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

Cases of otitis media in infants under 12 weeks of age were reviewed to delineate the frequency, clinical features, and etiologic agents involved. Tympanocentesis was performed in 42 infants, 0 to 5 weeks of age, and in 17, from 6 to 11 weeks of age. The most common symptoms were irritability/lethargy (69%), fever (52%), cough (36%), vomiting (21%), diarrhea (20%), tachypnea (20%), and anorexia (18%). Associated illnesses were present in 33 (54%) of the patients, the most common being pneumonia (9), bronchiolitis (7), meningitis (6), conjunctivitis (4), and omphalitis (4). No peripartum infections or severe perinatal problems were found. Common respiratory pathogens were the predominant etiologic organisms, but coliform organisms were identified in 18% of the infants under 6 weeks of age. Cultures were sterile or grew organisms of questionable pathogenicity ("nonpathogens") in 39% of specimens. Since the signs and symptoms of otitis media in children less than 12 weeks of age are nonspecific and frequently associated with other major illnesses, the physician caring for these infants needs to be more aware of this disease and the therapeutic problems it presents.
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PMID:Otitis media in children less than 12 weeks of age. 1 93

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

Clinical and autopsy data indicate that ventriculitis persists despite parenteral and intralumbar antibiotic therapy. In the present study, ventriculitis was documented as postmortem examination in nine newborns. These studies indicate that ventriculitis occurs commonly in neonates with meningitis, particularly when there is delayed sterilization of CSF culture, A clinician has to bear in mind the diagnosis of ventriculitis when: 1) There is poor clinical and/or laboratory response to the usual therapy. 2) He has a critically ill patient with lethargy, convulsions and bulging fontanels. 3) He culture an unusual organism. 4) He faces a suspected complication of meningitis: subdural effusion, ventriculitis or abscess. 5) A CSF from ventricular puncture with more than 150 WBC, glucose less than 50 mg. and protein more than 200 mg.
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PMID:[Neonatal meningoventriculitis]. 83 10

A case-control study was performed to investigate the significance of arteriosclerosis, heredity and some infections in the etiology of Parkinson's disease. The study group consisted of all traceable patients with Parkinson's disease living in a defined area, a total of 444 patients, and of control subjects for each patient, matched in sex and age, chosen from among the general population residing in the same area. No significant differences were found between the patients and the controls concerning the occurrence of cardiac insufficiency, coronary heart disease, or stroke. The Parkinsonian patients, however, had a significantly lower incidence of clinical arterial hypertension when compared with the controls. In addition, the patients more often had low systolic blood pressures and more rarely high pressures than the controls. Even the mean systolic blood pressure was significantly lower in the patients than in the controls. The low blood pressure seems to be an effect of Parkinson's disease itself with a minor contribution of levodopa therapy. The observations above are considered to indicate that arteriosclerosis and Parkinson's disease are probably only concurrent disorders and not in etiological relationship with each other. There was no statistically significant difference in the proportion of the patients and the controls with relatives with Parkinson's disease or essential tremor, which suggests that genetic factors do not have a significant role in Parkinson's disease and on the other hand that essential tremor and Parkinson's disease are two separate disease entities. No other encephalitis than a lethargic one was found to precede Parkinson's disease and the occurrence of meningitis was rare both among the patients and the controls. The history of Spanish influenza was found to be as frequent in the patients as in the controls, thus not supporting the idea that influenza has etiological importance in Parkinson's disease.
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PMID:Arteriosclerosis, heredity, and some previous infections in the etiology of Parkinson's disease. A case-control study. 100 13

Three calves (Nos. 1, 2 = 7 days old; No. 3 = 21 days old) were inoculated subcutaneously with virulent Rift Valley fever (RVF) virus. All calves became viremic and clinically ill, but the two 7-day-old calves were moribund and were euthanatized subsequently on post-inoculation day (PID) 3. Highest viral titers were measured in the serum, with lesser concentrations in the brain, heart, spleen, and liver of these animals. Viral antigens were detected by immunohistochemical analysis only in the livers, where positive staining was localized in coalescing foci of hepatocellular necrosis. The 21-day-old calf appeared to recover after viremia and pyrexia but became lethargic and ataxic and was euthanatized on PID 9. The calf was no longer viremic, and RVF virus was isolated only from the brain. Microscopic examination of the central nervous system revealed diffuse perivascular infiltrates of lymphocytes and macrophages, multifocal meningitis, and focal areas of neuronal necrosis and aggregates of macrophages, lymphocytes, and neutrophils throughout all regions of the brain and cervical spinal cord. There was positive immunohistochemical staining for viral antigens within the cytoplasm of neurons and glial cells throughout the central nervous system. Thus, RVF virus can cause encephalomyelitis in calves, and the specific virologic diagnosis can be made by immunohistochemical localization of viral antigens in formalin-fixed tissues.
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PMID:Rift Valley fever virus-induced encephalomyelitis and hepatitis in calves. 144 95

