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

PRESENTING FEATURES: A 29-year-old woman with a history of rheumatic heart disease and one episode of endocarditis as an adolescent was admitted to the hospital after 1 week of headache, fever, and myalgia. Her past medical history was otherwise unremarkable and did not include illicit drug use. On physical examination, she had a previously noted 3/6 holosystolic murmur at the apex, which radiated to her back; a previously noted 1/4 diastolic murmur at the right upper sternal border; diminished strength in her right upper extremity; multiple painful erythematous nodules on her fingers (Figure 1); and red streaks under her nails (Figure 2). Magnetic resonance imaging of the brain demonstrated multiple lesions; the largest was in the right frontal lobe with associated hemorrhage (Figure 3). What is the diagnosis?
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PMID:Cases from the osler medical service at Johns Hopkins University. 1213 56

A patient with multiple mycotic aneurysms associated with infective endocarditis is reported. A 45-year-old man was admitted on February 16, 2001 under the diagnosis of infective endocarditis. After alpha-streptococcus was identified by a blood culture, he was treated with high doses of antibiotics. However, 2 weeks after admission, he suddenly suffered from headache and mild left hemiparesis. A CT showed a parenchymal hematoma in the right parietal lobe. Cerebral angiography demonstrated aneurysms of the bilateral middle cerebral artery and the left posterior cerebral artery. At first, we trapped and resected the ruptured right middle cerebral aneurysm. After the surgery, we tried to treat two unruptured aneurysms by endovascular treatment. During the provocation test for the posterior cerebral artery, the arterial wall was perforated by a guide wire. The parent artery was occluded by coils at this site. Although the aneurysm was still filled by retrograde blood flow, it finally disappeared six months after treatment. The left middle cerebral artery aneurysm could not be treated because the provocation test showed cognitive deficits. The patient recovered from infective endocarditis after four-months of antibiotic therapy; and the unruptured aneurysm had not changed in size for 11 months. Recently, the outcome of patients with intracranial mycotic aneurysm is improved by development of multimodality management. Especially, endovascular therapy may become an effective treatment for unruptured aneurysms, but it is necessary to take risks, such as arterial perforation into consideration.
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PMID:[A case of multiple mycotic intracranial aneurysms]. 1253 8

A non-neutropenic patient receiving corticosteroids for systemic lupus erythematosus presented with fever, headache, and seizures. Ring enhancing lesions were found on computed tomography of the brain, and biopsy demonstrated Aspergillus fumigatis. Despite treatment, the patient died, and necropsy revealed Aspergillus endocarditis of the mitral and tricuspid valves.
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PMID:A young woman with ring-enhancing lesions. 1287 3

Q fever is a bacterial zoonosis caused by Coxiella burnetii, a unique intracellular coccobacillus, adapted to live within the phagolysosomes of macrophages and monocytes. It is highly infectious, with as little as one organism needed to cause clinical infection, making it an attractive organism for use in biowarfare. Despite its high infectivity, it has low virulence, and most patients undergo only asymptomatic seroconversion. Acute clinical manifestations are a nonspecific febrile illness, pneumonia, hepatitis, and neurologic abnormalities ranging from headache to meningoencephalitis. Chronic Q fever can result in endocarditis, hepatitis, or a chronic fatigue syndrome. Diagnosis usually is made by serology because culture of the highly contagious organism is potentially hazardous. Tetracyclines are the antibiotics of choice. When individualized therapy is possible, a 14- to 21-day course of doxycycline usually is used. In a mass casualty situation, a 5- to 7-day course of doxycycline is recommended, both for therapy and prophylaxis. For chronic infections such as endocarditis, 18 months of doxycycline supplemented with hydroxychloroquine is currently the best therapy.
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PMID:Q fever as a biological weapon. 1450 80

Brucellosis is a common zoonotic disease transmittable to humans from infected animal reservoirs. Malta, Rock, Gibraltar, Cyprus or Mediterranean fever, Bang's disease, intermittent typhoid or typho-malarial fever, undulant fever, etc. are just various synonyms for brucellosis. Patients suffering from this disease show unspecific symptoms, e.g. fever, chills, malaise, arthralgia, headache, tiredness and weakness. Human brucellosis may be caused by four of totally six genetically and phenotypically closely related Brucella species, i.e. B. melitensis, B. abortus, B. suis and B. canis. Although many organ systems may be involved, brucellosis is rarely fatal. Therapeutic failure and relapses, chronic courses and severe complications like bone and joint involvement, neurobrucellosis and endocarditis are characteristic for the disease. A definite diagnosis requires the isolation of Brucellae from blood, bone marrow or other tissues. However, cultural examinations are time-consuming, hazardous and not sensitive. Thus, clinicians often rely on the indirect proof of infection. The detection of high or rising titers of specific antibodies in the serum allows a tentative diagnosis. A variety of serological tests has been applied, but at least two serological tests have to be combined to avoid false negative results. Usually, the serum agglutination test is used for a first screening and complement fixation or Coombs' test will confirm its results. As Brucella ELISAs are more sensitive and specific than other serological tests, they may replace them step by step. This review will summarize advantages and disadvantages of the serological techniques used in clinical laboratories for indirect verification of human brucellosis.
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PMID:Laboratory-based diagnosis of brucellosis--a review of the literature. Part II: serological tests for brucellosis. 1465 29

