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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cases of penicillin-resistant pneumococcal meningitis have been reported in other countries since 1977, but never before reported in Taiwan. In 1990, two cases of the disease were diagnosed here. Case one was a two-year-old boy who had had fever and vomiting for several days prior to admission. Under the impression of meningitis, a spinal tap was done. The CSF yielded pneumococcus, which was misinterpreted as sensitive to penicillin. Penicillin (400,000 units/kg/day) was given parenterally without effect. On the 12th day after admission, another spinal tap still yielded pneumococcus. This time the sensitivity test was reread with great care, and then reported to be penicillin-resistant pneumococcus. Minimal inhibitory concentration (MIC) of penicillin was performed simultaneously and it revealed 0.1 microgram/ml. Vancomycin (60 mg/kg/day) was substituted for penicillin. The patient became afebrile two days later, and was discharged ten days later without sequelae. Case two, a five-month-old girl, was diagnosed to have meningitis because of fever, vomiting, tense fontanel and seizure on admission. After a spinal tap was done, she was put on ampicillin and cefotaxime. The fever subsided two days later. At that time, the CSF was reported to grow pneumococcus, again misread as sensitive to penicillin. The antibiotics was switched to penicillin, but fever recurred. The second spinal tap still yielded pneumococcus which was sensitive to penicillin but resitstant to oxacillin. Based on experience with the first case, penicillin was changed to vancomycin, and performed MIC immediately. The MIC was 1.0 microgram/ml. The patient became afebrile two days later, and was discharged in good condition after ten days of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Penicillin-resistant pneumococcal meningitis: report of two cases]. 177 62

A breast-fed boy, born to first-cousin parents, had been vomiting since birth; his general condition remained good until age 6 weeks when vomiting became more frequent, and his status suddenly worsened, with polypnea, shock, hypothermia, jaundice, presence of blood in urine, gastric juice, stool, and bleeding tendency during veno-punctures. There was an huge hepatomegaly and a splenomegaly. Hypoglycaemia, metabolic acidosis, severe blood coagulation disturbances, elevated liver enzymes, hypoalbuminemia, pointed to an acute liver failure. He was resuscitated with current supportive measures, and was given a wide spectrum antibiotherapy. Because serologic tests for syphilis were positive in the child and his mother, including the presence of specific IgM the infant was then given Penicillin G therapy only, which resulted in a complete recovery. One month later, a needle liver biopsy showed residual signs of hepatitis. Other possible infectious or metabolic causes of acute liver failure occurring early in life had been excluded.
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PMID:[Acute hepatic insufficiency disclosing congenital syphilis]. 240 70

A 15 year old boy was admitted to hospital with five days history of fever, headache, vomiting and otorrhea. Findings on physical examination included high fever, purulent drainage from right ear, nuchal rigidity, Brudzinski's and Kernig's signs. Laboratory finding was polymorphonuclear leukocytosis. Computerized tomography (CT) of his brain was normal. A lumbar puncture disclosed purulent CSF. Chloramphenicol and Penicillin G were given intravenously as treatment for the meningitis. After five days of this therapy he continued to be febrile and nuchal rigidity, Brudzinski's and Kerning's signs increased. The second CT demonstrated the presence of an abscess in the cerebellum. The abscess was aspirated during mastoidectomy. In the cultures of the aspiration material Bacteroides species and gram positive micrococci grew out. Metronidazole, 500 mg qid per oral, was added to the therapy. During treatment, his condition was evaluated with serial computerized tomography scans of his brain and these studies showed progressive decrease in the size of the lesion. Metronidazole and antibiotics therapies were continued 45 days. The patient made an uneventful recovery.
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PMID:[A cerebellar abscess caused by anaerobic and aerobic (mixed) microorganisms]. 651 26

