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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Brain abscesses are severe infections with lethal outcome in the case of delay in diagnosis and treatment. The authors report their experience about 30 patients with pyogenic brain abscesses treated between 1989 and 2000. The goal of the study is to analyse epidemiological, clinical and therapeutic aspects of this disease. The sex ratio (M:W) was 2,3 and the mean age was 34 years. Predisposing factors were sepsis of adjacent organs (53%) and bacteremia (30%). The clinical manifestations were: fever (83%), headaches (90%) and focal neurologic signs (57%). CT-scan findings were single lesions in 80% of cases. CT-scan showed a deep ring-enhancing lesion with surrounding edema in 77% of cases. Bacteriological agents in 13 cases (43%) were: 4 Staphylococcus aureus, 2 Neisseria meningitidis and 7 negative Gram bacilli. Medical treatment alone was in 77% of cases; seven patients benefited from medical and neurosurgical approaches. Death occured in 10% of cases.
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PMID:[Current concepts in the management of pyogenic brain abscesses]. 1622 Jun 95

Brain abscess with bacteremia caused by Listeria monocytogenes in a young woman with immune thrombocytopenic purpura was reported. The clinical features included fever, headache, and left-side weakness. Computed tomography and magnetic resonance imaging of the brain showed a large single abscess at the right frontoparietal area. L. monocytogenes was isolated from a blood culture. The patient promptly received a surgical drainage. Because she had a history of penicillin allergy, and the organism was resistant to ampicillin, she was treated with trimethoprim-sulfamethoxazole (TMP-SMX) alone for 12 months. During a one-year follow-up period, the patient improved and her neurological deficit gradually recovered. This is the first case of listerial brain abscess in Thailand that was successfully treated with TMP-SMX monotherapy and surgical drainage.
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PMID:Brain abscess due to Listeria monocytogenes: first case report in Thailand. 1710 Mar 94

Escherichia coli meningitis is a frequent pathology in children younger than 3 years old, but is an uncommon disease in adults. E. coli infection is the main cause of intrahospital bacteremia as a consequence of the employment of different medical procedures. Our patient, male, 69 years old, presented with fever, progressive difficulty in breathing, and shivers 24 h after transrectal prostate biopsy, with an absence of any other symptoms. He received prophylactic treatment with ciprofloxacin and later empirical treatment with ampicillin and tobramicin. After that, the patient presented with fever, headache, behavioral changes, somnolence, disorientation, a fluctuating level of conscience, cutaneous widespread pallor, and acute urinary retention. On physical exploration, we observed generalized hypoventilation, Glasgow 10, stiffness of the neck, inconclusive Kernig; the remaining neurological exploration was normal. Systematic of blood: leukocytes = 8,510/mm3 (94.5% polymorphonuclear), platelet = 87,000/mm3, pH = 7.51, pCO2 = 28.8 mmHg, pO2 = 61 mmHg, O2 saturation = 93.8%, and remaining values were normal. Chest X- ray, cranial CT scan, urine cultures were normal. Blood culture: E. coli. CSF: glucose <0.4 g/l, total proteins = 3.05 g/l, PMN = 7 cells. Microscopic examination of the CSF: Gram-negative bacilli; CSF's culture: abundant E. coli. The case of acute meningitis by multiresistant E. coli after transrectal prostate biopsy presented demonstrates that antibiotic prevention with ciprofloxacin is not absolutely risk free. Besides the use of antibiotic prevention for multiresistant microorganisms, the urologist and other physicians involved in the procedure must not forget that the rate of major complications of transrectal prostate biopsy is 1%, especially when it is performed in patients who will not benefit from that biopsy.
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PMID:E. coli multiresistant meningitis after transrectal prostate biopsy. 1761 98