A 23-year-old woman presented with a history of some months of malaise, anorexia, fever and behavioural changes. She had been examined by a general physician on repeated occasions before coming to the hospital. After physical examination and laboratory investigations, she was sent home. She returned to the hospital the same day with increased drowsiness and headache. Additional diagnostic procedures were performed. An echocardiography showed vegetations on the mitral valve. A CT scan of the brain showed a left frontotemporal haemorrhage. Infective endocarditis with septic embolisation to the brain, which resulted in a cerebral haemorrhage, was diagnosed. The patient was admitted and intravenous antibiotics were administered. Because of haemodynamic instability, a mitral valve replacement was performed on the fifth day of admission. The patient recovered well postoperatively. Four weeks later, she was found in a comatose condition. She died as a result of a second intracerebral haemorrhage, which was probably caused by a mycotic aneurysm. An important lesson to be learned from this case is that endocarditis should be considered in patients with a long history of anorexia, weight loss, malaise and fever, especially when a heart murmur is present. Secondly, if intracranial haemorrhage has occurred in patients with infective endocarditis, therapeutic options should always be discussed with a neurosurgeon, even in those cases where the probability of a mycotic aneurysm is low.
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PMID:[Clinical reasoning and decision making in practice. A 23 year old woman with malaise, anorexia, fever and behavior changes]. 1549 47

Infection disease due to Listeria monocytogenes, which is a ubiquitous positive Gram bacillus to the essentially alimentary transmission, listeriosis happens on patients presenting an immunodeficiency. The authors report the two first cases of listeriosis diagnosed at Hopital Principal de Dakar. The first case was observed on a 73 years old man, hospitalised for a feverish coma scored at 9 using Glasgow scale, with neither meningitis syndrome, nor sign of neurological localisation. The analysis of the RLC reveals a hypercytosis at 126 GB/mm3, with prevailing neutrophile polynuclears, a hyperproteinorachia at 3.2 g/l. The culture of the RLC was sterile but the blood culture showed the presence of L. monocytogenes. The other paraclinical tests has revealed a glycaemia at 2.45 g/l, an imporant hepatic cytolisis with ASAT at 13 N and ALAT at 20 N. The patient was also presenting a cerebromeningitis and hepatic listeriosis on a diabetic field. The second case was observed on a 58 years old patient admitted for headaches, fever and an important degradation of the general state with an emaciation of 17 kg in 5 months. The physical screening revealed a bad general state, a fever at 38 degrees 2 and was without other particularity. The analysis of the RLC showed a hyperproteinorachia at 1.35 g/l with neither hypercytosis nor germ at the culture. Haemoculture isolated Listeria monocytogenes. HIV serology was positive. CD4 were counted to 61/mm3. and the viral charge was at 110.000 copies / mm3. The patient was presenting a Listeria monocytogenes at meningo-encephalitis on HIV-1 field. stade B of the CDC classification. This ubiquitous anthropozoonosis should be searched through early haemocultures before antibiotherapy. in case of long lasting fever, endocarditis, meningo-encephalitis, localised infections on children. pregnant women, diabetic persons, and people infected with HIV and some others presenting immunity troubles.
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PMID:[Listeria disease. The first 2 cases reported at the Principal Hospital of Dakar]. 1577 52

A 28-year-old woman previously known to have a ventricular septal defect presented with fever, headache, abdominal pain and nausea. Positive blood culture of methicillin-sensitive Staphylococcus aureus and the detection of vegetation attached to the right ventricular wall near the ostium of the ventricular septal defect confirmed diagnosis of infective endocarditis. After four weeks' treatment with proper antibiotics the patient recovered.
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PMID:A case of right-side infective endocarditis with ventricular septal defect. 1588 81

Human brucellosis has become a rare disease in Germany since the eradication of bovine and ovine/caprine brucellosis in this country. Therefore, most physicians are unfamiliar with the illnesses clinical presentation, diagnostic tools, and therapeutic strategies. This retrospective study was carried out to evaluate the epidemiological, clinical, and laboratory features of human brucellosis in Germany in the years 2002 and 2003. Thirty-one bacterial isolates from 30 patients sent to the German national reference laboratory were characterized using the genus-specific bcsp31 real-time PCR, the species-specific AMOS-PCR, and standard microbiological methods for the detection and identification of Brucella spp. The medical records of all patients with bacteriologically confirmed brucellosis were evaluated. All 31 isolates proved to be Brucella (30 Brucella melitensis and 1 Brucella suis). Most of the brucellosis patients were infected in endemic countries while visiting friends and relatives during their summer holidays. One case of laboratory-acquired infection was identified. Brucellosis was transmitted mainly by the consumption of contaminated unpasteurized milk or cheese from goats and sheep. The patients presented primarily with flu-like symptoms, i.e. fever, chills, sweating, headaches, arthralgia, and myalgia. In most cases, however, symptoms and signs of focal complications, e.g. spondylitis, endocarditis, and meningoencephalitis, predominated. The rate of complications was much higher than that in endemic countries, presumably as a result of diagnostic delay due to a low index of suspicion. In summary, physicians in nonendemic countries such as Germany must be aware of brucellosis being a possible cause of fever of unknown origin in immigrants and tourists travelling from endemic countries.
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PMID:Human brucellosis in a nonendemic country: a report from Germany, 2002 and 2003. 1595 15

A case of deep brain abscess by Gemella morbillorum is described. Due to high fever, lethargy, severe headache, and the risk of intraventricular rupture of the suppurative lesion, a CT-guided stereotactic aspiration of the abscess was successfully performed. The patient responded well to a 6-week course of meropenem, metronidazole, and fluconazole. Gemella spp. should not be considered as trivial commensals of the mucous membranes, but appear as emerging pathogens involved in endocarditis, septic shock, and necrotizing pneumonia, as well as in serious intracranial infections.
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PMID:An unusual case of brain abscess by Gemella morbillorum. 1663 15


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