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Related Concept Videos

Methods of reducing fever01:22

Methods of reducing fever

The signs and symptoms of fever include hot and dry skin, flushed face, thirst, muscle aches, anorexia, headache, tachycardia, tachypnea, and fatigue. Elevated body temperature is reduced using two methods: pharmacological and nonpharmacological. Proper identification and treatment of the root cause of a fever is of utmost importance.
Pharmacological Methods of Reducing Fever:
Pulmonary Tuberculosis V01:28

Pulmonary Tuberculosis V

Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the progression...
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics01:23

Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics

Respiratory symptoms, such as congestion and cough, commonly accompany respiratory tract conditions. Various medications, such as antitussives, expectorants, and mucolytics, play crucial roles in providing relief.
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla.  Benzonatate operates peripherally within the respiratory tract by anesthetizing...
Pulmonary Tuberculosis IV01:26

Pulmonary Tuberculosis IV

Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...

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Related Experiment Videos

Fever and Cough in Methotrexate-treated Patients: An Approach.

L S Aboussouan1, J M Cash

  • 1Departments of Pulmonary and Critical Care Medicine (L.S.A.) and Rheumatic and Immunologic Diseases (J.M.C.), Cleveland Clinic Foundation, Cleveland, Ohio.

Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases
|December 17, 2008
PubMed
Summary

Acute methotrexate pneumonitis, a lung condition affecting up to 5.5% of patients, presents with cough, fever, and infiltrates. Diagnosis requires excluding infection and confirming with histology, often responding to corticosteroids.

Related Experiment Videos

Area of Science:

  • Pulmonology
  • Rheumatology
  • Pharmacology

Background:

  • Acute methotrexate pneumonitis (AMP) affects up to 5.5% of patients treated with methotrexate.
  • AMP symptoms like cough, dyspnea, and fever can mimic opportunistic infections or underlying rheumatic disease infiltrates.
  • Accurate diagnosis is crucial for appropriate management and to prevent severe outcomes.

Purpose of the Study:

  • To outline the diagnostic criteria for acute methotrexate pneumonitis.
  • To emphasize the importance of differentiating AMP from other pulmonary conditions.
  • To discuss diagnostic methods and treatment strategies for AMP.

Main Methods:

  • Clinical presentation review including cough, dyspnea, fever, pulmonary function tests, and chest radiograph findings.
  • Diagnostic confirmation through exclusion of infection and histologic evidence.
  • Utilizing bronchoalveolar lavage (BAL) for cultures and special stains.
  • Employing transbronchial biopsy and considering open lung biopsy when necessary.

Main Results:

  • Recognition of AMP relies on characteristic clinical symptoms, new pulmonary function abnormalities, and acute radiographic infiltrates.
  • Histologic confirmation and exclusion of infection are essential for definitive diagnosis.
  • BAL and transbronchial biopsies can identify opportunistic pathogens and provide diagnostic material.
  • Open lung biopsy is reserved for cases undiagnosed by bronchoscopy.

Conclusions:

  • Acute methotrexate pneumonitis requires a high index of suspicion and a systematic diagnostic approach.
  • Prompt diagnosis and treatment, including drug discontinuation and corticosteroid therapy, can lead to favorable outcomes.
  • Despite a potential mortality of up to 10%, AMP is often responsive to treatment, highlighting the importance of early recognition.