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Parasitic rheumatism is a rare condition characterized by inflammatory joint manifestations due to a parasitic infestation without parasites into joint cavity, (but, with circulating immune complexes, in serum, and synovial fluid; and with immunoglobulins and complement deposits in synovium in some cases reported in the literature). The number of parasites (now 15) which can induce such an arthritis by immune mechanisms is steadily increasing. In all, but few cases of parasitic rheumatism, usual parasitic manifestations (diarrhea, abdominal pain, nausea...) are mild or absent; but, if present, they are a very good criteria to evoke the diagnosis. Clinical pictures of arthritis induced by parasitic infestation are very polymorphic, and non specific of the involved parasite; they seem to depend on genetic predisposition: the symptoms are monoarticular, pauciarticular, or polyarticular, involving small, medium, and or large joints. They can mimic the clinical picture of different inflammatory rheumatic diseases. The most striking feature of parasitic rheumatism is the failure of antirheumatic agents (especially non steroidal anti-inflammatory agents), contrasting with the dramatic efficacy of specific anti-parasitic treatment. The proof of the responsibility of parasitic infestation by indirect mechanism is given by an exceptional case report of a patient with arthritis, dramatically cured after removal of larvae from Anisakiasis gastric granuloma. To explain the uncommon occurrence of this variety of reactive arthritis, due to parasitic infestation, despite the high prevalence of parasitic infestation in the world, hypothesis of genetic predisposition seems valuable. Among 34 well documented reported cases of parasitic rheumatism in the literature, HLA B 27 antigen has been researched in 13; out of these 13, HLA B 27 is absent in 9; in 7 out of these 9, clinical picture is symmetrical polyarthritis. Out of the 13 cases, HLA B 27 is present in 4: In all these 4 cases, clinical picture is asymmetrical pauciarthritis, mimicking arthritis of Reiter's disease.
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PMID:[Is there a role for parasites in the etiology of inflammatory rheumatism?]. 227 83

A white homosexual man presented with a 6-week history of intermittent diarrhoea, abdominal pain, nausea and malaise. Threadworm infestation was present, but other gastro-intestinal infection was excluded. Rectal spirochaetosis was found on examination of a rectal biopsy specimen. The patient's symptoms disappeared and the rectal tissue returned to normal on biopsy after treatment with metronidazole and mebendazole. It is suggested that the symptoms were directly related to the presence of rectal spirochaetosis, which responded to the antibiotic.
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PMID:Rectal spirochaetosis--symptomatic response to metronidazole and mebendazole. A case report. 403 98

Among 810 parasitologically examined persons (1981) 277 (34%) showed positive findings. The high percentage of parasitisation in foreigners (86%) is to be explained by the in most cases aimed transfer of these patients (215 of the 810 persons). Affection with Schistosoma was recognized in 51 patients at the age of 17-47 years (means = 21.86), without Africans, and stood in the 3rd place of the distribution of frequency of the heterogeneous parasitoses. 49 of these patients came from Mozambique, 1 from Namibia and 1 from Zambia. In 51% S. haematobium was diagnosed, in 22% S. mansoni and in 27% a double infestation with the two forms of parasites. While 80% of the patients with affection of S. haematobium showed clinical symptoms (macrohaematuria, cystitis complaints), there were only 44% among the S. mansoni group. 47 patients were treated with Niridazole (Ambilhar, 25 mg/kg, 5-7 days), 2 patients with Praziquantel (Biltricide, 40 mg/kg, 1 day) and 2 other patients with Praziquantel after unsuccessful Niridazole therapy. Follow-up examinations were performed after 1, 3, 6 and 12 months. In 17% of the patients treated with Niridazole the primary treatment did not lead to cure; side effects (abdominal pain, nausea, vertigo) were observed in 55%. Praziquantel was tolerated very well. During a control period of 1 year living eggs of Schistosoma were no more proved.
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PMID:[Clinical aspects and therapy of schistosomiasis]. 661 96