Listeria monocytogene is a well-recognized cause of bacteremia in immunocompromised individuals, including solid organ transplant recipients, but has been rarely reported following orthotopic liver transplantation. We describe a case of listeria meningitis that occurred within a week after liver transplantation. The patient developed a severe headache that mimicked tacrolimus encephalopathy, and was subsequently diagnosed with listeria meningitis by cerebrospinal fluid culture. The infection was successfully treated with three-week course of intravenous ampicillin. Recurrent hepatitis C followed and was successfully treated with interferon alfa and ribavirin. Fourteen cases of listeriosis after orthotopic liver transplantation have been reported in the English literature. Most reported cases were successfully treated with intravenous ampicillin. There were four cases of listeria meningitis, and the mortality of them was 50%. Early detection and treatment of listeria meningitis are the key to obtaining a better prognosis.
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PMID:Listeria monocytogenes following orthotopic liver transplantation: central nervous system involvement and review of the literature. 1770 17

Salmonellosis is a worldwide health problem; Salmonella infections are the second leading cause of bacterial foodborne illness in the United States. Approximately 95% of cases of human salmonellosis are associated with the consumption of contaminated products such as meat, poultry, eggs, milk, seafood, and fresh produce. Salmonella can cause a number of different disease syndromes including gastroenteritis, bacteremia, and typhoid fever, with the most common being gastroenteritis, which is often characterized by abdominal pain, nausea, vomiting, diarrhea, and headache. Typically the disease is self-limiting; however, with more severe manifestations such as bacteremia, antimicrobial therapy is often administered to treat the infection. Currently, there are over 2,500 identified serotypes of Salmonella. A smaller number of these serotypes are significantly associated with animal and human disease including Typhimurium, Enteritidis, Newport, Heidelberg, and Montevideo. Increasingly, isolates from these serotypes are being detected that demonstrate resistance to multiple antimicrobial agents, including third-generation cephalosporins, which are recommended for the treatment of severe infections. Many of the genes that encode resistance are located on transmissible elements such as plasmids that allow for potential transfer of resistance among strains. Plasmids are also known to harbor virulence factors that contribute to Salmonella pathogenicity. Several serotypes of medical importance, including Typhimurium, Enteritidis, Newport, Dublin, and Choleraesuis, are known to harbor virulence plasmids containing genes that code for fimbriae, serum resistance, and other factors. Additionally, many Salmonella contain pathogenicity islands scattered throughout their genomes that encode factors essential for bacterial adhesion, invasion, and infection. Salmonella have evolved several virulence and antimicrobial resistance mechanisms that allow for continued challenges to our public health infrastructure.
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PMID:Food animal-associated Salmonella challenges: pathogenicity and antimicrobial resistance. 1787 85

Staphylococcus aureus bacteremia is a frequent occurrence in patients with indwelling catheters. Endocarditis, osteomyelitis, and septic arthritis are common metastatic complications. A hemodialysis patient developed fever, headache, neck pain, sore throat, and dysphagia in the setting of S. aureus bacteremia. Contrast computed tomography scan of the neck revealed a retropharyngeal phlegmon. Recurrent bacteremia led to the identification of the access graft as the infectious source. We present this case to increase awareness among emergency physicians that retropharyngeal infection by S. aureus can arise by hematogenous spread and should be considered in the differential diagnosis of a bacteremic patient with sore throat or neck pain.
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PMID:Retropharyngeal phlegmon in a hemodialysis patient with Staphylococcus aureus bacteremia. 1829 11

A previously healthy 10-year-old patient with headache, otalgia, and hearing loss was diagnosed with pachymeningitis and methicillin-resistant Staphylococcus aureus otitis media and bacteremia. Despite antimicrobial therapy, intracranial extension progressed, including clival osteomyelitis, sphenoid sinusitis, cavernous sinus inflammation and cranial nerve palsies, until the sphenoid sinus was drained. This case exemplifies an aggressive MRSA intracranial infection that advanced despite antibiotic therapy.
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PMID:MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient. 1847 69

