T1  Age 36 47   60-year-old

T2  Sex 48 51   man

T3  Personal_background 57 70   San Francisco

T5  Activity 103 112    traveling

E1  Activity:T5 

T6  Nonbiological_location 120 131  Philippines

R1  MODIFY Arg1:T6 Arg2:E1  

T7  Activity 79 96  consumed raw pork

E2  Activity:T7 

T8  Date 136 145    June 2003

E3  Date:T8 

T9  Sign_symptom 163 166    ill

E4  Sign_symptom:T9 

T10 Sign_symptom 172 177    fever

E5  Sign_symptom:T10 

T11 Sign_symptom 179 190    diaphoresis

E6  Sign_symptom:T11 

T12 Sign_symptom 192 200    headache

E7  Sign_symptom:T12 

T13 Sign_symptom 202 208    nausea

E8  Sign_symptom:T13 

T14 Sign_symptom 214 222    anorexia

E9  Sign_symptom:T14 

T15 Duration 252 259    7-month

E10 Duration:T15 

T16 Activity 236 244    returned

E11 Activity:T16 

T18 Nonbiological_location 276 287  Philippines

T19 Date 289 320    Three days after symptoms onset

E12 Date:T19 

T20 Medication 347 358  doxycycline

E13 Medication:T20 

T22 Clinical_event 390 398  admitted

E14 Clinical_event:T22 

T23 Nonbiological_location 404 418  local hospital

T24 Date 419 431    5 days later

E15 Date:T24 

T25 Lab_value 448 454   38.9°C

T26 Sign_symptom 439 444    fever

E16 Sign_symptom:T26 

R3  MODIFY Arg1:T25 Arg2:E16    

T27 Sign_symptom 456 471    nuchal rigidity

E17 Sign_symptom:T27 

T28 Sign_symptom 473 481    headache

E18 Sign_symptom:T28 

T29 Sign_symptom 495 502    malaise

E19 Sign_symptom:T29 

T30 History 563 600 past medical history was unremarkable

T31 History 526 561 no recent contact with sick persons

T32 Diagnostic_procedure 605 625    physical examination

E20 Diagnostic_procedure:T32 

T33 Sign_symptom 634 643    somnolent

E21 Sign_symptom:T33 

T34 Sign_symptom 648 662    fully oriented

E22 Sign_symptom:T34 

T35 Diagnostic_procedure 690 712    neurologic examination

E23 Diagnostic_procedure:T35 

T36 Sign_symptom 672 686    focal findings

E24 Sign_symptom:T36 

A1  POLARITY E24 NEG

R4  MODIFY Arg1:E24 Arg2:E23    

T37 Sign_symptom 729 744    nuchal rigidity

E25 Sign_symptom:T37 

T38 Severity 722 728    slight

R5  MODIFY Arg1:T38 Arg2:E25    

T39 Diagnostic_procedure 755 770    leukocyte count

E26 Diagnostic_procedure:T39 

T40 Lab_value 774 784   21,000/mm3

T41 Diagnostic_procedure 807 818    neutrophils

E27 Diagnostic_procedure:T41 

T42 Lab_value 796 806   16,400/mm3

T43 Biological_structure 820 839    Cerebrospinal fluid

T44 Biological_structure 841 844    CSF

T45 Diagnostic_procedure 853 868    leukocyte count

E28 Diagnostic_procedure:T45 

T46 Lab_value 872 878   487/μL

T47 Lab_value 884 911   80% polymorphonuclear cells

T48 Lab_value 916 931   18% lymphocytes

T49 Diagnostic_procedure 937 944    glucose

E29 Diagnostic_procedure:T49 

T50 Diagnostic_procedure 949 956    protein

E30 Diagnostic_procedure:T50 

T51 Lab_value 964 973   <20 mg/dL

