scholarly journals Acute Stridor and Respiratory Failure due to Retrosternal Subglottic Stenosis of Unknown Origin

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Tharindu Vithanage ◽  
Gerben Keijzers ◽  
Nicola Jane Willis ◽  
Tara Cochrane ◽  
Linda Smith
Keyword(s):  
Respiratory Failure ◽  
Multidisciplinary Approach ◽  
Unknown Origin ◽  
Subglottic Stenosis ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Oral Antibiotics ◽  
Night Sweats ◽  
Upper Respiratory ◽  
Tone Of Voice

Respiratory failure due to subglottic stenosis is a rare but serious condition. A 22-year-old male presented to the emergency department (ED) with shortness of breath, stridor, and change in tone of voice. The patient did not complain of B-symptoms (fever, weight loss, and night sweats). In the week before this presentation, he was diagnosed with an upper respiratory tract infection with associated bronchospasm and discharged on oral antibiotics and inhaled salbutamol without effect. He developed hypercapnic respiratory failure in the ED after a coughing episode. A normal nasopharyngoscopic examination and a subtle mediastinal abnormality on chest radiograph lead to a working diagnosis of retrosternal subglottic obstruction. The complexities of his airway management and suggestions for multidisciplinary approach are discussed.

scholarly journals A quantitative exploration of symptoms in COVID-19 patients: an observational cohort study

2020 ◽  
Author(s):  
Gaojing Qu ◽  
Junwen Chen ◽  
Guoxin Huang ◽  
Meiling Zhang ◽  
Hui Yu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Tract Infection ◽  
Digestive System ◽  
Observational Cohort Study ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Associated Symptoms ◽  
Observational Cohort ◽  
Upper Respiratory ◽  
Critical Type

AbstractBackgroundAs the spreading of the COVID-19 around the global, we investigated the characteristics and changes of symptoms in COVID-19 patients.MethodsThis was an ambispective observational cohort study, and 133 confirmed COVID-19 patients were included and all symptoms over the course were analyzed qualitatively. The symptoms, their changes over the course in the cohort and in the different clinical types, etc. were illustrated. Differences in different periods and severities were analyzed through Chi square test, association with severity was analyzed through LASSO binomial logistic regression analysis. Inter-correlation and classification of symptoms were completed. Major symptoms were screened and their changes were illustrated.ResultsA total of 43 symptoms with frequencies as 6067 in this cohort. Differences of symptoms in different stages and clinical types were significant. Expectoration, shortness of breath, dyspnea, diarrhea, poor appetite were positively but vomiting, waist discomfort, pharyngeal discomfort, acid reflux were negatively correlated with the combined-severe and critical type; dyspnea was correlated with the critical type. The 17 major symptoms were identified. The average daily frequency of symptoms per case was decreased continuously before the transition into the severe type and increased immediately one day before the transition and then decreased. It was decreased continuously before the transition date of the critical type and increased from the transition into the critical type to the next day and decreased thereafter. Dyspnea (P<0.001), shortness of breath (P<0.01) and chest distress (P<0.05) were correlated with death and their corresponding coefficient was 0.393, 0.258, 0.214, respectively.ConclusionThe symptoms of COVID-19 patients mainly related to upper respiratory tract infection, cardiopulmonary function, and digestive system. The mild type and the early stage in other types mainly related to upper respiratory tract infection. The cardiopulmonary function and digestive system associated symptoms were found in all other types and stages. Dyspnea was correlated with critical type and dyspnea, shortness of breath, and chest distress were correlated with death. Respiratory dysfunction (or incompleteness) associated symptoms were the characteristic symptoms. The changes of symptoms did not synchronously with the changes of severity before the transition into the severe or critical type.

scholarly journals Acute Respiratory Distress Syndrome Caused by Human Adenovirus in Adults: A Prospective Observational Study in Guangdong, 2019–2020

2021 ◽  
Author(s):  
Zhan Wu ◽  
Rong Zhang ◽  
Dongdong Liu ◽  
Xuesong Liu ◽  
Jierong Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Characteristics ◽  
Distress Syndrome ◽  
Early Stage ◽  
Invasive Mechanical Ventilation ◽  
Viral Pneumonia ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Upper Respiratory

