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

The article describes the versions of meningeal tuberculosis in 300 patients observed by the author from 1975 to 1990. In the majority of the patients, the onset of the disease was gradual and its course, typical. For an acute onset of the disease, certain types of serous meningitis (6.7%), influenza (2.3%), acute psychosis (3%), purulent meningitis (1.3%), craniocerebral injury (1%), seriously disturbed cerebral circulation (4%) and lethargic encephalitis (0.66%) were identified. Chronic forms were mainly characterized by fibroplastic processes, local focal neurologic symptoms and congestive changes in the eye ground. The full-scale picture of the disease was sometimes observed at the terminal stage only. In 5% of the patients, such neurologic symptoms, as aphasias and paralyses, were prevalent in the clinical picture. The final diagnosis of a follow-up and repeated examination of the cerebrospinal fluid.
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PMID:[Variants of meningeal tuberculosis in adults]. 208 86

Forty-two cases of abdominal tuberculosis seen between June 1984 and June 1988 at Amiri Hospital in Kuwait were reviewed retrospectively. The clinical diagnosis was correct in only 35%. Nine patients presented as an emergency, but in none was a diagnosis of tuberculosis considered. Abdominal pain and tenderness were the commonest clinical findings; "doughy abdomen" and a mass in right iliac fossa were uncommon. Thus, symptoms were vague, signs nonspecific and investigations nonpathognomonic. In spite of this, abdominal tuberculosis should be considered in any patient who has obscure abdominal symptoms, weight loss and lethargy. Laparoscopy and colonoscopy with biopsy for histologic and bacteriologic study led to a definitive diagnosis in 66% of cases, obviating the need for exploratory laparotomy in many. Histologic examination was the surest way to establish the diagnosis.
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PMID:Abdominal tuberculosis. 235 Jul 49

Meningitis should be suspected in a patient who presents with fever, meningism, or severe headache. A careful physical examination should be performed of perimeningeal foci, with emphasis on the sinuses, ears, throat, neck, and lungs. A history of exposure to tuberculosis, viral disease, rodents, or suspicious dairy products or farm animals may give clues to the source of the meningitis. Immunosuppression through the use of corticosteroids or chemotherapy for such conditions as Hodgkin's disease, lymphoma, leukemia, malnutrition, or acquired immunodeficiency syndrome (AIDS) should also be noted and alert the clinician to the possible presence of an unusual pathogen. Meningitis associated with leukemia or most of the non-T-cell lymphomas is likely to be from a common bacterial agent (often Listeria), unless the patient is being treated with a steroid or is receiving other chemotherapy. Patients with Hodgkin's disease or AIDS or who have been treated with a steroid are more likely to have cryptococcal or tuberculous meningitis. Neonates and the very elderly may present with only irritability or lethargy and fever, without any of the other common symptoms. In neonates up to one week of age, group B streptococcal infection should be suspected. Gram-negative organisms should be suspected in elderly patients and those who have had neurosurgery. In patients with CSF shunts, infection with coagulase-negative Staphylococcus should be assumed and these patients are treated empirically until results of cultures are received. Several noninfectious conditions may mimic infectious meningitis, as may some unusual causes of infectious meningitis (eg, syphilis and schistosomiasis), which have not been discussed in this article.
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PMID:The many causes of meningitis. 361 11

We evaluated clinical features of five cases of Toxoplasma encephalitis (TE) occurring in recent Haitian entrants into the United States. None of the patients had any underlying malignancy or known immunosuppressive therapy. Histopathologic findings of TE at autopsy were confirmed by peroxidase-antiperoxidase method. Four patients had an antecedent episode of disseminated tuberculosis and all five were receiving antituberculous therapy when neurologic manifestations of lethargy, seizures, and motor weakness first developed. These symptoms progressed into coma and death within 15 days. Peripheral lymphocytopenia was noted in all patients; three were anergic. Parenchymal lesions were identified by CT brain scans and total proteins were elevated in spinal fluid in all cases. TE appears to be a manifestation of the acquired immune deficiency syndrome in Haitians; it should be suspected in those with a febrile illness and multiple focal lesions of the central nervous system.
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PMID:Toxoplasma encephalitis in recent Haitian entrants. 662 28

In a survey of 15,272 canine necropsies, natural infection with Mycobacterium tuberculosis was found to have been diagnosed in eight dogs (0.05%). Clinical findings were anorexia, loss of body weight, lethargy, vomiting, and leukocytosis; radiography revealed pleural and pericardial effusion, ascites, and hepatomegaly. Granulomatous lesions with acid-fast bacilli were consistently found. Mycobacterium tuberculosis was isolated from lesions in the lungs, liver, or lymph nodes of five dogs. All eight dogs had a history of contact with human patients with tuberculosis.
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PMID:Canine tuberculosis. 742 50

This community-based study analyzed 54 patients with definite or probable tuberculous meningitis (TBM) in New Mexico from 1970 through 1990. Patients ranged in age from 4 months to 86 years. The highest age-specific incidence occurred in the elderly, but 22% of patients were less than 10 years old. Native American patients were overrepresented. Patients were as likely to live in small towns as in large urban cities. Symptoms were present for a median of 13 days before admission. The majority of patients had fevers, headache, stiff neck, and mental changes, such as confusion or lethargy. No patient was admitted comatose. Focal neurologic signs were present in 33%. Laboratory testing found hyponatremia in 79%, pulmonary infiltrates on chest x-ray in 40%, ventricular dilatation on CT or MRI in 52%, and tuberculomas in 16%. PPD skin tests were positive in 64%. CSF cultures grew Mycobacterium tuberculosis in 50%, but colony counts were always lower than 10(2)/ml. As a consequence, acid-fast stains of CSF sediment were reported as positive in only 4%. Six patients were not diagnosed during the hospitalization and died of complications. Twenty-three percent of patients who were appropriately treated also died of complications during the initial hospitalization. Tuberculous meningitis continues to be an important disease in small communities, and affects all ages and ethnic and socioeconomic backgrounds.
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PMID:Tuberculous meningitis in the southwest United States: a community-based study. 841 30

