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

Beagle dogs inoculated with the agent of Rocky Mountain spotted fever, Rickettsia rickettsii, developed a clinical syndrome that extended from febrile exanthema to death and appeared to be dose related. Infected dogs were anorectic and lethargic and developed cutaneous lesions characteristic of Rocky Mountain spotted fever, including petechia, ecchymosis, edema, and necrosis. Hematologic changes after inoculation included anemia, leukopenia proceeding to leukocytosis, and thrombocytopenia. Changes in blood chemistry values included increases in serum alkaline phosphatase and cholesterol, and hyponatremia and hypochloremia. The prominent histopathologic change was necrotizing vasculitis. The canine disease is comparable with human Rocky Mountain spotted fever on a clinical, hematologic, biochemical, and pathologic basis, and may provide a model system for this disease in man. The results suggest the dog may be involved in the epidemiology of R rickettsii infections.
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PMID:Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection. 87 82

A well-qualified and dedicated pediatrician in a mid-Atlantic state recently cared for a 4-year-old child with a fever and a truncal rash. On the second visit the child was lethargic but seemed to improve with oral hydration and fever control. Twenty hours later the child's rash became petechial and the child returned moribund and died shortly thereafter. Looking for an emergency differential diagnosis on a 4-year-old child with fever and a truncal rash would have been cumbersome using traditional reference materials. With PEM-DXP, however, a nurse or secretary could have produced for the physician in 60 seconds a list of 12 emergency diagnoses to be considered. Rocky Mountain spotted fever would have appeared on that list. (Ten percent of patients with Rocky Mountain spotted fever have a maculopapular rash, and in 10% of those children the rash begins on the trunk.) This list might have prompted this physician to ask about a tick bite. A positive response would have been obtained. Possibly the tragic outcome, for both the child and the physician, could have been avoided. Children with urgent complaints are frequently cared for by physicians who are busy, tired, sleep-deprived, and stressed in many other ways. These physicians often have not read last month's medical journals in their specialty or even last year's journals. Yet the parents' expectation, and rightly so, is that their pediatrician or emergency physician has at his or her command and is bringing to bear on the care of their child the vast knowledge base of medical science as it pertains to their child's condition. It is a totally unrealistic expectation. By computerizing reference materials in ways that allow for selectively searching for and compiling information pertinent to a given presentation, however, we can move a bit closer to meeting both the parents' expectations of us and our own expectations of ourselves.
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PMID:Computerized diagnostic referencing in pediatric emergency medicine. 152 22

A 32-year-old black man from rural southeastern Texas had headache, fever, chills, bronchopneumonia, and an atypical rash, complicated by hypotension, lethargy, confusion, liver dysfunction, thrombocytopenia, and acute renal failure. The diagnosis of Rocky Mountain spotted fever (RMSF) was not suspected until eight days after the onset of symptoms. He was subsequently treated with chloramphenicol, followed by hemodialysis and aggressive supportive therapy. He recovered uneventfully with complete return of renal function. This case emphasizes that RMSF should be considered in the differential diagnosis of any obscure febrile illness even in nonendemic areas.
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PMID:Viscerotropic Rocky Mountain spotted fever in southeastern Texas: report of a survivor with atypical manifestations and multiple organ failure. 271 89

Within a period of 5 consecutive days after the initial observation of illness was made, 7 of 12 Siberian Husky dogs developed clinical signs of Rickettsia rickettsii infection. One dog died and was necropsied. Clinical signs of infection consisted of lethargy, anorexia, ocular and nasal discharges, and neurologic disorder (incoordination and rolling). Scleral blood vessel injection, fever, lymphadenomegaly, splenomegaly, and increased bronchovesicular lung sounds were prominent findings. Clinical laboratory test results identified decreased platelet numbers, variable neutrophil counts, increased serum alkaline phosphatase activity, hyponatremia, hypokalemia, and bilirubinuria. Diagnosis of Rocky Mountain spotted fever was confirmed by serologic evaluation of acute and convalescent sera, using the micro-immunofluorescence technique, and R rickettsii antigen was determined by demonstration of intracellular rickettsial organisms in vascular endothelial cells of brain and lung (stained with carbol-basic fuchsin and aqueous malachite green) and by demonstration of spotted fever-group rickettsiae in tissues by direct fluorescent antibody technique. Near-simultaneous naturally occurring tick-borne infection of 7 dogs with R rickettsii documents an unreported occurrence.
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PMID:Canine Rocky Mountain spotted fever: a kennel epizootic. 406 17