Abstract Background: Viral causes of acute respiratory distress syndrome (ARDS) are mostly limited to influenza. However, adenovirus has been emerging as a cause of ARDS with a high mortality rate and described in adults are rare.Methods: We conducted a prospective, single-center observational study of viral pneumonia with ARDS and confirmed adenovirus-associated ARDS in adults at our quaternary referral institution between March 2019 and June 2020. We prospectively analyzed clinical characteristics, laboratory test results, radiological characteristics, viral load from nasopharyngeal swabs and endotracheal aspirates, treatments, and outcomes for the study participants.Results: The study enrolled 143 ARDS patients, including 47 patients with viral pneumonia-related ARDS, among which there were 14 adenovirus-associated ARDS patients, which accounted for 29.79% of the viral pneumonia-related ARDS cases. Among the adenovirus-associated ARDS patients, 78.57% were men with a mean age of 54.93 ± 19.04 years. Adenovirus-associated ARDS patients had no specific clinical characteristics, but they presented with shortness of breath and fever, and their initial chest radiographic findings were multifocal or showed diffuse opacity. The viral load and the positivity rate in the lower respiratory tract were higher than that of the upper respiratory tract in the patients with adenovirus-associated ARDS, and 85.71% of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. All patients required invasive mechanical ventilation treatment. The average time from shortness of breath to the application of invasive ventilation was 24 hours. The median duration of invasive mechanical ventilation was 22 days (14–75 days). Six patients (42.86%) required renal replacement therapy, and three patients (21.43%) required extracorporeal membrane oxygenation support. Additionally, 85.71% of the 14 adenovirus-associated ARDS patients survived.Conclusion: Adenovirus infection is an important cause of virus-related ARDS. The positivity rate of adenovirus infection in lower respiratory tract secretions was higher than that in upper respiratory tract secretions in these patients. Most of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. Early identification and intervention to prevent disease progression are essential for reducing the mortality rate in these patients.

Successful management of subglottic stenosis in pregnancy

2021 ◽  
Vol 14 (3) ◽  
pp. e236466
Author(s):  
Shenghao Fang ◽  
Poonam Pai B H
Keyword(s):  
Multidisciplinary Approach ◽  
Postoperative Management ◽  
Subglottic Stenosis ◽  
Routine Practice ◽  
Shortness Of Breath ◽  
Successful Management ◽  
The Past ◽  
Surgical History ◽  
History Of ◽  
In Pregnancy

Evaluation and management of subglottic stenosis in pregnancy is challenging. It often is not only a multidisciplinary approach between obstetricians, otolaryngologists (ENT surgeons) and anesthesiologists, but also requires a thorough understanding of possible foreseen complications by the patient as well. Hence, whenever we are presented with a challenging case requiring multidisciplinary approach involving team of physicians from different specialties, it is routine practice to huddle regarding the preoperative, intraoperative and postoperative management and care. We present a case of a 37-year-old woman with a known history of idiopathic subglottic stenosis, 16 weeks’ pregnant, G4P1, with a surgical history significant for two previous subglottic dilations in the past and who now presented with an audible stridor and shortness of breath on activity. We highlighted the unique challenges encountered and the corresponding management adopted. This is a case of successful management of symptomatic worsening of subglottic stenosis managed during pregnancy.

scholarly journals Undetectable SARS-CoV-2 in a nasopharyngeal swab but persistent viral RNA from deep lung swabs: findings from an autopsy

2020 ◽  
Vol 13 (10) ◽  
pp. e237446
Author(s):  
Prema Seetulsingh ◽  
Chiranthi Iresha Kannangara ◽  
Paul Richman
Keyword(s):  
Accurate Diagnosis ◽  
Viral Rna ◽  
Nasopharyngeal Swab ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Radiological Findings ◽  
Global Pandemic ◽  
Nasal Swabs ◽  
Upper Respiratory ◽  
Preventative Interventions

During the global pandemic of COVID-19 accurate diagnosis of the infection by demonstrating SARS-CoV-2 viral RNA by PCR in specimens is crucial for therapeutic and preventative interventions. There have been instances where nasal and throat swabs have been negative despite the patient having typical clinical and radiological findings compatible with the disease. We report a case of a man in his late 50s, brought to the hospital following a cardiac arrest and prolonged unsuccessful resuscitation. The history was typical for COVID-19 with fever for 10 days and worsening shortness of breath. His throat and nasal swabs (after death) were negative for SARS-CoV-2. A limited diagnostic autopsy was performed after 27 days, and lung swabs confirmed presence of SARS-CoV-2. This case highlights the importance of lung swabs when initial upper respiratory tract swabs are negative and proves that the virus can be detected from dead human tissue almost a month later.

scholarly journals Association of Schistosoma haematobium infection morbidity and severity on co-infections in pre-school age children living in a rural endemic area in Zimbabwe

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tariro L. Mduluza-Jokonya ◽  
Thajasvarie Naicker ◽  
Luxwell Jokonya ◽  
Herald Midzi ◽  
Arthur Vengesai ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Schistosoma Haematobium ◽  
Endemic Area ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
School Age Children ◽  
School Age ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