The authors report the clinical, laboratorial and epidemiological aspects of a human case of jungle yellow fever. The patient suffered from fever, chills, sweating, headaches, backaches, myalgia, epigastric pains, nausea, vomiting, diarrhea and prostration. He was unvaccinated and had been working in areas where cases of jungle yellow fever had been confirmed. Investigations concerning the yellow fever virus were performed. Blood samples were collected on several days in the course of the illness. Three of these samples (those obtained on days 5, 7 and 10) were inoculated into suckling mice in attempt to isolate virus and to titrate the viremia level. Serological surveys were carried out by using the IgM Antibodies Capture Enzyme Linked Immunosorbent Assay (MAC-ELISA), Complement Fixation (CF), Hemagglutination Inhibition (HI) and Neutralization (N) tests. The yellow fever virus, recovered from the two first samples and the virus titration, showed high level of viremia. After that, specific antibodies appeared in all samples. The interval between the end of the viremia and the appearance of the antibodies was associated with the worsening of clinical symptoms, including bleeding of the mucous membrane. One must be aware of the risk of having a urban epidemics in areas where Aedes aegypti is found in high infestation indexes.
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PMID:Jungle yellow fever: clinical and laboratorial studies emphasizing viremia on a human case. 859 63

Severe or complicated malaria is defined by infestation by Plasmodium falciparum into all red blood cells, especially those in the brain, causing coma and repeated convulsions; severe anemia (6 g/dl hemoglobin, 20% hematocrit); renal insufficiency (265 mcmol/l creatinine, 400 ml/day diuresis); pulmonary edema; hypoglycemia (2.2 ml/l or 0.4 g/l); shock; diffuse hemorrhaging; massive hemoglobinuria; and blood acidosis. Other possible symptoms of severe malaria are clouded thinking, changes in behavior, and inability to focus. It is most common in people with no immunity to malaria (children aged 4 and travelers in endemic zones). Pregnancy, splenectomy, corticotherapy, or poorly maintained immunity status favor severe anemia in adults. Sources of chloroquine-resistant P. falciparum have existed since 1960. Resistance has since expanded from Southeast Asia and South America to Africa, posing treatment problems. Malaria usually begins with fever (40 or more degrees Celsius), headaches, muscular pain, digestive troubles (e.g., diarrhea, nausea, or vomiting), and abdominal pain. In suspected cases of malaria, a blood sample or a thick blood smear as well as treatment (even in the absence of parasitological proof) needs to be done as soon as possible. Intravenous quinine diluted in a 5-10% glucose solution should be delivered at a rate of 24 mg/kg/day. In the case of severe jaundice, the dose should be cut in half beginning 8 hours after treatment began. If intravenous delivery is impossible, intramuscular delivery should be done. Corticosteroids, anticoagulants, and aspirin are contraindicated. In 2-4 days, oral administration (chloroquine, halofantrine, or mefloquine) is warranted. 20% of malaria-related deaths among patients who receive treatment are due to complications of the central nervous system. Protection against mosquito bites prevents malaria. Chemoprophylaxis in endemic zones should be limited to short trips to malaria zones or to pregnant women.
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PMID:[Severe malaria]. 1229 Jan 83

An estimated 50% of pregnant women in Africa are anemic-- a condition that has been linked to intrauterine growth retardation, increased perinatal mortality, low birthweight, compromised immunity, and possible psychomotor and cognitive impairments. In tropical Africa, iron and folate deficiencies and malaria are the major causes of anemia in pregnancy. Iron deficiency anemia results from a combination of dietary insufficiency, excessive requirements associated with multiparity, and chronic blood loss from hookworm infestation. An essential component of maternal-child health services in Africa is prevention of anemia and therapeutic management once severe anemia is documented. Since 35% of nonpregnant African women are anemic, many women will enter pregnancy with inadequate iron stores. Thus, the prophylactic dose of iron should be at least 120 mg/day rather than the usual 60 mg dose. Unfortunately, increased dosages of iron increase the side effects of constipation and nausea, so careful counseling is necessary to ensure compliance. Folic acid, which has no side effects, should be administered in doses of 1.5 mg/day. To reduce the risk of malaria, a therapeutic dose of chloroquine should be administered at the 1st prenatal visit (600 mg for 2 days and 300 mg on the 3rd day) followed by proguanil (100 mg/day) until delivery. In cases where anemia persists or emerges, the iron dose should be increased to 200 mg of ferrous sulfate 3 time/day (180 m,g of elemental iron) and 5 mg of folic acid should be provided. Blood transfusion should be used sparingly and only in severe cases, given the risk of transmission of human immunodeficiency virus.
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PMID:Towards a more effective management of pregnancy related anaemias in Africa. 1231 81