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

Case records of 32 neonatal calves with the antemortem diagnosis of meningitis were reviewed. Mean age at admission was 6 days (range, 11 hours to 30 days), and the most common concurrent clinical problem was diarrhea (16/32). Twenty-seven of the calves were available for necropsy. At postmortem, there was evidence of septicemia in 22 (81%) of these calves. Escherichia coli was the organism most frequently isolated (11/16; 69%) from the CNS. The major clinical signs of CNS disturbance observed over the course of hospitalization were lethargy, recumbency, anorexia, loss of suckle reflex, and coma. Leukocytosis and a left shift was evident in 11 of 15 (73%) calves. Concurrent metabolic problems that could have aggravated the CNS disturbance included hyperkalemia and respiratory acidosis. Analysis cerebrospinal of fluid from 22 of the calves, revealed pleocytosis, xanthochromia, turbidity, and high total protein concentration. Cytologically, neutrophils predominated in the CSF in calves with acute disease. Mononuclear cells dominated in calves with chronic disease. Microscopically, bacteria were evident in 10 of 22 (45%) of the antemortem CSF samples and bacteria were isolated from slightly more than half (11/19) of the specimens subjected to microbial culturing. Escherichia coli was the agent most frequently isolated from the CSF. Two of the 9 E coli isolates were resistant to trimethoprim potentiated sulfonamide drugs and all (4/4) of the CSF E coli isolates tested for susceptibility to triple-sulfonamide drugs were resistant. Twenty-seven of the 32 calves died or were euthanatized within 2.43 days after hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Meningitis in neonatal calves: 32 cases (1983-1990). 164 35

To assess the appropriateness of pediatric telephone advice given by emergency departments (EDs), a mock scenario simulating a 5-week-old with fever of 102 degrees F and signs compatible with meningitis was used to evaluate the responses of 61 randomly selected EDs, of which half were affiliated with pediatric residency training programs. All EDs were given the identical chief complaint: "My baby has been having a fever all day, and I can't seem to get it down." Calls were made by research technicians and monitored by one or more of the investigators by speakerphone. Fifty-three (87%) programs gave advice by telephone; in 42 (79%) of the 53 respondents the individual giving advice was a nurse. Fourteen programs (26%) gave advice without asking either the age of the child or height of the fever. Few of the respondents took historical information assessing irritability (4 programs), fluid intake (11 programs), urine output (8 programs), or breathing pattern (6 programs). Thirty-eight (71.7%) EDs advised the patient to see a physician, while only 32 (60.4%) suggested same-day evaluation. In several instances the caller was not advised to seek medical attention despite having given a history documenting the infant's fever, irritability, and lethargy. These findings show variability and inadequacies in pediatric telephone advice currently offered by the EDs that were studied.
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PMID:Pediatric telephone advice in the emergency department: results of a mock scenario. 172 17

From January 1981 to December 1988, we collected 11 cases of neonatal meningitis caused by Flavobacterium meningosepticum. The 6 male and 5 female newborns ranged from 3 days to 20 days old. Birth body weight varied from 1100 gm to 3600 gm. Seven cases were premature or small for date. Nosocomial infection was noted in 7 of these 11 cases. Clinically, lethargy and poor activity were the most common symptoms. Cyanosis, fever and convulsion were the next. There were 9 cases showing pleocytosis, increased protein and decreased glucose level in the cerebrospinal fluid examination. The organisms isolated in all 11 cases were susceptible to piperacillin, resistant to ampicillin, aminoglycosides and cephalosporin. Five patients were treated with antibiotics other than piperacillin for 5 to 18 days. Three patients died; hydrocephalus was the cause of death in 2 of them. Two patients were discharged against advice. Among the remaining 6 cases we gave piperacillin for 3 weeks, one case developed hydrocephalus but eventually succumbed to K. pneumoniae sepsis. Out of five surviving cases, 3 developed hydrocephalus (VP shunt performed in two). The other two patients were discharged without neurological deficit. In conclusion, neonatal Flavobacterium meningosepticum meningitis was more frequent in premature or small for date babies, and it usually appeared in nosocomial infection. The prognosis was poor and piperacillin was proved to be the drug of choice.
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PMID:[Clinical observation of neonatal meningitis caused by flavobacterium meningosepticum]. 177 41

The children were admitted over a 14-year period (1975-1988) from an admission area of average Danish population distribution. The incidence was 15.5/100,000 children per year. The area had endemics of meningococcal disease in the years 1983-1984. The etiology was meningococcal in 43%, Hemophilus influenzae in 33% and pneumococci in 9% of the patients. Regardless of etiology, the antibiotic schedule was ampicillin 400 mg/kg body weight/day. Resistance to ampicillin was not found in any of the bacterial cultures. Within two weeks before admission 59% of the children had experienced a febrile illness. The diagnosis of meningitis was missed before admission in 24% of the cases. On admission, 93% had typical clinical signs of meningitis. 87% were lethargic or comatose. 31% had convulsion and in 13% the peripheral circulation was compromised. Recrudescence was suspected in one patient. Sequelae were most commonly found in children with meningococcal meningitis and were persistent in 23% of all the children. Severe or less severe neurological handicaps were seen in 29% (psychomotor retardation, epilepsy, cerebral palsy and hearing loss). One patient with Waterhouse-Friederichsens syndrome died. Thus the overall mortality was 1.2%, which is low compared to treatment results reported by others.
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PMID:[Purulent meningitis in childhood. Treatment results in 87 children between 7 month and 15 years of age]. 200 Jun 65


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