Seventy-seven episodes of pneumococcal meningitis in 69 patients were reviewed. Twelve (15.6%) episodes occurred in those over 60 years old, 14 (18.2%) in patients between 10 and 60 years, 22 (28.6%) in patients between 2 and 10 years and 29 (37.7%) in those under 2 years. Overall mortality was 13.0% (10/77) and age of > 60 years was significantly associated with mortality (P < 0.05). Twelve episodes resulted in disabilities, eight of which were in those under 2 years, and took the form of hearing impairment in nine. Many patients had predisposing conditions with aural pathology, malignancy and diabetes mellitus being commonest in those over 10 years of age and aural pathology, preceding viral infection, renal disease, sinusitis or recent lower respiratory tract infection commonest in those aged between 2 and 10 years. Three of five patients with recurrent meningitis had CSF leaks. The most common features at presentation were fits, irritability, diarrhoea, and bulging fontanelles in those under 6 months; vomiting, drowsiness and poor feeding in those between 6 months and 2 years; neck stiffness, vomiting and drowsiness in those between 2 and 10 years while neck stiffness, focal neurology, headache and vomiting were commonest in those over 10 years old. Fever was common in all age groups as were foci of infection outside the CSF, with chest infections being significantly associated with mortality (P < 0.05). Of the laboratory parameters measured, low platelets (< 100 x 10(9)/l and high blood urea (> 7 mmol/l) were associated with mortality (P < 0.05). Blood cultures grew Streptococcus pneumoniae in 79.7% patients. Seventy-four (96%) patients had CSF taken of which 81% had gram films which were positive and interpreted correctly as showing pneumococci. Pneumococci were grown in 87.8% CSF cultures and all were sensitive to penicillin but a single isolate was chloramphenicol resistant. Many different antimicrobial drugs were used but penicillin plus chloramphenicol was the most commonly employed after the results of CSF microscopy were known and penicillin alone after culture results were available. Penicillin mono-therapy was associated with a low mortality.
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PMID:A review of the clinical presentation, laboratory features, antimicrobial therapy and outcome of 77 episodes of pneumococcal meningitis occurring in children and adults. 780 80

The epidemiological distribution and clinical features of 12 cases of Weil's disease from Turkey, are reviewed. The disease is most common in male farmers from rural areas. Myalgia and jaundice were recorded in all patients. Signs included vomiting in 9 patients, haemorrhages in 6, and renal function was impaired in 6. Creatine phosphokinase levels were found above normal limits in 75% of the cases. Leptospires were demonstrated with dark-field microscopy in the blood of 9 and in the urine of 5 of these patients. The diagnosis was confirmed with microscopic agglutination test (MAT) as well as with ELISA. Ig M antibodies were detected in 11 (92%) of the patients and is an accurate marker for acute leptospirosis. Penicillin was used for therapy and the outcome was favorable in 10 patients. Two patients died. It should be kept in mind that leptospirosis is an extremely severe disease which requires appropriate examinations at the right moment.
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PMID:Weil's disease: report of 12 cases. 906 72

There are three clinical presentations of anthrax in humans: cutaneous (>95% of cases), orogastric and inhalational. The infectious form, the spore, enters the body and is thought to germinate within macrophages either at the site of inoculation (cutaneous or orogastric) or in the regional lymph node (inhalational). The bacillus then synthesizes its antiphagocytic capsule and the lethal and oedema toxins which interfere with the non-specific host defences leading to the characteristic locally destructive lesion and spread by lymphatics to the systemic circulation and other organs. The cutaneous form begins as a papule which progresses over several days to a vesicle and then ulcerates. There is often oedema, sometimes massive, probably due to the oedema toxin that surrounds the lesions which then develop a characteristic black eschar. The patient may be febrile with mild to severe systemic symptoms of malaise, headache and toxicity. Oropharyngeal anthrax presents with severe sore throat or an ulcer in the oropharyngeal cavity associated with neck swelling, fever, toxicity and dysphagia. Gastrointestinal anthrax begins with anorexia, nausea, vomiting and abdominal pain which may be similar to an acute abdomen. There may be diarrhoea and ascites, both of which may be haemorrhagic. Inhalational anthrax begins with non-specific symptoms of malaise, fever, myalgia and non-productive cough. After a period of 2-3 days, this is followed by a sudden onset of severe respiratory distress associated with diaphoresis, cyanosis and increased chest pain. There may be a widened mediastinum and pleural effusions on chest X-ray. Death follows in 24-36 h from respiratory failure, sepsis and shock. The diagnosis of anthrax is easy if it is considered. The organism is readily observed by Gram or Wright stain in local lesions or blood smear and can be easily cultured from the blood and other body fluids. However, because of its rarity, it is not often included in the differential diagnosis and in inhalational disease the diagnosis is rarely made until the patient is moribund. More rapid diagnostic tests are under development. Penicillin, combined with supportive care, remains the mainstay of treatment, although the organism is susceptible in vitro to many antibiotics. In recent years, there have been significant advances in our knowledge of the organism and its toxins and it is anticipated that similar progress will be made in the future in developing more rapid diagnostic tests and new modalities of treatment.
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PMID:Clinical aspects, diagnosis and treatment of anthrax 1047 74

