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Author(s): Cassandra A. Petri [sup.1] , Yalile Perez [sup.2] , Leah S. Heidenreich [sup.1] , Carl H. Cramer [sup.3] , Timothy M. Olson [sup.2] , Nathan C. Hull [sup.4] , [...]

A burgeoning epidemic of drug-resistant tuberculosis (TB) threatens to derail global control efforts. Although the mechanisms remain poorly clarified, drug-resistant strains are widely believed to be less infectious than drug-susceptible strains. Consequently, we hypothesized that lower proportions of patients with drug-resistant TB would have culturable Mycobacterium tuberculosis from respirable, cough-generated aerosols compared to patients with drug-susceptible TB, and that multiple factors, including mycobacterial genomic variation, would predict culturable cough aerosol production. We enumerated the colony forming units in aerosols ([less than or equal to]10 [micro]m) from 452 patients with TB (227 with drug resistance), compared clinical characteristics, and performed mycobacterial whole-genome sequencing, dormancy phenotyping and drug-susceptibility analyses on M. tuberculosis from sputum. After considering treatment duration, we found that almost half of the patients with drug-resistant TB were cough aerosol culture-positive. Surprisingly, neither mycobacterial genomic variants, lineage, nor dormancy status predicted cough aerosol culture positivity. However, mycobacterial sputum bacillary load and clinical characteristics, including a lower symptom score and stronger cough, were strongly predictive, thereby supporting targeted transmission-limiting interventions. Effective treatment largely abrogated cough aerosol culture positivity; however, this was not always rapid. These data question current paradigms, inform public health strategies and suggest the need to redirect TB transmission-associated research efforts toward host-pathogen interactions. Culturable Mycobacterium tuberculosis can be detected in cough aerosol from a high proportion of individuals infected with drug-resistant M. tuberculosis and correlate with a strong cough and low symptom score, indicating the need to focus on targeted interventions., Author(s): Grant Theron [sup.1] [sup.2] , Jason Limberis [sup.1] , Rouxjeane Venter [sup.2] , Liezel Smith [sup.1] [sup.2] , Elize Pietersen [sup.1] , Aliasgar Esmail [sup.1] , Greg Calligaro [sup.1] [...]

Purpose Chronic cough is a common problem in various populations. The present study assessed the impact of cough and unmet needs in Korean patients with chronic cough. Methods This cross-sectional multi-center study enrolled adult patients newly referred to clinic for assessment of chronic cough. A second group of patients with unexplained chronic cough following detailed assessment were recruited for comparison. Patients completed self-reported questionnaires, including cough characteristics, impact of cough on daily life, and unmet needs. Results A total of 447 subjects were recruited from six referral clinics, including 408 with chronic cough and 39 with unexplained chronic cough. Almost all patients reported that cough impacted their daily lives. Psychosocial impacts were more evident in unexplained cough patients compared to newly referred patients. Approximately 75% of newly referred patients had previously sought medical care for cough on multiple occasions, but the effectiveness of treatment was limited (70.3%) or absent (17.3%). The most frequent unmet need was the ineffectiveness of treatment (49.3%), followed by unclear diagnosis (30.1%). The majority of participants ( > 80%) expressed the need for further information on accessing cough specialists and disease management. The main problem faced by unexplained cough patients was poor cough control despite treatment (64%). Conclusions Chronic cough has a substantial impact on daily life and is worst in those whose cough remains unexplained following assessment. Ineffectiveness of treatment and unclear diagnosis were major unmet needs. Medical information about chronic cough was also lacking. Improvements in the management of chronic cough patients in Korea are necessary., Author(s): Sung-Yoon Kang [sup.1] , Ha-Kyeong Won [sup.2] , Sang Min Lee [sup.1] , Jae-Woo Kwon [sup.3] , Min-Hye Kim [sup.4] , Eun-Jung Jo [sup.5] , Seung-Eun Lee [sup.6] , [...]

