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

The authors report an episode of mass psychogenic illness exacerbating respiratory symptoms in military recruits. The epidemic occurred over a 10- to 12-hour period in September 1988, in a group initially complaining of cough and pleuritic chest pain. More than 1,800 men were evacuated from their barracks because of a suspected toxic gaseous exposure. Approximately 1,000 recruits developed at least one new symptom, 375 were evacuated by ambulance to receive further medical evaluation, and at least eight were hospitalized. Air sample testing from the area was unremarkable, and there were few abnormal physical examination or laboratory findings. The epidemiologic investigation included a questionnaire administered 2 weeks after the epidemic to 1,000 of the recruits involved. A total of 55% of those who completed the questionnaire reported the onset of at least one new symptom after supper, with at least 25% reporting the new onset of cough, light-headedness, chest pain, shortness of breath, headache, sore throat, or dizziness. A total of 18% received further medical evaluation. The development of new symptoms and the receipt of further medical evaluation were associated with evidence of physical stress, mental stress, and awareness of rumors of odors, gases, and/or smoke. This epidemic was unique because of its size and its occurrence in an all-male population.
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PMID:An epidemic of respiratory complaints exacerbated by mass psychogenic illness in a military recruit population. 226 May 44

Between August 1982 and December 1985, seven patients at a children's hospital developed hospital-acquired pneumonia caused by Legionella pneumophila. Demographic data included the following: mean age 12.3 years (range 9 months to 20.5 years); male/female ratio 5:2; all patients were white. Some previously identified risk factors present in our patients included high-dose corticosteroid therapy (five patients), other immunosuppressive therapy (four), and chronic lung (five) or kidney (three) disease. Symptoms and signs included rapid onset, fever, cough, pleuritic chest pain, dyspnea, abdominal pain, diarrhea, and headache. Rhinitis, myalgia, and neurologic abnormalities were not noted. Chest roentgenograms revealed single-lobe consolidation in three patients, diffuse bilateral alveolar infiltrates in three, and pleural effusion in three. All patients were treated with erythromycin; three patients also received rifampin. Tracheal intubation and mechanical ventilation were required by four patients. Six patients improved after therapy. One child died of persistent lung disease 1 month after the onset of legionnaires disease. L. pneumophila was isolated from potable water in the hospital. Aerosol equipment cleansed with tap water and the showers were implicated as means of exposure by patients to contaminated potable water. No new nosocomial cases were seen after immunocompromised children were prohibited from taking showers, and sterile water was used to cleanse equipment for administering aerosol medications.
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PMID:Nosocomial legionnaires disease in a children's hospital. 273 94

A 22-year-old woman with systemic lupus erythematosus experienced generalized pruritus, shortness of breath, pleuritic chest pain, visual blurring, severe photophobia, a stiff neck, an occipital headache, and a temperature of 39.4 degrees C within one hour after taking sulindac (Clinoril). Findings from a CSF examination disclosed a notable elevation of protein and a polymorphonuclear pleocytosis. All symptoms disappeared within 24 hours. Inhibition of prostaglandin synthesis did not seem to be the mechanism of this adverse reaction, since the patient tolerated aspirin.
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PMID:Sulindac-induced aseptic meningitis. 705 20

Legionella pneumophila is the cause of Legionnaires' disease, and Pontiac fever, an influenza-like condition without pneumonia. We present a case of Pontiac fever after exposure to a hot tub contaminated with L pneumophila. A 37 y/o wf presented to the office with acute onset of sore throat, fever, headache, and myalgia. Patient was hospitalized 3 days later because of worsening shortness of air. Chest x-ray was normal. Patient was treated with 2 days of IV erythromycin and was discharged home on oral erythromycin. Her Legionella IFA was 1:16,384. Two days later, she developed chest tightness, pleuritic chest pain, and increasing shortness of air but did not have any cough or sputum production. She was re-hospitalized with a diagnosis of Pontiac fever and treated with IV erythromycin plus oral rifampin. A repeat chest x-ray remained normal. After a detailed epidemiologic history was obtained, it was noted that she became ill after using a hot tub, which her two children also used and they themselves developed a self limited illness. Water from the hot tub was positive for L pneumophila by DFA, culture, and PCR. Patient improved gradually with therapy and was discharged home. This report emphasizes the importance of a complete epidemiologic history in the diagnosis of respiratory infections. It also demonstrates that aquatic environment can be contaminated with Legionella and serve as a source of infection.
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PMID:Hot tub legionellosis. 885 93

