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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With the purpose of describing the clinical and laboratory characteristics of cryptococcus meningoencephalitis, we reviewed the records of 104 patients admitted with this diagnosis at Couto Maia Hospital, reference for patients with infectious diseases in Salvador-BA Northeastern Brazil, from 1972 to 1996. The patients' age varied from 8 months to 79 years. Sixty-four (61.5%) patients were male. The duration of the disease varied from 2 to 150 days, average 27.7 days. The most common signs and symptoms were headache (92.7%), fever (84.4%) and neck stiffness (83.2%). The cell number in cerebrospinal fluid was greater than 4/mm > or = in 95.8% of the patients with lymphocyte predominance in 86.3% of the cases. The lethality rate was 42.7%.
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PMID:[The clinical laboratory characteristics of 104 cases of cryptococcal meningoencephalitis]. 1088 Nov 14

Leptospirosis, a zoonosis with worldwide distribution, may have a broad spectrum of clinical manifestations that can delay the diagnosis, especially in wet climates where other conditions may dissimulate the main aspects. The authors describe 42 cases of patients with leptospirosis admitted to the Infectious Diseases Unit of a general hospital since 1990. The goal was to analyse epidemiological features, clinical manifestations, laboratory findings, treatment and evolution. There were 23 males (54.7%) and 19 females (45.2%), with ages ranging from 17 to 82 years. Most cases occurred in occupational settings, especially in those in contact with animals or stagnant water. All the cases had serological confirmation (by MAT or ELISA methods). Anicteric forms represented 42.9% of the total, which implies that in many cases a diagnosis is not immediately evident. The main symptoms, other than fever (97.6%) and jaundice (57.1%), were myalgia (71.4%), headache (42.8%) and nausea (33.3%). Renal involvement was common (52%), but the most severe forms occurred in 3 patients who required hemodialysis; followed by D.I.C. in 9.5%; meningitis in 4.7% and pulmonary involvement in 2.3% of the cases. The serovars most commonly identified were L. icterohaemorraghiae (28.5%), L. australis (14.3%), L. grippothyphosa (11.9%) and L. canicola (9.5%). The patients were treated with penicillin G (83.3%) or doxycyclin (9.5%). Two of them deceased (4.7%) and the remainder had a good evolution. The diagnosis of leptospirosis may be delayed if physicians fail to include this infection in the initial differential diagnosis. In view of this, the authors emphasize that when nonspecific clinical manifestations occur, a good epidemiological history is useful in proposing this diagnosis.
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PMID:[Human leptospirosis. A short review concerning a caseload]. 1089 35

Coccidioides immitis is a causative agent of coccidioidomycosis, which is one of the most dreadful mycosis because of its infectious and pathogenic nature. The endemic areas are in the southwestern parts of the United States and other semi-arid regions throughout the Western Hemisphere. During the early 1990s, the incidence of coccidioidomycosis in California increased dramatically, resulting in recognition for this mycosis as a reemerging infectious disease in the United States. The patients included a large number of non-informed visitors from non-endemic countries. Our report is on an imported case of primary pulmonary coccidioidomycosis. A 35-year-old Japanese male, after living in the United States for nine months, suffered from a combination of headache and fever. He was given a serological examination, and a chest radiograph in Phoenix, Arizona in the United States and was diagnosed as coccidioidomycosis. A daily dosage of 400 mg of fluconazole was administered and he returned to Japan. His headache and skin rash persisted and he was admitted to our hospital to evaluate the severity of his disease. There were no fungi cultured from neither bronchoalveolar nor cerebrospinal fluid and he was discharged. The patient had been treated with fluconazole and his symptoms, high-resolution CT and serological antibody titer were monitored. After 18 months, his clinical and radiological evolution was favorable and his serological IgM titer was below its sensitivity medication was stopped and there were no relapses.
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PMID:[An imported case of primary pulmonary coccidioidomycosis]. 1096 61

Methotrexate has a long history of use in the treatment of various immunologic diseases, including rheumatoid arthritis and psoriasis. Although the drug is usually prescribed by a subspecialist, a family physician may assume responsibility for monitoring methotrexate therapy. Major toxic effects, such as hepatic, pulmonary, renal and bone marrow abnormalities, require careful monitoring. Minor toxic effects, such as stomatitis, malaise, nausea, diarrhea, headaches and mild alopecia, are common but respond to folate supplementation. Methotrexate is administered once weekly as a single dose or in divided doses given over a 24-hour period. To reduce the incidence of major toxic effects, methotrexate should never be given in daily doses. Relative contraindications include renal dysfunction, liver disease, active infectious disease and excessive alcohol consumption. Both women and men of reproductive age should use birth control during methotrexate therapy. Potential drug interactions include salicylates and nonsteroidal anti-inflammatory drugs, which are both commonly used in patients with rheumatoid arthritis or psoriasis. A premethotrexate evaluation is important to ensure proper patient selection for this effective but potentially toxic drug.
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PMID:A family physician's guide to monitoring methotrexate. 1103 77

