zithromax and Dyspnea

With the growing number of COVID-19 cases in recent times. significant set of patients with extra pulmonary symptoms has been reported worldwide. Here we venture out to summarize the clinical profile, investigations, and radiological findings among patients with SARS-CoV-2-associated meningoencephalitis in the form of a systemic review. This review was carried out based on the existing PRISMA (Preferred Report for Systematic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase, and Cochrane library and Preprint servers up till 30 June 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2," "COVID-19," and "meningoencephalitis." All peer reviewed, case-control, case report, pre print articles satisfying our inclusion criteria were involved in the study. Quantitative data was expressed in mean ± SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p < 0.05 considered to be statistically significant. A total of 61 cases were included from 25 studies after screening from databases and preprint servers, out of which 54 of them had completed investigation profile and were included in the final analysis. Clinical, laboratory findings, neuroimaging abnormalities, and EEG findings were analyzed in detail. This present review summarizes the available evidences related to the occurrence of meningoencephalitis in COVID-19.

Topics: Adult; Aged; Antiviral Agents; Azithromycin; Confusion; Cough; COVID-19; COVID-19 Drug Treatment; Dyspnea; Electroencephalography; Fatigue; Female; Fever; Humans; Hydroxychloroquine; Male; Meningoencephalitis; Middle Aged; Neuroimaging; SARS-CoV-2

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degrees of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes, and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably parainfectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case. Finally, we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.

Topics: Adult; Anticonvulsants; Ataxia; Azithromycin; Clonazepam; Cough; COVID-19; COVID-19 Drug Treatment; Dyspnea; Female; Fever; Humans; Hydroxychloroquine; Levetiracetam; Male; Middle Aged; Myalgia; Opsoclonus-Myoclonus Syndrome; Oseltamivir; SARS-CoV-2; Valproic Acid

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary condition, characterized by diffuse proliferation of neuroendocrine cells in the respiratory epithelium. DIPNECH lesions are less than 5 mm in size and are limited to the basement membrane with no invasion. There is limited information regarding epidemiology, natural history of disease progression, or the management of this rare entity. We present the experience of a center with extensive expertise in neuroendocrine disease.. A cohort of patients (N = 13) with DIPNECH treated and followed at our institution was identified. We describe the our approach to their care, our disease management and also provide a review of DIPNECH pathophysiology.. Our patient cohort consisted of twelve females and one male with a mean age of 63 years at the time of diagnosis. Dyspnea on exertion and dry cough were the most common presenting symptoms. Two patients were under surveillance without treatment; three patients were treated with a short-acting somatostatin analog; three patients were treated with azithromycin alone; four were treated with a combination of long-acting monthly somatostatin analogs and azithromycin; one patient received a combination of long-acting somatostatin analog and everolimus. Five patients had concomitant bronchial carcinoids.. DIPNECH is a rare pathology that can profoundly affect a patient's quality of life. Paroxysmal coughing episodes can be difficult to treat. Our limited single center experience shows encouraging response to use of somatostatin analogs, azithromycin, and everolimus in the management of debilitating DIPNECH associated symptoms.

Topics: Aged; Anti-Bacterial Agents; Antineoplastic Agents, Hormonal; Azithromycin; Bronchial Neoplasms; Carcinoid Tumor; Cough; Dyspnea; Everolimus; Female; Humans; Hyperplasia; Immunosuppressive Agents; Lung Diseases; Male; Middle Aged; Multiple Pulmonary Nodules; Neuroendocrine Cells; Octreotide; Pulmonary Disease, Chronic Obstructive; Pulmonary Fibrosis; Quality of Life; Respiratory Mucosa

Acute fibrinous and organizing pneumonia, a recently described form of diffuse acute lung injury, sometimes affects adults with inflammatory myopathy. We describe a child with juvenile dermatomyositis who had development of acute fibrinous and organizing pneumonia. There does not appear to be a successful method of treatment, particularly in severe cases with respiratory failure.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Dermatomyositis; Dyspnea; Fatal Outcome; Fatty Liver; Female; Humans; Pneumonia; Prednisone