R6  MODIFY Arg1:T51 Arg2:E29    

T52 Lab_value 978 988   <167 mg/dL

R7  MODIFY Arg1:T52 Arg2:E30    

R8  MODIFY Arg1:T44 Arg2:E28    

R9  IDENTICAL Arg1:T43 Arg2:T44 

R10 MODIFY Arg1:T46 Arg2:E28    

R11 MODIFY Arg1:T47 Arg2:E28    

R12 MODIFY Arg1:T48 Arg2:E28    

R13 MODIFY Arg1:T44 Arg2:E29    

R14 MODIFY Arg1:T44 Arg2:E30    

T53 Diagnostic_procedure 1004 1014  Gram stain

E31 Diagnostic_procedure:T53 

T54 Biological_structure 1018 1021  CSF

T55 Sign_symptom 1029 1057  gram-positive cocci in pairs

E32 Sign_symptom:T55 

R15 MODIFY Arg1:T54 Arg2:E31    

T56 Medication 1085 1096    ceftriaxone

E33 Medication:T56 

T57 Medication 1098 1108    vancomycin

E34 Medication:T57 

T58 Medication 1114 1124    ampicillin

E35 Medication:T58 

T59 Disease_disorder 1130 1150  bacterial meningitis

E36 Disease_disorder:T59 

T60 Diagnostic_procedure 1162 1187  Computed tomographic scan

E37 Diagnostic_procedure:T60 

T61 Biological_structure 1195 1199  head

R16 MODIFY Arg1:T61 Arg2:E37    

T62 Sign_symptom 1212 1221  sinusitis

E38 Sign_symptom:T62 

T63 Diagnostic_procedure 1241 1251  radiograph

E39 Diagnostic_procedure:T63 

T64 Biological_structure 1235 1240  chest

R17 MODIFY Arg1:T64 Arg2:E39    

T65 Diagnostic_procedure 1256 1286  transesophageal echocardiogram

E40 Diagnostic_procedure:T65 

T66 Lab_value 1292 1300 negative

R18 MODIFY Arg1:T66 Arg2:E40    

R19 MODIFY Arg1:T66 Arg2:E39    

T67 Date 1305 1319  hospital day 2

E41 Date:T67 

T68 Diagnostic_procedure 1321 1335  blood cultures

E42 Diagnostic_procedure:T68 

T69 Sign_symptom 1341 1360  gram-positive cocci

E43 Sign_symptom:T69 

T70 Detailed_description 1364 1369  pairs

R20 MODIFY Arg1:T70 Arg2:E43    

T71 Detailed_description 1374 1380  chains

R21 MODIFY Arg1:T71 Arg2:E43    

T72 Sign_symptom 1386 1394  organism

E44 Sign_symptom:T72 

T73 Diagnostic_procedure 1399 1407  catalase

E45 Diagnostic_procedure:T73 

T74 Lab_value 1408 1416 negative

R22 MODIFY Arg1:T74 Arg2:E45    

T75 Diagnostic_procedure 1418 1430  bile esculin

E46 Diagnostic_procedure:T75 

T76 Lab_value 1431 1439 negative

R23 MODIFY Arg1:T76 Arg2:E46    

T77 Diagnostic_procedure 1445 1472  pyrrolidonyl aminopeptidase

E47 Diagnostic_procedure:T77 

T78 Lab_value 1473 1481 negative

R24 MODIFY Arg1:T78 Arg2:E47    

T79 Sign_symptom 1499 1516  Streptococcus spp

E48 Sign_symptom:T79 

R25 MODIFY Arg1:E45 Arg2:E44    

R26 MODIFY Arg1:E46 Arg2:E44    

R27 MODIFY Arg1:E47 Arg2:E44    

T80 Diagnostic_procedure 1520 1544  latex agglutination test

E49 Diagnostic_procedure:T80 

T81 Sign_symptom 1560 1592  Streptococcus pneumoniae antigen

E50 Sign_symptom:T81 

A2  POLARITY E50 NEG

T82 Diagnostic_procedure 1594 1630  Antimicrobial susceptibility testing

E51 Diagnostic_procedure:T82 

T83 Sign_symptom 1659 1724  sensitive to penicillin (MIC = 0.03), ceftriaxone, and vancomycin