Members of the genus Trypanosoma cause African trypanosomiasis in humans and animals in Africa. Infection of mammals by African trypanosomes is characterized by an upregulation of prostaglandin (PG) production in the plasma and cerebrospinal fluid. These metabolites of arachidonic acid (AA) may, in part, be responsible for symptoms such as fever, headache, immunosuppression, deep muscle hyperaesthesia, miscarriage, ovarian dysfunction, sleepiness, and other symptoms observed in patients with chronic African trypanosomiasis. Here, we show that the protozoan parasite T. brucei is involved in PG production and that it produces PGs enzymatically from AA and its metabolite, PGH(2). Among all PGs synthesized, PGF(2alpha) was the major prostanoid produced by trypanosome lysates. We have purified a novel T. brucei PGF(2alpha) synthase (TbPGFS) and cloned its cDNA. Phylogenetic analysis and molecular properties revealed that TbPGFS is completely distinct from mammalian PGF synthases. We also found that TbPGFS mRNA expression and TbPGFS activity were high in the early logarithmic growth phase and low during the stationary phase. The characterization of TbPGFS and its gene in T. brucei provides a basis for the molecular analysis of the role of parasite-derived PGF(2alpha) in the physiology of the parasite and the pathogenesis of African trypanosomiasis.
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PMID:Identification of a novel prostaglandin f(2alpha) synthase in Trypanosoma brucei. 1106 81

Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries.
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PMID:Emergency department presentations of typhoid fever. 1107 22

We set out to describe the occurrence of headache in adolescents in general practice, the diagnoses made, the referrals to specialised care and the role of psychosocial problems in idiopathic headache. Data from the Dutch national survey of morbidity and interventions in general practice were used. The practice population (103 practices) comprised 37,187 children aged 12-18 years. In 650 episodes headache was a reason for encounter. The incidence of headache as presented to the GP was 69.9 per 1000 person years. The incidence in girls was twice as high as in boys. Half of the episodes with headache complaints were related to an infectious disease. The incidence rate of idiopathic headache was 18.0 per 1000 person years. Eight percent of all headache episodes were diagnosed as a psychosocial problem. Of all episodes, 25% percent were diagnosed as idiopathic headache (i.e. headache as symptom diagnosis, tension headache or migraine). Of these episodes, 21% were associated with an underlying psychosocial problem. Referrals were made by the GP in three percent of all headache episodes and four percent of idiopathic headache episodes. Headache in adolescents is a common reason for visiting a general practice. The symptom is often associated with an infectious disease. The GP is aware of underlying psychosocial problems. Only few children are referred for specialist care.
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PMID:Headache in adolescents in Dutch general practice. 1120 Jul 83

We studied the neurological comorbidity of parkinsonism in 368 consecutive patients from the Lausanne Movement Disorders Registry. Only 6 patients had no neurological comorbidity. We found that 23p.100 of our patients had ischemic strokes, especially large vessel strokes, i.e three times more than in an age-matched control study performed in a recent survey in our country, which is a new finding in contradiction with previous reports mentioning that Parkinson's disease may be a protective factor against stroke. This finding opens new directions for further studies concerning some shared mechanisms in both diseases associated with age. Predominantly tremulous parkinsonism (46p.100) and progressive supranuclear palsy patients (PSP) (40p.100) had the highest prevalence of cerebrovascular disease of all subgroups of parkinsonism, especially lacunar infarcts, which is in accord with a higher frequency of hypertension in these subgroups according to a recent study of ours. Transient ischemic attacks or hemorrhages were not more frequent than in the general population. We did not find a higher frequency of head trauma except for Parkinson's disease, but a trend for a higher frequency of headache and migraine. Brain tumors were more frequent in Parkinson's disease and hydrocephalus and radiculopathies in parkinsonism in general when compared to age-matched populations from the literature. Polyneuropathies were more frequently observed in familial parkinsonism only, but myopathies and cranial neuropathies were not more frequent in our patients. Epilepsy was significantly less frequent in parkinsonism, especially in Parkinson's disease, infectious diseases of the nervous system were rarely encountered, and restless legs syndrome was surprisingly not more frequent than in a normal population. Dementia was associated in 20p.100, but multiple sclerosis is noticeably absent.
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PMID:[Neurological comorbidity in parkinsonism]. 1124 May 47

Schistosomiasis japonica is a serious communicable disease and a major disease risk for more than 30 million people living in the tropical and subtropical zones of China. Infection remains a major public health concern despite 45 years of intensive control efforts. It is estimated that 865,000 people and 100,250 bovines are today infected in the provinces where the disease is endemic, and its transmission continues. Unlike the other schistosome species known to infect humans, the oriental schistosome, Schistosoma japonicum, is a true zoonotic organism, with a range of mammalian reservoirs, making control efforts extremely difficult. Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death. Infected children are stunted and have cognitive defects impairing memory and learning ability. Current control programs are heavily based on community chemotherapy with a single dose of the drug praziquantel, but vaccines (for use in bovines and humans) in combination with other control strategies are needed to make elimination of the disease possible. In this article, we provide an overview of the biology, epidemiology, clinical features, and prospects for control of oriental schistosomiasis in the People's Republic of China.
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PMID:Schistosomiasis in the People's Republic of China: prospects and challenges for the 21st century. 1129 39

Brucellosis is hyperendemic in Saudi Arabia. We report infection in a breast implant as an unusual complication of laboratory-acquired brucellosis. A 48-year-old female developed fever, rigors, headache, arthralgia and weight loss. A blood culture for Brucella was positive. A 6-week course of antibiotics effected a clinical and bacteriological cure but the resolution was short-lived. Six weeks later a relapse of her febrile symptoms occurred together with the appearance of a breast abscess. Cultures of the abscess and blood yielded brucella. A second course of antibiotics together with surgical drainage and subsequent reconstruction resulted in a cure.
Infection 2001 Oct
PMID:Unusual complication of breast implants: Brucella infection. 1168 12


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