manifestation of such combined infections may be, difficult to interpret, and they are often misdiagnosed as "atypical bacterial infection." Five patients with concomitant viral-bacterial infections are described. In all five cases, virus detection enabled the physicians to better understand an otherwise puzzling clinical presentation. In view of the recent progress in rapid viral diagnoses and the potential of antiviral drugs, the possibility of dual infection should be investigated more often.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Pertussis in a vaccinated 12-year-old girl.Pertussis, though uncommon in people older than 9 years, does occur (in girls and women primarily) and should be considered in the differential diagnosis of persistent cough. Earlier this year in british columbia a 12-year-old girl contracted the disease, even though she had been fully vaccinated against it at the appropriate ages. The source of her infection was unknown. The clinical picture was classic except that the girl experienced intense headaches, lasting up to an hour, after the episodes of paroxysmal coughing. Canadian physicians and public health practitioners should encourage vaccination against pertussis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Pertussis deaths: report of 23 cases in the united states, 1992 and 1993.OBJECTIVE. To characterize pertussis deaths and to identify possible risk factors and prevention strategies. methods. A retrospective review of all deaths attributed to pertussis with disease onset during 1992 and 1993 reported to the Centers for disease Control and Prevention. Hospital discharge summaries and autopsy reports were reviewed, and additional clinical information was provided by physicians involved in the care of the children. RESULTS. During 1992 and 1993, 23 deaths attributed to pertussis were reported to the Centers for disease Control and Prevention. Cultures for bordetella pertussis were positive in 18 (90%) of the 20 cases in which it was performed. Twenty (87%) of the 23 children who died were young than 1 year of age, and 18 (78%) of the children had received no doses orf pertussis vaccine. Among 20 children for whom gestational ages were known, 12 (60%) were born at36 weeks' gestation or earlier; in contrast, 10.7% of live births in the united states in 1992 were at 36 weeks' gestation or earlier. The median age of mothers whose children had fatal pertussis was 20 (range, 14 to 37) years in the 15 cases in which ages were known, compared with the national median age of 26.3 years in 1992. pneumonia was a complication in all but 1 (96%) of the cases. seizures occurred in 4 cases (17%), and acute encephalopathy occurred in 3 cases (13%). CONCLUSIONS. Pertussis continues to cause serious illness and death in the united states, particularly among infants who are not vaccinated. Preterm delivery and young maternal age may place infants at increased risk of death because of pertussis. Under the current pertussis vaccination schedule, three fourths of the infants who died were too young to have received three doses of pertussis vaccine, the minimum number of doses considered necessary for adequate protection against clinical pertussis. Additional strategies, to prevent deaths caused by pertussis in young infants, such as starting infant vaccination at an earlier age and booster doses to adolescents and adults, need to be evaluated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |