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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirteen cases of group D streptococcal neonatal sepsis and/or meningitis were identified at the Cincinnati Children's Hospital from 1970 to 1976. Ages at onset of disease ranged from 1 to 25 days. The most frequent symptoms were fever (five cases), lethargy (five cases), and respiratory difficulty (four cases). Blood cultures for seven infants were positive; CSF cultures for five infants were positive; and CSF and blood cultures for one infant were both positive. In 12 patients, parenteral antibiotic therapy consisted of a penicillin and an aminoglycoside. One infant with a severe meningomyelocele died. The other 12 infants showed a rapid clinical response with seven patients improving within 48 hours of the start of therapy. Infection with group D streptococcus results in a low-grade systemic disease in both full-term and premature infants that responds favorably to appropriate therapy.
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PMID:Systemic group D streptococcal infection in newborn infants. 10 22

A cytauxzoon-like agent caused fatal disease in 4 domestic cats from separate, rural, heavily wooded premises in southwestern Missouri. Clinical signs included lethargy; pale, icteric mucous membranes; fever; and dehydration. One case of fatal cytauxzoonosis occurred in early September, 1973, and another in September, 1974. Two additional cases were detected in June, 1975. Tick infestations were reported from a variety of animals, including cats, on all premises. Necropsy revealed generalized icterus and petechial and ecchymotic hemorrhages over the surfaces of the heart and lungs. The pericardial sac was distended with clear yellow serous fluid. Large numbers of schizonts characteristic of Cytauxzoon spp were discovered in specimens of liver, lung, spleen, and lymph nodes of all cats. Infection of vascular endothelial cells, a characteristic of cytauxzoonosis, was observed in all organs examined. Piroplasms or ring forms of the agent were observed in erythrocytes of affected cats.
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PMID:A fatal cytauxzoonosis-like disease in cats. 81 65

We reviewed 75 outpatient cases of systemic infection due to group B beta-hemolytic streptococcus (GBS) evaluated during a 13-year period. Patient ages ranged from five days to eight months; 75% were younger than two months. Early-onset (less than or equal to seven days of age) GBS disease occurred in 10% of the patients, and late-onset GBS disease in 90%. The racial distribution was 60% black, 35% white, and 5% Hispanic. Symptoms included fever, irritability, lethargy, and altered-feeding pattern which lasted less than 24 hours in 88% of patients. On presentation, 33% were afebrile (eight had GBS meningitis); 32% did not appear ill (six had GBS meningitis). Of the total, 40% had GBS meningitis, of these, a greater proportion had either early-onset GBS disease or neutropenia. Infection other than meningitis was identified in 24% of all patients: pneumonia (six cases), cellulitis/adenitis (six cases), osteomyelitis/septic arthritis (five cases), and otitis media (one case). All patients survived. Systemic GBS infection in an outpatient population can involve infants up to eight months old, is more common in blacks than in whites, can be present without fever or compromised appearance, and usually has low mortality.
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PMID:Systemic infection due to group B beta-hemolytic streptococcus in children. A review of 75 outpatient-evaluated cases during 13 years. 156 97

Energy conservation, insufficient ventilation and introduction of new building materials are accompanied by increasingly frequent complaints of increasingly frequent mucosal irritation, headache and lethargy among occupants, commonly called "sick building syndrome". Infections and toxic allergic reactions may be caused by infected humidifiers. The article includes a review of symptoms and causes. Many of the complaints can be prevented. Combined efforts by medical and technical personnel are necessary in diagnosing and solving indoor climatic problems.
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PMID:[Indoor climate as a cause of health complaints. A review]. 274 41

Infection with an atypical (lactose-negative) E. coli was associated with increased mortality rates in a colony of triple immune deficient N:NIH(S) III mice. Affected mice were lethargic and exhibited perianal fecal staining. Slight-to-moderate thickening of the wall of the cecum and colon was found on necropsy examination. Microscopic examination revealed segmental hyperplasia of the cecal and colonic mucosa with clusters of gram negative bacteria on the surface and within the cytoplasm of mucosal epithelial cells. Scattered foci of epithelial invasion and hyperplasia were observed in the colons of C57B1/6N-nunu mice after per os inoculation with the atypical E. coli. Immunocompetant mice housed in the same room as the N:NIH(S) III's remained healthy and exhibited no gross or microscopic lesions in spite of infection.
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PMID:Cecocolitis in immunodeficient mice associated with an enteroinvasive lactose negative E. coli. 305 10

A total of 208 patients underwent brain biopsy for presumptive herpes simplex encephalitis and were randomized to receive either vidarabine, vira-A, at 15 mg/kg/day, or acyclovir, at 30 mg/kg/day for ten days. 69 patients (33%) had biopsy-proven disease; 37 received vira-A and 32 acyclovir. With the exception of age, patient populations were balanced for demographic characteristics. Overall survival for acyclovir recipients was 72% compared with 46% for vira-A-treated patients 18 months after therapy (p = 0.008). After adjustment for differences of age between treatment populations by multivariant regression analyses, acyclovir treatment remained superior to vidarabine therapy (p = 0.041). Mortality varied according to the level of consciousness at the onset of therapy. For lethargic, semicomatose and comatose patients, mortality was 42%, 46%, and 67%, respectively, for the vira-A-treated patients and 0%, 25% and 25%, respectively, for acyclovir-treated patients. Six months post-therapy morbidity assessments revealed five (14%) vira-A versus 12 (38%) acyclovir recipients who had returned to normal function, while eight (22%) and three (9%), respectively, had moderate debility. Outcome differences were significant (p = 0.02; Wilcoxon, 2-sample test) using an adapted scoring system. Age and Glasgow coma scale greater than 10 predicted the best outcome following acyclovir treatment. Disoriented patients who flex and respond by eye to pain had no mortality and 50% returned to normal. These data indicate that acyclovir is the treatment of choice for biopsy-proven herpes simplex encephalitis.
Infection 1987
PMID:Factors indicative of outcome in a comparative trial of acyclovir and vidarabine for biopsy-proven herpes simplex encephalitis. 329 70

