ABSTRACT
We describe a 23-year-old patient who presented acutely with haemophagocytic lymphohistiocytosis (HL) and Melkersson-Rosenthal syndrome (MRS). MRS and HL are two unusual and complex clinical patterns that may present acutely and to our knowledge, an association between them has never been reported. The clinical investigations in this patient led to identification of parvovirus B19 (PB19) viraemia by PCR. Parvovirus infection has been reported as a cause of virus-associated HL, but the presence of PB19 has never been sought or reported as a possible trigger for MRS. This observation suggests a possible association between PB19 and HL, and opens the possibility of its association also with acute-onset MRS. Further investigations for the presence of PB19 in cases of MRS are warranted.
Subject(s)
Lymphohistiocytosis, Hemophagocytic/pathology , Melkersson-Rosenthal Syndrome/pathology , Parvoviridae Infections/pathology , Parvovirus B19, Human , Fatal Outcome , Humans , Lymphohistiocytosis, Hemophagocytic/immunology , Male , Melkersson-Rosenthal Syndrome/immunology , Parvoviridae Infections/immunology , Parvovirus B19, Human/immunology , Severity of Illness Index , Viremia/diagnosis , Viremia/virology , Young AdultABSTRACT
Even though chronic cough (CC) is a bothersome symptom, only a small number of studies have evaluated its specific burden on health-related quality of life (HRQL). The aim of the present study was to assess how the presence of CC interferes with HRQL. A total of 95 outpatients were enrolled during medical consultation at our "Chronic Cough Center". A health status measure (SF-36) and a new HRQL questionnaire specific for CC (CCIQ) were administered before the initial visit. Compared to the reference sample, CC patients reported significantly lower scores in 5 of 8 SF-36 domains: Social functioning (t=10.292), Physical role limitation (t=9.667), Emotional role limitation (t=7.712), General health (t=5.154) and Vitality (t=4.426). The analysis of CCIQ scores showed a disability due to CC, independent of its etiology. The greatest disabilities were observed in the Social relationship (58.33) domain, followed by Sleep/Concentration (54.26), Mood (51.49) and Daily activities (47.69). Sleep, disturbing the partner, and irritability were the three outstanding aspects, affecting 80% of patients. These results show that CC has a high negative impact on HRQL, and they further suggest that the CCIQ is a useful tool for obtaining a global evaluation including its impact and therapeutic options.
Subject(s)
Cough/psychology , Quality of Life , Surveys and Questionnaires , Affect , Asthma/complications , Asthma/psychology , Chronic Disease/psychology , Cough/etiology , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/psychology , Humans , Interpersonal Relations , Male , Nose Diseases/complications , Nose Diseases/psychology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/psychology , SleepABSTRACT
INTRODUCTION: Chronic cough, one of the most frequent causes for a patient to consult a medical practitioner, limits the course of normal activities in everyday life of the patient affected (work, physical activities, social relations, night sleep). By now, there are few validated questionnaires for the evaluation of the impact of this symptom in the patient's quality of life (QoL). For this reason, we created a new questionnaire for the assessment of QoL in patients affected by chronic cough (Chronic Cough Impact Questionnaire, CCIQ). MATERIALS AND METHODS: In the development procedure of CCIQ an initial questionnaire of 40 items was compiled and given to a first pool of 170 patients, each coming to our attention because of chronic cough; then the 25 most significant items were detected and converted into questions evaluating the answers on a Likert scale of five steps. Consequently, this final questionnaire underwent a validation procedure to assess its construct validity, internal consistency, reliability, and responsiveness. 95 patients (44.2% F, 55.8% M) were evaluated (age 53.69 +/- 11.7 years). RESULTS: Following a statistical analysis, CCIQ showed a four-dimensional structure and good levels of internal consistency for the extracted factors: sleep/concentration (79.98), relationship (86.98), daily life impact (69.04), and mood (65.41). In stable conditions CCIQ showed a good reliability, ranged between 0.67 and 0.88. Responsiveness to clinical changes was accomplished. DISCUSSION: These results provide evidence that CCIQ has specificity enough for being a valid tool for detecting the relative burden of cough on subjective well-being, and for obtaining a global evaluation both of chronic cough impact and of treatments for it, taking into account the patient's point of view. The CCIQ was easily and quickly filled in by the patients while waiting, and it was accepted by the patients.