We report three children with tubulointerstitial renal failure following leptospirosis. All had acute nonoliguric renal failure with mild hypocalemia and mild metabolic acidosis. Maximum blood urea nitrogen (BUN) and creatinine were 217 and 7.1 mg/dl, respectively, on the 6th day of disease, and no patient required dialysis. They presented with acute febrile illness and dehydration, and required intravenous fluid supplements. Myalgia, vomiting, and bleeding were found in two children. Abdominal pain, arthralgia, diarrhea, and conjunctival suffusion were found in one child. Only one child, who had an underlying disease of beta-thalassemia/Hb E, had jaundice, hepatosplenomegaly, anemia, and thrombocytopenia. Penicillin treatment was given in one case. All recovered, with normal renal function. The leptospirosis complement fixation test was used to confirm diagnosis. L. batavia was considered the etiologic agent in two of the children.
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PMID:Tubulointerstitial renal failure in childhood leptospirosis. 1053 63

Mushroom poisoning, mainly due to the Amanita genus, is an infrequent cause of liver failure in our environment. However, because of its high morbidity and mortality, it constitutes a medical emergency. The characteristic initial symptoms of vomiting, abdominal pain, and diarrhea are nonspecific and may be confused with gastroenteritis. If correct and early treatment is not given, renal and hepatic failure can develop, sometimes requiring liver transplantation. We present three cases of mushroom poisoning, which presented a different clinical course ranging from complete recovery with traditional medical treatment to severe acute liver failure requiring transplantation in one patient and albumin dialysis (molecular absorbent recycling system [MARS]) in another with favorable outcome. Although controlled clinical studies of the treatment of mushroom poisoning are lacking, recommendations based on the experience of various authors have been established. Penicillin G and silymarin seem to be useful. The development of new techniques of extracorporeal detoxification, mainly MARS, may represent an important support system in the treatment of these patients.
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PMID:[Liver failure due to mushroom poisoning: clinical course and new treatment perspectives]. 1288 55

A pregnant woman at the 28th gestational week and three other members of the family had mushrooms for dinner. One of these mushrooms was an Amanita mushroom. The morning after, three of them suffered from nausea, vomiting and diarrhoea. The pregnant woman was admitted to hospital, and therapy with Penicillin and Silibinin was started immediately. Hepatic and renal blood parameters were observed repeatedly for early detecting of organ failure. Fetal lung maturation was forced by administration of betamethasone. After five days at the intensive care unit mother and unborn child were dismissed at normal physical condition.
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PMID:[Amanita poisoning during pregnancy]. 1460 Aug 62

Leptospirosis, a re-emerging zoonosis caused by pathogenic Leptospira, has a low incidence in Bulgaria. This paper reports a case of leptospirosis in Pleven, Bulgaria, in which the subject was infected after wading through irrigative canal in northern Greece. Two days later, he had a fever, myalgia and vomiting followed by jaundice, darkness of urine and oliguria. The patient was admitted to Clinic of Infectious Diseases at University Hospital-Pleven after returning to Bulgaria. The history and laboratory findings suggested icterohaemorrhagic leptospirosis. Penicillin G was prescribed and intensive supportive treatment was initiated. Dialysis was performed two hours after admission and was followed by poliuric stage of acute renal failure (peak urine output 16 600 mL/day). Microaglutination test (MAT) for sero-diagnosis was positive (L. hardjo 1:1600, L. icterohaemorrhagiae 1:800). The patient was discharged after sixteen days with improved renal and liver functions. In conclusion, The probability of leptospirosis should not be ignored in patients with fever after returning from abroad. The prompt dialysis and adequate treatment improve prognosis.
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PMID:Severe leptospirosis observed in a man who had just returned from abroad. 2520 81


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