We performed an observational analysis of prospectively collected data on 1,474 adult patients who were hospitalized for community-acquired pneumonia; 1,169 patients were under 80 years of age and 305 (21%) patients were over 80 years ("very elderly"). Mean patient ages were 60 years in the former group and 85 years in the latter group. Severely immunosuppressed patients and nursing-home residents were not included. Comorbidities significantly associated with older age were chronic obstructive pulmonary disease, chronic heart disease, and dementia. The most common causative organism was Streptococcus pneumoniae (23% in both groups). Aspiration pneumonia was more frequent in the very elderly (5% in younger patients versus 10% in the very elderly); Legionella pneumophila (8% in younger patients versus 1% in the very elderly) and atypical agents (7% in younger patients versus 1% in the very elderly) were rarely recorded in the very elderly. While very elderly patients complained less frequently of pleuritic chest pain, headache, and myalgias, they were more likely to have absence of fever and altered mental status on admission. No significant differences were observed between groups as regards incidence of classic bacterial pneumonia syndrome (60% versus 59%) in 343 patients with pneumococcal pneumonia. The development of inhospital complications (26% in younger versus 32% in very elderly patients) as well as early mortality (2% in younger versus 7% in very elderly patients) and overall mortality (6% in younger versus 15% very elderly patients) were significantly higher in very elderly patients. Acute respiratory failure and shock/multiorgan failure were the most frequent causes of death, especially of early mortality. Factors independently associated with 30-day mortality in the very elderly were altered mental status on admission (odds ratio, 3.69), shock (odds ratio, 10.69), respiratory failure (odds ratio, 3.50), renal insufficiency (odds ratio, 5.83), and Gram-negative pneumonia (odds ratio, 20.27).
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PMID:Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. 1279 2

We present a case of a 48-year-old male who presented with worsening pleuritic chest pain for 2 h. He also complained of fever, malaise, headache and severe neck pain. Electrocardiogram (ECG) showed ST segment elevation in leads I, II, aVL and V5 with PR elevation and ST depression in aVR. On admission, troponin-I was 14.8 ng/mL. Based on ECG changes, elevated troponin and family history of early coronary artery disease, the patient was emergently taken to cardiac catheterization lab. Angiography showed non-obstructive coronaries, mild hypokinesis of mid inferior and anterolateral wall with ejection fraction (EF) of 40-45%. Based on above presentation and angiography findings, the diagnosis of acute myopericarditis was made. He was started on colchicine and ibuprofen. The other workup to determine etiology of myopericarditis was negative as shown below. Given the history of fever, headache and worsening neck pain, we also became suspicious of meningitis. Lumbar puncture was performed which was negative. On the day of admission, he was found to have blasts on complete blood count and peripheral smear. Bone marrow biopsy and flow cytometry confirmed the diagnosis of acute myeloid leukemia (AML). He received induction and salvage therapy. Repeat bone marrow confirmed complete remission and normal cytogenetics. Although pericardial or myocardial biopsies are unavailable for our patient, in the absence of other causes, it does appear that his acute myopericarditis was associated with AML.
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PMID:Atypical Presentation of Acute Myeloid Leukemia. 2958 13

Pneumonia is a common cause of respiratory infection, accounting for more than 800,000 hospitalizations in the United States annually. Presenting symptoms of pneumonia are typically cough, pleuritic chest pain, fever, fatigue, and loss of appetite. Children and the elderly have different presenting features of pneumonia, which include headache, nausea, abdominal pain, and absence of one or more of the prototypical symptoms. Knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles is the key for effective pharmacologic selection and treatment of pneumonia.
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PMID:Guidelines for the Evaluation and Treatment of Pneumonia. 3011 36