Abstract Background Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking of schistosomiasis infection. In this study we investigated the prevalence and severity of coinfections in pre-school age children and further investigated associations between S. haematobium prevalence and under 5 mortality. Methods A community based cross-sectional survey was conducted in Shamva District, Zimbabwe. Using random selection, 465 preschool age children (1–5 years of age) were enrolled through clinical examination by two independent clinicians for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions and their severe sequels were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Data was analysed using univariate and multinomial regression analysis and relative risk (RR) calculated. Results Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis 18% and malaria 18% (75). The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection aOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis aOR = 4.79 (95% CI 2.78 to 8.25), fever of unknown origin aOR = 10.63 (95% CI 6.48–17.45) and malaria aOR = 0.91 (95% CI 0.51 to1.58). Effect of schistosomiasis coinfection on disease progression based on the odds of the diseases progressing to severe sequalae were: Severe pneumonia aOR = 8.41 (95% CI 3.09–22.93), p < 0.0001, complicated malaria aOR = 7.09 (95% CI 1.51–33.39), p = 0.02, severe dermatophytosis aOR = 20.3 (95% CI 4.78–83.20):p = 0.03, and fever of unknown origin aOR = 1.62 (95%CI 1.56–4.73), p = 0.02. Conclusion This study revealed an association between schistosomiasis and the comorbidity conditions of URTI, dermatophytosis, malaria and FUO in PSAC living in a schistosomiasis endemic area. A possible detrimental effect where coinfection led to severe sequels of the comorbidity conditions was demonstrated. Appropriate clinical diagnostic methods are required to identify associated infectious diseases and initiate early treatment of schistosomiasis and co-infections in PSAC.

scholarly journals Association of Schistosoma haematobium Infection Morbidity and Severity on Co-infections status in Pre-school Age Children Living in a Rural Endemic Area in Zimbabwe

2020 ◽  
Author(s):  
Tariro Lavender Mduluza-Joko ◽  
Thajasvarie Naicker ◽  
Luxwell Jokonya ◽  
Herald Midzi ◽  
Arthur Vengesai ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Schistosoma Haematobium ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
School Age Children ◽  
School Age ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

Abstract Background: Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases, simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking schistosomiasis infection. In this study we investigated the prevalence and effects of coinfections in pre-school age children and further investigated association between S. haematobium prevalence and under 5 mortality.Methods: Four hundred and sixty five Preschool age children (1-5 years old) with 51% being male were clinically examined for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Results: Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis and malaria both had 18% (75), The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection AOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis AOR = 4.79 ( 95% CI 2.78 to 8.25), fever of unknown origin AOR = 10.63 ( 95% CI 6.48-17.45) and malaria AOR = 0.91 ( 95% CI 0.51 to1.58). Relative risks of the severe sequels when coinfected were: Severe pneumonia RR=7.5 (95% CI 2.92-19.23), p<0.0001, complicated malaria RR=12 (95%CI 11.53-94.53), p=0.02, severe dermatophytosis RR=8.5 (95% CI 1.2-60.2):p=0.03, and fever of unknown origin RR=2.32 (95% CI 1.12-4.80), p=0.02.Conclusion: This study is novel as it identifies a possible association relationship between S. haematobium infection and top morbidity conditions in children under five years. There is need to alert policy makers so as to initiate early treatment of schistosomiasis in pre-school age children.

scholarly journals Acute Respiratory Distress Syndrome Caused By Human Adenovirus In Adults: A Prospective Observational Study In Guangdong, 2019–2020

2021 ◽  
Author(s):  
Zhan Wu ◽  
Rong Zhang ◽  
Dongdong Liu ◽  
Xuesong Liu ◽  
Jierong Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Characteristics ◽  
Distress Syndrome ◽  
Early Stage ◽  
Invasive Mechanical Ventilation ◽  
Viral Pneumonia ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Upper Respiratory

Abstract Background: Viral causes of acute respiratory distress syndrome (ARDS) are mostly limited to influenza. However, adenovirus has been emerging as a cause of ARDS with a high mortality rate and described in adults are rare.Methods: We conducted a prospective, single-center observational study of viral pneumonia with ARDS and confirmed adenovirus-associated ARDS in adults at our quaternary referral institution between March 2019 and June 2020. We prospectively analyzed clinical characteristics, laboratory test results, radiological characteristics, viral load from nasopharyngeal swabs and endotracheal aspirates, treatments, and outcomes for the study participants.Results: The study enrolled 143 ARDS patients, including 47 patients with viral pneumonia-related ARDS, among which there were 14 adenovirus-associated ARDS patients, which accounted for 29.79% of the viral pneumonia-related ARDS cases. Among the adenovirus-associated ARDS patients, 78.57% were men with a mean age of 54.93 ± 19.04 years. Adenovirus-associated ARDS patients had no specific clinical characteristics, but they presented with shortness of breath and fever, and their initial chest radiographic findings were multifocal or showed diffuse opacity. The viral load and the positivity rate in the lower respiratory tract were higher than that of the upper respiratory tract in the patients with adenovirus-associated ARDS, and 85.71% of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. All patients required invasive mechanical ventilation treatment. The average time from shortness of breath to the application of invasive ventilation was 24 hours. The median duration of invasive mechanical ventilation was 22 days (14–75 days). Six patients (42.86%) required renal replacement therapy, and three patients (21.43%) required extracorporeal membrane oxygenation support. Additionally, 85.71% of the 14 adenovirus-associated ARDS patients survived.Conclusion: Adenovirus infection is an important cause of virus-related ARDS. The positivity rate of adenovirus infection in lower respiratory tract secretions was higher than that in upper respiratory tract secretions in these patients. Most of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. Early identification and intervention to prevent disease progression are essential for reducing the mortality rate in these patients.Trial registration: ChiCTR1900022822. Registered 27 April 2019, https://www.chictr.org.cn/showproj.aspx?proj=38064