Telavancin is a lipoglycopeptide derivative of vancomycin. Similar to vancomycin, it demonstrates activity in vitro against a variety of Gram-positive pathogens, including but not limited to methicillin-resistant Staphylococccus aureus (MRSA) and penicillin-resistant Streptococcus pneumoniae (PRSP). Modifications to vancomycin's structure expanded telavancin's spectrum of activity in vitro to include organisms such as glycopeptide-intermediate S. aureus (GISA), vancomycin-resistant S. aureus (VRSA) and vancomycin-resistant enterococci (VRE). However, the clinical implications of this are currently unknown. Similar to other glycopeptides, televancin binds to the D-alanyl-D-alanine (D-Ala-D-Ala) terminus in Gram-positive organisms, resulting in inhibition of bacterial cell wall synthesis. In addition, telavancin causes depolarization of the bacterial cell membrane and increased membrane permeability. The resulting activity in vitro is rapidly bactericidal and concentration dependent, with the ratio of area under the time concentration curve to minimum inhibitory concentration (AUC/MIC) as the best predictor of activity in animal models to date. In humans, telavancin exhibits a pharmacokinetic profile that permits once-daily intravenous administration. Doses of 7.5 and 10 mg/kg/day have been studied in clinical trials. The need for dosage adjustments based on age, gender and obesity appear unnecessary. In addition, moderate hepatic impairment does not appreciably alter the pharmacokinetics of the drug. Because telavancin is extensively cleared by the kidneys, dosage adjustments will be required in patients with moderate to severe renal impairment. Published phase II and III clinical trials have shown telavancin to be comparable to standard therapy for the treatment of complicated skin and soft tissue infections. Clinical trials in the treatment of S. aureus bacteremia and hospital-acquired pneumonia are under way. Adverse effects overall appear to be mild and reversible, with taste disturbance, foamy urine, headache, procedural site pain, nausea and vomiting being the most commonly reported. However, renal toxicity was reported more frequently with telavancin than with vancomycin in two phase III clinical trials (3% versus 1%). Prolongation of the corrected QT (QTc) interval has been more common with telavancin than comparator agents, but no clinically significant electrocardiogram (ECG) changes or cardiac abnormalities have been observed to date. Although human pregnancy data is not currently available, animal data revealed limb malformations that were possibly related to telavancin therapy. Therefore, the potential teratogenicity of this agent must be considered in women who are pregnant or may become pregnant.
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PMID:Telavancin: a new lipoglycopeptide for gram-positive infections. 1943 39

Scrub typhus is widespread in rural south and southeastern Asia and the western Pacific. The scrub typhus incidence is the highest among vector-borne diseases in Japan, but imported cases are extremely rare. A 49-year-old man admitted for persistent fever, headache, and rash after returning from Myanmar had been exposed to mosquito and tick bites while doing a 12-day forest inventory in Myanmar. On admission, he had a generalized maculopapular rash but no apparent eschars characteristic of scrub typhus. Blood examination and abdominal ultrasonography showed elevated liver enzymes, thrombocytopenia, and hepatosplenomegaly. Repeated blood smears and blood cultures were negative for malaria infection and bacteremia. Dengue fever was denied by both PCR and serology. The patient deteriorated on the ninth day and suffered complications of rhabdomyolysis, pneumonia, and enteritis. Based on a tentative diagnosis of typhoid fever or rickettiosis, we administratered ceftriaxone and minocycline, which dramatically reduced clinical signs and symptoms. After discharge on day 19, immunofluorescence assay showed significantly increased antibodies for Orienta tsutsugamushi serotype Gilliam, first discovered in Myanmar. All serological results were negative for other rickettioses, leptospirosis and Q fever. Given the many travelers from Japan visiting endemic scrub typhus areas, we must recognize cases of imported scrub typhus among those travelers with fever and rash returning from endemic areas.
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PMID:[Case of imported scrub typhus contracted in Myanmar]. 1952 10

Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B. holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.
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PMID:[Bordetella holmesii bacteremia in a 26-year-old patient with sickle cell disease]. 1958 32


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