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)

Common clinical practice relies on the absence of neck stiffness or other meningeal signs to rule out meningitis in the alert, healthy adult. The literature does not address this specifically but implies that meningeal signs are reliable and usually present in awake patients, except infants, the elderly, and the immunosuppressed. In the following three cases two adults and a 4-year-old child, none of them immunosuppressed, presented with bacterial meningitis with no meningeal signs. In the first case, mental status was completely normal; in the second, there was only minor lethargy attributed to pain medication. In the third, lethargy was attributed to head trauma. In all three the diagnosis of meningitis was delayed up to 19 hours; lumbar puncture was performed while meningeal signs were still absent and cerebrospinal fluid analysis was grossly abnormal. All three patients had Streptococcus pneumoniae meningitis, and all three suffered massive brain damage within 24 hours of presentation and eventually died. Although the true incidence of absent meningeal signs in meningitis is unknown, the condition is rare. Clinicians cannot rely on the absence of neck stiffness to rule out meningitis, even in healthy and awake adults, and lumbar puncture should be performed whenever there is serious consideration of that diagnosis.
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PMID:Fulminant bacterial meningitis without meningeal signs. 291 Jan 68

The course of bacterial titers, meningeal inflammation, behavioral abnormalities, and neuronal damage was studied in a mouse model of Streptococcus pneumoniae meningitis. At 24 h after injection of 10(4) colony-forming units (CFU) S. pneumoniae into the right forebrain, infected mice became severely lethargic. Bacterial titers in cerebrospinal fluid and cerebellum rose to 10(9) CFU/ml, with strong granulocyte invasion into the meninges and neuronal necroses in the neocortex, striatum and hippocampal formation. Meningeal inflammation and neuronal damage in intercellular cell adhesion molecule-1- and macrophage colony-stimulating factor-deficient mice was similar to that in wild-type littermates. Untreated, the infection was fatal. Wild-type mice treated earlier than 24 h after infection with ceftriaxone (2 mg every 12 h for 3 days) survived without apparent behavioral abnormalities. Delay of treatment beyond 30 h led to the death of more than 50% of the infected mice. This mouse model is suitable for therapeutic studies and for the investigation of inflammation in knockout mice. The neuronal damage resembles morphological abnormalities observed in humans.
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PMID:A mouse model of Streptococcus pneumoniae meningitis mimicking several features of human disease. 1148 22