Bacteria and viruses are equally associated with the risk of acute episodes of asthma-like symptoms in young children, suggesting antibiotics as a potential treatment for such episodes. We aimed to assess the effect of azithromycin on the duration of respiratory episodes in young children with recurrent asthma-like symptoms, hypothesising that it reduces the duration of the symptomatic period.. In this randomised, double-blind, placebo-controlled trial, we recruited children aged 1-3 years, who were diagnosed with recurrent asthma-like symptoms from the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort; a birth cohort consisting of the general Danish population of Zealand, including Copenhagen. Exclusion criteria were macrolide allergy, heart, liver, neurological, and kidney disease, and, before each treatment, one or more clinical signs of pneumonia (respiratory frequency of ≥50 breaths per min; fever of ≥39°C; C-reactive protein concentration of ≥476·20 nmol/L [≥50 mg/L]). Each episode of asthma-like symptoms lasting at least 3 days was randomly allocated to a 3-day course of azithromycin oral solution of 10 mg/kg per day or placebo after thorough examination by a study physician at the Copenhagen Prospective Studies on Asthma research unit. Each episode was randomly allocated independently of previous treatment from a computer-generated list of random numbers in blocks of ten (generated at the Pharmacy of Glostrup). Investigators and children were masked until the youngest child turned 3 years of age and throughout the data validation and analysis phases. The primary outcome was duration of the respiratory episode after treatment, verified by prospective daily diaries and analysed with Poisson regression. Analyses were per protocol (excluding those without a primary outcome measure or who did not receive treatment). This trial is registered with ClinicalTrials.gov, number NCT01233297.. Between Nov 17, 2010, and Jan 28, 2014, we randomly allocated 158 asthma-like episodes in 72 children (79 [50%] to azithromycin and 79 [50%] to placebo). The mean duration of the episode after treatment was 3·4 days for children receiving azithromycin compared with 7·7 days for children receiving placebo. Azithromycin caused a significant shortening of the episode of 63·3% (95% CI 56·0-69·3; p<0·0001). The effect size increased with early initiation of treatment, showing a reduction in episode duration of 83% if treatment was initiated before day 6 of the episode compared with 36% if initiated on or after day 6 (p<0·0001). We noted no differences in clinical adverse events between the azithromycin (18 [23%] of 78 episodes included in final analysis) and placebo (24 [30%] of 79) groups (p=0·30), but we did not investigate bacterial resistance patterns after treatment.. Azithromycin reduced the duration of episodes of asthma-like symptoms in young children, suggesting that this drug could have a role in acute management of exacerbations. Further research is needed to disentangle the inflammatory versus antimicrobial aspects of this relation.. Lundbeck Foundation, Danish Ministry of Health, Danish Council for Strategic Research, Capital Region Research Foundation.

Topics: Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Agonists; Anti-Bacterial Agents; Asthma; Azithromycin; C-Reactive Protein; Child, Preschool; Cough; Denmark; Double-Blind Method; Dyspnea; Early Medical Intervention; Female; Hospitalization; Humans; Infant; Male; Respiratory Sounds; Time Factors

Patient is a 77-year-old female who is a retired teacher living with her husband. Patient presents to the clinic for a post-hospital discharge visit. She was treated for bacterial pneumonia with combination therapy of azithromycin and cefpodoxime. She was diagnosed with COPD seven years ago when she had to be treated for chronic dyspnea, cough, and sputum that kept her breathless and required hospitalization.

Topics: Aged; Azithromycin; Cough; Dyspnea; Female; Humans; Pneumonia, Bacterial; Pulmonary Disease, Chronic Obstructive

In this prospective study, children from 1-month to 12-years, admitted with positive IgM ELISA testing for scrub typhus, were enrolled over 1-year and administered an empirical single dose of azithromycin (10 mg/kg). All 189 (median age 4.84-years) children had fever with median duration of 8 days at admission. Shortness of breath, altered sensorium, headache, lymphadenopathy, hepatosplenomegaly, pallor, oedema and hypotension were the most prominent symptoms/signs. About 46% of children developed complications, among them hepatic, neurological and cardiovascular were most common. Our study showed a remarkable response to azithromycin, with mean defervescence of 32 h and no mortality. The presence of shortness of breath, headache, altered sensorium, hepatosplenomegaly, meningeal signs, severe anemia, leucocytosis, hyponatremia along with/without any of above mentioned three systemic complications were independent predictors for delayed treatment response by multivariate logistic regression analysis. Hepatic, neurological and cardiovascular complications are an emerging trend. Empiric azithromycin based on clinical suspicion of scrub typhus can be lifesaving.

Topics: Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Doxycycline; Dyspnea; Headache; Hepatomegaly; Humans; India; Prospective Studies; Scrub Typhus; Splenomegaly; Treatment Outcome