There is increasing evidence of permanent sequalae from acute organophosphate poisoning. We report on accidental diazinon overexposure with acute organophosphate poisoning through cutaneous absorption and inhalation followed by persistent neurological effects. In addition, we observed skeletal and endocrine effects likely attributable to the diazinon poisoning. A family of seven was exposed to diazinon in June 1999 over a two-day period. The pesticide company mistakenly used diazinon to heavily spray the inside of the home instead of permethrin. The applicator applied the pesticide over the entire surface of the floor, carpeting, furniture, and clothing in closets to eradicate an infestation of fleas. Acute symptoms in the family members included headaches, nausea, skin irritation, runny nose, and vomiting. The family was first evaluated at 3 months and then 3 years after the acute poisoning. There were persisting neurological symptoms of memory loss, decreased concentration, irritability, and personality changes of varying degrees in all family members. Objective neurological findings of impaired balance, reaction time, color vision, slotted pegboards and trials making were present in the three older children who could be tested. Neuropsychological evaluation revealed evidence of organic brain dysfunction in all seven family members. Bone growth difficulties are present in four of five children. One child has delayed menarche.
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PMID:Health effects of diazinon on a family. 1546 49

Hydatid disease is a parasitic infestation caused by a tapeworm of the genus Echinococcus, and it is common in Mediterranean regions. Cystic lesions cause symptoms via compressing adjacent organs or may be totally silent. Morbidity is usually secondary to free rupture of the echinococcal cyst with or without anaphylaxis, infection of the cyst or dysfunction of affected organs. The cyst of Echinococcus granulosus is commonly located in the liver and frequently causes no symptoms. Anaphylactic reactions as a result of cyst perforation generally occur during interventions such as needle aspiration or open surgery; however, the spillage of cyst fluid with intravascular spread resulting from trauma may also trigger anaphylaxis, and rare case reports of this kind are present in the literature. We report the case of a 17-year-old man who was admitted to the public hospital with a sudden onset of nausea, vomiting and fainting. After a short period of intervention in the emergency department he died. As the cause of his sudden death was unknown, a forensic autopsy was carried out by the Forensic Council of Turkey. The autopsy revealed a macroscopically non-ruptured hydatid cyst in the liver and laryngeal oedema. In histopathological examination, two scolices in the pulmonary artery and inflammatory infiltration mainly composed of mast cells in the larynx were detected. Sudden death in this case was attributed to anaphylactic shock caused by intravascular spread of the cyst contents.
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PMID:Non-ruptured hydatid cyst can lead to death by spread of cyst content into bloodstream: an autopsy case. 1587 31

Infestation with Ascaris lumbricoides (roundworm) is very common in the tropics and subtropics. Patients with ascariasis can be asymptomatic or may present with different clinical features in the form of simple nausea, decreased appetite, abdominal pain or more severe bowel obstruction, perforation, intussusception, biliary colic etc. Ultrasonography (USG) can be quick, safe, noninvasive and relatively inexpensive tool in diagnosing the presence of worms and also evaluating response to treatment (1, 2, and 3). Here we present four cases of roundworm infestation presenting with acute abdomen in the emergency department, which were diagnosed by USG and further imaging features of ascariasis on USG is described.
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PMID:Roundworm infestation presenting as acute abdomen in four cases--sonographic diagnosis. 1640 53

Gnathostomiasis is a nematode infestation endemic in Southeast Asia, which can involve multiple organs including the liver, eyes, gastrointestinal tract and CNS. The most common manifestation is recurrent migratory subcutaneous swellings which can appear anywhere on the body and are accompanied by pruritus and systemic symptoms such as low-grade fever, loss of appetite and nausea. The diagnosis is based on the clinical picture, history of travel, peripheral blood eosinophilia and the determination of agent-specific antibody levels. The standard treatment is albendazole. We present a 37-year-old Laotian woman, who had lived in Germany for 17 years, but developed recurrent swelling of the cheek following a visit to Laos. Because of the typical clinical findings, the history of a visit to Laos, and the presence of specific anti-Gnathostoma antibodies on Western blot, the diagnosis of cutaneous gnathostomiasis was made.
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PMID:Gnathostomiasis: import from Laos. 1668 9


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