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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
The production of mucus by the respiratory tract acts as a moisturiser and helps protect the vital organs from drying out. Adults normally produce about 1–1.5 L per day of mucus in the respiratory tract, but it goes unnoticed as it is usually swallowed (Fahy and Dickey 2010). Mucus can trap particles of dust, allergens and smoke to further protect the body from harm. In those with cystic fibrosis, excess mucus is seen in the airways and a respiratory infection will exacerbate mucous production. The mucus clogs the airway and makes breathing out problematic for the person (see What Is Cystic Fibrosis. Available from: https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/, Accessed on 9 June 2021). Smoking can also stimulate excessive mucus production. The mucus expectorated from the lungs is termed ‘sputum’. Sputum consists of lower respiratory tract secretions, nasopharyngeal and oropharyngeal material (including saliva), microorganisms and cells (Rubin 2009). Clearance of secretions is very important to maintain a clear airway and reduce the risk of infection (Rubin 2009). However, individuals may deny the existence of sputum due to social stigma or lack of awareness, for example, in cases such as cystic fibrosis or those who smoke excessively. Some, particularly women, feel embarrassed to expectorate, and they are more likely to swallow their sputum.
Respiratory disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
CLINICAL FEATURES Patients with pneumonia are often sick. Symptoms include fever, malaise, lethargy, SOB, cough productive of sputum (rusty = S. pneumoniae) and pleuritic chest pain. Ask about pets/birds at home (psittacosis) and hotel visits (Legionella). Examination: pyrexia; flushed, warm peripheries (septic); increased respiratory rate and heart rate; decreased oxygen saturations; signs of consolidation (percussion note dull, bronchial breathing, crepitations, pleural rub).
Respiratory
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Patients with a suspected acute exacerbation of chronic obstructive pulmonary disease should undergo an arterial blood gas, chest X-ray and ECG. Blood investigations include a full blood count, urea and electrolytes, C-reactive protein and blood cultures. Sputum should also be sent for microscopy, culture and sensitivity. If the patient is on theophylline, a theophylline level should be taken at admission.
Diagnostic performance of an in-house multiplex PCR assay and the retrospective surveillance of bacterial respiratory pathogens at a teaching hospital, Kelantan, Malaysia
Published in Pathogens and Global Health, 2023
Nik Mohd Noor Nik Zuraina, Suharni Mohamad, Habsah Hasan, Mohammed Dauda Goni, Siti Suraiya
Sputum specimens used in this study were collected from the Department of Medical Microbiology and Parasitology, Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia. Leftover sputum specimens were originated from patients visiting Hospital USM with various severities and manifestations of symptomatic upper and/or lower RTIs. All the specimens had initially undergone routine microbial culture by the laboratory technologists, which comprised macroscopic and microscopic examination, sputum culture on blood, chocolate and MacConkey agar plates, followed by antibiotic susceptibility testing. However, information of the sputum culture status was unknown during the sampling to avoid diagnostic accuracy biases. All collected sputum specimens were treated as they were infectious and underwent the same procedure for the evaluation of multiplex PCR assay under blinded conditions. Subsequent to microbial sputum culture, an aliquot containing of at least 500 μl to 1 ml of each sputum (depending on the left-over sputum volume) was collected in 1.5 ml tube for further DNA extraction. All the laboratory procedures involving sputum specimens were performed in a biological safety cabinet (level 2). This study was approved by the Institutional Review Board of the Human Research Ethics Committee, Universiti Sains Malaysia (Reference number: USMKK/PPP/JEPeM [266.3. (3)]).
Disseminated Mycobacterium szulgai in an immunocompromised patient
Published in Baylor University Medical Center Proceedings, 2022
Akanksha Verma, Laura Shevy, Abu Baker Sheikh, David Clanon
Antibiotic susceptibility testing is one of the most helpful tools when choosing an antibiotic regimen to treat a complicated infection. Regrettably, this could not be performed as the organism was no longer viable. Based on the official 2003 American Thoracic Society/Infectious Diseases Society of America statement,5M. szulgai is susceptible to most antituberculous drugs (isoniazid, rifampin, ethambutol, or pyrazinamide), macrolides, and fluoroquinolones. Treatment is most successful with a combination regimen of more than two susceptible antibiotics. While no optimal duration of treatment has been established, in cases of pulmonary involvement, treatment is considered adequate when 12 months of negative sputum cultures are obtained while on therapy. In cases of extrapulmonary involvement, treatment is considered adequate after 4 to 6 months of therapy. In our patient, treatment is prolonged and is ongoing at 9 months due to immunosuppression and drug-induced neutropenia.
Investigation of drug regimens and treatment outcome in patients with Mycobacterium Simiae: a systematic review
Published in Expert Review of Anti-infective Therapy, 2022
Shirin Dashtbin, Shiva Mirkalantari, Masoud Dadashi, Davood Darban-Sarokhalil
Typical symptoms include mild to chronic coughs with mucus production [52]. In this review, mild to severe coughs with sputum production were the main symptoms among the patients with M. simiae pulmonary infections. Lotfi et al. [48] surveyed the clinical features, risk factors, diagnosis, and management of M. simiae infection among 20 patients and found that, similar to the present study, the most common symptoms among the patients were coughing, sputum production, and hemoptysis. However, Jabbour et al. [2] revealed in their study that patients typically present nonspecific symptoms, including mild to severe coughs, hemoptysis, dyspnea, fever, night sweats, malaise, and weight loss. Also, in addition to the symptoms mentioned above, Heap et al. [53] reported intra-abdominal pain among patients with M. simiae infection. In some studies, patients with M. simiae infection have also Cytomegalovirus (CMV), Herpes zoster, and aspergillosis co-infections [54–56].