To explore the clinical benefits of azithromycin in the treatment of Pseudomonas aeruginosa induced bronchiectasis and to evaluate its effect on MUC5AC. From April 2018 to June 2020, 160 patients with bronchiectasis due to Pseudomonas aeruginosa infection were selected. The patients were divided into a control groupand an azithromycin group. Statistics of patients' general clinical data, lung function indexes, sputum volume, oxidative stress level, Bhalla score before and after treatment; Western blot analysis of MUC5AC expression; RT-PCR analysis of TNF-α, IL-8, IL- 1β mRNA expression. The mRNA expression of TNF-α, IL-8 and IL-1β in the azithromycin group was lower than that in the control group (P<0.05). After treatment, the protein expression of MUC5AC in the azithromycin group was lower than that in the control group (P<0.05). The improvement rate in the azithromycin group was significantly higher than that in the control group (P<0.05). The azithromycin group had a lower lung infection rate than the control group (P<0.05). The azithromycin group had a lower dyspnea rate than the control group (P<0.05). Azithromycin treatment has certain clinical benefits for patients with bronchiectasis induced by Pseudomonas aeruginosa and inhibits the MUC5AC expression.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bronchiectasis; Dyspnea; Female; Humans; Interleukin-1beta; Interleukin-8; Male; Middle Aged; Mucin 5AC; Pseudomonas aeruginosa; Pseudomonas Infections; RNA, Messenger; Tumor Necrosis Factor-alpha

We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19).. This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death.. A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107–20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473–14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012–1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000–1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001–1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126–1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811–0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065–0.874, P: 0.031).. The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; C-Reactive Protein; Comorbidity; Coronary Artery Disease; COVID-19; Creatinine; Diabetes Mellitus, Type 2; Dyspnea; Female; Heart Failure; Humans; Hypertension; Hypoxia; L-Lactate Dehydrogenase; Leukocyte Count; Lymphocyte Count; Male; Neoplasms; Neutrophils; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Factors; SARS-CoV-2; Severity of Illness Index; Turkey

There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis.. In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection.. The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.

Topics: Adult; Anti-Bacterial Agents; Antiviral Agents; Azithromycin; Cardiomyopathies; Cesarean Section; Cough; COVID-19; Diagnosis, Differential; Diuretics; Dyspnea; Echocardiography; Electrocardiography; Female; Furosemide; Heart Failure; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Interferon-beta; Lung; Pre-Eclampsia; Pregnancy; Puerperal Disorders; Pulmonary Edema; SARS-CoV-2; Stroke Volume; Tomography, X-Ray Computed

Topics: Adult; Aftercare; Anti-Bacterial Agents; Anti-HIV Agents; Anti-Inflammatory Agents; Azithromycin; Bronchiolitis; CD4 Lymphocyte Count; Denmark; Dyspnea; Granulomatosis with Polyangiitis; HIV Infections; Humans; Malaysia; Male; Pneumonia, Pneumocystis; Prednisolone; Rare Diseases; Respiratory Function Tests; Sustained Virologic Response; Thailand; Tomography, X-Ray Computed; Treatment Outcome; Viral Load

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Biopsy; Bronchi; Bronchography; Diagnosis, Differential; Dyspnea; Female; Hemoptysis; Humans; Kidney Transplantation; Levofloxacin; Malacoplakia; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Azithromycin; Biopsy; Bronchiolitis Obliterans; Bronchodilator Agents; Diagnosis, Differential; Drug Resistance; Dyspnea; Glucocorticoids; Humans; Lung; Male; Middle Aged; Respiratory Function Tests; Tomography, X-Ray Computed; Treatment Outcome

We present an atypical case of subglottic stenosis with diffuse tracheal stenoses in a child responsive only to steroid and azithromycin (AZI) therapy. A 12-year-old boy presented with acute biphasic stridor on the background of an 18-month history of progressive shortness of breath, decreased exercise tolerance and snoring. Subsequent laryngoscopy and bronchoscopy revealed granulation tissue in the subglottic area, two circumferential stenoses of the trachea and a number of fibrous bands at the carina and at the aperture if the right main bronchus were seen. A battery of serological and histological investigations did not reveal a specific aetiology. In the acute phase this patient only responded to steroid therapy. In the medium term, repeat laryngoscopies were performed with sharp division of stenotic bands and balloon dilatation. The patient's condition was unresponsive to non-steroidal anti-inflammatories, multiple first-line antibiotics, and surgical treatment of the tracheal lesions. However definitive treatment was found with the macrolide antibiotic AZI used for its anti-inflammatory properties. This highly unusual case of diffuse tracheal stenoses in a child proved to be a management challenge. Definitive treatment was found with the use of AZI. From our literature search this appears to be the first reported case of AZI successfully treating subglottic and tracheal stenoses.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Child; Dyspnea; Enzyme Inhibitors; Humans; Laryngostenosis; Male; Omeprazole; Prednisone; Respiratory Sounds; Tracheal Stenosis

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Antibodies, Viral; Azithromycin; Cytomegalovirus; Cytomegalovirus Infections; Diagnosis, Differential; DNA, Viral; Dyspnea; Epstein-Barr Virus Infections; Fever of Unknown Origin; Humans; Jaundice, Obstructive; Liver Function Tests; Lung; Male; Radiography; Virus Diseases