E52 Sign_symptom:T83 

T84 Sign_symptom 1729 1770  resistant to tetracycline and clindamycin

E53 Sign_symptom:T84 

T85 Coreference 1647 1654   isolate

E54 Coreference:T85 

R28 IDENTICAL Arg1:E54 Arg2:E44 

R29 MODIFY Arg1:E52 Arg2:E54    

R30 MODIFY Arg1:E53 Arg2:E54    

T86 Medication 1772 1793    Antimicrobial therapy

E55 Medication:T86 

T87 Medication 1809 1821    penicillin G

E56 Medication:T87 

T88 Dosage 1823 1839    24 million units

T89 Administration 1840 1853    intravenously

T90 Frequency 1854 1861 per day

R31 MODIFY Arg1:T88 Arg2:E56    

R32 MODIFY Arg1:T89 Arg2:E56    

R33 MODIFY Arg1:T90 Arg2:E56    

T91 Date 1866 1880  hospital day 5

E57 Date:T91 

R34 SUB_PROCEDURE Arg1:E56 Arg2:E55 

T92 Sign_symptom 1908 1920  hearing loss

E58 Sign_symptom:T92 

T93 Biological_structure 1928 1936  left ear

R35 MODIFY Arg1:T93 Arg2:E58    

T94 Diagnostic_procedure 1949 1973  nasopharyngeal endoscopy

E59 Diagnostic_procedure:T94 

T95 Lab_value 1979 1987 negative

R36 MODIFY Arg1:T95 Arg2:E59    

T96 Date 1992 2006  hospital day 7

E60 Date:T96 

T97 Diagnostic_procedure 2043 2062  API 20 Strep System

E61 Diagnostic_procedure:T97 

T98 Sign_symptom 2104 2122  S. suis serotype 2

E62 Sign_symptom:T98 

T99 Occupation 2170 2177    butcher

T100    Detailed_description 2185 2231  culinary preference for partially cooked pork,

R37 MODIFY Arg1:T100 Arg2:T99   

T101    Date 2270 2311  until the week prior to onset of symptoms

E63 Date:T101 

T103    Nonbiological_location 2258 2269    Philippines

T104    Other_entity 2209 2230  partially cooked pork

T105    Date 2316 2330  hospital day 9

E64 Date:T105 

T106    Diagnostic_procedure 2334 2361  formal audiology evaluation

E65 Diagnostic_procedure:T106 

T107    Sign_symptom 2376 2427  bilateral sensorineural high-frequency hearing loss

E66 Sign_symptom:T107 

T108    Severity 2369 2375  severe

R40 MODIFY Arg1:T108 Arg2:E66   

T109    Lab_value 2429 2435 –70 dB

R41 MODIFY Arg1:T109 Arg2:E66   

T110    Duration 2462 2475  10-day course

E67 Duration:T110 

T111    Medication 2479 2509    parenteral antimicrobial drugs

E68 Medication:T111 

T112    Clinical_event 2518 2528    discharged

E69 Clinical_event:T112 

T113    Medication 2542 2554    oral therapy

E70 Medication:T113 

T114    Detailed_description 2532 2541  continued

R42 MODIFY Arg1:T114 Arg2:E70   

T115    Date 2576 2602  Two months after discharge

E71 Date:T115 

T116    Sign_symptom 2625 2646  much improved hearing

E72 Sign_symptom:T116 

T117    Sign_symptom 2661 2669  sequelae

E73 Sign_symptom:T117 

A3  POLARITY E73 NEG

T118    Coreference 2012 2020   organism

E74 Coreference:T118 

R43 IDENTICAL Arg1:E74 Arg2:E44 

*   OVERLAP E2 E1

R45 BEFORE Arg1:E1 Arg2:E3  

*   OVERLAP E3 E4 E5 E6 E7 E8 E9

R46 AFTER Arg1:E9 Arg2:E11  

T17 Activity 260 268    vacation

E75 Activity:T17 

R2  MODIFY Arg1:E10 Arg2:E75    

R44 MODIFY Arg1:T18 Arg2:E75    

*   OVERLAP E11 E75

R47 BEFORE Arg1:E75 Arg2:E12    

*   OVERLAP E12 E13

T119    Sign_symptom 360 378    Symptoms continued

E76 Sign_symptom:T119 

R48 BEFORE Arg1:E13 Arg2:E76    

R49 MODIFY Arg1:T23 Arg2:E14    

*   OVERLAP E76 E14 E15 E16 E17 E18 E19 E20 E21 E22 E24 E25 E26 E27 E28 E29 E30 E31 E32

R50 MODIFY Arg1:T40 Arg2:E26    

R51 MODIFY Arg1:T42 Arg2:E27    

R52 BEFORE Arg1:E32 Arg2:E33    

*   OVERLAP E33 E34 E35 E36 E37 E38 E39 E40

R53 BEFORE Arg1:E40 Arg2:E41    

*   OVERLAP E41 E42 E43 E44 E48 E49 E50 E51 E54 E55

R54 BEFORE Arg1:E55 Arg2:E57    

*   OVERLAP E57 E58 E59

R55 BEFORE Arg1:E59 Arg2:E60    

*   OVERLAP E60 E74 E61 E62

R58 BEFORE Arg1:E63 Arg2:E64    

*   OVERLAP E64 E65 E66

R59 BEFORE Arg1:E66 Arg2:E67    

*   OVERLAP E67 E68 E69 E70

R60 BEFORE Arg1:E70 Arg2:E71    

*   OVERLAP E71 E72 E73

T4  Activity 2245 2250  eaten

E77 Activity:T4 

R38 MODIFY Arg1:T104 Arg2:E77   

R39 MODIFY Arg1:T103 Arg2:E77   

R56 AFTER Arg1:E62 Arg2:E77 

R57 BEFORE Arg1:E77 Arg2:E63