Background Suboptimal tuberculosis (TB) diagnostics and HIV contribute to the high global burden of TB. We investigated costs and yield from systematic HIV-TB screening, including computer-aided digital chest X-ray (DCXR-CAD). Methods and findings In this open, three-arm randomised trial, adults ([greater than or equal to]18 years) with cough attending acute primary services in Malawi were randomised (1:1:1) to standard of care (SOC); oral HIV testing (HIV screening) and linkage to care; or HIV testing and linkage to care plus DCXR-CAD with sputum Xpert for high CAD4TBv5 scores (HIV-TB screening). Participants and study staff were not blinded to intervention allocation, but investigator blinding was maintained until final analysis. The primary outcome was time to TB treatment. Secondary outcomes included proportion with same-day TB treatment; prevalence of undiagnosed/untreated bacteriologically confirmed TB on day 56; and undiagnosed/untreated HIV. Analysis was done on an intention-to-treat basis. Cost-effectiveness analysis used a health-provider perspective. Between 15 November 2018 and 27 November 2019, 8,236 were screened for eligibility, with 473, 492, and 497 randomly allocated to SOC, HIV, and HIV-TB screening arms; 53 (11%), 52 (9%), and 47 (9%) were lost to follow-up, respectively. At 56 days, TB treatment had been started in 5 (1.1%) SOC, 8 (1.6%) HIV screening, and 15 (3.0%) HIV-TB screening participants. Median (IQR) time to TB treatment was 11 (6.5 to 38), 6 (1 to 22), and 1 (0 to 3) days (hazard ratio for HIV-TB versus SOC: 2.86, 1.04 to 7.87), with same-day treatment of 0/5 (0%) SOC, 1/8 (12.5%) HIV, and 6/15 (40.0%) HIV-TB screening arm TB patients (p = 0.03). At day 56, 2 SOC (0.5%), 4 HIV (1.0%), and 2 HIV-TB (0.5%) participants had undiagnosed microbiologically confirmed TB. HIV screening reduced the proportion with undiagnosed or untreated HIV from 10 (2.7%) in the SOC arm to 2 (0.5%) in the HIV screening arm (risk ratio [RR]: 0.18, 0.04 to 0.83), and 1 (0.2%) in the HIV-TB screening arm (RR: 0.09, 0.01 to 0.71). Incremental costs were US$3.58 and US$19.92 per participant screened for HIV and HIV-TB; the probability of cost-effectiveness at a US$1,200/quality-adjusted life year (QALY) threshold was 83.9% and 0%. Main limitations were the lower than anticipated prevalence of TB and short participant follow-up period; cost and quality of life benefits of this screening approach may accrue over a longer time horizon. Conclusions DCXR-CAD with universal HIV screening significantly increased the timeliness and completeness of HIV and TB diagnosis. If implemented at scale, this has potential to rapidly and efficiently improve TB and HIV diagnosis and treatment. Trial registration clinicaltrials.gov NCT03519425., Author(s): Peter MacPherson 1,2,3,*, Emily L. Webb 4, Wala Kamchedzera 2, Elizabeth Joekes 1, Gugu Mjoli 5, David G. Lalloo 1, Titus H. Divala 2,3,6, Augustine T. Choko 1,2, Rachael [...]

Author(s): Cassandra A. Petri [sup.1] , Yalile Perez [sup.2] , Leah S. Heidenreich [sup.1] , Carl H. Cramer [sup.3] , Timothy M. Olson [sup.2] , Nathan C. Hull [sup.4] , [...]

A 68-year-old woman with a history of hypertension, paroxysmal atrial fibrillation, and liver transplant for primary sclerosing cholangitis (PSC) presented with a 2-month history of cough and shortness of breath. [...]

The case study of a patient suffering from chronic cough is discussed to understand the diagnosis procedure clinicians use to try and establish a connection between present illness and past ailments.

Abstract. Gastroesophageal reflux is known to cause chronic cough and is also implicated in worsening of asthma. We conducted a prospective study to examine the clinical significance of gastroesophageal reflux [...]

Byline: T. Sano (1), H. Ueda (1), H. Bando (1) Keywords: Chronic cough; Cough variant asthma; Peak expiratory flow rate; Suplatast tosilate Abstract: It is important to make a differential diagnosis of cough variant asthma in patients with chronic cough. To examine whether or not peak expiratory flow rate (PEFR) is useful for the differential diagnosis of cough variant asthma in such patients, diurnal variation rates of PEFR were calculated in 23 patients who presented with dry cough lasting four or more weeks and who showed no abnormalities on chest radiographs. None of the patients had wheezes, and pulmonary function testing at the time of visit to the hospital revealed no abnormalities. During the control period, the mean diurnal variation rate of PEFR in 23 patients was 16.3 +- 7.9%. Six, nine and eight patients had PEFR diurnal variations rates of &lt 10% (Group 1), 10--19% (Group 2), and aY= 20% (Group 3), respectively. At week 3 of treatment with bronchodilators, only Group 3 showed a significant decrease in PEFR diurnal variation rate from 25.7% to 10.1%. The cough score decreased significantly in Group 3 only. These patients had enhanced bronchial hyperresponsiveness and showed eosinophils in induced sputum, leading to the diagnosis of cough variant asthma (CVA). After making the diagnosis of CVA, an inhaled corticosteroid or a Th2 cytokine production inhibitor suplatast tosilate was administered to patients consequently, they showed no recurrence of cough. PEFR monitoring allowed the detection of morning dip and was suggested to be potentially useful for the differential diagnosis of cough variant asthma in patients with chronic cough. Author Affiliation: (1) Department of Pulmonary Medicine, Tokushima Prefectural Central Hospital, Kuramoto-cho 1-10-3, Tokushima, Tokushima, 770-8539, Japan Article History: Registration Date: 01/01/2004 Accepted Date: 29/06/2004

Colds, hay-fever, sinusitis, chronic obstructive lung disease, and whooping cough are the most common causes of cough. A persistent cough is commonly caused by asthma, post-nasal drip syndrome and gastroesophageal reflux. The diagnosis and management of cough is reviewed.

The American College of Chest Physicians recently issued guidelines in the journal CHEST for the diagnosis and treatment of coughing in adults and children--acute cough (lasting less than three weeks), [...]