Bacteremia in Children: An Outpatient Clinical Review

PEDIATRICS ◽  
1976 ◽  
Vol 57 (6) ◽  
pp. 861-868
Author(s):  
Paul L. McCarthy ◽  
Gordon W. Grundy ◽  
Sydney Z. Spiesel ◽  
Thomas F. Dolan
Keyword(s):  
Soft Tissue ◽  
Pneumococcal Disease ◽  
Unknown Origin ◽  
Blood Cultures ◽  
Upper Respiratory Tract ◽  
Pneumococcal Bacteremia ◽  
Soft Tissue Involvement ◽  
Two Factors ◽  
Persistent Bacteremia ◽  
Upper Respiratory

In a 20-month period, 1,783 children seen in the pediatric outpatient department had blood cultures performed and 117 (6.5%) of these children had bacteremia. Two thirds of the isolates were Diplococcus pneumoniae and Hemophilus influenzae b. Ninety-three percent of children with H. influenzae b bacteremia and 20% of children with pneumococcal bacteremia had soft tissue involvement at the initial visit. Most children with positive blood cultures (102) were previously well and beyond the newborn period and many (46) had seemingly trivial illnesses initially: upper respiratory tract infection, fever of unknown origin, otitis media, and diarrhea. In the absence of soft tissue infection, the latter three diagnoses correlated best with bloodstream invasion. Nineteen children had persistent bacteremia and five developed soft tissue complications not noted initially. Two factors, age between 7 and 24 months and temperature between 39.4 and 40.6 C, showed increased specificity for bacteremia but were sensitive only for pneumococcal disease. A temperature of ≥ 40.5 C showed more specificity for bacteremia than lesser fevers. A white blood cell count &gt; 20,000/cu mm was poorly sensitive, and pulmonary infiltrates were neither specific nor sensitive for positive blood cultures. Five bacteremic children had aseptic lymphocytosis in the cerebrospinal fluid. Two days of intravenous antibiotic therapy and eight days of oral therapy were adequate for pneumococcal bacteremia without soft tissue involvement. This therapy may not be ideal, however, since other routes and duration of therapy were not evaluated.

scholarly journals Protection of upper respiratory tract of patient in conditions of respiratory support: current state of issue

2019 ◽  
Vol 1 (16) ◽  
pp. 30-36 ◽  
Author(s):  
A. V. Vlasenko ◽  
A. G. Koryakin ◽  
E. A. Evdokimov ◽  
D. A. Eryomin
Keyword(s):  
Respiratory Failure ◽  
Respiratory Tract ◽  
Acute Respiratory Failure ◽  
Respiratory Support ◽  
High Tech ◽  
Upper Respiratory Tract ◽  
Duration Of Treatment ◽  
Upper Airways ◽  
Current State ◽  
Upper Respiratory

Acute respiratory failure has been and remains one of the main problems of modern medicine. Among the large number of high-tech methods of treating acute respiratory failure, adequate moisture and warming of the upper respiratory tract of the patient at all stages of the respiratory therapy are important. It should be noted that ensuring optimal moistening and warming of the inhaled gas mixture allows to avoid the development of many pulmonary complications. On the other hand, even with the use of the most modern treatment methods, inadequate microclimate in the upper respiratory tract can significantly reduce the effectiveness of their use. Thus, maintaining an adequate microclimate in the upper airways is normal, with various bronchopulmonary diseases and in conditions of respiratory support will improve the functional state of the lungs, prevent the development of many complications, reduce material costs and duration of treatment, reduce the mortality of this patient population. Despite the existence of the large database, the question of choosing the most effective technology to ensure homeostasis and protection of the upper respiratory tract in different clinical situations with different methods of respiratory support is still relevant. This dictates the necessity of continuing the research in this direction. This review is devoted to the current state of the problem of moistening, warming and filtering the breathing mix under conditions of prosthetic respiratory function.

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