Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied 100 patients with tick-borne meningopolyneuritis (Garin-Bujadoux, Bannwarth), the neurologic component of European erythema chronicum migrans disease. They had intensive radicular pain, asymmetric polyneuritis combined often with uni- or bilateral facial palsy, lymphocytic meningitis without or with only slight meningismus, and a course lasting three to five months. Neurologic abnormalities were preceded by the bite of a tick or an insect in 37 percent of patients or by an erythema in 41 percent. In addition, many patients had extraneural involvement, such as fever or fatigue. The outcome was favorable in all cases, and occurred faster with antibiotic treatment, but a few patients had slight residual peripheral nervous system deficits.
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PMID:Tick-borne meningopolyneuritis (Garin-Bujadoux, Bannwarth). 609 60

Lyme meningitis is the direct result of invasion of the nervous system by Borrelia burgdorferi. Occurring within the first few months of infection, it initially presents as a chronic basilar meningitis. Much about the pathogenesis of Lyme meningitis has been learned from animal models, the best being the adult Rhesus macaque. Injection of these animals with a highly infective strain of B. burgdorferi has led to a very predictable course of events: erythema migrans within the first few weeks after injection, development of anti-B. burgdorferi antibody, detection of spirochetemia in weeks 3 and 4, and central nervous system (CNS) invasion within 1 month with cerebrospinal fluid (CSF) pleocytosis. In humans, facial palsy is the earliest clinical indicator. Headache and meningismus are symptoms of inflammation of the subarachnoid space. Severe fatigue and arthralgia are common extra-CNS symptoms. Culture is not generally useful for detecting or confirming Lyme meningitis. False-positive serologic tests may occur in patients with other infections, inflammatory processes, or malignancies. Immunoblotting will differentiate true-from false-positive antibody reactivity. Lack of a consistently positive serum antibody titer should make the diagnosis of Lyme meningitis suspect. Positive CSF antibody is almost universal in patients with Lyme meningitis. Polymerase chain reaction is a direct test that is highly specific and sensitive. The antibiotic treatment of choice is intravenous (i.v.) cephalosporins or penicillin for 2-3 weeks. If the clinical picture is anything less than absolutely classic, a lumbar puncture and Western blot of serum should be obtained in a seropositive patient before initiating intravenous antibiotic therapy. There is no role at this time for long-term (> 1 month) intravenous antibiotics. Nonsteroidal antiinflammatory agents can also be of benefit.
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PMID:Early disseminated Lyme disease: Lyme meningitis. 772 90

Listeria monocytogenes rhombencephalitis has never been studied in a significant group of patients. We describe 14 adult cases who were seen over a 10-year period. A biphasic illness was characteristic: (1) prodromes (5-15 days) with malaise, fatigue, headache, nausea or vomiting, and fever; (2) cranial nerve palsy with facial palsy, diplopia, dysphagia, dysarthria, usually multiple. Meningism and hemi- or tetraparesis were present in 11 patients and cerebellar dysfunction in 9 patients. In 4 cases, CT showed widening of the brain stem with disappearance of the surrounding cisterns. The cerebrospinal fluid was abnormal in all patients in whom this investigation was done (pleocytosis, elevation in protein content). The patients received antibiotic therapy for 2-6 weeks. In the 9 patients who recovered, the neurological dysfunction improved within 2 days to 1 week of the initiation of therapy. There were 5 deaths. At autopsy in 2 cases, there was severe purulent meningitis and rhombencephalitis with predominantly polymorphonuclear cellular infiltration in 1 case, while numerous microabscesses in the midbrain, pons and medulla were observed in the other. We conclude that L. monocytogenes infection should be considered in patients who develop fever and focal neurological signs particularly localized to the brain stem.
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PMID:Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases. 849 12

An immunocompetent 51 year-old female presented to the Emergency Department (ED) with a chief complaint of transient loss of consciousness and was found to have cryptococcal meningitis. She complained of general fatigue and a 'cramping' sensation in her right arm for one week. The physical exam was significant for the presence of a right homonymous hemianopsia and the absence of fever or signs of meningismus. A computed tomography (CT) of the brain was interpreted as showing an age-indeterminate infarct in the left parietal region. However, a magnetic resonance imaging (MRI) of the brain showed multiple areas of meningeal enhancement. Cerebrospinal fluid analysis revealed a positive cryptococcal antigen and 105 white blood cells. The patient was successfully treated with Amphotericin B and fluconazole. While cryptococcal meningitis is typically a disease of the immunocompromised, it can, as in this case, present in an immuncompetent host.
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PMID:Transient loss of consciousness caused by cryptococcal meningitis in an immunocompetent patient: a case report. 1914 89

Bacterial meningitis and meningococcal sepsis are rare in adults. Any diagnostic delays with subsequent delay to treatment can have disastrous consequences. The decline in bacterial meningitis over the past few decades has not been accompanied by a reduction in case fatality rate which can be as high as 20% for all causes of bacterial meningitis and 30% in pneumococcal meningitis. The classic triad of neck stiffness, fever and altered consciousness is present in < 50% of cases of bacterial meningitis. Patients with viral meningitis also present with signs of meningism (headache, neck stiffness and photophobia) possibly with additional non-specific symptoms such as diarrhoea or sore throat. Suspected cases of meningitis or meningococcal sepsis must be referred for further assessment and consideration of a lumbar puncture. Most patients will fully recover. However, the sequelae of bacterial meningitis and meningococcal disease can be disabling. Many patients feel well at discharge and do not realise that they may not be able to return to all their normal duties and activities straightaway. Fatigue, headaches, sleep disorders and emotional problems are often reported in the weeks and months after discharge.
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PMID:Have a high index of suspicion for meningitis in adults. 2899 55