Diagnosis and management of atypical pneumonia

2016 ◽  
Author(s):  
Martin Langer ◽  
Edoardo Carretto
Keyword(s):  
Legionella Pneumophila ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Atypical Pneumonia ◽  
Close Collaboration ◽  
Antimicrobial Sensitivity ◽  
Diagnostic Work ◽  
Micro Organisms ◽  
Work Up

‘Atypical pneumonia’ is an old, but successful term, which covers respiratory infections caused by different micro-organisms, causing similar clinical symptoms, and characterized by similar antimicrobial sensitivity/resistance. Out of specific epidemic contexts, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumonia are the micro-organisms involved, L. pneumophila being by far the most frequently involved in severe community-acquired ‘atypical’ pneumonia. It is important to suspect ‘atypical’ pneumonia on the basis of clinical presentation and the correlated extrapulmonary symptoms. Knowledge of symptoms leads to suspicion and, consequently, to timely and adequate empiric treatment and proper diagnostic work-up. Standard microbiological diagnosis is based on urinary antigen test for L. pneumophila and on serology for the other pathogens. A culture should be performed if legionellosis is suspected. NATs techniques could be the future diagnostic tests. Close collaboration with the microbiologist will improve the diagnosis.

Schwannomas of the Nose and Paranasal Sinuses

1993 ◽  
Vol 7 (2) ◽  
pp. 59-65 ◽  
Author(s):  
John R. Wanamaker ◽  
Hayes H. Wanamaker ◽  
Bernard Kotton ◽  
Greg D. Akers ◽  
Pierre Lavertu
Keyword(s):  
Paranasal Sinuses ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Diagnostic Techniques ◽  
Therapeutic Approaches ◽  
Management Philosophy ◽  
Nose And Paranasal Sinuses ◽  
Therapeutic Tools ◽  
Diagnostic Work ◽  
Work Up

Schwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusual location for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician will be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immuno-chemistry in the diagnosis and treatment of these tumors will be discussed.

scholarly journals Mitochondrial Depletion Syndromes in Children and Adults

2013 ◽  
Vol 40 (5) ◽  
pp. 635-644 ◽  
Author(s):  
Josef Finsterer ◽  
Uwe Ahting
Keyword(s):  
Early Onset ◽  
Genetic Background ◽  
Clinical Presentation ◽  
Progressive External Ophthalmoplegia ◽  
Adult Onset ◽  
Chain Defects ◽  
Diagnostic Work ◽  
Work Up ◽  
Respiratory Chain Defects ◽  
Diagnostic Work Up

Abstract:To highlight differences between early-onset and adult mitochondrial depletion syndromes (MDS) concerning etiology and genetic background, pathogenesis, phenotype, clinical presentation and their outcome. MDSs most frequently occur in neonates, infants, or juveniles and more rarely in adolescents or adults. Mutated genes phenotypically presenting with adult-onset MDS include POLG1, TK2, TyMP, RRM2B, or PEO1/twinkle. Adult MDS manifest similarly to early-onset MDS, as myopathy, encephalo-myopathy, hepato-cerebral syndrome, or with chronic progressive external ophthalmoplegia (CPEO), fatigue, or only minimal muscular manifestations. Diagnostic work-up or treatment is not at variance from early-onset cases. Histological examination of muscle may be normal but biochemical investigations may reveal multiple respiratory chain defects. The outcome appears to be more favorable in adult than in early-onset forms. Mitochondrial depletion syndromes is not only a condition of neonates, infants, or juveniles but rarely also occurs in adults, presenting with minimal manifestations or manifestations like in the early-onset forms. Outcome of adult-onset MDS appears more favorable than early-onset MDS.

scholarly journals Esophageal Microperforation due to Calcified Mediastinal Lymph Node Leading to Tracheoesophageal Fistula

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Sankalp Dwivedi ◽  
E. Brooke Schrickel ◽  
Fayez Siddiqui ◽  
John O’Brien ◽  
James Kruer
Keyword(s):  
Lymph Node ◽  
Tracheoesophageal Fistula ◽  
Clinical Symptoms ◽  
Mediastinal Lymph Node ◽  
Rapid Decline ◽  
Disease Symptoms ◽  
Course Of Illness ◽  
Diagnostic Work ◽  
Subcarinal Lymph Node ◽  
Work Up

A 42-year-old male presented with worsening gastroesophageal reflux disease symptoms and cough. The clinical symptoms during the early course of illness were striking for aspiration pneumonia. He was given a prescription of proton pump inhibitors and antibiotics. Rapid decline in the clinical condition with worsening respiratory status was noted. Worsening symptoms of fever, cough, and chest pain prompted further diagnostic work-up suggesting esophageal microperforation. Esophagogram was found to be suggestive of tracheoesophageal fistula. The tracheoesophageal fistula was due to subcarinal lymph node of nontuberculous origin.

