Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 45-year-old Italian woman, who was admitted to the Royal Free Hospital in London, England, with a 14-day history of general malaise, lethargy, epigastric pain after meals, and night sweats, had had an IUD inserted 13 years earlier which had not been changed. The patient was pyrexial on examination; she had a temperature of 38 degrees Centigrade but no jaundice or enlarged lymph nodes. There was mild epigastric tenderness, and a tender indurated rectal stricture involving the posterior fornix of the vagina was palpable on pelvic examination. The rectal stricture was confirmed on sigmoidoscopy. The biopsy revealed a chronic inflammatory cell infiltrate with lymphocytes, extending from the submucosa through to the muscularis mucosae. A preoperative barium enema showed a long irregular rectal stricture. A large mass of inflammatory tissue was found adherent to the uterus, rectum, fallopian tubes, and ovaries at laparotomy. Bilateral retrograde ureterograms showed complete obstructions of the left ureter at 5 cm and a long irregular stricture was seen at the same level on the right. The histological examination revealed actinomycosis of the uterus, fallopian tubes, and ovaries. 12 weeks postoperatively the patient was well; sigmoidoscopy to 25 cm showed complete resolution of the rectal stricture. The antibiotic treatment was stopped. The most likely source of this patient's actinomycosis was the IUD for the relationship between the two is well established. In this patient a prolonged course of antibiotics proved effective in treating the infection.
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PMID:Rectal stricture due to actinomycosis. 373 Jul 97

A case history is reported of a 29-year old patient who presented with a chronic illness characterized by lethargy, back pain, fever, and anemia. Evaluation disclosed the presence of a large pelvic mass which was confirmed as a tubo-ovarian abscess at surgery. Histological evaluation demonstrated involvement by Actinomyces species. The patient's illness is discussed as a complication of chronic IUD usage with reference to specific management for this emerging problem. Data from the National Fertility Study conducted in 1973 revealed that nearly 2 million married women in the US, ages 15-44, were using IUDs. Scott noted the serious potentially fatal complications associated with IUD use, including pelvic inflammatory disease (PID), uterine perforation, ectopic pregnancy, and spontaneous or septic abortion. The relative risk of PID among IUD users has been reported to be increased 2-12 fold over controls. The risk of infection appears to increase as the period of IUD use lengthens, but the risk associated with the use of copper IUDs may be slightly less than with plastic IUDs. Actinomycosis has traditionally been described in 3 anatomical regions, the cervicofacial, thoracic, and abdominal areas, but pelvic and genital disease has been recognized with increasing frequency over the past decade. The common denominator associated with the latter syndrome appears to be the concurrent presence of an IUD. The Actinomyces are gram positive, nonacid fast, anaerobic, obligate parasites which are classified somewhere between the true bacteria and the complete fungi. Actinomyces species are not generally considered part of the normal vaginal flora but rather are associated with the presence of a foreign body, most often an IUD. It is thought that the IUD causes the initial tissue injury which permits subsequent colonization by these organisms. It is not known whether orogenital contact is a means of transmission of Actinomyces to the lower genital tract of sexual partners. One might estimate that the overall rate of cytological detection of A. israelii in cervical smears of IUD users at about 10%. This incidence increases sharply in patients being evaluated for symptomatic pelvic infection. Conversely, in women with IUDs in place and Actinomyces demonstrable in cervical smears, PID is up to 4 times as common as in those who have negative smears. Antibiotic treatment should probably be dictated by the clinical setting. As a general guide, the threshold for treatment should be low, since the therapy is relatively benign and the extent to which colonization and tissue invasion may have occurred is unknown.
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PMID:Pelvic actinomycosis and usage of intrauterine contraceptive devices. 718 22