Treatment of tuberculous meningitis should begin with an anti-tuberculous regimen of at least three drugs: isoniazid, pyrazinamide, and rifampin. Early in the course of therapy, ethambutol or streptomycin may be of some added benefit. If the local incidence of drug resistance to Mycobacterium tuberculosis is greater than 4%, or is unknown, then a fourth drug (ethambutol or streptomycin) should be added. If the patient is from an area with organisms resistant to multiple drugs, or is likely to be infected with a multiply resistant organism for any reason, then the patient should be on enough drugs to insure that at least two active anti-tubercular drugs are included in the therapy. An expert should be consulted Length of therapy is not standardized. For sensitive organisms, a regimen of three drugs daily for 2 months, followed by two-drug therapy (isoniazid and rifampin) has been recommended. The American Thoracic Society (ATS) and the Centers for Disease Control (CDC) have recommended a minimum of 12 months of therapy for tuberculous meningitis. If cultures remain positive for extended periods, or signs or symptoms respond slowly, therapy should be extended to 18 months. Patients with HIV also may need longer courses of therapy. The severity of tuberculous meningitis can be classified based on a system devised by the British Medical Research Council. Stage I patients are fully conscious, rational, and do not have neurologic signs. Stage II patients are confused or have neurologic signs such as cranial nerve palsy or hemiparesis. Stage III patients are comatose or stuporous with more severe neurologic signs. Corticosteroids are recommended if the patient is mentally confused, has neurologic signs, or is comatose (Stages II and III). In patients with moderate disease (Stage II), corticosteroids appear to improve neurologic sequelae and survival. Dexamethasone 6 to 12 mg per day and prednisone 60 to 80 mg per day tapered over 4 to 8 weeks has been used. Symptoms of central nervous system (CNS) inflammation may recur if the corticosteroid taper is implemented too soon or too fast. Steroids and diuretics such as furosemide and acetazolamide are sometimes used to treat hydrocephalus. Ventriculoperitoneal or ventriculoatrial shunting may be required to relieve signs and symptoms of hydrocephalus.
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PMID:Tuberculosis Meningitis. 1148 56

The story of Bulgarian physician Ivan Raev is indicative to define the importance of medical relations between Italy and Bulgary. Ivan Raev was the inventor of the "Bulgarian cure" for treating lethargic encephalitis, and he obtained a lot of remarkable results also in Italy, working in Queen Elena di Savoia's service, and studying epilepsy and tuberculosis. With Ivan Raev and many other healers, popular Bulgarian medicine married the official one, giving her dates and methods. These methods showed their efficacy in curing patients not only in the biological context but also in the social one.
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PMID:[Bulgary-Italy medical relationships]. 1164 Jan 21

An 11-year-old cat with a history of renal transplantation and treatment with cyclosporine and prednisolone was examined because of vomiting, diarrhea, inappetence, lethargy, and weight loss. Abdominal ultrasonography revealed 2 large heteroechoic masses thought to be mesenteric lymph nodes. Ultrasound-guided biopsy was performed, and histologic examination of biopsy specimens revealed granulomatous inflammation of presumptive lymph node tissue. Examination of sections stained with acid-fast stains revealed innumerable acid-fast bacilli within histiocytes, and a presumptive diagnosis of mycobacteriosis was made. The cat's clinical condition deteriorated, and euthanasia was elected. At necropsy, granulomatous inflammation was present within the mesenteric lymph nodes, spleen, liver, small and large intestines, lungs, and bone marrow. Bacterial culture yielded Mycobacterium avium, a slow-growing, opportunistic, saprophytic mycobacterium that can cause tuberculous lesions that are clinically indistinguishable from those associated with classic tuberculosis. It is a rare cause of disseminated mycobacteriosis in human transplant recipients. To our knowledge, this is the first report of disseminated M avium complex infection in a feline transplant recipient.
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PMID:Disseminated Mycobacterium avium complex infection following renal transplantation in a cat. 1271 Jul 73

Cases of disseminated Mycobacterium avium infections in dogs are rare because it appears that the species is innately resistant to infection. A 2-year-old, castrated, 5 kg Shih Tzu-Poodle-cross developed anemia, abdominal pain, lethargy, and splenomegaly. Histological examination of surgically removed spleen indicated marked granulomatous splenitis with myriad intracytoplasmic acid-fast bacterial rods. Ultrastructural examination revealed the presence of 3-4-microm-long mycobacteria in phagolysosomes of epithelioid macrophages. Tissue extract of lightly fixed spleen was positive for M. avium 16S ribosomal RNA and negative for M. tuberculosis complex IS6110 DNA by polymerase chain reaction testing. Anemia was associated with the presence of mycobacteria-infected macrophages in bone marrow. The animal's condition deteriorated, and euthanasia was performed after a clinical course of 2 months. The principal morphological findings at necropsy were severe diffuse granulomatous hepatitis, enteric lymphadenomegaly, and segmental granulomatous enteritis with intralesional mycobacteria present. Mycobacterium avium was cultured from enteric lymph nodes sampled at necropsy. The source of infection was not established but was presumed to be environmental with an enteric portal of entry.
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PMID:Fatal mycobacteriosis with hepatosplenomegaly in a young dog due to Mycobacterium avium. 1582 7


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