A dog was examined because of petechiation, an inability to stand, pale mucous membranes, a possible seizure, and thrombocytopenia. Tick-borne illness was suspected, but despite treatment, the dog died. Eight days later, a second dog owned by the same individual also died. The dog was not examined by a veterinarian, but Rocky Mountain spotted fever (RMSF) was suspected on the basis of clinical signs. Two weeks after the second dog died, the owner was examined because of severe headache, fever, nausea, vomiting, decreased appetite, lethargy, and a fine rash on the body, face, and trunk. Despite intensive treatment for possible RMSF, the owner died. Although results of an assay for antibodies to Rickettsia rickettsii were negative, results of polymerase chain reaction assays of liver, spleen, and kidney samples collected at autopsy were positive for spotted fever group Rickettsia spp. These cases illustrate how dogs may serve as sentinels for RMSF in humans and point out the need for better communication between physicians and veterinarians when cases of potentially zoonotic diseases are seen.
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PMID:Implications of presumptive fatal Rocky Mountain spotted fever in two dogs and their owner. 1462 95

A 4-year-old spayed female Irish Setter was examined because of acute onset of lethargy, anorexia, and weakness. The dog had eaten an adult rabbit 36 hours earlier. Tularemia was suspected because of the rabbit exposure; however, other common diseases characterized by fever, malaise, and lymphadenopathy of acute onset were also considered (ie, ehrlichiosis and Rocky Mountain spotted fever). The dog was treated with doxycycline (5 mg/kg [2.3 mg/lb], PO, q 24 h) for 14 days as well as supportive treatment with a balanced electrolyte solution (lactated Ringer's solution [200 mL, SC]). The diagnosis was first established by results of bacteriologic cultures of fine-needle aspirates obtained from lymph nodes and confirmed by results of ELISA and a polymerase chain reaction assay Successful and timely antemortem diagnosis of tularemia in dogs can be accomplished through lymph node aspiration and bacteriologic culture.
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PMID:Naturally occurring tularemia in a dog. 1534 61

The bacterium Rickettsia rickettsii is the etiological agent of an acute, severe disease called Rocky Mountain spotted fever in the United States or Brazilian spotted fever (BSF) in Brazil. In addition to these two countries, the disease has also been reported to affect humans in Mexico, Costa Rica, Panama, Colombia and Argentina. Like humans, dogs are also susceptible to R. rickettsii infection. However, despite the wide distribution of R. rickettsii in the Western Hemisphere, reports of R. rickettsii-induced illness in dogs has been restricted to the United States. The present study evaluated the pathogenicity for dogs of a South American strain of R. rickettsii. Three groups of dogs were evaluated: group 1 (G1) was inoculated ip with R. rickettsii; group 2 (G2) was infested by R. rickettsii-infected ticks; and the control group (G3) was infested by uninfected ticks. During the study, no clinical abnormalities, Rickettsia DNA or R. rickettsii-reactive antibodies were detected in G3. In contrast, all G1 and G2 dogs developed signs of rickettsial infection, i.e., fever, lethargy, anorexia, ocular lesions, thrombocytopenia, anemia and detectable levels of Rickettsia DNA and R. rickettsii-reactive antibodies in their blood. Rickettsemia started 3-8 days after inoculation or tick infestation and lasted for 3-13 days. Our results indicate that a Brazilian strain of R. rickettsii is pathogenic for dogs, suggesting that canine clinical illness due to R. rickettsii has been unreported in Brazil and possibly in the other South American countries where BSF has been reported among humans.
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PMID:Experimental infection of dogs with a Brazilian strain of Rickettsia rickettsii: clinical and laboratory findings. 1905 21

Following recent tick exposure in Arkansas, a 2-year-old, female spayed Labradoodle was examined because of a one-week history of lethargy and shifting-leg lameness. The dog was febrile, had prominent lymph nodes, dull mentation, a stiff gait, and left forelimb lameness. Thrombocytopenia was the only initial hematological or biochemical abnormality. Despite treatment with doxycycline for suspected Rocky Mountain spotted fever, the dog continued to have waxing and waning clinical signs including inappetence, fever, shifting-leg lameness, lymphadenopathy, splenomegaly, and weight loss in association with moderate to severe hematological abnormalities, including anemia, thrombocytopenia, neutrophilia, and monocytosis. Sequential serological testing confirmed Bartonella henselae, Bartonella koehlerae and R. rickettsii seroconversion. Doxycycline, enrofloxacin and clarithromycin were administered in sequential combination for treatment of rickettsioses, B. henselae and B. koehlerae. Prednisone, thyroid supplementation and other drugs were administered to elicit symptomatic improvement. Based upon seroreversion, and the eventual resolution of all clinical and hematological abnormalities, therapeutic elimination of all three pathogens was seemingly achieved. Whether cortisol insufficiency due to adrenal exhaustion syndrome or post-infectious immune-mediated sequelae contributed to the symptoms and pathophysiological abnormalities reported in this dog was not determined, but are considerations for future cases.
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PMID:Bartonella henselae, Bartonella koehlerae and Rickettsia rickettsii seroconversion and seroreversion in a dog with acute-onset fever, lameness, and lymphadenopathy followed by a protracted disease course. 3101 51