Rhinomyiasis: clinical and surgical management

2020 ◽  
Vol 13 (12) ◽  
pp. e236421
Author(s):  
Fabio Bertone ◽  
Marta Cerutti ◽  
Elena Serusi ◽  
Carmine Fernando Gervasio
Keyword(s):  
Clinical Presentation ◽  
Endoscopic Examination ◽  
Northern Italy ◽  
Sinus Surgery ◽  
Mediterranean Countries ◽  
Uncommon Disease ◽  
Therapeutic Procedures ◽  
Diagnostic Work ◽  
Work Up ◽  
Diptera Larvae

Myiasis by Oestrus ovis, the zoonotic infestation with Diptera larvae, primarily diagnosed in goats and rams in tropical and Mediterranean countries, is an uncommon disease in humans; indeed, literature data are still lacking. Nevertheless, few cases of human myiasis have been reported, leading to benign or severe complications. Here, we report a rare case of human rhinomyiasis detected in Northern Italy. A 39-year-old Italian woman, returning from vacation in Corsica, showed several sinusal symptoms and progressive asthenia and was therefore admitted at the Otorhinolaryngology Unit of Biella Hospital, Italy. Endoscopic examination of the nasal cavity revealed some formations, morphologically identified as O. ovis larvae. The patient then underwent endoscopic sinus surgery, followed by complete resolution of symptoms. Clinical presentation, diagnostic work-up and therapeutic procedures have been compared with few other cases found in the literature.

Impact of gender on the clinical presentation and diagnosis of deep-vein thrombosis

2010 ◽  
Vol 103 (04) ◽  
pp. 710-717 ◽  
Author(s):  
Hanno Riess ◽  
Viola Hach-Wunderle ◽  
Horst Gerlach ◽  
Heike Carnarius ◽  
Sonja Eberle ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Presentation ◽  
Risk Groups ◽  
Pretest Probability ◽  
Probability Score ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

SummaryIt is uncertain whether gender influences the clinical presentation of deep-vein thrombosis (DVT) and the discriminative value of the Wells diagnostic pretest probability score. The aim of the study was to determine whether gender impacts the clinical presentation and diagnosis of DVT. The study analysed a cohort of 4,976 outpatients with clinically suspected DVT of the leg prospectively recruited by 326 vascular medicine physicians in the German ambulatory care sector between October and December 2005. The diagnosis of DVT was based on compression ultrasonography in 96% of patients. Among 4,777 patients who had a diagnostic work-up for DVT there were more women (n=2,998) than men (n=1,779). However, the prevalence of confirmed DVT was 37.0% (658/1779) in men vs. 24.3% (730/2,998) in women (p<0.001). Among patients with confirmed DVT, proximal DVT was more common in men (59.6% vs. 44.5% in women, p<0.001). Swelling of the leg, pitting oedema and dilated superficial veins were more frequently reported by men (p<0.001). The percentage of patients with a high probability Wells clinical pretest score was higher in men than in women (67.0% vs. 57.0%, p<0.001). However, overall, the score equally discriminated risk groups for DVT in both sexes. In conclusion, women were more frequently referred for a diagnostic work-up for DVT than men, but the prevalence of DVT was higher in men and their thrombotic events were more severe. Nevertheless, the Wells clinical pretest probability score correctly identified low- and high-risk groups in both genders.

Rectal Bleeding in Childhood

1983 ◽  
Vol 5 (2) ◽  
pp. 35-41
Author(s):  
Craig Hillemeier
Keyword(s):  
Clinical Presentation ◽  
Large Degree ◽  
Gastric Aspirate ◽  
Gi Tract ◽  
Pediatric Age Group ◽  
Risk Of Malignancy ◽  
Ligament Of Treitz ◽  
Diagnostic Work ◽  
Work Up ◽  
Upper Gastrointestinal

The passing of blood through the rectum is not an uncommon event in the pediatric age group. The most likely etiology varies to a large degree depending upon the age of the patient. Fortunately, the risk of malignancy in children with lower gastrointestinal (GI) tract bleeding is considerably less than that of adults, and the degree of the invasive diagnostic work-up can often be far less extensive than that used in an adult with a similar clinical presentation. Bleeding anywhere throughout the GI tract will cause blood to be present in the stools. Melena refers to the passage through the rectum of black tarry stools and usually denotes bleeding from the upper gastrointestinal tract or small bowel. The tarry stools may be intermingled with maroon or red blood. Hematochezia is a passage of bright red blood through the rectum and usually indicates a source of bleeding low in the GI tract, often in the colon. However, inasmuch as blood exerts a strong Cathartic action, massive upper GI tract hemorrhage may occasionally present as bright red blood passed through the rectum. In most instances a negative gastric aspirate for blood will assure that the bleeding is distal to the ligament of Treitz Many substances ingested by children may simulate fresh or chemically changed blood.

scholarly journals Heart failure in the elderly: A geriatric syndrome. Picture of the modern situation

2019 ◽  
Vol 89 (1) ◽  
Author(s):  
Valentina Fagotto ◽  
Alessandro Cavarape ◽  
Alessandro Boccanelli
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Clinical Presentation ◽  
The Elderly ◽  
Geriatric Syndrome ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up ◽  
Diagnostic Work Up

Among the older patients’ cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient’s history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration.

Clinical Presentation of Sarcoidosis and Diagnostic Work-Up

2014 ◽  
Vol 35 (03) ◽  
pp. 336-351 ◽  
Author(s):  
Jean-François Bernaudin ◽  
Yurdagul Uzunhan ◽  
Marianne Kambouchner ◽  
Pierre-Yves Brillet ◽  
Michael Soussan ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up
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