COUGH

Cough is a protective reflex usually serving to expel secretions, exudates, transudates, or extraneous materials from the respiratory tract. When cough is serving any such useful function, it should not be suppressed except under special circumstances like when it is exhausting the patient.

Useless cough should be suppressed or, if possible, made useful and effective. Any symptomatic treatment of cough should be accompanied by measures aimed at diagnosis and treatment of the underlying cause.

A positive acid-fast bacilli (AFB) smear result is considered a major determinant as to whether a pulmonary tuberculosis (TB) case will transmit the bacilli to a contact. However, according to a study that utilized molecular characterization of Mycobacterium tuberculosis (MTB) isolates, smear-negative cases are still responsible for approximately 17% of recently transmitted TB. Three negative, consecutive, sputum smear results are also indicative of TB. However, there is a paucity of data supporting a specific number of negative smear results as adequate in assessing the infectious potential of such patients (2005). Patients with pulmonary tuberculosis having consistently negative smears for AFB are less infectious than patients with positive smear results as shown by various epidemiologic studies. Tuberculosis is an acute or chronic infection caused by Mycobacterium tuberculosis. It is almost always initiated by inhalation. Pulmonary disease is most common, but disease can spread via the lymphatics and bloodstream to any other organ.

Purified protein derivative (PPD) is a sterile solution prepared from the tubercle bacillus and injected into the dermis to test for tuberculosis infection (2001). The appearance of an indurated area of 5 mm or more 48 to 72 hours after administration of purified protein derivative (PPD) is considered a positive reaction in persons who have recently had close contact with an individual with active tuberculosis, in persons with radiographic findings consistent with a past history of tuberculosis or in persons with known or suspected human immunodeficiency virus infection. Ten or more millimeters of induration is considered a positive reaction in persons at increased risk of tuberculosis. Induration of 15 mm or more is considered a positive result in all other persons (1995).

Lupus is a very diverse disorder and this is one of the reasons it is sometimes difficult to diagnose, and why some patients wait for years for a proper diagnosis. It can affect many organ systems in a large number of ways. The lungs are frequently involved and can be the initial presenting complaint or occur late in the course of established disease. The seriousness of lung involvement varies from that which produces no symptoms and has no consequence to potentially very serious changes. The clinical symptoms of idiopathic systemic lupus erythematosus (SLE) most often include dry cough, arthralgias, arthritis, myalgias, fevers, hematologic dyscrasias, and serositis. In SLE, the renal, pulmonary, visceral, and central nervous systems are usually spared. In 95% to 100% of patients with SLE, serum is positive for antinuclear antibody (ANA), which most often has a homogenous pattern (2001).

Lymph nodes are considered to be the fortresses that aid immunologic defense. Lymphadenitis is the inflammation and/or enlargement of a lymph node. But based on the clinical findings of the case study, it could be leukemia. Leukemia is a generalized neoplastic disorder of the blood-forming tissues, primarily those of leukocytic series.

It seems that the condition is sarcoidosis. It is a multisystem granulomatous disorder of unknown etiology characterized histologically by epitheloid tubercles involving various organs or tissues, with symptoms dependent on the site and degree of involvement. Bilateral dry crackles are heard at lung bases in sarcoidosis. Dyspnea on exertion is a characteristic of this disease, dry cough and non-specific joint pain in knees and ankles are also present as well. The patient with sarcoidosis is usually febrile, tachypneic with basilar lung crackles and has swelling of ankles and knees. New bilateral hilar and mediastinal lymphadenopathy with unchanged infiltrates are usually seen on CXR and CT. Cultures and stains were negative. The clinico-pathologic findings of the case presented were consistent with sarcoidosis.

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