Gram-negative osteomyelitis frequently responds poorly to conventional therapy. Ciprofloxacin displays excellent in vitro activity against gram-negative bacilli and offers the potential for outpatient therapy. In this ongoing study, ciprofloxacin therapy is being evaluated for the treatment of gram-negative osteomyelitis. Twenty-three patients (16 men and seven women) have been treated under the protocol (750 mg orally twice daily for 1.5 to six months), and 14 patients have completed therapy. All patients had either growth on bone cultures from an open or percutaneous biopsy, or an arthrocentesis to confirm the diagnosis. Involved sites included ankle or tibia (seven patients), vertebra (four patients), hip (five patients), metatarsal (four patients), phalanx (two patients), and metacarpal (one patient); 16 patients had chronic disease, and seven patients had acute disease. Patients had a total of 28 gram-negative bacilli, 12 gram-positive cocci, and one anaerobic gram-negative rod, for an average of 1.8 pathogens per patient. Eighteen of the 28 gram-negative bacilli were Pseudomonas species. The geometric mean minimal inhibitory concentration for all the gram-negative bacilli was 0.15 microgram/ml. The geometric mean minimal inhibitory concentration for the gram-positive isolates was 0.41 microgram/ml. All patients who completed therapy experienced a cure, with a mean follow-up of 6.1 months. Infections in all patients, except for two who are still taking ciprofloxacin, are resolving, both clinically and radiologically. One patient who was not eligible for the protocol experienced a superinfection with methicillin-resistant Staphylococcus aureus. Side effects have included urticaria, lethargy, nausea, and transient elevations of liver and renal function test results. Overall, ciprofloxacin therapy was well tolerated. This study suggests that ciprofloxacin holds promise for the outpatient treatment of gram-negative osteomyelitis.
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PMID:Oral ciprofloxacin therapy for gram-negative bacillary osteomyelitis. 355 43

This report concerns 60 children with documented Staphylococcus epidermidis sepsis. There were 34 boys and 26 girls, ages 2 weeks to 15 years. The primary diagnosis included malignancy (13), congenital (13) or acquired (11) gastrointestinal disorders, prematurity (7), cardiac defect (5), hydrocephalus (2) and miscellaneous (9). Clinical presentation included fever (54), tachycardia (15), lethargy (20), hypotension (8), irritability (6), increased gastric residuals (6) and apnea/bradycardia (3). A documented source of sepsis was noted in 56 patients, including percutaneous central venous catheters (23), Broviac catheters (17), umbilical arterial catheters (6), wound (3), V-P shunt (2), cardiac defect (2), cholangitis (1), chest tube (1) and peripheral arterial line (1). There were six sepsis-related deaths, four in premature infants. Two of six infected subclavian catheters were treated successfully with vancomycin. Infection was successfully cleared in 20 of 23 infected Broviac catheters with vancomycin through the line. However, six were eventually removed for tract infection (1), persistent fever (2), and Candida sp. infection (3). Although once considered a non-pathogenic skin contaminant, S. epidermidis has emerged as a serious pathogen in hospitalized, immunosuppressed, premature and malnourished pediatric patients. Indwelling catheters enhance the likelihood of infection in these patients. Aggressive antimicrobial therapy is vital in this potentially lethal infection. Vancomycin proved efficacious in this series.
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PMID:Staphylococcus epidermidis sepsis in pediatric patients: clinical and therapeutic considerations. 648 77

Severe acidosis associated with acetazolamide therapy is rare. We report the first case in which plasma and whole blood acetazolamide concentrations were measured. A 61 year-old patient receiving oral acetazolamide for treatment of glaucoma presented with a 7 day history of declining mental status. The patient was lethargic and oriented only to name. The respiratory rate was 36 per minute in a Kussmaul pattern with arterial blood gases revealing a pH of 7.23, pO2 68 mmHg, paCO2 14 mmHg and bicarbonate 6 mEq/L. Serum creatinine was 3.1 mg%, Cl 126 mEq/L, and anion gap 15. Urine pH was 6.0. Infection and other causes of acidosis and bicarbonate loss were excluded, and he was discharged with normal mental status and improving acid-base balance 18 days after admission. Acetazolamide concentrations four days after the last dose were 26.38 mcg/ml and 38.84 mcg/ml in serum and whole blood, respectively. The serum half-life was 34 hours, compared to a range of 1.5 to 6 hours in subjects with normal renal function. Monitoring acetazolamide concentrations may be useful in adjusting dosage and preventing toxicity in patients with decreased renal function.
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PMID:Chronic acetazolamide intoxication. 653 47

Infection with rickettsiae of the spotted fever group was clinically and serologically diagnosed in four dogs from two households on Long Island. In two dogs, clinical signs included high fever (to 40.5 C), abdominal pain, lethargy, depression, anorexia, and nystagmus. One of these dogs had conjunctivitis and petechial hemorrhages in the oral mucous membranes. The third dog initially had high fever, evidence of abdominal pain, anorexia, and depression. The fourth dog appeared clinically normal. Clinical signs disappeared following treatment with tetracycline given orally.
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PMID:Rocky Mountain spotted fever in dogs. 738 Jul 21


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